Industrial Ecology

Einführung in das Schwerpunktthem

Oligoclonal bands and kappa free light chains : Competing parameters or complementary biomarkers?

Background: The 2024-revised McDonald criteria for multiple sclerosis (MS) proposed to incorporate cerebrospinal fluid (CSF)-specific oligoclonal bands and kappa free light chains (KFLC) as diagnostic biomarkers. While the 2017-revised criteria highlighted CSF-specific oligoclonal bands to indicate intrathecal IgG synthesis, significantly enhancing early MS diagnosis, KFLC have emerged as additional marker. Now, the question rises of whether both biomarkers serve as competing or complementary tools in MS diagnostics. Methods: In this narrative review, we extensively searched the literature on oligoclonal bands and KFLC determination in CSF and serum across neurological disorders, with a focus on MS, using the PubMed database to demonstrate the complementarity of both biomarkers. Results: Oligoclonal bands have long been a reliable marker of intrathecal IgG synthesis in MS, valued for their high diagnostic sensitivity, unique patient “fingerprints,” clonality differentiation, semi-quantitative analysis, and pre-analytic robustness. However, they present challenges in standardization, labor-intensity, method variability, examiner dependency, and limited data on non-IgG immunoglobulins. Quantitative KFLC measurement provides rapid, examiner-independent, and cost-effective assessment across all immunoglobulin classes but might have lower specificity, lacked consensus on standardized interpretation in recent years, and is not yet supported by comprehensive prospective multinational studies on its prognostic role. Conclusion: Both oligoclonal bands and KFLC have unique strengths and limitations that complement each other, potentially serving as complementary markers for evaluating intrathecal Ig synthesis in MS diagnosis. Further evidence is needed to establish the value of KFLC in MS diagnosis, thus multicenter prospective studies are being conducted to compare the diagnostic utility of both markers

Primary cCT Imaging Based Clinico-Neurological Assessment—Calling for Addition of Telestroke Video Consultation in Patients With Intracerebral Hemorrhage

Background and Purpose: Intracerebral hemorrhage (ICH) requires rapid decision making to decrease morbidity and mortality although time frame and optimal therapy are still ill defined. Ideally, specialized neurologists, neurosurgeons, and (neuro-) radiologists who know the patient's clinical status and their cerebral computed tomography imaging (cCT) make a joint decision on the clinical management. However, in telestroke networks, a shift toward cCT imaging criteria used for decisionmaking can be observed for practical reasons. Here we investigated the "reverse correlation" from cCT imaging to the actual clinical presentation as evaluated by the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS). Methods: CCT images and basic information (age, sex, and time of onset) of 50 patients with hypertensive and lobar ICH were presented to 14 experienced neurologists and 15 neurosurgeons. Based on this information, the NIHSS and GCS scores were estimated for each patient. The differences between the actual GCS and NIHSS scores and the cCT-imaging-based estimated scores were plotted in a bland-Altman plot. Results: The average estimated GCS score mainly based on cCT imaging was 12. 4 +/- 2.8 (actual value: 13.0 +/- 2.5; p = 0.100), the estimated NIHSS score was 13.9 +/- 9.1 (actual value: 10.8 +/- 7.3; p < 0.001). Thus, in cCT-imaging-based evaluation, the neurological status of patients especially employing the NIHSS was estimated poorer, particularly in patients with lobar ICH. "Reverse clinical" evaluation based on cCT-imaging alone may increase the rate of intubation and secondary transferal and neurosurgical treatment. Telestroke networks should consider both, videoassessment of the actual clinical picture and cCT-imaging findings to make appropriate acute treatment decisions

Interdisciplinary Decision Making in Hemorrhagic Stroke Based on CT Imaging—Differences Between Neurologists and Neurosurgeons Regarding Estimation of Patients' Symptoms, Glasgow Coma Scale, and National Institutes of Health Stroke Scale

Background and Purpose: Acute intracerebral hemorrhage (ICH) requires rapid decision making toward neurosurgery or conservative neurological stroke unit treatment. In a previous study, we found overestimation of clinical symptoms when clinicians rely mainly on cerebral computed tomography (cCT) analysis. The current study investigates differences between neurologists and neurosurgeons estimating specific scores and clinical symptoms. Methods: Overall, 14 neurologists and 15 neurosurgeons provided clinical estimates and National Institutes of Health Stroke Scale (NIHSS) as well as Glasgow Coma Scale (GCS) based on cCT images and basic information of 50 patients with hypertensive and lobar ICH. Subgroup analyses were performed for the different professions (neurologists vs. neurosurgeons) and bleeding subtypes (typical location vs. atypical). The differences between the actual GCS and NIHSS scores and the cCT-imaging-based estimated scores were depicted as Bland-Altman plots and negative and positive predictive value (NPV and PPV) for prediction of clinical relevant items. Delta NIHSS points (Delta GCS points) were calculated as the difference between actual and rated NIHSS (GCS) including 95% confidence interval (CI). Results: Mean Delta GCS points for neurosurgeons was 1.16 (95% CI: -2.67-4.98); for neurologists, 0.99 (95% CI: -2.58-4.55), p = 0.308; mean Delta NIHSS points for neurosurgeons was -2.95 (95% CI: -12.71-6.82); for neurologists, -0.33 (95% CI: -9.60-8.94), p < 0.001. NPV and PPV for stroke symptoms were low, with large differences between different symptoms, bleeding subtypes, and professions. Both professions had more problems in proper rating of specific clinic-neurological symptoms than rating scores. Conclusion: Our results stress the need for joint decision making based on detailed neurological examination and neuroimaging findings also in telemedicine

