bluuebunny/crossref_metadata_2025 huggingface dataset:
Uterine Monitoring Techniques from Patients' and Users' Perspectives
Authors: Thijssen Kirsten , Vlemminx Marion , Westerhuis Michelle , Dieleman Jeanne , Van der Hout-Van der Jagt M. Beatrijs , Oei S. Guid
Published: September 2018

Objective To evaluate preferences from patients and users on 3 uterine monitoring techniques, during labor.

Study Design Women in term labor were simultaneously monitored with the intrauterine pressure catheter, the external tocodynamometer, and the electrohysterograph. Postpartum, these women filled out a questionnaire evaluating their preferences and important aspects. Nurses completed a questionnaire evaluating users' preferences.

Results Of all 52 participating women, 80.8% preferred the electrohysterograph, 17.3% the intrauterine pressure catheter and 1.9% the external tocodynamometer. For these women, the electrohysterograph scored best regarding application and presence during labor (p < 0.001). Most important aspects were “least likely to harm” and “least discomfort”. Of 57 nurses, 40.4% preferred the electrohysterograph, 35.1% the external tocodynamometer, and 24.6% had no preference, or replied that their preference is subject to situation and patient.

Conclusion Patients prefer the electrohysterograph over the external tocodynamometer and the intrauterine pressure catheter, while healthcare providers report ambiguous results.
Inflammatorische Prozesse in der Pathogenese psychischer Störungen
Authors: Schwarz M. , Müller N.
Published: September 2018

Ein entzündliches Geschehen wird sowohl in der Pathogenese der Schizophrenie, als auch der Depression postuliert. Dies wird einschließlich möglicher therapeutischer Effekte einer antientzündlichen Therapie in diesem Artikel diskutiert. Unterschiedliche Mechanismen, die in der Aktivierung des Enzyms Indoleamin-2,3-dioxygenase (IDO) und im Tryptophan-Kynurenin-Metabolismus liegen und zu einem Anstieg der Kynureninsäure bei Schizophrenie und wahrscheinlich von Quinolinsäure bei Depression führen, spielen vermutlich eine Schlüsselrolle bei diesen Erkrankungen. Diese Unterschiede gehen mit einer Imbalance der glutaminergen Neurotransmission einher, die zu einem Übergewicht des N-methyl-D-aspartate-(NMDA-)Agonismus bei Depression und des NMDA-Antagonismus bei Schizophrenie führen. Die immunologische Imbalance resultiert sowohl bei Schizophrenie, als auch bei Depression in der erhöhten Produktion von Prostaglandin E2 (PE2) und wahrscheinlich auch in einer stärkeren Zyklooxygenase-2-(COX-2-)Expression. Obwohl es viele Evidenzen dafür gibt, dass Interaktionen des Immunsystems, der IDO, des serotonergen Systems und der glutamatergen Neurotransmissionn eine wichtige Rolle bei Schizophrenie und Depression spielen, müssen weitere Untersuchungen zur Rolle von Genetik, Krankheitsverlauf, Geschlecht, Psychopathologie etc. durchgeführt werden. Inzwischen liegen auch erste Hinweise auf therapeutische Effekte von anti-entzündlichen Therapien vor. Ergebnisse von Tierversuchen und vorläufigen klinischen Studien mit COX-2-Inhibitoren zeigen sich bei Schizophrenie und Depression gegenüber Placebo überlegen.
Psychiatric Victims of Human Experiments under National Socialism
Authors: Weindling P.
Published: September 2018

This paper considers whether it is right to identify by name victims of experiments abused either for psychiatric research, or for other types of experimentation in psychiatric hospitals and institutions. Similar questions arise as to whether it is possible to identify any of the persons for whom brains and other body parts were held for medical research and teaching.
Psychiatrische Dienste – viel Evidenz, aber wo geht es hin?
Authors: Becker T.
Published: September 2018

Der Artikel referiert Initiativen und Modelle integrierter Versorgung in Deutschland, er nimmt Bezug auf die Evaluation des Modellversuchs Regionales Psychiatriebudget. Neue tragende Paradigmen psychiatrischer Arbeit wie Choice, Empowerment und Recovery werden erwähnt. Methodische Grenzen der Untersuchung kurz- und längerfristiger, partikularer und systemischer Effekte von Versorgungsinnovation werden referiert. In einem sich verändernden psychiatrischpsychotherapeutischen Versorgungssystem können sich Versorgungsforschung und die Suche nach innovativen Grundorientierungen therapeutischer Arbeit ergänzen und befruchten.
Treatment and rehabilitation concepts for patients with addiction and concurrent disorders
Authors: Vogel M. , Nikoo M. , Krausz M.
Published: September 2018

