The 10 most recently published documents
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.
Introduction
Growing evidence suggests a causal role for atherosclerotic vascular disease in cognitive impairment and dementia. Atherosclerosis may present as monovascular disease (monoVD) or as widespread polyvascular atherosclerotic disease (polyVD). Evidence on the relationship between monoVD or polyVD and cognitive impairment is limited.
Methods
We conducted a cross-sectional analysis of baseline data from the LipidCardio Study. The main outcome measure was the presence of cognitive impairment, defined as a Mini-Mental State Examination (MMSE) score < 26.
Results
The mean age was 71.5 years, 30.3% were female, 17.3% had no evidence of large-vessel atherosclerosis, 71.1% had monoVD, and 11.7% had polyVD, defined as the presence of atherosclerosis in ≥ 2 vascular territories (coronary, cerebral, aortic, or lower extremity). A total of 21.6% had cognitive impairment according to the prespecified cutoff (MMSE < 26). Overall, the odds of cognitive impairment increased for each additional vascular territory affected by atherosclerosis [adjusted odds ratio 1.76, 95% confidence interval (CI) 1.21–2.57, p = 0.003]. Furthermore, there was evidence for an interaction between vascular disease and chronic kidney disease (CKD). The odds of cognitive impairment were not greater in the monoVD subgroup compared to those without any atherosclerosis, if CKD was absent (OR 0.98, 95% CI 0.48–2.10; p = 0.095), while the odds ratio (OR) of cognitive impairment with polyVD compared to no atherosclerosis was 2.71 (95% CI 1.10–6.92; p = 0.031). In contrast, in patients with CKD, both monoVD and polyVD were associated with significantly higher odds of cognitive impairment than no atherosclerosis.
Conclusions
PolyVD is associated with increased odds of cognitive impairment. MonoVD is associated with cognitive impairment only in the presence of CKD.
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.
Background
Up to 27% of the German population suffers from recurrent or persistent pain (lasting more than three months). Therefore, prevention of chronic pain is one major object of pain management interventions. The aim of this nationwide, multicentre, randomised controlled trial is to evaluate the efficacy of a 10-week ambulatory (outpatient) interdisciplinary multimodal pain therapy (A-IMPT) for patients with recurrent pain and at risk of developing chronic pain. This project was initiated by the German Pain Society (Deutsche Schmerzgesellschaft e.V.) and the public health insurance provider BARMER. It is currently funded by the German Innovation Fund (01NVF20023). The study PAIN2.0 focuses on reducing pain intensity and pain-related disability and investigates whether this intervention can improve physical activity, psychological well-being, and health literacy.
Methods
PAIN2.0 is designed as a multicentre 1:1 randomised controlled trial with two parallel groups (randomisation at the patient level, planned N = 1094, duration of study participation 12 months, implemented by 22 health care facilities nationwide). After 6 months, patients within the control group also receive the intervention. The primary outcomes are pain intensity and pain-related impairment, measured as Characteristic Pain Intensity (PI) and Disability Score (DS) (Von Korff), as well as patient-related satisfaction with the intervention. Secondary outcomes are the number of sick leave days, sickness allowance, treatment costs, psychological distress, health-related quality of life, and catastrophizing. The effects of the intervention will be analysed by a parallel-group comparison between the intervention and control groups. In addition, the long-term effects within the intervention group will be observed and a pre-post comparison of the control group before and after the intervention will be performed.
Discussion
Recurrent or persistent pain is common in the German population and causes high costs for patients and society. The A-IMPT aims to improve pain and pain-related impairments in pain patients at risk of chronification, thereby reducing the risk of developing chronic pain with its high socioeconomic burden. This new therapy could easily be integrated into existing therapy programs if positively evaluated.
Trial registration
The trial PAIN2.0 has been registered in the German Clinical Trials Register (DRKS) since 21/11/2022 with the ID DRKS00030773.
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.