In Situ Dividing and Phagocytosing Retinal Microglia Express Nestin, Vimentin, and NG2 In Vivo

BACKGROUND: Following injury, microglia become activated with subsets expressing nestin as well as other neural markers. Moreover, cerebral microglia can give rise to neurons in vitro. In a previous study, we analysed the proliferation potential and nestin re-expression of retinal macroglial cells such as astrocytes and Müller cells after optic nerve (ON) lesion. However, we were unable to identify the majority of proliferative nestin(+) cells. Thus, the present study evaluates expression of nestin and other neural markers in quiescent and proliferating microglia in naïve retina and following ON transection in adult rats in vivo. METHODOLOGY/PRINCIPAL FINDINGS: For analysis of cell proliferation and cells fates, rats received BrdU injections. Microglia in retinal sections or isolated cells were characterized using immunofluorescence labeling with markers for microglia (e.g., Iba1, CD11b), cell proliferation, and neural cells (e.g., nestin, vimentin, NG2, GFAP, Doublecortin etc.). Cellular analyses were performed using confocal laser scanning microscopy. In the naïve adult rat retina, about 60% of resting ramified microglia expressed nestin. After ON transection, numbers of nestin(+) microglia peaked to a maximum at 7 days, primarily due to in situ cell proliferation of exclusively nestin(+) microglia. After 8 weeks, microglia numbers re-attained control levels, but 20% were still BrdU(+) and nestin(+), although no further local cell proliferation occurred. In addition, nestin(+) microglia co-expressed vimentin and NG2, but not GFAP or neuronal markers. Fourteen days after injury and following retrograde labeling of retinal ganglion cells (RGCs) with Fluorogold (FG), nestin(+)NG2(+) microglia were positive for the dye indicating an active involvement of a proliferating cell population in phagocytosing apoptotic retinal neurons. CONCLUSIONS/SIGNIFICANCE: The current study provides evidence that in adult rat retina, a specific resident population of microglia expresses proteins of immature neural cells that are involved in injury-induced cell proliferation and phagocytosis while transdifferentiation was not observed

COVID-19: Symptome und Frühzeichen auch bei leichten Verlaufsformen – Bedeutung von Riechstörungen und Ruhepuls

Zusammenfassung Einleitung Die ersten Arbeiten über die neue COVID-19-Erkrankung berichteten von schwer betroffenen, häufig intensivpflichtigen Patienten mit Pneumonien. Zwischenzeitlich wurden vermehrt mildere Verläufe beschrieben. Hier wird erstmals der Verlauf der Symptomatik von 5 leichten COVID-19-Erkrankungen ohne stationäre Behandlungspflicht in einer Familie dargestellt. Anamnese Ein 56-jähriger, bislang gesunder Mann, Freizeit-Ausdauersportler, bemerkte nach kurzen Episoden mit Geruchsmissempfindungen eine Anosmie. Wenige Tage später stieg sein Ruhepuls deutlich an. Es folgten Reizhusten, Abgeschlagenheit und Myalgien. Im gleichen Zeitraum traten Symptome bei den 4 bislang ebenfalls gesunden Familienmitgliedern auf. Diagnostik und Befunde Beim Indexpatienten bestand ein trockener Reizhusten. Der internistische Befund war unauffällig, Herzfrequenz 60/min, Temperatur 36,6 °C. Neurologisch zeigte sich eine Anosmie. Die RT-PCR für SARS-CoV-2 aus dem tiefen Rachenabstrich war bei allen 5 Familienmitgliedern positiv. Therapie und Verlauf In häuslicher Quarantäne bestanden Symptome über etwa 2 Wochen. Eine Anosmie sowie Gliederschmerzen bestanden bei allen Betroffenen, eine Geschmacksstörung, Abgeschlagenheit sowie Reizhusten und Halsschmerzen bei 4 von 5. Ruhedyspnoe oder gastrointestinale Symptome traten nicht auf. Es kam zu Ein- und Durchschlafstörungen. Erhöhte Temperatur oder Fieber bestand bei keinem der Betroffenen. Spezifische medizinische oder medikamentöse Behandlung war nicht erforderlich. Es kam in der Folge der Erkrankung zu keinen fassbaren Organkomplikationen; die körperliche Leistungsfähigkeit erholte sich. Diskussion Es wird eine 5-köpfige Familie ohne Vorerkrankungen mit mildem Verlauf einer COVID-19-Erkrankung beschrieben. Die Symptome werden in Verlauf und Intensität dargestellt. Eine Anosmie kann den übrigen Symptomen um Tage vorangehen und als Frühzeichen einer Infektion erfasst werden, was auch epidemiologisch von Bedeutung sein kann. Ein Anstieg des Ruhepulses kann auch ohne Fieber als Erkrankungszeichen beobachtet werden. Symptome und Verlauf werden im Kontext der Pandemie und der Infektionskontrolle diskutiert.</jats:p