Background: Addiction and concurrent disorders give rise to a major burden of disease in both North America and Europe. However, these two continents have some fundamental differences in regards to the health care system and its funding as well as the types of vulnerable subpopulations to serve. For example, while emergency rooms are often the only available care for patients in the US and Canada due to financial barriers or structural deficits, stepped care approaches and separate rehabilitation systems are more commonplace in Europe. These differences can be observed not only on a transatlantic but also on an intra-European level. These differing attitudes and policies impact on treatment paradigms such as harm reduction, abstinence-based or opioid maintenance treatments etc. Structural components and clinical pathways lead to dissimilarities in access to care services such as detoxification, rehabilitation and community services. The role of primary care as an important treatment interface is much more recognized in Europe. While innovations are ongoing and scientific progress has been made in the treatment of concurrent disorders in recent years, implementing these findings into “real-world practice” has been insufficient so far.
Das Störungsbild der „Glücksspielsucht“ und seine Behandlung
Authors: Petry J.
Published: September 2018

Die Begriffe „Spiel“, „Glück“ und „Sucht“ als Teile der deutsprachigen Bezeichnung „Glücksspielsucht“ werden definiert. Es erfolgen Hinweise auf die Verbreitung der Glücksspielsucht in der Bevölkerung und die häufigsten Erscheinungsformen. Ein Vulnerabilitätsmodell zur Entstehung der Glücksspielsucht wird vorgestellt. Die abstinenzorientierten Behandlungsmethoden zur Motivierung, Veränderung von Kontrollillusionen und Rückfallprävention werden erläutert. Ansätze zur Behandlung der Selbstwertstörung, Gefühlsdysregulation und Beziehungsstörung werden vorgestellt. Auf differenzielle Behandlungsmaßnahmen für weibliche, ältere, russisch- und französischsprachige Glücksspieler und Patienten mit seltenen komorbiden Störungen (Psychose, ADHS, Drogenabhängigkeit) wird verwiesen. Die Behandlungseffektivität wird im Überblick dargestellt.
Exzessives Computerspielen und Computerspielabhängigkeit im Jugendalter
Authors: Kleimann M. , Mößle T. , Rehbein F.
Published: September 2018

In diesem Artikel werden die Ergebnisse einer bundesweit repräsentativen Schülerbefragung an 44 610 Schülerinnen und Schülern neunter Klassen vorgestellt, die in den Jahren 2007 und 2008 vom Kriminologischen Forschungsinstitut Niedersachsen (KFN) durchgeführt wurde. Basierend auf einem neu entwickelten Screeninginstrument (KFN-CSAS-II), welches jedem dritten jugendlichen Befragungsteilnehmer (n = 15 168) vorgelegt wurde, werden 3% der Jungen und 0,3% der Mädchen als computerspielabhängig diagnostiziert. Die Daten zeigen, dass sich Computerspielabhängigkeit als klinisch relevantes Phänomen gut von einem ausschließlich zeitlich auffälligen und damit vergleichsweise weniger problematischen Spielverhalten abgrenzen lässt. In einer Validitätsprüfung des Diagnoseinstrumentes ergibt sich für computerspielabhängige Jugendliche eine erhöhte psychosoziale Belastung in Form geringerer Schulleistungen, vermehrten Schulschwänzens, verringerter Schlafzeiten, eingeengtem Freizeiterleben und vermehrter Suizidgedanken. Zusätzlich zeigt sich, dass Spieler bestimmter Computerspiele offenbar in besonderem Maße von Computerspielabhängigkeit betroffen sind. Aus diesen Erkenntnissen leiten sich neben zusätzlichem Forschungsbedarf gesundheitspolitische Folgerungen ab, die am Ende des Artikels diskutiert werden.
Das „Attenuierte Psychose-Syndrom“ in DSM-5
Authors: Klosterkötter J.
Published: September 2018

