Open Access

Functional imaging has helped to understand the role of the human insula as a major processing network for integrating input with the current state of the body. However, these studies remain at a correlative level. Studies that have examined insula damage show lesion-specific performance deficits. Case reports have provided anecdotal evidence for deficits following insula damage, but group lesion studies offer a number of advances in providing evidence for functional representation of the insula. We conducted a systematic literature search to review group studies of patients with insula damage after stroke and identified 23 studies that tested emotional processing performance in these patients. Eight of these studies assessed emotional processing of visual (most commonly IAPS), auditory (e.g., prosody), somatosensory (emotional touch) and autonomic function (heart rate variability). Fifteen other studies looked at social processing, including emotional face recognition, gaming tasks and tests of empathy. Overall, there was a bias towards testing only patients with right-hemispheric lesions, making it difficult to consider hemisphere specificity. Although many studies included an overlay of lesion maps to characterise their patients, most did not differentiate lesion statistics between insula subunits and/or applied voxel-based associations between lesion location and impairment. This is probably due to small group sizes, which limit statistical comparisons. We conclude that multicentre analyses of lesion studies with comparable patients and performance tests are needed to definitively test the specific function of parts of the insula in emotional processing and social interaction.

Recent years have seen a growing focus in research on species diversity due to concerns over anthropogenic factors like climate change and eutrophication, posing new threats to ecosystems. In aquatic ecosystems, phytoplankton form the central base of food webs and these shifting environmental conditions can affect both the phytoplankton’s physiology as well as the species composition of a community, triggering cascading effects across the whole ecosystem. While benefits of increased species diversity (such as resource use efficiency) have been previously established, the underlying mechanisms remain unclear. I first investigated the responses of phytoplankton communities (consisting of five species belonging to different taxa) to a multifactorial environment regarding different light intensities, light variability conditions, and nutrient supplies (experiment 1, study 1). The responses of phytoplankton at different time scales showed that communities can to some extent compensate for light variability. The communities adjusted the pigment composition over the intermediate scale to adapt the fast photosynthesis response to the new conditions. While the effect on the slow response of biomass and species composition was relatively small, it was species specific. Additionally, by using the Bray-Curtis similarity index I showed that the mechanisms which are important in shaping phytoplankton communities are determined by the environmental conditions (experiment 1, study 2). While nutrients were limiting species sorting (changes of the species composition) was more relevant, whereas at sufficient nutrient supply species engaged in physiological plasticity (changes of fatty acid profile). Furthermore, fatty acid concentrations as indicators of food quality were dependent on phosphorous and light condition, emphasizing the importance of multifactorial studies at the phytoplankton community level for zooplankton consumers. Lastly, I used a custom-built LED lighting system to simulate the vertical light quality distribution in most lakes. (Experiment 2, study 3). In this laboratory experiment, I assembled 13 unique communities from a collection consisting of seven species of different taxa. With these I investigated the effects of different light qualities (increasing proportion of blue light) on growth rates, resulting community composition, and biomass production. The results showed how each species in a community can react to specific wavelengths and competitor species. In conclusion, the interplay of resource requirements and utilization, as well as inter- and intraspecific competition, are key components understanding phytoplankton species distribution and community structure in changing aquatic ecosystems. Here, I advanced the field by using a multifactorial environment, developing a new lighting system, and applying conservative biodiversity indices on new response variables. These allow for more detailed examination of the responses of phytoplankton communities to the changing world.

