Case report of MR perfusion imaging in Sinking Skin Flap Syndrome: growing evidence for hemodynamic impairment

<p>Abstract</p> <p>Background</p> <p>The syndrome of the sinking skin flap (SSSF) with delayed sensorimotor deficits after craniectomy is not well known and often neglected. Among various postulated causes, there is evidence that disturbed brain perfusion may be related to the observed symptoms, and that cranioplasty reliably alleviates these symptoms. We report a case of sinking skin flap syndrome (SSFS) with recovery from neurological sensorimotor deficits after cranioplasty correlated with pre- and postsurgical MR brain perfusion studies.</p> <p>Case Presentation</p> <p>A 42-year-old woman presented with slowly progressive sensorimotor paresis of her left arm after decompressive extensive craniectomy due to subarachnoid hemorrhage four months ago. Her right cranium showed a "sinking skin flap". After cranioplastic repair of her skull defect, the patient fully recovered from her symptoms. Before cranioplasty, reduced brain perfusion in the right central cortical region was observed in MR-perfusion images. After cranioplasty, a marked increase in brain perfusion was observed which correlated with objective clinical recovery.</p> <p>Conclusion</p> <p>There is increasing evidence that impaired blood flow is responsible for delayed motor deficits in patients with sinking skin flap syndrome in the area of compressed brain regions. Symptoms should be evaluated by brain perfusion imaging complementing surgical decision-making.</p

Impact of Adjunctive VNS on Drug Load, Depression Severity, and Number of Neuromodulatory Maintenance Treatments

Vagus nerve stimulation (VNS) is a long-term adjunctive treatment option in patients with difficult-to-treat depression (DTD). A total of n = 20 patients (mean age 52.6 years) were included in the multicenter, prospective, observational, naturalistic RESTORE-LIFE study and were treated with adjunctive VNS as an add-on to treatment as usual. Exploratory and secondary outcome parameters from a single center were investigated for this present analysis. The overall mean drug load slightly decreased from 4.5 at baseline to 4.4 at 12 months (Z = −0.534, p = 0.594). The drug load was lower in previous electroconvulsive therapy (ECT) responders than in non-responders. There was a reduction in the mean number of hospitalizations per month after VNS implantation (Z = 1.975, p = 0.048) and a significant decrease in the mean Montgomery Åsberg Depression Rating Scale (MADRS) score from 27.3 at baseline to 15.3 at 12 months (T = 4.230, degree of freedom (df) = 19, p = 0.001). A history of ECT response at baseline was associated with greater improvement in the MADRS score after 12 months of VNS (F = 8.171, p = 0.013). The number of neuromodulatory maintenance treatments decreased during the follow-up period. In summary, there was an alleviation in the burden of illness among DTD patients treated with VNS

First results from the study ‘Disease knowledge and information needs - Diabetes mellitus (2017)’

Very little research has been undertaken into what people in Germany know about diabetes, the information they may require about the condition, where they look for such information and how they rate the information currently available. In 2017, the Robert Koch Institute (RKI) carried out a nationwide telephone survey aimed at answering these questions. The study entitled ‘Disease knowledge and information needs - Diabetes mellitus (2017)’ focused on people aged at least 18 years. A total of 2,327 people without diabetes and 1,479 people with diagnosed diabetes were interviewed for the study. First results show that 56.7% of people without diabetes and 92.8% of those with diabetes rate their knowledge about the condition as ‘very good’ or ‘good’. People without diabetes were found to have the strongest need for information in terms of ‘lifestyle changes, health promotion and disease prevention’, whereas respondents with diabetes stressed the strongest need for information about ‘treatment and therapy’. Almost a third of respondents without diabetes have actively sought information about diabetes at least once, mostly via print media. Patients with diabetes stated that their general practitioner was their most frequent source of information about the condition. In both groups, about half of respondents reported that they found it difficult to judge the trustworthiness of the information published in the media about diabetes. The results of the study form part of the German National Diabetes Surveillance, which is coordinated by the RKI. The data are also intended to be used by the Federal Centre for Health Education to develop a strategy to improve the information provided about diabetes

An under-ice bloom of mixotrophic haptophytes in low nutrient and freshwater-influenced Arctic waters

Abstract The pelagic spring bloom is essential for Arctic marine food webs, and a crucial driver of carbon transport to the ocean depths. A critical challenge is understanding its timing and magnitude, to predict its changes in coming decades. Spring bloom onset is typically light-limited, beginning when irradiance increases or during ice breakup. Here we report an acute 9-day under-ice algal bloom in nutrient-poor, freshwater-influenced water under 1-m thick sea ice. It was dominated by mixotrophic brackish water haptophytes (Chrysochromulina/ Prymnesium) that produced 5.7 g C m−2 new production. This estimate represents about half the annual pelagic production, occurring below sea ice with a large contribution from the mixotrophic algae bloom. The freshwater-influenced, nutrient-dilute and low light environment combined with mixotrophic community dominance implies that phagotrophy played a critical role in the under-ice bloom. We argue that such blooms dominated by potentially toxic mixotrophic algae might become more common and widespread in the future Arctic Ocean