Hintergrund: Der Vorschlag, für das erfolgreich herausgearbeitete klinische Hochrisikostadium im Vorfeld psychotischer Erstmanifestation eine eigenständige DSM-5-Diagnosekategorie zu schaffen, hat eine Reihe von strukturellen Fragen aufgeworfen, die für die Weiterentwicklung unserer psychiatrischen Diagnostik von grundsätzlicher Bedeutung sind. Sollten in der Zukunft auch Risikosyndrome in den gültigen Klassifikationssystemen verankert werden, wenn ihre rechtzeitige Feststellung signifikante Vorteile für die Betroffenen und ihre Familien mit sich bringt? Wie kann überhaupt der sich sowohl grundlagenwissenschaftlich als auch versorgungspraktisch abzeichnende Übergang zu einer prädiktiven und präventiven Medizin in der nach wie vor klinisch-nosologisch orientierten psychiatrischen Diagnostik Berücksichtigung finden? Methoden: Der Beitrag stellt zunächst den heutigen Entwicklungsstand der klinischen Hochrisikoforschung auf dem Gebiet der Psychosen dar und erläutert die Transformation später Hochrisikokriterien in das für den Einschluss in DSM-5 vorgeschlagene „Attenuierte Psychosesyndrom“. Ziel: Anschließend werden die Argumente für und gegen die offizielle Anerkennung als Diagnosekategorie, die tatsächlich erfolgte Inklusion des Syndroms in DSM-5 sowohl unter den klinischen Erscheinungsbildern mit weiterem Forschungsbedarf als auch unter den Diagnosen des Schizophreniespektrums sowie die sich hieraus ergebenden Zukunftsperspektiven diskutiert.
Balloon-Anchored CoKatte® for Successfully Delivering Balloons for an Occluded Anomalous Right Coronary Artery
Authors: Hikita Hiroyuki , Hishikari Keiichi , Takahashi Atsushi , Araki Makoto
Published: September 2018

Percutaneous coronary intervention (PCI) for anomalous right coronary artery (RCA), originating from the left coronary cusp is challenging, because of the difficulty in engaging the guiding catheter coaxially, and delivering balloons and stents. A 65-year-old man with effort angina underwent PCI for anomalous RCA. This report describes the method we used. Although, delivering the balloon was difficult in short of the guiding catheter's backup force, we finally succeeded by using one more guiding catheter and the balloon-anchored CoKatte®, a novel, straight 4.5-French child catheter, to strengthen the backup force.
Urinary Sodium Loss following Hypertonic Saline Administration Curtails its Superior Osmolar Effect in Comparison to Mannitol in Severe Traumatic Brain Injury: A Secondary Analysis of a Randomized Controlled Trial
Authors: Jagannatha Aniruddha Tekkatte , Sriganesh Kamath , Devi Bhagavatula Indira , Umamaheswara Rao Ganne Sesha
Published: September 2018

Background Mannitol and hypertonic saline (HTS) are used as boluses during episodes of raised intracranial pressure (ICP) in severe traumatic brain injury (TBI). We recently demonstrated that ICP reduction and neurological outcomes are similar with mannitol and HTS in TBI. In the current post hoc analysis, we hypothesized that this lack of difference between mannitol and HTS is due to increased urinary sodium losses after HTS.

Methods In this post hoc analysis of our earlier randomized controlled trial, we analyzed serum and urine osmolarity and sodium levels in 38 patients with severe TBI over 6 days. Equiosmolar boluses of mannitol and HTS were administered whenever ICP increased above 20 mm Hg. Seven hundred sixty samples each of serum sodium, urine sodium, serum osmolarity, and urine osmolarity were analyzed during this period.

Results Three hundred and one and 187 boluses of mannitol and HTS, respectively, were required to maintain ICP below 20 mm Hg. The urinary osmolarity was similar between mannitol and HTS groups (p = 0.63). The urinary sodium excretion was significantly higher in HTS group compared with mannitol group (p = 0.002). Serum sodium and osmolarity values were similar between mannitol and HTS groups (p = 0.16 and 0.31, respectively). There was no difference in the mean ICP between the groups (p = 0.31).

Conclusion Increased urinary sodium loss after HTS contributes to its lack of superiority over mannitol in controlling raised ICP.
A Case of Neonate with Vein of Galen Malformation Refractory to Weaning Attempts from Mechanical Ventilation Managed Successfully with Noninvasive Ventilation
Authors: Kumar Ashutosh , Ajayan Neeraja , Sethuraman Manikandan , Hrishi Ajay Prasad
Published: September 2018

Weaning of patients with vein of Galen malformations (VOGM) from mechanical ventilation can be challenging in the postprocedure period due to underlying high-output cardiac failure and the fluid overload caused by the neurointervention procedure. We present the case of a neonate with VOGM who was refractory to multiple weaning attempts from mechanical ventilation and was successfully managed with noninvasive ventilation (NIV). NIV can be safely used as a method of weaning, post mechanical ventilation in this subset of patients. The use of NIV will facilitate successful weaning and reduce the incidence of extubation failure in neonates with VOGM in cardiac failure.
Effect of Prior etching on Bond Strength of Self-Etch adhesive in case of Sensitive Teeth treated with CPP-ACP.
Authors: Chaudhary Tayal Suruchi , Dhillon Jaidev , Tayal Abhishek
Published: September 2018

Introduction: The management of dentinal hypersensitivity involves remineralization by various means, one of which being CPP-ACP paste, followed by restoration. It was speculated that the bond strength of self-etching adhesive was affected following the application of CPP-ACP paste and prior etching with phosphoric acid.

