Antineuronale Autoimmunenzephalitis

Vor etwa 10 Jahren wurde eine neue Kategorie von Autoimmunenzephalitiden entdeckt, die durch Autoantikörper gegen synaptische oder Oberflächenantigene verursacht werden und in der psychiatrischen Praxis von hoher Relevanz sind. Insbesondere bei subakuter Psychose, Gedächtnisstörungen und einer Kombination psychiatrischer und neurologischer Symptome sollten die Autoimmunenzephalitiden in die Differenzialdiagnose eingeschlossen werden. Mit der Testung von Liquor und/oder Serum in einem spezialisierten Labor können die bekannten Antikörper innerhalb weniger Tage detektiert werden. Eine frühe Diagnose und rasche Immuntherapie führen in den meisten Fällen zu einer Remission der Symptome.Approximately 10 years ago, a new category of autoimmune encephalitis was described that is caused by autoantibodies against synaptic or surface antigens and has a high relevance for psychiatric care. In particular, in cases of subacute psychosis, memory deficit, and combination of neurological and psychiatric symptoms, the differential diagnoses should include autoimmune encephalitis. In a specialized lab, the known antibodies can be detected in cerebrospinal fluid and/or serum within a couple of days. Early diagnosis and immunotherapy are crucial for a favorable outcome and lead in most cases to complete remission.(VLID)353202

The Effect of Pulling Out Cochlear Implant Electrodes on Inner Ear Microstructures: A Temporal Bone Study

The exchange of an cochlear implant or the re-positioning of an electrode have become more frequently required than a decade ago. The consequences of such procedures at a microstructural level within the cochlea are not known. It was the aim of the present study to further investigate the effects of an CI electrode pull-out. Therefore 10 freshly harvested temporal bones (TB) were histologically evaluated after a cochlear implant electrode pull-out of a perimodiolar electrode. In additional 9 TB the intrascalar movements of the CI electrode while being pulled-out were digitally analysed by video- capturing. Histologically, a disruption of the modiolar wall or the spiral osseous lamina were not observed. In one TB, a basilar membrane lifting up was found, but it could not be undoubtedly attributed to the pull-out of the electrode. When analyzing the temporal sequence of the electrode movement during the pull-out, the electrode turned in one case so that the tip elevates the basilar membrane. The pull- out of perimodiolarly placed CI electrodes does not damage the modiolar wall at a microstructural level and should be guided (e.g., forceps) to prevent a 90 o turning of the electrode tip into the direction of the basilar membrane

The semisolid bolus swallow test for clinical diagnosis of oropharyngeal dysphagia: a prospective randomised study

Contrary to clinical experience, clinical swallow tests are predominantly performed using water (water swallow tests, WST). In this study, we examine whether swallow tests performed using a bolus of semisolid food (bolus swallow test, BST) offer benefits. In a prospective, randomised, blind study, the results of a standardised saliva swallow test (SST), WST, BST, combinations of these tests and an endoscopic swallow test (FEES) in patients with oropharyngeal swallowing disorders of neurological (NEU) and non-neurological (NNEU) origin were compared. Sensitivity, specificity, test accuracy and inter-rater reliability were analysed. 62 patients (mean age = 64.68; range = 22–84) were included in the study (NEU = 40; NNEU = 22). A sensitivity of 70.7% (NEU = 70.3%, NNEU = 71.4%) and specificity of 82.5% (NEU = 92.3%; NNEU = 100%) were determined for the WST. The BST + SST was found to have a sensitivity of 89.6% (NEU = 66.7%; NNEU = 90.9%) and a specificity of 72.7% (NEU = 87.5%; NNEU = 90.9%). Analysis of test accuracy showed a statistically significant correlation between FEES and BST + SST. Only BST + SST exhibited statistically significant inter-rater reliability. BST in combination with SST was the sensitive clinical instrument for detecting aspiration both over the patient population as a whole and over the two sub-populations. Inter-rater reliability was found to be statistically significant. The results presented here demonstrate the benefit of semisolid food in investigating clinical dysphagia