Erste Ergebnisse der Studie „Krankheitswissen und Informationsbedarfe – Diabetes mellitus (2017)“

Bislang ist wenig dazu bekannt, was Menschen in Deutschland zum Thema Diabetes wissen, welche Informationen sie sich wünschen, wo sie Informationen suchen und wie sie vorhandene Informationen einschätzen. Das Robert Koch-Institut (RKI) führte mit einem Schwerpunkt auf diesen Fragestellungen im Jahr 2017 den bundesweiten telefonischen Survey „Krankheitswissen und Informationsbedarfe – Diabetes mellitus (2017)“ in der Bevölkerung ab 18 Jahren durch. Insgesamt wurden 2.327 Personen ohne und 1.479 Personen mit diagnostiziertem Diabetes befragt. Erste Ergebnisse zeigen, dass 56,7 % der Befragten ohne Diabetes und 92,8 % der Befragten mit Diabetes ihr Diabeteswissen als sehr gut oder gut einschätzen. Befragte ohne Diabetes empfinden das größte Informationsbedürfnis zum Thema „Lebensstilanpassungen, Gesundheitsförderung und Prävention“, Befragte mit Diabetes zum Thema „Behandlung und Therapie“. Fast ein Drittel der Befragten ohne Diabetes hat sich schon einmal aktiv zu Diabetes informiert, am häufigsten über gedruckte Informationen. Für Menschen mit Diabetes ist die behandelnde (Haus-)Ärztin beziehungsweise der behandelnde (Haus-)Arzt die am häufigsten genannte Informationsquelle. In beiden Gruppen findet es etwa die Hälfte der Befragten schwierig, die Vertrauenswürdigkeit von Informationen zu Diabetes in den Medien einzuschätzen. Die Ergebnisse der Studie gehen in die vom RKI koordinierte Nationale Diabetes-Surveillance ein und werden von der Bundeszentrale für gesundheitliche Aufklärung zur Entwicklung von Strategien für eine verbesserte Information der Bevölkerung zum Thema Diabetes mellitus genutzt

Routine detection of serum anti-desmocollin autoantibodies is only useful in patients with atypical pemphigus

Autoantibodies against the 3 desmocollin (Dsc; Dsc1-Dsc3) isoforms have been described in different pemphigus variants. Here, we developed state-of-the-art detection systems for serum anti-Dsc1, Dsc2 and Dsc1 IgG and IgA. These assays were applied in 5 different cohorts including pemphigus vulgaris (PV) patients with compatible direct immunofluorescence (IF) microscopy but no reactivity against desmogleins 1 and 3 (n = 24) and sera from patients with autoimmune blistering diseases with positive direct IF microscopy taken at the time of diagnosis (n = 749). We found that detection of anti-Dsc serum reactivity is not helpful in the routine diagnosis of PV, pemphigus foliaceus and paraneoplastic pemphigus but may be valuable in pemphigus vegetans

Multicenter prospective study on multivariant diagnostics of autoimmune bullous dermatoses using the BIOCHIPTM technology.

BACKGROUND The current standard in the serological diagnosis of autoimmune bullous diseases (AIBD) is a multistep procedure sequentially applying different assays. In contrast, the BIOCHIPTM mosaic technology combines multiple substrates for parallel analysis by indirect immunofluorescence (IF). METHODS Sera from 749 consecutive, prospectively recruited, direct IF positive AIBD patients from 13 international study centers were analyzed independently and blinded using (i) a BIOCHIPTM mosaic including primate esophagus, salt-split skin, recombinant BP180 NC16A and gliadin GAF3x as well as HEK293 cells expressing recombinant desmoglein1, desmoglein3, type VII collagen, and BP230 C-terminus and (ii) the conventional multistep approach of the Department of Dermatology, University of Lübeck. RESULTS In 731 of 749 sera (97.6%) specific autoantibodies could be detected using the BIOCHIPTM mosaic, similar to the conventional procedure (725 cases, 96.8%). Cohens κ for both serological approaches ranged from 0.84 to 1.00. In 6.5% of sera, differences between the two approaches occurred and were mainly attributed to autoantigen fragments not present on the BIOCHIPTM mosaic. LIMITATIONS Laminin 332 and laminin γ1 are not represented on the BIOCHIPTM mosaic. CONCLUSIONS The BIOCHIPTM mosaic is a standardized, time- and serum-saving approach that further facilitates the serological diagnosis of AIBD