Maschinelles Sehen als Hilfsmittel in der Differentialdiagnostik des Cushing-Syndroms

Objective: Cushing's syndrome is a rare disease characterized by clinical features that show morphological similarity with the metabolic syndrome. Distinguishing these diseases is a challenge in clinical practice. We have previously shown that computer vision technology can be a potentially useful diagnostic tool in Cushing's syndrome. In this follow-up study, we addressed the described problem by increasing the sample size and including controls matched by age and body-mass-index. Methods: 82 patients (22 male, 60 female) and 98 control subjects (32 male, 66 female) matched by age, gender and body-mass-index were included. The control group consisted of patients with initially suspected, but biochemically excluded Cushing's syndrome. Standardized frontal and profile facial digital photographs were acquired. The images were analyzed using specialized computer vision and classification software. A grid of nodes was semi-automatically placed on disease-relevant facial structures for analysis of texture and geometry. Classification accuracy was calculated using a leave-one-one cross-validation procedure with a maximum likelihood classifier. Results: The overall correct classification rates were 10/22 (45.5%) for male patients and 26/32 (81.3%) for male controls, and 34/60 (56.7%) for female patients and 43/66 (65.2%) for female controls. In subgroup analyses, correct classification rates were higher for iatrogenic than for endogenous Cushing's syndrome. Conclusion: Regarding the advanced problem of detecting Cushing's syndrome within a study sample matched by body-mass-index, we found moderate classification accuracy by facial image analysis. Classification accuracy is most likely higher in a sample with healthy control subjects. Further studies might pursue a more advanced analysis and classification algorithm

Maschinelles Sehen als Hilfsmittel in der Differentialdiagnostik des Cushing-Syndroms

Objective: Cushing's syndrome is a rare disease characterized by clinical features that show morphological similarity with the metabolic syndrome. Distinguishing these diseases is a challenge in clinical practice. We have previously shown that computer vision technology can be a potentially useful diagnostic tool in Cushing's syndrome. In this follow-up study, we addressed the described problem by increasing the sample size and including controls matched by age and body-mass-index. Methods: 82 patients (22 male, 60 female) and 98 control subjects (32 male, 66 female) matched by age, gender and body-mass-index were included. The control group consisted of patients with initially suspected, but biochemically excluded Cushing's syndrome. Standardized frontal and profile facial digital photographs were acquired. The images were analyzed using specialized computer vision and classification software. A grid of nodes was semi-automatically placed on disease-relevant facial structures for analysis of texture and geometry. Classification accuracy was calculated using a leave-one-one cross-validation procedure with a maximum likelihood classifier. Results: The overall correct classification rates were 10/22 (45.5%) for male patients and 26/32 (81.3%) for male controls, and 34/60 (56.7%) for female patients and 43/66 (65.2%) for female controls. In subgroup analyses, correct classification rates were higher for iatrogenic than for endogenous Cushing's syndrome. Conclusion: Regarding the advanced problem of detecting Cushing's syndrome within a study sample matched by body-mass-index, we found moderate classification accuracy by facial image analysis. Classification accuracy is most likely higher in a sample with healthy control subjects. Further studies might pursue a more advanced analysis and classification algorithm

Statin-induced myopathic changes in primary human muscle cells and reversal by a prostaglandin F2 alpha analogue

Statin-related muscle side effects are a constant healthcare problem since patient compliance is dependent on side effects. Statins reduce plasma cholesterol levels and can prevent secondary cardiovascular diseases. Although statin-induced muscle damage has been studied, preventive or curative therapies are yet to be reported. We exposed primary human muscle cell populations (n = 22) to a lipophilic (simvastatin) and a hydrophilic (rosuvastatin) statin and analyzed their expressome. Data and pathway analyses included GOrilla, Reactome and DAVID. We measured mevalonate intracellularly and analyzed eicosanoid profiles secreted by human muscle cells. Functional assays included proliferation and differentiation quantification. More than 1800 transcripts and 900 proteins were differentially expressed after exposure to statins. Simvastatin had a stronger effect on the expressome than rosuvastatin, but both statins influenced cholesterol biosynthesis, fatty acid metabolism, eicosanoid synthesis, proliferation, and differentiation of human muscle cells. Cultured human muscle cells secreted ω-3 and ω-6 derived eicosanoids and prostaglandins. The ω-6 derived metabolites were found at higher levels secreted from simvastatin-treated primary human muscle cells. Eicosanoids rescued muscle cell differentiation. Our data suggest a new aspect on the role of skeletal muscle in cholesterol metabolism. For clinical practice, the addition of omega-n fatty acids might be suitable to prevent or treat statin-myopathy

Protective immune trajectories in early viral containment of non-pneumonic SARS-CoV-2 infection