Characterisation of the antibiotic profile of Lysobacter capsici AZ78, an effective biological control agent of plant pathogenic microorganisms

Determining the mode of action of microbial biocontrol agents plays a key role in their development and registration as commercial biopesticides. The biocontrol rhizobacterium Lysobacter capsici AZ78 (AZ78) is able to inhibit a vast array of plant pathogenic oomycetes and Gram-positive bacteria due to the release of antimicrobial secondary metabolites. A combination of MALDI-qTOF-MSI and UHPLC-HRMS/M was applied to finely dissect the AZ78 metabolome and identify the main secondary metabolites involved in the inhibition of plant pathogenic microorganisms. Under nutritionally limited conditions, MALDI-qTOF-MSI revealed that AZ78 is able to release a relevant number of antimicrobial secondary metabolites belonging to the families of 2,5-diketopiperazines, cyclic lipodepsipeptides, macrolactones and macrolides. In vitro tests confirmed the presence of secondary metabolites toxic against Pythium ultimum and Rhodococcus fascians in AZ78 cell-free extracts. Subsequently, UHPLC-HRMS/MS was used to confirm the results achieved with MALDI-qTOF-MSI and investigate for further putative antimicrobial secondary metabolites known to be produced by Lysobacter spp. This technique confirmed the presence of several 2,5-diketopiperazines in AZ78 cell-free extracts and provided the first evidence of the production of the cyclic depsipeptide WAP-8294A2 in a member of L. capsici species. Moreover, UHPLC-HRMS/MS confirmed the presence of dihydromaltophilin/Heat Stable Antifungal Factor (HSAF) in AZ78 cell-free extracts. Due to the production of HSAF by AZ78, cell-free supernatants were effective in controlling Plasmopara viticola on grapevine leaf disks after exposure to high temperatures. Overall, our work determined the main secondary metabolites involved in the biocontrol activity of AZ78 against plant pathogenic oomycetes and Gram-positive bacteria. These results might be useful for the future development of this bacterial strain as the active ingredient of a microbial biopesticide that might contribute to a reduction in the chemical input in agricultur

The duration of intrauterine development influences discrimination of speech prosody in infants.

AbstractAuditory speech discrimination is essential for normal language development. Children born preterm are at greater risk of language developmental delays. Using functional near‐infrared spectroscopy at term‐equivalent age, the present study investigated early discrimination of speech prosody in 62 neonates born between week 23 and 41 of gestational age (GA). We found a significant positive correlation between GA at birth and neural discrimination of forward versus backward speech at term‐equivalent age. Cluster analysis identified a critical threshold at around week 32 of GA, pointing out the existence of subgroups. Infants born before week 32 of GA exhibited a significantly different pattern of hemodynamic response to speech stimuli compared to infants born at or after week 32 of GA. Thus, children born before the GA of 32 weeks are especially vulnerable to early speech discrimination deficits. To support their early language development, we therefore suggest a close follow‐up and additional speech and language therapy especially in the group of children born before week 32 of GA

Initiation of electric discharge. Method of covering the electrode

A report of our experiences involving the treatment six male patients with a new method of closing perforations in the pharynx and upper esophagus, following surgery of the cervical spine region. Perforation of the pharynx and upper esophagus are rare complications following cervical spine surgery. The grave consequences of these complications necessitate in most cases immediate surgical therapy. In most cases, the first step involves the removal of the cervical plate and screws. The defect was then closed using a vascular pedicled musculofascia flap derived from the infrahyoid musculature. In all cases, the flap healed into place without complications. The patients began taking oral nutrients after an average of seven postoperative (5–12) days. In none of the cases did functional disorders or complications arise during the follow-up period (1–5 years). The infrahyoid muscle flap is well suited for reconstruction of the posterior pharyngeal wall and the upper esophagus

Система бухгалтерского учета в средних общеобразовательных учреждениях на примере МБОУ «СОШ №2 города Юрги»

Данная выпускная квалификационная работа посвящена изучению особенностей бухгалтерского учета и организации финансов в бюджетных государственных предприятиях с последующим внесением предложений по их совершенствованию.This graduation qualification work is devoted to the study of the specifics of accounting and the organization of finance in budgetary state enterprises with subsequent proposals for their improvement

Fetal eye movements on magnetic resonance imaging.