Aims and objectives: To evaluate the tensile bond strength (TBS) of G-Bond (GB, self-etching adhesive) to dentin following the application of CPP-ACP (Tooth Mousse/TM), with and without prior etching.

Materials and method: Freshly extracted forty five permanent molars were collected for the study. All the teeth were ground and polished to expose the flat dentinal surface. The teeth were embedded in the resin in separate molds and were divided into three equal groups of fifteen samples each Group 1: Samples treated with Tooth Mousse for 60 min daily for 7 days and then restored with GB and composite (Filtek Z350, 3M ESPE). Group 2: Samples treated with Tooth Mousse and etched with phosphoric acid prior to restoration with GB and composite. Group3: Samples restored with GB and composite. A split brass mold was placed over the predesigned location and with help of the plasma coated instrument, composite resin was placed. Tensile loading was done using Universal Testing Machine.

Conclusion: TBS of GB was not significantly reduced after CPP-ACP application, but after prior etching the CPP-ACP specimens, the bond strength of GB was significantly reduced.
Denture Stomatitis An Underlying Menace
Authors: Bansal Pardeep , Sharma Akshey , Bhanot Rajesh , Chahal Gagan
Published: September 2018

Denture stomatitis is a yeast/fungal infection in the mouth caused by Candida, also known as thrush. It is not a type of infection that can be passed on to others. Denture wearers are the most common group to be affected, along with people who have difficulty in keeping their mouths clean. Diabetics and anyone who takes steroids by mouth or inhalers may also have problems with this condition. Some antibiotics are also responsible for causing thrush. If left untreated, the condition can cause soreness in the mouth and may lead to poorly fitting dentures in the future. So it is important to keep your mouth as clean as possible and rinse after every meal.
Endodontics Generation Next- Microrobotics Category of The Article-Review
Authors: Mittal Sunandan , Kumar Tarun , Mittal Shifali , Sharma Jyotika
Published: September 2018

A typical endodontic procedure includes access preparation, root canal preparation and root canal filling. This treatment process is time-consuming and prone to human error. The outcome relies on the clinician's master skills that can be gained only through years of training and practice. In order to improve the quality and reliability of endodontic therapy, an endodontic micro robot is proposed to be built. The objective is to modernize the traditional treatment, moving from a “manual art” to science-based automation. This computer controlled micro machine is mounted on the teeth within patient's mouth. With on-line monitoring and positioning control, the multipurpose micro robot performs automatic treatment procedures, including probing, drilling, filing, cleaning and filling. This article gives an insight to design and applications of the intelligent robotic micro-machine applicable to root canal preparation with on-line monitoring capabilities that will increase the accuracy and efficiency of the treatment.
Neurovascular Anatomy at the “Box Junction”: Considerations in the Anterolateral Thigh Flap
Authors: Stewart Max , Brassett Cecilia , Abood Ahid
Published: September 2018

Background The anterolateral thigh (ALT) perforator flap is one of the most widely used flaps in reconstructive microsurgery. This study investigated a previously unexplored and clinically relevant aspect of perforator anatomy: the “box junction” (BxJn), the point at which the perforator arises from its source vessel. Negotiating the BxJn can be a challenging and time-consuming step in flap harvest, due to the neurovascular structures in the area which must be protected from injury. However, as the presence and location of these structures have yet to be clearly defined, painstaking exploration is necessary on each occasion. Knowledge of BxJn anatomy could allow surgeons to harvest the ALT flap more rapidly and safely.

Methods We dissected 20 cadaveric thighs and identified perforators to the ALT region and investigated the neurovascular anatomy at their BxJns.

Results In 51 BxJns, two clinically relevant vascular structures were identified: an intramuscular artery arising from the perforator (23, 45% of cases) and a “deep” artery to the underlying muscle arising from the source vessel (29, 57% of cases). We confirmed the consistent presence of motor nerve branches and describe one previously unreported, clinically significant variation, in which the nerve to vastus lateralis crosses the BxJn (12, 24% of cases); 36, 71% of BxJns contained at least one vascular and one neural structure.

