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

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Measurement of the Splitting Function in &ITpp &ITand Pb-Pb Collisions at root&ITsNN&IT=5.02 TeV

Data from heavy ion collisions suggest that the evolution of a parton shower is modified by interactions with the color charges in the dense partonic medium created in these collisions, but it is not known where in the shower evolution the modifications occur. The momentum ratio of the two leading partons, resolved as subjets, provides information about the parton shower evolution. This substructure observable, known as the splitting function, reflects the process of a parton splitting into two other partons and has been measured for jets with transverse momentum between 140 and 500 GeV, in pp and PbPb collisions at a center-of-mass energy of 5.02 TeV per nucleon pair. In central PbPb collisions, the splitting function indicates a more unbalanced momentum ratio, compared to peripheral PbPb and pp collisions.. The measurements are compared to various predictions from event generators and analytical calculations.Peer reviewe

Search for anomalous production of events with three or more leptons in pp collisions at √s = 8TeV

Published by the American Physical Society under the terms of the Creative Commons Attribution 3.0 License. Further distribution of this work must maintain attribution to the author(s) and the published articles title, journal citation, and DOI.A search for physics beyond the standard model in events with at least three leptons is presented. The data sample, corresponding to an integrated luminosity of 19.5fb-1 of proton-proton collisions with center-of-mass energy s=8TeV, was collected by the CMS experiment at the LHC during 2012. The data are divided into exclusive categories based on the number of leptons and their flavor, the presence or absence of an opposite-sign, same-flavor lepton pair (OSSF), the invariant mass of the OSSF pair, the presence or absence of a tagged bottom-quark jet, the number of identified hadronically decaying τ leptons, and the magnitude of the missing transverse energy and of the scalar sum of jet transverse momenta. The numbers of observed events are found to be consistent with the expected numbers from standard model processes, and limits are placed on new-physics scenarios that yield multilepton final states. In particular, scenarios that predict Higgs boson production in the context of supersymmetric decay chains are examined. We also place a 95% confidence level upper limit of 1.3% on the branching fraction for the decay of a top quark to a charm quark and a Higgs boson (t→cH), which translates to a bound on the left- and right-handed top-charm flavor-violating Higgs Yukawa couplings, λtcH and λctH, respectively, of |λtcH|2+|λctH|2<0.21