OBJECTIVES: Eye movements are the physical expression of upper fetal brainstem function. Our aim was to identify and differentiate specific types of fetal eye movement patterns using dynamic MRI sequences. Their occurrence as well as the presence of conjugated eyeball motion and consistently parallel eyeball position was systematically analyzed. METHODS: Dynamic SSFP sequences were acquired in 72 singleton fetuses (17-40 GW, three age groups [17-23 GW, 24-32 GW, 33-40 GW]). Fetal eye movements were evaluated according to a modified classification originally published by Birnholz (1981): Type 0: no eye movements; Type I: single transient deviations; Type Ia: fast deviation, slower reposition; Type Ib: fast deviation, fast reposition; Type II: single prolonged eye movements; Type III: complex sequences; and Type IV: nystagmoid. RESULTS: In 95.8% of fetuses, the evaluation of eye movements was possible using MRI, with a mean acquisition time of 70 seconds. Due to head motion, 4.2% of the fetuses and 20.1% of all dynamic SSFP sequences were excluded. Eye movements were observed in 45 fetuses (65.2%). Significant differences between the age groups were found for Type I (p = 0.03), Type Ia (p = 0.031), and Type IV eye movements (p = 0.033). Consistently parallel bulbs were found in 27.3-45%. CONCLUSIONS: In human fetuses, different eye movement patterns can be identified and described by MRI in utero. In addition to the originally classified eye movement patterns, a novel subtype has been observed, which apparently characterizes an important step in fetal brainstem development. We evaluated, for the first time, eyeball position in fetuses. Ultimately, the assessment of fetal eye movements by MRI yields the potential to identify early signs of brainstem dysfunction, as encountered in brain malformations such as Chiari II or molar tooth malformations

MR-based morphometry of the posterior fossa in fetuses with neural tube defects of the spine.

OBJECTIVES: In cases of "spina bifida," a detailed prenatal imaging assessment of the exact morphology of neural tube defects (NTD) is often limited. Due to the diverse clinical prognosis and prenatal treatment options, imaging parameters that support the prenatal differentiation between open and closed neural tube defects (ONTDs and CNTDs) are required. This fetal MR study aims to evaluate the clivus-supraocciput angle (CSA) and the maximum transverse diameter of the posterior fossa (TDPF) as morphometric parameters to aid in the reliable diagnosis of either ONTDs or CNTDs. METHODS: The TDPF and the CSA of 238 fetuses (20-37 GW, mean: 28.36 GW) with a normal central nervous system, 44 with ONTDS, and 13 with CNTDs (18-37 GW, mean: 24.3 GW) were retrospectively measured using T2-weighted 1.5 Tesla MR -sequences. RESULTS: Normal fetuses showed a significant increase in the TDPF (r = .956; p<.001) and CSA (r = .714; p<.001) with gestational age. In ONTDs the CSA was significantly smaller (p<.001) than in normal controls and CNTDs, whereas in CNTDs the CSA was not significantly smaller than in controls (p = .160). In both ONTDs and in CNTDs the TDPF was significantly different from controls (p<.001). CONCLUSIONS: The skull base morphology in fetuses with ONTDs differs significantly from cases with CNTDs and normal controls. This is the first study to show that the CSA changes during gestation and that it is a reliable imaging biomarker to distinguish between ONTDs and CNTDs, independent of the morphology of the spinal defect