Conclusion Our study confirms that the BxJn is a site of potentially complex and challenging neurovascular anatomy for the surgeon. Based on these results, we propose an algorithm to guide inexperienced surgeons in negotiating this area.
Complex Valve Surgery in Elderly Patients: Increasingly Necessary and Surprisingly Feasible
Authors: Saha Shekhar , Varghese Sam , Ahmad Ammar Al , Jebran Ahmad Fawad , Waezi Narges , Niehaus Heidi , Baraki Hassina , Kutschka Ingo
Published: September 2018

Objectives The increasing proportion of elderly patients in cardiac surgery poses additional challenges for the clinical management and leads to a higher operative risk due to multiple comorbidities of these patients. We reviewed the outcome of patients who were 75 years and older and underwent complex multiple valve surgery at our institution.

Methods A retrospective review was performed to identify patients who were 75 years and older and underwent multiple valve surgery between January 2011 and May 2016 at our institution. Patients were assigned to one out of four subgroups: combined aortic and mitral valve surgery (group AM), aortic and tricuspid valve surgery (group AT), mitral and tricuspid valve surgery (group MT), and aortic, mitral, and tricuspid valve surgery (group AMT).

Results A total of 311 patients underwent multiple valve surgery, of whom 119 (38.3%) were 75 years and older (median: 78 [25th–75th quartile: 76–80]). The estimated operative mortality (EuroSCORE II) in the overall cohort was 10.7%. The observed 30-day mortality was 4.2% (7% in group AM, 0% in group AT, 2.2% in group MT, 3.8% in group AMT; p = 0.685). Main complications were reexplorative surgery in 16%, adverse cerebrovascular events in 6.7%, prolonged mechanical ventilation in 10.1%, renal replacement therapy in 15.1%, nosocomial pneumonia in 15.1%, and pacemaker implantation in 18.5%.

Conclusions This study demonstrates the feasibility of complex multiple valve surgery in elderly patients. The observed perioperative mortality was lower than predicted. However, we observed a substantial rate of adverse events; therefore, careful patient selection is required in this high-risk patient population.
Renal Transplantation after Transcatheter Aortic Valve Replacement: Case Report
Authors: Gangadharan Keerthana , Parameswaranunni Reshmibhat , Merzkani Massini , Molmenti Ernesto , Bhaskaran Madhu
Published: September 2018

Patients with chronic kidney disease (CKD) have an increased likelihood of developing calcific aortic stenosis (AS). These patients also often suffer from multiple comorbidities, potentially making them high-risk surgical candidates and limiting their treatment options. Transcatheter aortic valve replacement (TAVR) is the recommended therapeutic approach for severe AS in patients who are not suitable candidates for surgical aortic valve replacement (SAVR). TAVR is being increasingly considered as a viable alternative to SAVR. As such, its applications in patients with CKD and other chronic diseases, as well as methods to optimize peri- and postoperative results are of great interest and significance. We present the case of a successful renal transplant procedure, performed within a year following a TAVR, in a 52-year-old man who suffered from multiple comorbidities.
Reversible Visual Involvement in Critical Illness Polyneuropathy
Authors: Mudawi Khalid , Rizk Tamer
Published: September 2018

We hereby describe a 3-year-old boy who developed severe fulminant sepsis with the need of urgent intubation, ventilation, and inotropic support. He was admitted to the pediatric intensive care unit where he was initially ventilated for 10 days. Extubation failed, so he was reventilated for further 10 days. Neuromuscular blocking agents, inotropes, steroids, and broad-spectrum antibiotics, including aminoglycosides, were all used. Weakness of all limbs was noticed on day 7. This was associated with visual disturbances. He was diagnosed as having critical illness polyneuropathy and myopathy (CIP/CIM). His outcome was favorable. This case report highlights the unique combination of CIP/CIM features associated with visual impairment and also suggests that full recovery is possible for this clinical presentation.
Description of an ELANE Mutation in a Girl with Severe Congenital Neutropenia: A Paradigm of Targeted Genetic Screening Based on Clinical Findings
Authors: Damianidou Labrini , Papageorgiou Theodotis , Tragiannidis Athanasios , Haidopoulou Katerina , Giannopoulos Andreas , Hatzipantelis Emmanuel , Gogou Maria
Published: September 2018

