176 research outputs found
Does a single session of theta-burst transcranial magnetic stimulation of inferior temporal cortex affect tinnitus perception?
<p>Abstract</p> <p>Background</p> <p>Cortical excitability changes as well as imbalances in excitatory and inhibitory circuits play a distinct pathophysiological role in chronic tinnitus. Repetitive transcranial magnetic stimulation (rTMS) over the temporoparietal cortex was recently introduced to modulate tinnitus perception. In the current study, the effect of theta-burst stimulation (TBS), a novel rTMS paradigm was investigated in chronic tinnitus. Twenty patients with chronic tinnitus completed the study. Tinnitus severity and loudness were monitored using a tinnitus questionnaire (TQ) and a visual analogue scale (VAS) before each session. Patients received 600 pulses of continuous TBS (cTBS), intermittent TBS (iTBS) and intermediate TBS (imTBS) over left inferior temporal cortex with an intensity of 80% of the individual active or resting motor threshold. Changes in subjective tinnitus perception were measured with a numerical rating scale (NRS).</p> <p>Results</p> <p>TBS applied to inferior temporal cortex appeared to be safe. Although half of the patients reported a slight attenuation of tinnitus perception, group analysis resulted in no significant difference when comparing the three specific types of TBS. Converting the NRS into the VAS allowed us to compare the time-course of aftereffects. Only cTBS resulted in a significant short-lasting improvement of the symptoms. In addition there was no significant difference when comparing the responder and non-responder groups regarding their anamnestic and audiological data. The TQ score correlated significantly with the VAS, lower loudness indicating less tinnitus distress.</p> <p>Conclusion</p> <p>TBS does not offer a promising outcome for patients with tinnitus in the presented study.</p
Characterizing the temporal discrimination threshold in musician’s dystonia
The temporal discrimination threshold (TDT) has been established as a biomarker of impaired temporal processing and endophenotype in various forms of focal dystonia patients, such as cervical dystonia, writer's cramp or blepharospasm. The role of TDT in musician's dystonia (MD) in contrast is less clear with preceding studies reporting inconclusive results. We therefore compared TDT between MD patients, healthy musicians and non-musician controls using a previously described visual, tactile, and visual-tactile paradigm. Additionally, we compared TDT of the dystonic and non-dystonic hand and fingers in MD patients and further characterized the biomarker regarding its potential influencing factors, i.e. musical activity, disease variables, and personality profiles. Repeated measures ANOVA and additional Bayesian analyses revealed lower TDT in healthy musicians compared to non-musicians. However, TDTs in MD patients did not differ from both healthy musicians and non-musicians, although pairwise Bayesian t-tests indicated weak evidence for group differences in both comparisons. Analyses of dystonic and non-dystonic hands and fingers revealed no differences. While in healthy musicians, age of first instrumental practice negatively correlated with visual-tactile TDTs, TDTs in MD patients did not correlate with measures of musical activity, disease variables or personality profiles. In conclusion, TDTs in MD patients cannot reliably be distinguished from healthy musicians and non-musicians and are neither influenced by dystonic manifestation, musical activity, disease variables nor personality profiles. Unlike other isolated focal dystonias, TDT seems not to be a reliable biomarker in MD
Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients—Results from the Eurotransplant database
BackgroundPredicting complications associated with pulmonary hypertension (PH) after cardiac transplantation is an important factor when considering cardiac transplantation. The transpulmonary gradient (TPG) is recommended to quantify PH in transplant candidates. Nonetheless, PH remains a common driver of mortality. The diastolic pressure gradient (DPG) and pulmonary vascular resistance (PVR) can differentiate post- from combined pre- and post-capillary PH and may improve estimation of PH-associated risks. We used a large European cohort of transplant candidates to assess whether the pulmonary pulsatility index (PAPi), improves prediction of graft failure and mortality compared to DPG and PVR.MethodsOut of all patients undergoing heart transplantation between 2009 and 2019 in Eurotransplant member states (n = 10,465), we analyzed the impact of PH (mPAP > 25 mmHg) and right heart catheter hemodynamic data on graft failure and mortality within 1–5 years.ResultsIn 1,407 heart transplant patients with PH (79% male, median age 54 years, IQR 39–69 years), the median PVR was 2.5 WU (IQR 1.6 WU) with a median mPAP (pulmonary arterial pressure) of 32 mmHg (IQR 9 mmHg). Patients with low (< 3 mmHg) DPG had a better 5 year survival than those with higher DPG (log rank p = 0.023). TPG, mPAP, PAPi, and PVR did not improve prediction of survival. Low PAPi (OR = 2.24, p < 0.001) and high PVR (OR = 2.12, p = 0.005) were associated with graft failure.ConclusionPAPI and PVR are associated with graft failure in patients with PH undergoing cardiac transplantation. DPG is associated with survival in this cohort
