Sakrale Neuromodulation bei neurogenen Blasenfunktionsstörungen

Zusammenfassung: Die sakrale Neuromodulation (SNM) stellt bei therapierefraktären neurogenen Blasenfunktionsstörungen eine vielversprechende Therapieoption dar. Es bleibt allerdings zu zeigen, welche Typen der neurogenen Blasenfunktionsstörungen und welche zugrunde liegenden neurologischen Erkrankungen am besten auf die SNM ansprechen. Die SNM wurde ständig weiterentwickelt und ist heute ein minimal-invasives, in Lokalanästhesie durchführbares Therapieverfahren, das vor größeren rekonstruktiven Eingriffen zumindest erwogen werden sollte. Es wird eine Elektrodenimplantation ins Sakralforamen S3 oder S4 durchgeführt und in einer Testphase über Tage bis Wochen unter Führen eines Blasentagebuches geprüft, ob die SNM dem Patienten einen relevanten Nutzen bringt. Wenn sich eine positive Testphase zeigt, wird der Neuromodulator gluteal (oder seltener in die Bauchdecke) implantiert. Der Wirkmechanismus der SNM ist nicht gänzlich geklärt, doch Afferenzen dürften eine Schlüsselrolle spielen. So scheint die SNM via periphere Afferenzen eine Modulation von Rückenmarkreflexen und Gehirnzentren zu bewirken. Das implantierte Neuromodulationssystem führt zu keiner Einschränkung der Aktivitäten der Patienten. Allerdings gilt es zu beachten, dass bei Neuromodulatorträgern Hochfrequenzwärmetherapie und unipolare Elektrokauterisation kontraindiziert sind, dass bei einer extrakorporellen Stoßwellenlithotripsie der Brennpunkt nicht in unmittelbarer Nähe des Neuromodulators oder der Elektrode liegen darf, dass Ultrasonographie und Strahlentherapie im Bereich der Implantatkomponenten vermieden werden sollten, dass bei Schwangerschaft der Neuromodulator auszuschalten ist und dass MR-Untersuchungen nur bei zwingender Indikation und bei ausgeschaltetem Neuromodulator durchgeführt werden solle

Avoiding Pitfalls in Comparison of Activity and Selectivity of Solid Catalysts for Electrochemical HMF Oxidation

Electrocatalytic oxidation of 5-hydroxymethylfurfural (HMF) offers a renewable approach to produce the value-added platform chemical 2,5-furandicarboxylic acid (FDCA). The key for the economic viability of this approach is to develop active and selective electrocatalysts. Nevertheless, a reliable catalyst evaluation protocol is still missing, leading to elusive conclusions on criteria for a high-performing catalyst. Herein, we demonstrate that besides the catalyst identity, secondary parameters such as materials of conductive substrates for the working electrode, concentration of the supporting electrolyte, and electrolyzer configurations have profound impact on the catalyst performance and thus need to be optimized before assessing the true activity of a catalyst. Moreover, we highlight the importance of those secondary parameters in suppressing side reactions, which has long been overlooked. The protocol is validated by evaluating the performance of free-standing Cu-foam, and CuCoO modified with NaPO2H2 and Ni, which were immobilized on boron-doped diamond (BDD) electrodes. Recommended practices and figure of merits in carefully evaluating the catalyst performance are proposed. © 2021 The Authors. Published by The Chemical Society of Japan & Wiley-VCH Gmb

Avoiding Pitfalls in Comparison of Activity and Selectivity of Solid Catalysts for Electrochemical HMF Oxidation

Electrocatalytic oxidation of 5‐hydroxymethylfurfural (HMF) offers a renewable approach to produce the value‐added platform chemical 2,5‐furandicarboxylic acid (FDCA). The key for the economic viability of this approach is to develop active and selective electrocatalysts. Nevertheless, a reliable catalyst evaluation protocol is still missing, leading to elusive conclusions on criteria for a high‐performing catalyst. Herein, we demonstrate that besides the catalyst identity, secondary parameters such as materials of conductive substrates for the working electrode, concentration of the supporting electrolyte, and electrolyzer configurations have profound impact on the catalyst performance and thus need to be optimized before assessing the true activity of a catalyst. Moreover, we highlight the importance of those secondary parameters in suppressing side reactions, which has long been overlooked. The protocol is validated by evaluating the performance of free‐standing Cu‐foam, and CuCoO modified with NaPO₂H₂ and Ni, which were immobilized on boron‐doped diamond (BDD) electrodes. Recommended practices and figure of merits in carefully evaluating the catalyst performance are proposed

Keeping an eye on the violinist: motor experts show superior timing consistency in a visual perception task

