Untersuchung von Alterseffekten auf neuronale Korrelate exekutiver Funktionen und ihrer Lokalisation

In der vorliegenden Arbeit wurden Verhaltenskontrollprozesse gesunder, erwachsener Probanden im Alter von 18 bis 65 Jahren mittels 32-Kanal-EEG-Datenerhebung untersucht. Ziel war es, mit freien Entscheidungen assoziierte Veränderungen ereignis-korrelierter Potenziale sowie Unterschiede zwischen instruierter und freiwilliger Reaktionen im Vergleich zwischen jüngeren und älteren Probanden zu beschreiben. Hierzu nahmen insgesamt 35 Probanden (18 jüngere und 17 ältere Personen) an einem modifizierten auditorischen Go-/NoGo-Experiment mit Tastendruck teil. Dabei wurden 480 Stimuli, bestehend aus je einer von fünf möglichen Tonkombinationen, dargeboten, die entweder eine instruierte oder eine freiwillige Reaktion erforderlich machten bzw. eine Kontrollbedingung darstellten. Während des Experiments wurden Verhaltensdaten und ereignis-korrelierte Potenziale aufgezeichnet, nach Abschluss des Experiments wurden zusätzlich motivationale Aspekte mit einem Fragebogen erfasst. Entgegen den Erwartungen zeigten sich beim Vergleich der Leistungsdaten (Reaktionszeiten, Richtigkeit der instruierten Reaktionen, Häufigkeit der freiwilligen Entscheidungen) keine Unterschiede zwischen den jüngeren und älteren Probanden. Auffällige Befunde bei Entscheidungsbedingungen betrafen vor allem die parietalen N1-Amplituden im Vergleich älterer zu jüngeren Probanden. Hierbei zeigte sich bei N1-Amplituden der älteren Probanden- gruppe eine signifikant deutlichere Negativität in parietalen Abschnitten. Die Amplituden der P3a waren bei älteren Probanden signifikant niedriger als bei jüngeren Probanden. In der Korrrelationsanalyse zeigte zunehmendes Alter niedrigere Amplituden der P3a in parietalen und der P3b in zentralen Hirnregionen. Die Entscheidung zum freiwilligen Tastendruck unterschied sich elektrophysiologisch nicht von der Entscheidung, freiwillig den Tastendruck zu unterlassen. Allerdings konnten bei der jüngeren Probandengruppe niedrigere P3a- und P3b-Amplituden bei der Entscheidung zum Tastendruck gegenüber der Entscheidung gegen den Tastendruck gezeigt werden, was sich bei älteren Versuchspersonen nicht zeigte. Insgesamt schien die Art der Entscheidung keinen bzw. einen geringen Einfuss auf die neurobiologische Reaktion zu haben. Insgesamt scheinen Alterseffekte neuronaler Korrelate von Entscheidungen parietale Hirnabschnitte zu betreffen und vorrangig im Zusammenhang mit dem frühen ereignis-korrelierten Potenzial N1 sowie den späten Potenzialen P3a und P3b zu stehen. Diese Ergebnisse stützen die Hypothese, dass es elektrophysiologische, altersabhängige Unterschiede bei Entscheidungen gibt. Ferner ergeben sich Hinweise auf einen Schwerpunkt in zentro-parietalen Hirnarealen mit Einfuss auf N1 und P3a/P3b

A Novel Large-scale Mentoring Program for Medical Students based on a Quantitative and Qualitative Needs Analysis

Purpose: Mentoring plays an important role in students' performance and career. The authors of this study assessed the need for mentoring among medical students and established a novel large-scale mentoring program at Ludwig-Maximilians-University (LMU) Munich School of Medicine

Patient-reported outcomes of parenteral somatostatin analogue injections in 195 patients with acromegaly.

This work is licensed under a Creative Commons Attribution 3.0 Unported LicenseBACKGROUND: Long-acting somatostatin analogues delivered parenterally are the most widely used medical treatment in acromegaly. This patient-reported outcomes survey was designed to assess the impact of chronic injections on subjects with acromegaly. METHODS: The survey was conducted in nine pituitary centres in Germany, UK and The Netherlands. The questionnaire was developed by endocrinologists and covered aspects of acromegaly symptoms, injection-related manifestations, emotional and daily life impact, treatment satisfaction and unmet medical needs. RESULTS: In total, 195 patients participated, of which 112 (57%) were on octreotide (Sandostatin LAR) and 83 (43%) on lanreotide (Somatuline Depot). The majority (>70%) of patients reported acromegaly symptoms despite treatment. A total of 52% of patients reported that their symptoms worsen towards the end of the dosing interval. Administration site pain lasting up to a week following injection was the most frequently reported injection-related symptom (70% of patients). Other injection site reactions included nodules (38%), swelling (28%), bruising (16%), scar tissue (8%) and inflammation (7%). Injection burden was similar between octreotide and lanreotide. Only a minority of patients received injections at home (17%) and 5% were self-injecting. Over a third of patients indicated a feeling of loss of independence due to the injections, and 16% reported repeated work loss days. Despite the physical, emotional and daily life impact of injections, patients were satisfied with their treatment, yet reported that modifications that would offer major improvement over current care would be 'avoiding injections' and 'better symptom control'. CONCLUSION: Lifelong injections of long-acting somatostatin analogues have significant burden on the functioning, well-being and daily lives of patients with acromegaly.Chiasma, Inc. 60 Welles Ave, Newton, MA 02 459, USA

More mentoring needed? A cross-sectional study of mentoring programs for medical students in Germany

