Transcranial Magnetic Stimulation for the treatment of tinnitus: Effects on cortical excitability

<p>Abstract</p> <p>Background</p> <p>Low frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as an innovative treatment for chronic tinnitus. The aim of the present study was to elucidate the underlying mechanism and to evaluate the relationship between clinical outcome and changes in cortical excitability. We investigated ten patients with chronic tinnitus who participated in a sham-controlled crossover treatment trial. Magnetic-resonance-imaging and positron-emission-tomography guided 1 Hz rTMS were performed over the auditory cortex on 5 consecutive days. Active and sham treatments were separated by one week. Parameters of cortical excitability (motor thresholds, intracortical inhibition, intracortical facilitation, cortical silent period) were measured serially before and after rTMS treatment by using single- and paired-pulse transcranial magnetic stimulation. Clinical improvement was assessed with a standardized tinnitus-questionnaire.</p> <p>Results</p> <p>We noted a significant interaction between treatment response and changes in motor cortex excitability during active rTMS. Specifically, clinical improvement was associated with an increase in intracortical inhibition, intracortical facilitation and a prolongation of the cortical silent period. These results indicate that intraindividual changes in cortical excitability may serve as a correlate of response to rTMS treatment.</p> <p>Conclusion</p> <p>The observed alterations of cortical excitability suggest that low frequency rTMS may evoke long-term-depression like effects resulting in an improvement of subcortical inhibitory function.</p

Statuserhebung der studentischen Lehre für das Fach Nuklearmedizin in Deutschland

Aim Molecular imaging and therapy as applied in nuclear medicine represent an important contribution to modern medicine. The university curricula of medical schools permit to convey knowledge of nuclear medicine. In this study, the status quo of nuclear medicine teaching at German medical schools shall be surveyed for the first time. Methods In cooperation with the chairs and/or lecturers, the topics organizational conditions, scope of teaching, teaching methods, examinations, evaluations, composition of teaching staff, interest of the students in the field of nuclear medicine, as well as suggestions for improvement of teaching were recorded. Results All 36 public German medical schools participated in the survey. In these medical schools a median of 12 hours of nuclear medicine is being taught. 52 % of the teaching consists of teacher-centered learning. 18 medical schools teach additional elective courses in nuclear medicine. Nine 9 persons (median) per department are involved in the teaching. The examinations, in all but one school, follow a multiple choice format. The students' interest in nuclear medicine is perceived by the educators to be predominately medium to high. Conclusions Potential improvement might be achieved with regard to the quantity of teaching lessons, innovative methods of teaching, design of the exams, the establishment of a nationwide e-learning platform, as well as measures to increase the motivation of teachers

Survival and tumor localization of adoptively transferred Melan-A-specific T cells in melanoma patients

Adoptive T cell therapy has been successfully used for treatment of viral and malignant diseases. However, little is known about the fate and trafficking of transferred Ag-specific T cells. Using the tetramer (TM) technology which allows for detection and quantification of Ag-specific CTL, we assessed the frequency of circulating Melan-A-specific CTL in advanced melanoma patients during adoptive T cell therapy. Melan-A-specific CTL were generated from HLA-A2.1(+) patients by in vitro stimulation of CD8(+) T cells with dendritic cells pulsed with a mutated HLA-A2-binding Melan-A (ELAGIGILTV) peptide. Eight patients received three infusions of 0.25-11 x 10(8) Melan-A-specific CTL i.v. at 2-wk intervals along with low-dose IL-2. The transferred T cell product contained a mean of 42.1% Melan-A-TM(+) CTL. Before therapy, the frequencies of Melan-A-specific CTL in patients' circulating CD8(+) T cells ranged from 0.01 to 0.07%. Characterization of the TM frequencies before and at different time points after transfer revealed an increase of circulating Melan-A-specific CTL up to 2%, correlating well with the number of transferred CTL. An elevated frequency of TM(+) T cells was demonstrated up to 14 days after transfer, suggesting long-term survival and/or proliferation of transferred CTL. Combining TM analysis with a flow cytometry-based cytokine secretion assay, unimpaired production of IFN-gamma was demonstrated in vivo for at least 24 h after transfer. Indium-111 labeling of Melan-A-specific CTL demonstrated localization of transferred CTL to metastatic sites as early as 48 h after injection. Overall, the results suggest that in vitro-generated Melan-A-specific CTL survive intact in vivo for several weeks and localize preferentially to tumor

Pilot study of a newly developed eLearning tool to teach CT and PET/CT in radiology and nuclear medicine

Aim To test the usability and user experience of a newly self-developed eLearning tool to teach PET/CT and CT to undergraduate medical students. Methods The eLearning tool permits to display PET and CT DICOM images web-based. It contains a healthy subject with anatomical annotations and a clinical case study. The usability and user experience of the eLearning tool was evaluated in undergraduate medical students of the medical faculty of the RWTH Aachen. We applied a survey based on different already existing and validated questionnaires such as System Usability Scale (SUS) and User Experience Questionnaire (UEQ-S) as well as specific questions regarding the eLearning tool. Results 38 volunteers (9 males) participated in our study. Applying the SUS resulted in a mean of 82.24, and a median of 83.75. This positive evaluation is supported by the results of the UEQ-S that were 2.2 with regard to the pragmatic quality, 2.3 with regard to hedonic quality and 2.3 for overall quality indicating a very positive evaluation. In the free-text answers, students emphasised easy and intuitive use of the eLearning tool that was additionally described as interesting and exciting. The students also positively mentioned the case study and the possibility of practice-based learning. Negative aspects were mainly problems with synchronisation of the PET and CT images. Conclusion The positive evaluation is encouraging and form a foundation for further development of the eLearning module. It may be the basis for the implementation of a sustainable blended learning concept in the nuclear medicine curriculum