123I-Methyljodbenzylguanidin- (MIBG-) Szintigraphie: Paradoxe Nuklidspeicherung eines onkozytären Nebennierenrindenkarzinoms

Zusammenfassung: Das mit Radiojod markierte Katecholaminanalogon Methyljodbenzylguanidin (MIBG) eignet sich aufgrund seiner selektiven Aufnahme in chromaffine Gewebe in hervorragender Weise für die bildgebende Diagnostik des Phäochromozytoms und besitzt hier nach Literaturangaben eine Sensitivität von etwa 90% und eine Spezifität von annähernd 100%. Die falsch-positive oder paradoxe MIBG-Speicherung einer adrenokortikalen Neoplasie stellt demgegenüber eine Rarität dar. Wir berichten über diese Situation am Beispiel eines metastasierten onkozytären Nebennierenrindenkarzinoms mit teilweise therapeutisch genutzter MIBG-Speicherung in verschiedenen Tumormanifestatione

Accurate control of hyperbolic trajectories in any dimension

The unsteady (nonautonomous) analog of a hyperbolic fixed point is a hyperbolic trajectory, whose importance is underscored by its attached stable and unstable manifolds, which have relevance in fluid flow barriers, chaotic basin boundaries, and the long-term behavior of the system. We develop a method for obtaining the unsteady control velocity which forces a hyperbolic trajectory to follow a user-prescribed variation with time. Our method is applicable in any dimension, and accuracy to any order is achievable.We demonstrate and validate our method by (1) controlling the fixed point at the origin of the Lorenz system, for example, obtaining a user-defined nonautonomous attractor, and (2) the saddle points in a droplet flow, using localized control which generates global transport.Sanjeeva Balasuriya, Kathrin Padberg-Gehl

Controlling the unsteady analogue of saddle stagnation points

It is well known that saddle stagnation points are crucial flow organizers in steady (autonomous) flows due to their accompanying stable and unstable manifolds. These have been extensively investigated experimentally, numerically, and theoretically in situations related to macroand micromixers in order to either restrict or enhance mixing. Saddle points are also important players in the dynamics of mechanical oscillators, in which such points and their associated invariant manifolds form boundaries of basins of attraction corresponding to qualitatively different types of behavior. The entity analogous to a saddle point in an unsteady (nonautonomous) flow is a timevarying hyperbolic trajectory with accompanying stable and unstable manifolds which move in time. Within the context of nearly steady flows, the unsteady velocity perturbation required to ensure that such a hyperbolic (saddle) trajectory follows a specified trajectory in space is derived and shown to be equivalent to that which can be obtained via a heuristic approach. An expression for the error in the hyperbolic trajectory's motion is also derived. This provides a new tool for the control of both fluid transport and mechanical oscillators. The method is applied to two examples-a four-roll mill and a Duffing oscillator-and the performance of the control strategy is shown to be excellent in both instances. © 2013 Society for Industrial and Applied Mathematics.Sanjeeva Balasuriya and Kathrin Padberg-Gehl

Quality measurement of out-patient neuropsychological therapy after stroke in Germany: definition of indicators and retrospective pilot study

Background: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. Methods: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. Results: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time<1month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value=0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value=0.009). Conclusion: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes

Effects of Transcranial Direct Current Stimulation on Information Processing Speed, Working Memory, Attention, and Social Cognition in Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system. Cognitive impairment occurs in 40–65% of patients and could drastically affect their quality of life. Deficits could involve general cognition (e.g., attention and working memory) as well as social cognition. Transcranial direct current stimulation (tDCS), is a novel brain stimulation technique that has been assessed in the context of several neuropsychiatric symptoms, including those described in the context of MS. However, very rare trials have assessed tDCS effects on general cognition in MS, and none has tackled social cognition. The aim of this work was to assess tDCS effects on general and social cognition in MS. Eleven right-handed patients with MS received two blocks (bifrontal tDCS and sham, 2 mA, 20 min, anode/cathode over left/right prefrontal cortex) of 5 daily stimulations separated by a 3-week washout interval. Working memory and attention were, respectively, measured using N-Back Test (0-Back, 1-Back, and 2-Back) and Symbol Digit Modalities Test (SDMT) at the first and fifth day of each block and 1 week later. Social cognition was evaluated using Faux Pas Test and Eyes Test at baseline and 1 week after each block. Interestingly, accuracy of 1-Back test improved following sham but not active bifrontal tDCS. Therefore, active bifrontal tDCS could have impaired working memory via cathodal stimulation of the right prefrontal cortex. No significant tDCS effects were observed on social cognitive measures and SDMT. Admitting the small sample size and the learning (practice) effect that might arise from the repetitive administration of each task, the current results should be considered as preliminary and further investigations in larger patient samples are needed to gain a closer understanding of tDCS effects on cognition in MS

How to read a next-generation sequencing report-what oncologists need to know.

