Der Einfluss des Nucleus Subthalamicus auf die Raumorientierung bei Patienten mit Morbus Parkinson

Morbus Parkinson ist eine Erkrankung der Basalganglien, bei der motorische Symptome wie Rigor, Tremor, Hypo- bis Akinese und eine posturale Instabilität im Vordergrund stehen. Allerdings gibt es widersprüchliche Aussagen über den Einfluss der Basalganglien bzgl. der Ausrichtung der Aufmerksamkeit im Raum. Die meisten Studien zu diesem Thema untersuchten Patienten mit umschriebenen subkortikalen Läsionen (Hirninfarkte und Blutungen), deren Ausdehnung unterschiedlich und deren Pathologie nicht immer streng auf die Basalganglien bezogen waren. Mit Hilfe der tiefen Hirnstimulation des Nucleus subthalamicus (STN-DBS) gelingt es, den Tonus der Basalganglienschleifen individuell, reversibel und seitenbezogen zu untersuchen. Der STN gilt außerdem als ein Bindeglied bei der Integration motorischer, kognitiver und emotionaler Informationen. In der vorliegenden Studie wurden 15 Parkinson-Patienten mit STN-DBS untersucht, wobei in einem randomisierten doppelblinden Studiendesign jeweils nur die rechte, nur die linke oder beide Elektroden eingeschaltet waren. In diesen drei Bedingungen betrachteten und bewerteten die Patienten Bildersets und parallel hierzu wurden die Augen- bzw. Blickbewegungen aufgezeichnet (SensoMotoric Instruments) und für jede STN-DBS Bedingung separat ausgewertet (BeGaze II). Neben der Fixationsdauer innerhalb des Aufmerksamkeits-bereiches wurden auch die Sakkaden analysiert und die gezeigten Bilder wurden von den Patienten hinsichtlich der Eigenschaft „Erregung“ (arousal) bewertet. Das Bildmaterial bestand zu einem Drittel aus gespiegelten Landschaftsbildern und zu zwei Dritteln aus Bildern aus dem International Affective Picture System (IAPS). Zusätzlich absolvierte jeder Patient, ebenfalls zu den drei Stimulationsbedingungen, einen visuellen, spatialen Aufmerksamkeitstest, welcher sensitiv für eine Neglect-Symptomatik ist (Shakashita-Test). Beim Betrachten der Bilder zeigte sich hinsichtlich der Orientierung im Raum in der Stimulationsbedingung rechts Off/ links On eine verminderte Betrachtungsdauer des linken Bildbereiches im Vergleich zu den Stimulationsbedingungen rechts On/ links Off und rechts On/ links On, sowie ein Trend zur längeren Fixationsdauer im rechten Aufmerksamkeitsbereich in derselben Stimulationsbedingung (rechts Off/ links On) im Vergleich zur Stimulationsbedingung rechts On/ links Off. Der visuelle, spatiale Aufmerksamkeitstest ergab hingegen keine signifikanten Lateralisierungstendenzen in den einzelnen Stimulationsbedingungen. Die bei der Bildbetrachtung aufgezeichneten Sakkaden zeigten keine Änderung in Anzahl, Dauer und Maximalgeschwindigkeit in Abhängigkeit von der Stimulationsbedingung. Bei der Analyse der Bildbewertung konnte keine Änderung der arousal-Bewertung beim Wechsel der Stimulationsbedingung beobachtet werden. Somit zeigen die Ergebnisse während einer unilateralen linksseitigen STN-DBS eine Vernachlässigung des ipsilateralen, extrapersonellen Raumes. Diese Veränderung der räumlichen Orientierung lässt sich nicht durch eine veränderte Blickmotorik erklären. Die fehlende Replikation dieses Ergebnisses im visuellen, spatialen Aufmerksamkeitstest mag an Störungen der Konzentration und der motorischen Handlungskontrolle, welche dieser Test im Gegensatz zur Augenbewegungsanalyse aufweist, liegen. Die Vernachlässigung des linken Bild- und somit auch Aufmerksamkeitsbereiches während der Stimulationsbedingung rechts Off/ links On zeigt, dass der rechte STN in das Netzwerk der Raumorientierung integriert ist und dieses Netzwerk beeinflussen kann. Diese Lateralisation (Neglect-Symptomatik bei ausgeschalteter rechter Elektrode) ist gut mit der Annahme der Dominanz der rechten Hemisphäre bezüglich der Aufrechterhaltung und der Verteilung der Aufmerksamkeit im Raum vereinbar

Malignant melanoma of the urethra: a rare histologic subdivision of vulvar cancer with a poor prognosis