We describe the case of a 5-year-old girl with severe congenital neutropenia presenting with recurrent skin and respiratory infections. Sequence analysis of ELANE and HAX1 genes identified a mutation in heterozygous state in exon 2 of the ELANE gene: c.157C > G (p.His53Asp), not previously described in the literature at the exon coding level. Given the autosomal dominant inheritance and the location of the mutation within a “hotspot,” this mutation was considered as clinically relevant. ELANE should be screened in patients with congenital neutropenia of no obvious etiology. A detailed medical history and clinical evaluation can prevent unnecessary investigations allowing for a targeted diagnostic strategy.
Psychotic Disorders in DSM-5
Authors: Carpenter W. T. , Tandon R.
Published: September 2018

DSM-5 presents an opportunity to provide greater clarity to constructs involved in classification of psychotic disorders by establishing a meta-structure based on spectra of pathology, giving emphasis to the syndromal nature of current disorders, and to guide ascertainment of psycho-pathology domains to increase understanding of individual cases. There was a need to reduce spurious comorbidity, increase validity, improve reliability, consider possible new disorders, and provide more coherence across chapters in the diagnostic manual. While balancing these objectives, the new information about the nature of these disorders that has been generated since DSM-IV was incorporated into their definition. For example, variations in distinct psychopathological dimensions have been found to better account for the heterogeneity of schizophrenia than traditional subtypes. Resulting changes in DSM-5 include elimination of the classic sub-types of schizophrenia, addition of unique psychopathological dimensions, elimination of special treatment of Schneiderian “first-rank symptoms”, better delineation of schizoaffective disorder, clarification of the nosologic status of catatonia and its consistent treatment across the manual, more precise description of illness course specifiers, and addition of a new category of “attenuated psychosis syndrome” as a condition for further study. The rationale behind and the specific nature of these revisions in the DSM-5 criteria for schizophrenia spectrum and other psychotic disorders are summarized in this article.
Workplace related mental health problems – risks and prevention
Authors: Kuhn K.
Published: September 2018

A lot of work related exposures have health effects on individuals and have specific manifestations. It is the subjective evaluation of the exposure that is decisive for stress reaction. Minimizing risk factors and mental health promotion are part of preventive strategies.
Psychiatric remuneration systems in Europe: an overview
Authors: McDaid D.
Published: September 2018

New forms of psychiatric remuneration linked to levels of activity undoubtedly will have an increasing role to play in mental health systems right across Europe. Potentially they can be more efficient and promote choice, but valid concerns have been raised about their impact on the sustainability and nature of psychiatric care. This article looks in particular at recent developments in England and the Netherlands and reflects on how remuneration mechanisms may need to develop further both to improve efficiency and quality within the context of an ever more fragmented and multi-sectoral mental health system. Any introduction of activity- based reimbursement should be introduced gradually. This should be accompanied by investment in adequate information systems to help better understand service utilisation patterns, transitional funding safeguards to reduce the risk of financial instability and incentives/ contractual measures to ensure that services strive to offer services of the highest possible quality that meet the needs of service users.
Update zu Morbus Niemann-Pick Typ C (NPC)
Authors: Mengel E.
Published: September 2018

NPC ist eine neuroviszerale, lysosomale Lipidose. Das klinische Spektrum reicht von einer fatalen, infantilen Form zu adulten Formen mit chronischen Verläufen. Die neurologische Beteiligung bestimmt den Verlauf. Viszerale Befunde wie Ikterus prolongatus, cholestatische Hepatopathie, Splenomegalie können der neurologischen Manifestation um Jahre vorausgehen. Neben der perinatalen schweren Hepatopathie werden 4 neurologische Verlaufsformen – infantil, spätinfantil, juvenil, adult – mit fließenden Übergängen unterschieden. Charakteristisch sind eine gelastische Kataplexie sowie eine vertikalen Sakkadenstörung. Psychiatrische Befunde können auch ein wichtiges Merkmal von NPC sein. Bei juveniler Verlaufsform können häufig Aufmerksamkeits-Defizit, Hyperaktivität und Distanzlosigkeit erfragt werden. Bei adulter Verlaufsform werden regelmäßig psychotische Befunde wie Wahnvorstellungen und visuelle oder akustische Halluzinationen vorgefunden. NPC ist somit auch eine Differentialdiagnose hirnorganischer Psychosen. Seit 2009 steht zur Behandlung des NPC Miglustat zur Verfügung. In kontrollierten Studien konnte der positive Einfluss auf neurologische Zeichen gezeigt werden. Da der frühzeitige Behandlungsbeginn den Therapieerfolg bestimmt, kommt der rechtzeitigen Diagnosestellung auch durch Kinderpsychiater und Psychiater eine entscheidende Bedeutung zu.
Akute vorübergehende psychotische Störungen
Authors: Pillmann F.
Published: September 2018

