Combined cerebellar and bilateral cervical posterior spinal artery stroke demonstrated on MRI

Combined cerebellar and spinal ischemic stroke is a rare, critical condition. We report a patient with combined cerebellar and bilateral posterolateral cervical spinal cord infarction due to bilateral stenosis of the vertebral arteries. MRI is the method of choice for imaging this condition; diffusion-weighted imaging of the spinal cord gives reliable results

Upper atmospheres and ionospheres of planets and satellites

The upper atmospheres of the planets and their satellites are more directly exposed to sunlight and solar wind particles than the surface or the deeper atmospheric layers. At the altitudes where the associated energy is deposited, the atmospheres may become ionized and are referred to as ionospheres. The details of the photon and particle interactions with the upper atmosphere depend strongly on whether the object has anintrinsic magnetic field that may channel the precipitating particles into the atmosphere or drive the atmospheric gas out to space. Important implications of these interactions include atmospheric loss over diverse timescales, photochemistry and the formation of aerosols, which affect the evolution, composition and remote sensing of the planets (satellites). The upper atmosphere connects the planet (satellite) bulk composition to the near-planet (-satellite) environment. Understanding the relevant physics and chemistry provides insight to the past and future conditions of these objects, which is critical for understanding their evolution. This chapter introduces the basic concepts of upper atmospheres and ionospheres in our solar system, and discusses aspects of their neutral and ion composition, wind dynamics and energy budget. This knowledge is key to putting in context the observations of upper atmospheres and haze on exoplanets, and to devise a theory that explains exoplanet demographics.Comment: Invited Revie

BreathEase: Rationale, design and recruitment of a randomised trial and embedded mixed-methods study of a multiprofessional breathlessness service in early palliative care.

Background: The Munich Breathlessness Service has adapted novel support services to the German context, to reduce burden in patients and carers from breathlessness in advanced disease. It has been evaluated in a pragmatic fast-track randomised controlled trial (BreathEase; NCT02622412) with embedded qualitative interviews and postal survey. The aim of this article is to describe the intervention model and study design, analyse recruitment to the trial and compare sample characteristics with other studies in the field. Methods: Analysis of recruitment pathways and enrolment, sociodemographic and clinical characteristics of participants and carers. Results: Out of 439 people screened, 253 (58%) were offered enrolment and 183 (42%) participated. n=97 (70%) carers participated. 186 (42%) people did not qualify for inclusion, mostly because breathlessness could not be attributed to an underlying disease. All participants were self-referring; 60% through media sources. Eligibility and willingness to participate were associated to social networks and illness-related activities as recruitment routes. Mean age of participants was 71 years (51% women), with COPD (63%), chronic heart failure (8%), interstitial lung disease (9%), pulmonary hypertension (6%) and cancer (7%) as underlying conditions. Postal survey response rate was 89%. Qualitative interviews were conducted with 16 patients and nine carers. Conclusion: The BreathEase study has a larger and more heterogeneous sample compared to other trials. The self-referral-based and prolonged recruitment drawing on media sources approximates real-world conditions of early palliative care. Integrating qualitative and quantitative components will allow a better understanding and interpretation of the results of the main effectiveness study

Health-related quality of life in subjects with and without type 2 diabetes: Pooled analysis of five population-based surveys in Germany.

Aims To estimate population values of health-related quality of life (HRQL) in subjects with and without Type 2 diabetes mellitus across several large population-based survey studies in Germany. Systematic differences in relation to age and sex were of particular interest. Methods Individual data from four population-based studies from different regions throughout Germany and the nationwide German National Health Interview and Examination Survey (GNHIES98) were included in a pooled analysis of primary data (N = 9579). HRQL was assessed using the generic index instrument SF-36 (36-item Short Form Health Survey) or its shorter version, the SF-12 (12 items). Regression analysis was carried out to examine the association between Type 2 diabetes and the two component scores derived from the SF-36/SF-12, the physical component summary score (PCS-12) and the mental component summary score (MCS-12), as well as interaction effects with age and sex. Results The PCS-12 differed significantly by -4.1 points in subjects with Type 2 diabetes in comparison with subjects without Type 2 diabetes. Type 2 diabetes was associated with significantly lower MCS-12 in women only. Higher age was associated with lower PCS-12, but with an increase in MCS-12, for subjects with and without Type 2 diabetes. Conclusions Pooled analysis of population-based primary data offers HRQL values for subjects with Type 2 diabetes in Germany, stratified by age and sex. Type 2 diabetes has negative consequences for HRQL, particularly for women. This underlines the burden of disease and the importance of diabetes prevention. Factors that disadvantage women with Type 2 diabetes need to be researched more thoroughly

Die Bedeutung des Typ-2-Diabetes für die gesundheitsbezogene Lebensqualität. Ergebnisse aus bevölkerungsbasierten Studien in Deutschland (DIAB-CORE Verbund).

Gesundheitsbezogene Lebensqualität (HRQL) ist ein wichtiger Ergebnisparameter in der Versorgungsforschung und Gesundheitsökonomie. Durch die gemeinsame Auswertung von fünf bevölkerungsbasierten epidemiologischen Studien sollen Referenzwerte für Personen mit und ohne Typ-2-Diabetes für Deutschland ermittelt und der Einfluss von Vor- und Begleiterkrankungen, Lebensstilfaktoren und sozioökonomischen Variablen untersucht werden. Die gesundheitsbezogene Lebensqualität wurde in allen Studien mit der deutschen Version des SF-36v1 bzw. des SF-12v1 erfasst. Die Ergebnisse zeigen bei Personen mit Typ-2-Diabetes (N = 846) eine deutlich schlechtere körperlichen Lebensqualität im Vergleich zu nicht an Diabetes erkrankten Personen (N = 8733). Auch unter Berücksichtigung von Begleiterkrankungen wie Herzinfarkt und Schlaganfall bleiben diese Unterschiede signifikant bestehen. Bei der psychischen Lebensqualität ist ein entsprechender signifikanter Unterschied nur bei mit Insulin behandelten Frauen zu beobachten. Unabhängig vom Diabetesstatus ist Lebensqualität positiv mit gesunder Lebensführung, Normalgewicht und höherem Einkommen assoziiert