<p>Abstract</p> <p>Background</p> <p>Despite increasing recognition that mentoring is essential early in medical careers, little is known about the prevalence of mentoring programs for medical students. We conducted this study to survey all medical schools in Germany regarding the prevalence of mentoring programs for medical students as well as the characteristics, goals and effectiveness of these programs.</p> <p>Methods</p> <p>A definition of mentoring was established and program inclusion criteria were determined based on a review of the literature. The literature defined mentoring as a steady, long-lasting relationship designed to promote the mentee's overall development. We developed a questionnaire to assess key characteristics of mentoring programs: the advocated mentoring model, the number of participating mentees and mentors, funding and staff, and characteristics of mentees and mentors (e.g., level of training). In addition, the survey characterized the mentee-mentor relationship regarding the frequency of meetings, forms of communication, incentives for mentors, the mode of matching mentors and mentees, and results of program evaluations. Furthermore, participants were asked to characterize the aims of their programs. The questionnaire consisted of 34 questions total, in multiple-choice (17), numeric (7) and free-text (10) format. This questionnaire was sent to deans and medical education faculty in Germany between June and September 2009. For numeric answers, mean, median, and standard deviation were determined. For free-text items, responses were coded into categories using qualitative free text analysis.</p> <p>Results</p> <p>We received responses from all 36 medical schools in Germany. We found that 20 out of 36 medical schools in Germany offer 22 active mentoring programs with a median of 125 and a total of 5,843 medical students (6.9 - 7.4% of all German medical students) enrolled as mentees at the time of the survey. 14 out of 22 programs (63%) have been established within the last 2 years. Six programs (27%) offer mentoring in a one-on-one setting. 18 programs (82%) feature faculty physicians as mentors. Nine programs (41%) involve students as mentors in a peer-mentoring setting. The most commonly reported goals of the mentoring programs include: establishing the mentee's professional network (13 programs, 59%), enhancement of academic performance (11 programs, 50%) and counseling students in difficulties (10 programs, 45%).</p> <p>Conclusions</p> <p>Despite a clear upsurge of mentoring programs for German medical students over recent years, the overall availability of mentoring is still limited. The mentoring models and goals of the existing programs vary considerably. Outcome data from controlled studies are needed to compare the efficiency and effectiveness of different forms of mentoring for medical students.</p

Delving into Acromegaly

Acromegaly is a rare and disabling disease with some distinct and striking clinical features that have fascinated (and frightened) laypeople and medical experts alike throughout history [...

Can growth hormone lead to a faster recovery from Guillain-Barrée syndrome? Case report of the first therapeutic use in one patient

Although the prognosis in Guillain-Barré syndrome (GBS) is generally good, protracted and incomplete courses of recovery can be a heavy burden. Animal studies suggest growth hormone (GH) treatment could stimulate myelin repair and thus accelerate functional recovery in acute polyneuropathy. We report on the first use of GH in GBS. Our objective was to monitor safety and tolerability as well as to evaluate the effect of an off-label GH therapy during recovery from GBS in one patient. A 28-year-old male with flaccid tetraparesis caused by pure motor GBS was treated off-label with GH (1 mg/day) for 10 weeks. Muscle strength was measured regularly before, during and after the treatment over a total span of 330d. Serum levels of IGF-I were assessed before, during and after GH treatment. Changes in strength gain were used as the main parameter of efficacy. No side effects of GH treatment were observed. Serum IGF-I increased from 177 ng/mL at baseline to an average of 342 ng/mL (normal range 78 – 270 ng/mL) during treatment. Prior to GH administration, strength (R²=0.99, p<0.01) was associated with time, representing the natural course of recovery. During GH treatment, the slope of strength gain increased (Glass’ ∆=1.08, p<0.01). The association between alterations of strength gain and IGF-I serum levels reached trend-level (R²=0.36, p=0.09). In this single case, GH treatment seemed to be associated with faster muscular strength gain. Controlled studies are needed in order to establish GH as a potential therapeutic approach in motor GBS

Differences between immunotherapy-induced and primary hypophysitis—a multicenter retrospective study

OBJECTIVE Immune checkpoint inhibitors can cause various immune-related adverse events including secondary hypophysitis. We compared clinical characteristics of immunotherapy-induced hypophysitis (IIH) and primary hypophysitis (PH) DESIGN: Retrospective multicenter cohort study including 56 patients with IIH and 60 patients with PH. METHODS All patients underwent extensive endocrine testing. Data on age, gender, symptoms, endocrine dysfunction, MRI, immunotherapeutic agents and autoimmune diseases were collected. RESULTS Median time of follow-up was 18 months in IIH and 69 months in PH. The median time from initiation of immunotherapy to IIH diagnosis was 3 months. IIH affected males more frequently than PH (p < 0.001) and led to more impaired pituitary axes in males (p < 0.001). The distribution of deficient adenohypophysial axes was comparable between both entities, however, central hypocortisolism was more frequent (p < 0.001) and diabetes insipidus considerably less frequent in IIH (p < 0.001). Symptoms were similar except that visual impairment occurred more rarely in IIH (p < 0.001). 20 % of IIH patients reported no symptoms at all. Regarding MRI, pituitary stalk thickening was less frequent in IIH (p = 0.009). Concomitant autoimmune diseases were more prevalent in PH patients before the diagnosis of hypophysitis (p = 0.003) and more frequent in IIH during follow-up (p = 0.002). CONCLUSIONS Clinically, IIH and PH present with similar symptoms. Diabetes insipidus very rarely occurs in IIH. Central hypocortisolism, in contrast, is a typical feature of IIH. Preexisting autoimmunity seems not to be indicative of developing IIH