Identifying and evaluating flexible approaches for automobile body production areas
The increasing variety of models with simultaneously lower and more volatile quantities in the demanding environment of automotive engineering calls for flexible production systems. Considering an automobile production process, the body shop can be characterized as particularly inflexible. This results from highly product-specific and automated technical solutions such as rigid fixture systems and grippers, commonly used to fulfil the demanding geometrical requirements of body parts and the respective production system. Therefore, several approaches have been developed to increase the body production flexibility. This paper presents a three-step methodology to identify promising flexibilization approaches for each area of body production, comparing the flexibility needs of the area with the flexibility offers of specific flexibilization approaches. The outcome of this methodology enables body production planners to derive in which flexibilization approaches to invest and which approaches to discard
Use of vitamin K antagonists for secondary stroke prevention depends on the treating healthcare provider in Germany – results from the German AFNET registry
Background Anticoagulation using vitamin K antagonists (VKAs) significantly
reduces the risk of recurrent stroke in stroke patients with atrial
fibrillation (AF) and is recommended by guidelines. Methods The German
Competence NETwork on Atrial Fibrillation established a nationwide prospective
registry including 9,574 AF patients, providing the opportunity to analyse AF
management according to German healthcare providers. Results On enrolment, 896
(9.4 %) patients reported a prior ischaemic stroke or transient ischaemic
attack. Stroke patients were significantly older, more likely to be female,
had a higher rate of cardiovascular risk factors, and more frequently received
anticoagulation (almost exclusively VKA) than patients without prior stroke
history. Following enrolment, 76.4 % of all stroke patients without VKA
contraindications received anticoagulation, which inversely associated with
age (OR 0.95 per year; 95 % CI 0.92–0.97). General practitioners/internists
(OR 0.40; 95 % CI 0.21–0.77) and physicians working in regional hospitals (OR
0.47; 95 % CI 0.29–0.77) prescribed anticoagulation for secondary stroke
prevention less frequently than physicians working at university hospitals
(reference) and office-based cardiologists (OR 1.40; 95 % CI 0.76–2.60). The
impact of the treating healthcare provider was less evident in registry
patients without prior stroke. Conclusions In the AFNET registry,
anticoagulation for secondary stroke prevention was prescribed in roughly
three-quarters of AF patients, a significantly higher rate than in primary
prevention. We identified two factors associated with withholding oral
anticoagulation in stroke survivors, namely higher age and—most
prominently—treatment by a general practitioner/internist or physicians
working at regional hospitals
Problematic Internet Use among Adolescents 18 Months after the Onset of the COVID-19 Pandemic
Studies in recent years and especially since the beginning of the COVID-19 pandemic have
shown a significant increase in the problematic use of computer games and social media. Adolescents
having difficulties in regulating their unpleasant emotions are especially prone to Problematic Internet
Use (PIU), which is why emotion dysregulation has been considered a risk factor for PIU. The aim of
the present study was to assess problematic internet use (PIU) in adolescents after the third wave
(nearly 1.5 years after the onset in Europe) of the COVID-19 pandemic. In the German region of
Siegen-Wittgenstein, all students 12 years and older from secondary-level schools, vocational schools
and universities were offered a prioritized vaccination in August 2021 with an approved vaccine
against COVID-19. In this context, the participants filled out the Short Compulsive Internet Use
Scale (SCIUS) and two additional items to capture a possible change in digital media usage time
and regulation of negative affect due to the COVID-19 pandemic. A multiple regression analysis
was performed to identify predictors of PIU. The original sample consisted of 1477 participants,
and after excluding invalid cases the final sample size amounted to 1268 adolescents aged 12–17
(x = 14.37 years, SD = 1.64). The average prevalence of PIU was 43.69%. Gender, age, digital media
usage time and the intensity of negative emotions during the COVID-19 pandemic were all found to