Bei Patienten mit Hochrisiko- Neuroblastom, die mit einer kontinuierlichen Langzeitinfusion des anti- GD2- gerichteten Antikörpers Dinutuximab Beta (DB) in Kombination mit IL-2 behandelt wurden, konnte ein akzeptables Sicherheitsprofil gezeigt werden. In der vorliegenden Arbeit haben wir den Einfluss von IL-2 auf die Behandlungsverträglichkeit und die Hospitalisierungsdauer untersucht. Insgesamt erhielten 99 Hochrisiko- Neuroblastompatienten DB in bis zu fünf Zyklen in Form einer Langzeitinfusion (10 mg/m2/Tag, 100 mg/m2; pro Zyklus) mit IL-2 (53 Patienten; Schema A; 6 × 106 IU/m2/Tag; 60 × 106 IU/m2/Zyklus) und ohne IL-2 (46 Patienten, Schema B). Zur Bestimmung der Behandlungsverträglichkeit und Hospitalisierungsdauer wurden klinische Parameter (Körpertemperatur, Vitalparameter, Lansky- Performance Score), Laborwerte (C- reaktives Protein, IFN-γ, IL-6 und IL-18 im ersten Zyklus) und der Bedarf an i.v. Komedikation (z.B Morphin oder Metamizol) systematisch bewertet. Patienten mit stabilen klinischen Parametern und ohne Bedarf weiterer i.v. Komediaktion wurden als potenzielle „ambulante Kandidaten“ definiert. Die Patienten, die nach Schema A therapiert wurden, zeigten höhere Körpertemperaturen und CRP Werte im Vergleich zu den Patienten, die nach Schema B therapiert wurden. Obwohl die IL-6 Serumkonzentrationen in beiden Kohorten im ersten Zyklus ähnlich war, zeigten Patienten der B-Gruppe signifikant niedrigere IL-2-Serumkonzentrationen im Vergleich zur A-Gruppe. Dementsprechend erreichten Patienten der B-Gruppe schneller normale Vitalparameter und benötigten weniger i.v. Komediaktion im Vergleich zu Patienten aus Schema A, was zu einer kürzeren mittleren Verweildauer und einer schnelleren potenziell ambulanten Behandlungszeit führte (6 Tage für Schema A und 3-5 Tage für Schema B nach Beginn der Antikörperinfusion). Diese Arbeit zeigt, dass der Verzicht von IL-2 im Rahmen der Immuntherapie mit DB zu einem geringeren Bedarf an i.v. Komedikation führt und damit kürzere Hospitalisierungszeiten notwendig wären. Für Hochrisiko- Neuroblastompatienten bedeutet dies ein Gewinn an Lebensqualität.

Malnutrition is a common complication of chronic pancreatitis (CP) and liver cirrhosis (LC). Inadequate food intake is considered a relevant driver of malnutrition in both entities. However, the contribution of habitual diet to impaired nutritional status is unclear. In a prospective, multicenter cross-sectional study, we recruited patients with confirmed CP or LC and healthy volunteers as a control group. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria. We comprehensively investigated habitual dietary intake on nutrient, food group, and dietary pattern level applying two validated food frequency questionnaires. We included 144 patients (CP: n = 66; LC: n = 78) and 94 control subjects. Malnutrition was prevalent in 64% and 62% of patients with CP or LC, respectively. In both CP and LC, despite slightly altered food group consumption in malnourished and non-malnourished patients there were no differences in energy or nutrient intake as well as dietary quality. Compared to controls patients showed distinct dietary food group habits. Patients consumed less alcohol but also lower quantities of fruits and vegetables as well as whole grain products (p < 0.001, respectively). Nevertheless, overall dietary quality was comparable between patients and healthy controls. Nutritional status in CP and LC patients is rather related to disease than habitual dietary intake supporting the relevance of other etiologic factors for malnutrition such as malassimilation or chronic inflammation. Despite distinct disease-related differences, overall dietary quality in patients with CP or LC was comparable to healthy subjects, which suggests susceptibility to dietary counselling and the benefits of nutrition therapy in these entities.

Recently, the parameter internal work (IW) has been introduced as change in oxygen uptake (VO2) between resting and unloading workload in cardiopulmonary exercise testing (CPET). The proportional IW (PIW) was defined as IW divided by VO2 at peak exercise. A second option is to calculate the PIW based on the workload [PIW (Watt)] by considering the aerobic efficiency. The aim of our study was to investigate whether IW and PIW differ between patients with and without pulmonary hypertension and healthy controls. Our study population consisted of 580 patients and 354 healthy controls derived from the Study of Health in Pomerania. The PIW was slightly lower in patients (14.2%) than in healthy controls (14.9%; p = 0.030), but the PIW (Watt) was higher in patients (18.0%) than in the healthy controls (15.9%; p = 0.001). Such a difference was also observed, when considering only the submaximal workload up to the VAT (19.8% in patients and 15.1% in healthy controls; p < 0.001). Since the PIW (Watt) values were higher in patients with pulmonary hypertension, this marker may serve as a useful CPET parameter in clinical practice. In contrast to most of the currently used CPET parameters, the PIW does not require a maximal workload for the patient. Further studies are needed to validate the prognostic significance of the PIW.