Malignant melanoma of the urethra is a rare tumour that is difficult to diagnose and treat, resulting in a poor prognosis. In this paper, we present the case of a 65-year-old woman who was referred to a gynaecologist because of a urethral mass that mimicked a caruncle. The tumour was removed by local excision, and a pathological analysis revealed a malignant melanoma. Distal urethrectomy was performed after three months with no evidence of residual tumour. There was no evidence of disease at a six-year followup. In this paper, we compare the epidemiology, treatment, staging, and prognosis of vulvar cancer in general to malignant melanoma of the vulva in particular

Uterine Fibroids and Infertility

Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Uterine fibroids are the most common tumor in women, and their prevalence is high in patients with infertility. Fibroids may be the sole cause of infertility in 2-3% of women. Depending on their location in the uterus, fibroids have been implicated in recurrent pregnancy loss as well as infertility. Pregnancy and live birth rates appear to be low in women with submucosal fibroids; their resection has been shown to improve pregnancy rates. In contrast, subserosal fibroids do not affect fertility outcomes and their removal does not confer any benefit. Intramural fibroids appear to reduce fertility, but recommendations concerning their treatment remain unclear. Myomectomy should be discussed individually with the patient; other potential symptoms such as dysmenorrhea or bleeding disorders should be included in the indication for surgery

Inactivation of airborne bacteria by plasma treatment and ionic wind for indoor air cleaning

Airborne bacteria are a general problem in medical or health care facilities with a high risk for nosocomial infections. Rooms with a continuous airflow, such as operation theaters, are of particular importance due to a possible dissemination and circulation of pathogens including multidrug-resistant microorganisms. In this regard, a cold atmospheric-pressure plasma (CAP) may be a possibility to support usual disinfection procedures due to its decontaminating properties. The aim of this study was to determine the antimicrobial efficacy of a plasma decontamination module that included a dielectric barrier discharge for plasma generation. Experimental parameters such as an airflow velocity of 4.5 m/s and microbial contaminations of approximately 6,000 colony-forming units (cfu)/m3 were used to simulate practical conditions of a ventilation system in an operating theater. The apathogenic microorganism Escherichia coli K12 DSM 11250/NCTC 10538 and the multidrug-resistant strains E. coli 21181 and 21182 (isolated from patients) were tested to determine the antimicrobial efficacy. In summary, the number of cfu was reduced by 31–89% for the tested E. coli strains, whereby E. coli K12 was the most susceptible strain toward inactivation by the designed plasma module. A possible correlation between the number or kind of resistances and susceptibility against plasma was discussed. The inactivation of microorganisms was affected by plasma intensity and size of the plasma treatment area. In addition, the differences of the antimicrobial efficacies caused through the nebulization of microorganisms in front (upstream) or behind (downstream) the plasma source were compared. The presence of ionic wind had no influence on the reduction of the number of cfu for E. coli K12, as the airflow velocity was too high for a successful precipitation, which would be a prerequisite for an increased antimicrobial efficacy. The inactivation of the tested microorganisms confirms the potential of CAP for the improvement of air quality. The scale-up of this model system may provide a novel tool for an effective air cleaning process

Impact of nicotine and maternal BMI on fetal birth weight

Data from 110.047 singleton pregnancies, achieved from the German Perinatal Survey in Schleswig-Holstein and registered between 2010 and 2017 were analyzed in August 2018 concerning maternal BMI and smoking. The BMI was taken from the maternity log. Information concerning the smoking status were self-reported and further subdivided into the following four categories: a) non-smokers; b) 1-7 cigarettes/day; c) 8-14 cigarettes/ day; and d) ≥ 15 cigarettes/ day. Furthermore, we classified women by their BMI into underweight, normal weight, overweight and obese. Comparisons between non-smokers and the respective smoking group, and their relationship with maternal BMI were performed by the t-test (birth weight). A number of 97.092 women (88.2%) were non-smokers and 12.955 (11.8%) were smokers. Furthermore 10.3% of women of normal weight smoked during pregnancy, but both high and low BMI were associated with a high prevalence of smoking. The proportion of smokers was highest (18.1%) among underweight women (BMI ≤ 18.5 kg/m2). A large number of smokers (15.5%) were registered in the obesity group (BMI ≥ 30 kg/m2). Mean birth weight (≥ 37 + 0 gestational age) increased with increasing maternal BMI, and was reduced by smoking for every BMI category. The differences between smokers and non-smokers were always highly significant (p < 0.001). Mean birth weight varied between 2995 g in underweight frequent smokers and 3607 g in obese non-smokers. Conclusion Both maternal BMI and smoking during pregnancy influences the birth weight and therefore pregnancy outcome. Smoking during pregnancy was significantly associated with low birth weight. Pregnant women should be advised to cease or at least reduce smoking in order to improve the birth weight of the newborn and to minimize child morbidities