The antiviral immune response to SARS-CoV-2 infection can limit viral spread and prevent development of pneumonic COVID-19. However, the protective immunological response associated with successful viral containment in the upper airways remains unclear. Here, we combine a multi-omics approach with longitudinal sampling to reveal temporally resolved protective immune signatures in non-pneumonic and ambulatory SARS-CoV-2 infected patients and associate specific immune trajectories with upper airway viral containment. We see a distinct systemic rather than local immune state associated with viral containment, characterized by interferon stimulated gene (ISG) upregulation across circulating immune cell subsets in non-pneumonic SARS-CoV2 infection. We report reduced cytotoxic potential of Natural Killer (NK) and T cells, and an immune-modulatory monocyte phenotype associated with protective immunity in COVID-19. Together, we show protective immune trajectories in SARS-CoV2 infection, which have important implications for patient prognosis and the development of immunomodulatory therapies

Einjahreskatamnese der Anorexia nervosa nach stationärer Behandlung in der Klinik Lüneburger Heide Bad Bevensen

Die Anorexia nervosa weist trotz intensiver therapeutischer Bemühungen hohe Chronifizierungsraten und Mortalitäten auf. Das Ziel dieser Studie war, die Behandlung der neu eingerichteten Klinik Lüneburger Heide durch die Patientinnen beurteilen zu lassen und den poststationären Krankheitsverlauf der Befragten zu ermitteln. 105 Patientinnen mit der Diagnose Anorexia nervosa, die zwischen Mai 2006 und Oktober 2007 behandelt wurden, wurde nach durchschnittlich 11 Monaten ein Fragebogen und der EDI-2 zugeschickt. Von 64 % der Patientinnen konnten Daten erhoben werden. Analytisch ergab sich nur ein geringer Unterschied beim Entlassungs-BMI zwischen den Verweigerern und den Teilnehmern. Bei Aufnahme in die Klinik lag der BMI bei 15,0 (SD 2,1), bei Entlassung bei 17,7 (SD 1,5). Die Patientinnen verblieben im Mittel 104,9 Tage (SD 78,9) Tage in der Klinik. Zum Katamnesezeitpunkt betrug der BMI 17,4 (SD 2,2). Als etwas gebessert schätzten sich 31 % der Patientinnen ein, 40 % sehr verbessert und 6 % geheilt. Von den Patientinnen ohne Hormoneinnahme gaben 22 % an, eine regelmäßige Blutung zu haben, und 78 % nicht. Bei der Einschätzung, welche Therapie während des stationären Aufenthaltes am meisten geholfen hat, gaben die Patientinnen am häufigsten Kreativtherapie, Einzeltherapie, Eltern-Intensivtherapie-Woche und Ernährungstherapie an. 78 % gaben an, nach dem Klinikaufenthalt eine weiterführende ambulante Therapie begonnen zu haben. Den größten Einfluss auf ihre Genesung hatten, laut Patientinnen, ihr eigener Wille und die stationäre Behandlung. Patientinnen, bei denen sich keine Genesung eingestellt hatte, nennen den ungenügenden eigenen Willen als Haupteinflussfaktor sowie die Herkunftsfamilie. Insgesamt zeigen die Daten, dass das Therapiekonzept der Klinik gute Erfolge zeigt. Das relativ hohe Gewicht bei Entlassung kann von einem Großteil der Teilnehmerinnen gehalten oder noch gesteigert werden

Predisposing and precipitating factors of delirium after cardiac surgery: a prospective observational cohort study

To comprehensively assess pre-, intra-, and postoperative delirium risk factors as potential targets for intervention

Selective blood-nerve barrier leakiness with claudin-1 and vessel-associated macrophage loss in diabetic polyneuropathy

Diabetic polyneuropathy (DPN) is the most common complication in diabetes and can be painful in up to 26% of all diabetic patients. Peripheral nerves are shielded by the blood-nerve barrier (BNB) consisting of the perineurium and endoneurial vessels. So far, there are conflicting results regarding the role and function of the BNB in the pathophysiology of DPN. In this study, we analyzed the spatiotemporal tight junction protein profile, barrier permeability, and vessel-associated macrophages in Wistar rats with streptozotocin-induced DPN. In these rats, mechanical hypersensitivity developed after 2 weeks and loss of motor function after 8 weeks, while the BNB and the blood-DRG barrier were leakier for small, but not for large molecules after 8 weeks only. The blood-spinal cord barrier remained sealed throughout the observation period. No gross changes in tight junction protein or cytokine expression were observed in all barriers to blood. However, expression of Cldn1 mRNA in perineurium was specifically downregulated in conjunction with weaker vessel-associated macrophage shielding of the BNB. Our results underline the role of specific tight junction proteins and BNB breakdown in DPN maintenance and differentiate DPN from traumatic nerve injury. Targeting claudins and sealing the BNB could stabilize pain and prevent further nerve damage