Common coding theory states that perception and action may reciprocally induce each other. Consequently, motor expertise should map onto perceptual consistency in specific tasks such as predicting the exact timing of a musical entry. To test this hypothesis, ten string musicians (motor experts), ten non-string musicians (visual experts), and ten non-musicians were asked to watch progressively occluded video recordings of a first violinist indicating entries to fellow members of a string quartet. Participants synchronised with the perceived timing of the musical entries. Results revealed significant effects of motor expertise on perception. Compared to visual experts and non-musicians, string players not only responded more accurately, but also with less timing variability. These findings provide evidence that motor experts’ consistency in movement execution—a key characteristic of expert motor performance—is mirrored in lower variability in perceptual judgements, indicating close links between action competence and perception

Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions

Jürgen Pannek, Jens Wöllner Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland Introduction: Urinary tract infections (UTIs) are one of the most common morbidities in persons with neurogenic lower urinary tract dysfunction (NLUTD). They are associated with a significant morbidity and mortality, and they affect the quality of life of the affected patients. Diagnosis and treatment of UTI in this group of patients are challenging. In this review, the current strategies regarding diagnosis, treatment, and prevention are summarized. Diagnostics: it is important to correctly diagnose a UTI, as treatment of bacteriuria should strictly be avoided. A UTI is defined as a combination of laboratory findings (leukocyturia and bacteriuria) and symptoms. Laboratory findings without symptoms are classified as asymptomatic bacteriuria. Routine urine screening is not advised. Treatment: Only UTI should be treated; treatment of asymptomatic bacteriuria is not indicated. Prior to treatment, urine for a urine culture should be obtained. Antibiotic treatment for ~7 days is advised. Prevention: In recurrent UTI, bladder management should be optimized and morphologic causes for UTI should be excluded. If UTIs persist, medical prophylaxis should be considered. Currently, no prophylactic measure with evidence-based efficacy exists. Long-term antibiotic prophylaxis should be used merely as an ultimate measure. Among the various mentioned innovative approaches for UTI prevention, bacteriophages, intravesical instillations, complementary and alternative medicine techniques, and probiotics seem to be most promising. Conclusion: Recently, several promising innovative options for UTI prophylaxis have been developed which may help overcome the current therapeutic dilemma. However, further well designed studies are necessary to evaluate the safety and efficacy of these approaches. Keywords: neurogenic lower urinary tract dysfunction, spinal cord injury, prophylaxis, resistance, lactobacilli, cranberrie

Clinical usefulness of urine cytology in the detection of bladder tumors in patients with neurogenic lower urinary tract dysfunction

Jürgen Pannek, Franziska Rademacher, Jens Wöllner Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland Introduction: Screening for bladder cancer in patients with neurogenic lower urinary tract dysfunction is a challenge. Cystoscopy alone is not sufficient to detect bladder tumors in this patient group. We investigated the usefulness of combined cystoscopy and urine cytology.Materials and methods: By a systematic chart review, we identified all patients with neurogenic lower urinary tract dysfunction who underwent combined cystoscopy and urine cytology testing. In patients with suspicious findings either in cytology or cystoscopy, transurethral resection was performed.Results: Seventy-nine patients (age 54.8±14.3 years, 38 female, 41 male) were identified; 44 of these used indwelling catheters. Cystoscopy was suspicious in 25 patients and cytology was suspicious in 17 patients. Histologically, no tumor was found in 15 patients and bladder cancer was found in 6 patients. Sensitivity for both cytology and cystoscopy was 83.3%; specificity was 43.7% for cytology and 31.2% for cystoscopy. One bladder tumor was missed by cytology and three tumors were missed by cystoscopy. If a biopsy was taken only if both findings were suspicious, four patients would have been spared the procedure, and one tumor would not have been diagnosed.Conclusion: A combination of cystoscopy and urine cytology can improve bladder tumor detection rates and lower the number of unnecessary biopsies. Keywords: bladder cancer, neurogenic lower urinary tract dysfunction, urine cytology, cystoscop

Music researchers’ musical engagement

There is an increasing awareness of the importance of reflexivity across various disciplines, which encourages researchers to scrutinize their research perspectives. In order to contextualize and reflect upon research in music, this study explores the musical background, current level of musical engagement and the listening habits of music researchers. A total of 103 respondents of 17 different nationalities, working in music psychology, music science and related areas at various academic levels (e.g., doctoral students, professors and independent researchers), completed an internet survey. Questions addressed four major areas: (1) detailed demographic information and research interests; (2) musical training; (3) current musical activities (e.g., composing, conducting, improvising, listening, performing); (4) musical preferences and listening habits. Findings indicate that nearly all respondents to the survey had studied one or more musical instrument(s), and around 90% still enjoy performing music to some extent. A relatively high number of researchers had composed or improvised music, thus engaging in particularly creative musical activities. Respondents show stronger preferences for classical music and jazz/blues/RnB as compared with other musical genres. Contrary to notions of expert listening, emotional listening styles were rated as more important than analytical listening. Strong relationships between respondents’ musical practice and research were found, leading to the conclusion that music research is a highly practice-informed field