Akute psychotische Zustandsbilder mit raschem Beginn, dramatischem Erscheinungsbild und günstiger Prognose sind eine klinische Realität. Sie sind aber auch ein Ärgernis, da sie sich schlecht in das Raster der Kraepelin’schen Dichotomie von Dementia praecox/Schizophrenie und affektiven Störungen einfügen. Die Weltgesundheitsorganisation hat sie 1992 mit der ICD-10-Kategorie F23 der „Akuten vorübergehenden Psychosen“ vorläufig als diagnostische Einheit anerkannt, aber auch den offenen Forschungsbedarf konstatiert. Inzwischen haben empirische Untersuchungen viele der Charakteristika der Akuten vorübergehenden Psychosen bestätigt. Es zeigte sich aber auch eine gewisse syndromale Instabilität im longitudinalen Verlauf. Einige Autoren hat dies zu der Forderung geführt, die Diagnose der Akuten vorübergehenden Psychosen wegen mangelnder Stabilität zu verwerfen. Im Folgenden wird begründet, warum die diagnostische Kategorie der Akuten vorübergehenden Psychosen aus nosologisch-theoretischen und klinisch-praktischen Gründen beibehalten werden sollte.
Rechtliche Rahmenbedingungen für Psychopharmaka-Forschung in Deutschland
Authors: Fritze J.
Published: September 2018

Die im Arzneimittelgesetz (AMG) formulierten Rechtsgrundlagen entsprechen im Wesentlichen europäischen Richtlinien. Interventionelle Studien, seien sie Sponsor- oder Investigator- initiiert, sind genehmigungspflichtig, strikt durch Standards guter klinischer Praxis (GCP) reguliert und werden überwacht. Nicht-interventionelle Studien sind anzeigepflichtig. Für Psychopharmaka-Studien gibt es keine besonderen Bedingungen, besonders häufig aber stellt sich die Frage der Einwilligungsfähigkeit. Krankenhausbedürftigkeit kann nicht zu Lasten der Krankenversicherung gehen, wenn sie allein aus Studiengründen resultiert. Studien mit zugelassenen Arzneimitteln in nicht zugelassener Indikation („off-label“) können zu Lasten der GKV durchgeführt werden.
Einfluss der molekularen Bildgebung auf innovative Therapie-Verfahren am Beispiel der M. Alzheimer-Therapie
Authors: Vernaleken I.
Published: September 2018

Die Positronen-Emissionstomografie bietet in Abhängigkeit von den verwendeten Liganden ein hohes Maß an Strukturspezifität bei gleichzeitiger räumlicher Information unter in-vivo Bedingungen. Dennoch fand sich neben den durchaus etablierten [18F]FDG-PET Messungen kaum eine fundierte Anwendung mit direkter therapeutischer Konsequenz. Fortschritte in der Pharmakotherapie psychischer Erkrankungen können die PET allerdings auch klinisch rasch in eine relevante Schlüsselposition bringen. Am Beispiel der in Erprobung befindlichen Immun- Therapeutika für die Alzheimer-Demenz-Erkrankung wird gezeigt, dass die Liganden- Entwicklung zur Frühdiagnose (Amyloid-Imaging) integraler Bestandteil des gesamten Therapie- Prozesses werden kann. Die Entwicklung von geeigneten Amyloid-bindenden Liganden nimmt daher aktuell einen breiten Raum der Neuro-PET-Forschung ein.
Pharmakotherapie der juvenilen Schizophrenie mit atypischen Neuroleptika
Authors: Härtling F.
Published: September 2018

Auch wenn nur etwa 0,1–1% der Schizophrenien vor dem 10. Lebensjahr beginnen, sind es doch 7 –10%, die sich in der Adoleszenz manifestieren. Sie treffen die Patienten in einer besonders sensiblen Phase ihrer Entwicklung und prägen in der Regel ihr weiteres Leben maßgeblich. Obschon auch für diese jungen Schizophrenie-Patienten eine Pharmakotherapie mit Antipsychotika eine entscheidende Säule der Behandlung darstellt, ist die Verfügbarkeit von Studiendaten – und damit auch von zugelassenen Atypika – für den Kinder- und Jugendbereich deutlich schlechter als im Erwachsenenbereich. Der vorliegende Artikel gibt einen Überblick über den Zulassungsstatus sowie die Wirkungen und Nebenwirkungen atypischen Antipsychotika in der Akut- und Langzeitbehandlung der juvenilen Schizophrenie.
Networking, Leadership, Empowerment
Authors: Calliess I. T. , Treichel K. , Nikitopoulos J. , Malik A. , Rojnic Kuzman M.
Published: September 2018