Next-generation sequencing (NGS) of tumor cell-derived DNA/RNA to screen for targetable genomic alterations is now widely available and has become part of routine practice in oncology. NGS testing strategies depend on cancer type, disease stage and the impact of results on treatment selection. The European Society for Medical Oncology (ESMO) has recently published recommendations for the use of NGS in patients with advanced cancer. We complement the ESMO recommendations with a practical review of how oncologists should read and interpret NGS reports. A concise and straightforward NGS report contains details of the tumor sample, the technology used and highlights not only the most important and potentially actionable results, but also other pathogenic alterations detected. Variants of unknown significance should also be listed. Interpretation of NGS reports should be a joint effort between molecular pathologists, tumor biologists and clinicians. Rather than relying and acting on the information provided by the NGS report, oncologists need to obtain a basic level of understanding to read and interpret NGS results. Comprehensive annotated databases are available for clinicians to review the information detailed in the NGS report. Molecular tumor boards do not only stimulate debate and exchange, but may also help to interpret challenging reports and to ensure continuing medical education

Collapse from the top: Brushes of poly(N-isopropylacrylamide) in co-nonsolvent mixtures

Using a combination of ellipsometry and friction force microscopy, we study the reversible swelling, collapse and variation in friction properties of covalently bound poly(N-isopropylacrylamide) (PNIPAM) layers on silicon with different grafting densities in response to exposure to good solvents and cononsolvent mixtures. Changes in the thickness and segment density distribution of grafted films are investigated by in situ ellipsometry. Based on quantitative modelling of the ellipsometry spectra, we postulate a structural model, which assumes that collapse takes place in the contacting layer between the brush and the co-nonsolvent and the top-collapsed brushes remain hydrated in the film interior. Using the structural model derived from ellipsometry spectra, we analyse the AFM based friction force microscopy data, which were obtained by silica colloidal probes. Results show a large increase of the friction coefficient of PNIPAM grafts when the grafts swollen by water are brought in contact with cononsolvents. For instance, the value of the friction coefficient for a medium density brush in water is four times lower than the value observed in a water–methanol (50% v/v) mixture. This increase of friction is accompanied by an increase in adherence between the PNIPAM chains and the silica colloidal probes, and is a result of chain collapse in the graft when contacted by a co-nonsolvent mixture in agreement with the model postulated on the basis of ellipsometric characterisation. The kinetic behaviour of the collapse is assessed by measuring the temporal variation of friction in situ as a function of elapsed time following contact with the co-nonsolvent as a function of graft density. In conclusion, the effect of cononsolvency influenced both the thickness of the PNIPAM brushes and the tribological behavior of the brush surfaces

The relationship between magnetic and electrophysiological responses to complex tactile stimuli

<p>Abstract</p> <p>Background</p> <p>Magnetoencephalography (MEG) has become an increasingly popular technique for non-invasively characterizing neuromagnetic field changes in the brain at a high temporal resolution. To examine the reliability of the MEG signal, we compared magnetic and electrophysiological responses to complex natural stimuli from the same animals. We examined changes in neuromagnetic fields, local field potentials (LFP) and multi-unit activity (MUA) in macaque monkey primary somatosensory cortex that were induced by varying the rate of mechanical stimulation. Stimuli were applied to the fingertips with three inter-stimulus intervals (ISIs): 0.33s, 1s and 2s.</p> <p>Results</p> <p>Signal intensity was inversely related to the rate of stimulation, but to different degrees for each measurement method. The decrease in response at higher stimulation rates was significantly greater for MUA than LFP and MEG data, while no significant difference was observed between LFP and MEG recordings. Furthermore, response latency was the shortest for MUA and the longest for MEG data.</p> <p>Conclusion</p> <p>The MEG signal is an accurate representation of electrophysiological responses to complex natural stimuli. Further, the intensity and latency of the MEG signal were better correlated with the LFP than MUA data suggesting that the MEG signal reflects primarily synaptic currents rather than spiking activity. These differences in latency could be attributed to differences in the extent of spatial summation and/or differential laminar sensitivity.</p

Unbiased Global Optimization of Lennard-Jones Clusters for N <= 201 by Conformational Space Annealing Method

We apply the conformational space annealing (CSA) method to the Lennard-Jones clusters and find all known lowest energy configurations up to 201 atoms, without using extra information of the problem such as the structures of the known global energy minima. In addition, the robustness of the algorithm with respect to the randomness of initial conditions of the problem is demonstrated by ten successful independent runs up to 183 atoms. Our results indicate that the CSA method is a general and yet efficient global optimization algorithm applicable to many systems.Comment: revtex, 4 pages, 2 figures. Physical Review Letters, in pres