Broadband Alfvénic excitation & mode characterization in the Wendelstein 7-X stellarator plasmas
(2024)
Shear Alfvén waves (SAWs) can be important in plasma magnetohydrodynam-
ics (MHD) stability. In the Wendelstein 7-X (W7-X) stellarator plasmas, Alfvénic
fluctuations have been identified in routine plasma scenarios of the opera-
tional phase (OP) known as OP1.2b. Magnetic fluctuations between f = 100 −
200 kHz are measured using a system of Mirnov coils. The work presented
in the thesis aims to contribute to the physics understanding of SAWs in fu-
sion plasmas without externally driven fast ions. The dynamics of a broad
frequency range of SAWs in W7-X plasmas are analyzed. The time variations
of frequency, amplitude, and width of frequency bands of the magnetic fluc-
tuations’ spectra are determined using a new analysis method, the so-called
tracking method. The SAW variations are correlated to global plasma param-
eters during W7-X plasmas. The new tracking method enabled determining
the role of different plasma parameters in the observed variations of the SAW
spectral properties. This thesis furthermore discusses potential couplings be-
tween SAWs and ITG-driven turbulent modes to explain amplitude variations
of SAWs.
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.
Patients with chronic daily headaches (CDH) are often a diagnostic challenge and frequently undergo neuroimaging. One common underlying cause of CDH is idiopathic intracranial hypertension (IIH). However, certain neuroimaging abnormalities that suggest IIH, such as optic nerve sheath diameters (ONSD), pituitary gland height, and venous sinus diameter, require interpretation due to the absence of established normative values. Notably, intracranial pressure is known to varies with age, sex and weight, further complicating the determination of objectively abnormal findings within a specific patient group. This study aims to assist clinical neuroradiologists in differentiating neuroimaging results in CDH by providing weight-adjusted normative values for imaging characteristics of IIH. In addition to age and BMI we here assessed 1924 population-based T1-weighted MRI datasets of healthy participants for relevant MRI aspects of IIH. Association to BMI was analyzed using linear/logistic regression controlled for age and stratified for sex. ONSD was 4.3 mm [2.8; 5.9]/4.6 mm [3.6; 5.7] and diameter of transverse sinus was 4.67 mm [1.6; 6.5]/4.45 mm [3.0; 7.9]. Height of pituitary gland was 5.1 mm [2.2;8.1]/4.6 mm [1.9;7.1] for female and male respectively. Values generally varied with BMI with regression slopes spanning 0.0001 to 0.05 and were therefor presented as normative values stratified by BMI. Protrusion of ocular papilla, empty sella and transverse sinus occlusion were rare in total. Our data show an association between BMI and commonly used MRI features for diagnosing IIH. We provide categorized normative BMI values for ONSD, pituitary gland height, and transverse sinus diameter. This distinction helps objectively identify potential IIH indicators compared to regular population norms, enhancing diagnostic accuracy for suspected IIH patients. Notably, optic nerve head protrusion, empty sella, and transverse sinus occlusion are rare in healthy individuals, solidifying their importance as imaging markers regardless of BMI.
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.
Remembering objects and their associated location (object–location memory; OLM), is a fundamental cognitive function, mediated by cortical and subcortical brain regions. Previously, the combination of OLM training and transcranial direct current stimulation (tDCS) suggested beneficial effects, but the evidence remains heterogeneous. Here, we applied focal tDCS over the right temporoparietal cortex in 52 participants during a two-day OLM training, with anodal tDCS (2 mA, 20 min) or sham (40 s) on the first day. The focal stimulation did not enhance OLM performance on either training day (stimulation effect: −0.09, 95%CI: [−0.19; 0.02], p = 0.08). Higher electric field magnitudes in the target region were not associated with individual performance benefits. Participants with content-related learning strategies showed slightly superior performance compared to participants with position-related strategies. Additionally, training gains were associated with individual verbal learning skills. Consequently, the lack of behavioral benefits through focal tDCS might be due to the involvement of different cognitive processes and brain regions, reflected by participant’s learning strategies. Future studies should evaluate whether other brain regions or memory-relevant networks may be involved in the modulation of object–location associations, investigating other target regions, and further exploring individualized stimulation parameters.