be significant predictors of PIU: female gender, increasing age, longer digital media usage time and
higher intensity of negative emotions during the COVID-19 pandemic were associated with higher
SCIUS total scores. This study found a very high prevalence of PIU among 12- to 17-year-olds for the
period after the third wave of the COVID-19 pandemic, which has increased significantly compared
to pre-pandemic prevalence rates. PIU is emerging as a serious problem among young people in
the pandemic. Besides gender and age, pandemic-associated time of digital media use and emotion
regulation have an impact on PIU, which provides starting points for preventive interventions
Immunophenotyping in routine clinical practice for predicting treatment response and adverse events in patients with MS
BackgroundRecent studies proposed cellular immunoprofiling as a surrogate for predicting treatment response and/or stratifying the occurrence of adverse events (AEs) in persons with multiple sclerosis (pwMS). However, applicability in real-world circumstances is not sufficiently addressed.ObjectiveWe aimed to explore whether standard routine clinical leukocyte phenotyping before treatment initiation could help stratify patients according to treatment response or AEs in a real-world MS cohort.MethodsIn this retrospective study, 150 pwMS were included, who had been newly initiated on a disease-modifying drug (DMD) and had been assessed for standard immunophenotyping before DMD initiation (baseline) and at least once during the following year. Multivariate models were used to assess an association of immune subsets and the association between immune cell profiles regarding treatment response and AEs.ResultsWe found that the composition of T cell subsets was associated with relapse activity, as an increased proportion of CD8+ lymphocytes at baseline indicated a higher likelihood of subsequent relapse (about 9% per 1% increase in CD8+ proportion of all CD3+ cells). This was particularly driven by patients receiving anti-CD20 therapy, where also EDSS worsening was associated with a higher number of CD8+ cells at baseline (3% increase per 10 cells). In the overall cohort, an increase in the proportion of NK cells was associated with a higher risk of EDSS worsening (5% per 1% increase). Occurrence of AEs was associated with a higher percentage of T cells and a lower number of percentual NKT cells at baseline.ConclusionImmune cell profiles are associated with treatment response and the occurrence of AEs in pwMS. Hence, immunophenotyping may serve as a valuable biomarker to enable individually tailored treatment strategies in pwMS
Myeloid cell iron uptake pathways and paramagnetic rim formation in multiple sclerosis
In multiple sclerosis (MS), sustained inflammatory activity can be visualized by iron-sensitive magnetic resonance imaging (MRI) at the edges of chronic lesions. These paramagnetic rim lesions (PRLs) are associated with clinical worsening, although the cell type-specific and molecular pathways of iron uptake and metabolism are not well known. We studied two postmortem cohorts: an exploratory formalin-fixed paraffin-embedded (FFPE) tissue cohort of 18 controls and 24 MS cases and a confirmatory snap-frozen cohort of 6 controls and 14 MS cases. Besides myelin and non-heme iron imaging, the haptoglobin-hemoglobin scavenger receptor CD163, the iron-metabolizing markers HMOX1 and HAMP as well as immune-related markers P2RY12, CD68, C1QA and IL10 were visualized in myeloid cell (MC) subtypes at RNA and protein levels across different MS lesion areas. In addition, we studied PRLs in vivo in a cohort of 98 people with MS (pwMS) via iron-sensitive 3 T MRI and haptoglobin genotyping by PCR. CSF samples were available from 38 pwMS for soluble CD163 (sCD163) protein level measurements by ELISA. In postmortem tissues, we observed that iron uptake was linked to rim-associated C1QA-expressing MC subtypes, characterized by upregulation of CD163, HMOX1, HAMP and, conversely, downregulation of P2RY12. We found that pwMS with [Formula: see text] 4 PRLs had higher sCD163 levels in the CSF than pwMS with [Formula: see text] 3 PRLs with sCD163 correlating with the number of PRLs. The number of PRLs was associated with clinical worsening but not with age, sex or haptoglobin genotype of pwMS. However, pwMS with Hp2-1/Hp2-2 haplotypes had higher clinical disability scores than pwMS with Hp1-1. In summary, we observed upregulation of the CD163-HMOX1-HAMP axis in MC subtypes at chronic active lesion rims, suggesting haptoglobin-bound hemoglobin but not transferrin-bound iron as a critical source for MC-associated iron uptake in MS. The correlation of CSF-associated sCD163 with PRL counts in MS highlights the relevance of CD163-mediated iron uptake via haptoglobin-bound hemoglobin. Also, while Hp haplotypes had no noticeable influence on PRL counts, pwMS carriers of a Hp2 allele might have a higher risk to experience clinical worsening
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