Enhanced laccase-mediated transformation of diclofenac and flufenamic acid in the presence of bisphenol A and testing of an enzymatic membrane reactor

The inadequate removal of pharmaceuticals and other micropollutants in municipal wastewater treatment plants, as evidenced by their detection of these substances in the aquatic environment has led to the need for sustainable remediation strategies. Laccases possess a number of advantages including a broad substrate spectrum. To identify promoting or inhibitory effects of reaction partners in the remediation processes we tested not only single compounds-as has been described in most studies-but also mixtures of pollutants. The reaction of diclofenac (DCF) and flufenamic acid (FA), mediated by Trametes versicolor laccase resulted in the formation of products, which were more hydrophilic than the respective reactant (reactant concentration of 0.1 mM; laccase activity 0.5 U/ml). Analyses (HPLC, LC/MS) showed that the product 1a and 1b for DCF and FA, respectively, to be a para-benzoquinone imine derivative. The formation of 1a was enhanced by the addition of bisphenol A (BPA). After 6 days 97% more product was formed in the mixture of DCF and BPA compared with DCF tested alone. Product 1a was also detected in experiments with micropollutant-supplemented secondary effluent. Within 24 h 67% and 100% of DCF and BPA were transformed, respectively (25 U/ml). Experiments with a membrane reactor (volume 10 l; phosphate buffer, pH 7) were in good agreement with the results of the laboratory scale experiments (50 ml). EC50-values were also determined. The data support the use of laccases for the removal or detoxification of recalcitrant pollutants. Thus, the enzyme laccase may be a component of an additional environmentally friendly process for the treatment stage of wastewater remediation

Live Birth Rates after Active Immunization with Partner Lymphocytes

Although many potential causes have been established for recurrent implantation failure (RIF) and recurrent miscarriage (RM), about 50% of these remain idiopathic. Scientific research is focused on immunological risk factors. In the present study, we aim to evaluate live birth rates after immunization with paternal lymphocytes (lymphocyte immunotherapy (LIT)). This retrospective study consisted of 148 couples with a history of RM and/or RIF. The women underwent immunization with lymphocytes of their respective partners from November 2017 to August 2019. Fifty-five patients (43%) had live births. Stratified by indication (RM, RIF, combined), live birth rates in the RM and the combined group were significantly higher than that in the RIF group (53%, 59% and 33%, respectively, p = 0.02). The difference was especially noticeable during the first 90 days after immunization (conception rate leading to live births: 31%, 23% and 8% for RM, the combined group and RIF, respectively; p = 0.005), while there was no difference between groups during the later follow-up. LIT was associated with high live birth rates, especially in women with recurrent miscarriage. In view of the limited data from randomized studies, LIT cannot be recommended as routine therapy. However, it may be considered in individual cases

Rho-A prenylation and signaling link epithelial homeostasis to intestinal inflammation

Although defects in intestinal barrier function are discussed as a key pathogenic factor in patients with inflammatory bowel diseases (IBD), the molecular pathways driving disease-specific alterations of intestinal epithelial cells (IECs) are largely unknown. Here, we performed a novel approach to characterize the transcriptome of IECs from IBD patients using a genome wide approach. We observed disease-specific alterations in IECs with markedly impaired Rho-A signaling in active IBD patients. Localization of epithelial Rho-A was shifted to the cytosol in IBD where Rho-A activation was suppressed due to reduced expression of the Rho-A prenylation enzyme GGTase-I. The functional relevance of this pathway was highlighted by studies in mice with conditional gene targeting in which deletion of RhoA or GGTase-I in IECs caused spontaneous chronic intestinal inflammation with accumulation of granulocytes and CD4+ T cells. This phenotype was associated with cytoskeleton rearrangement and aberrant cell shedding ultimately leading to loss of epithelial integrity and subsequent inflammation. These findings uncover deficient prenylation of Rho-A as a key player in the pathogenesis of IBD. As therapeutic triggering of Rho-A signaling suppressed intestinal inflammation in mice with GGTase-I deficient IECs, our findings open new avenues for treatment of epithelial injury and mucosal inflammation in IBD patients

Diagnosis of Cervical Cancer and Pre-Cancerous Lesions by Artificial Intelligence: A Systematic Review

The likelihood of timely treatment for cervical cancer increases with timely detection of abnormal cervical cells. Automated methods of detecting abnormal cervical cells were established because manual identification requires skilled pathologists and is time consuming and prone to error. The purpose of this systematic review is to evaluate the diagnostic performance of artificial intelligence (AI) technologies for the prediction, screening, and diagnosis of cervical cancer and pre-cancerous lesions