As society’s expectations of mental health professional change radically, educational programs and policies need to keep pace with this change. Trainees and young psychiatrists have established their distinct identity and assured that educational policies are reformed to create competent mental health professionals who are fit for purpose in tomorrow’s world. In order for this to happen, it has taken over a decade of dedication, hard work and motivation from past and present psychiatric trainees and young psychiatrists to travel the journey from having a vision of an international network to develop the existing highly structured network. Networking and empowerment facilitated by national and international young psychiatrists’ organizations has allowed young psychiatrists to participate in decision-making processes and create frameworks for their own professional development. This paper outlines the principles and objectives that underpin the existing networks of national and international young psychiatrists’ organizations. It also describes the various educational and networking activities undertaken by these organizations and uses the case study from Croatia to describe the role of these networks in the formation of national associations of young psychiatrists and trainees.
Psychisch kranke Frauen
Authors: Riecher-Rössler A.
Published: September 2018

Obwohl die Lebenszeitprävalenz psychischer Erkrankungen insgesamt bei beiden Geschlechtern gleich hoch ist, kommen bestimmte psychische Erkrankungen häufiger bei Frauen vor, andere wiederum häufiger bei Männern. Die Ursachen dieser Unterschiede sind vielfältig. Zum einen handelt es sich nur um vermeintliche Unterschiede; doch es gibt auch zahlreiche echte Geschlechtsunterschiede. Diese sind meist multifaktoriell bedingt - durch das biologische Geschlecht, das sogenannte „sex“, einerseits, durch das psychosoziale Geschlecht, das sogenannte „gender“, mit all den zugeschriebenen und übernommenen Rollen in Partnerschaft, Familie, Beruf, Politik, etc. andererseits. Eine ”geschlechtersensible” Psychiatrie berücksichtigt all diese Einflüsse sowohl in der Diagnostik als auch in der Therapie.
Escitalopram – Daten zur Langzeitwirksamkeit
Authors: Volz H.-P.
Published: September 2018

Escitalopram, das pharmakodynamisch aktive S-Enantiomer des Razemats Citalopram, hat sich in Akutstudien als eines der wenigen Antidepressiva überhaupt, nicht nur effektiver als Placebo, sondern auch effektiver als Vergleichssubstanzen erwiesen. Darüber hinaus zeigen auch eine Reihe von Daten aus Langzeitstudien die gute Wirksamkeit in der Erhaltungstherapie sowie Wirkvorteile vs. Duloxetin und Paroxetin bei tendenziell besserer Verträglichkeit. Für die Langzeittherapie der Depression steht damit eine neue interessante Option zur Verfügung, die auch geeignet ist, Compliance-Probleme der Patienten zu vermindern, da eine sehr gute Wirksamkeit mit guter Verträglichkeit kombiniert ist.
Tracheoinnominate Artery Fistula Formation in a Child with Long-Term Tracheostomy Dependence
Authors: Chauhan Jigar , Hertzog James , Viteri Shirley , Slamon Nicholas
Published: September 2018

We report a fatal tracheoinnominate artery fistula (TIF) in a 13-year-old female patient with long-term tracheostomy tube dependence due to chronic respiratory failure. Thirteen years after placement of her tracheostomy tube, the patient experienced two separate episodes of sentinel bleeding prior to a fatal hemorrhagic event. Diagnostic evaluation after the sentinel events was mostly nonconclusive. This case highlights the risk of TIF in pediatric age group, even years after initial tracheostomy tube placement, and the need for a high index of suspicion for TIF when children present with unexplained tracheal bleeding.
A Case of Chromosome 22q11.2 Deletion Syndrome with White Matter Abnormalities and Hypernasal Speech: Importance of Extracardiac Symptoms for Earlier Diagnosis
Authors: Fujioka Kaoru , Kanemura Hideaki , Tando Tomoko , Aihara Masao
Published: September 2018

Chromosome 22q11.2 deletion syndrome (22q11.2DS) is one of the most common genetic syndromes. The varying presentation and severity of this syndrome result in diagnostic delays, especially in patients without cardiac malformation or characteristic features. We report a noncardiac case of 22q11.2DS with white matter abnormalities and velopharyngeal insufficiency. The recognition of white matter abnormalities as a feature of 22q11.2DS contributed to early diagnosis. Diagnostic delay could lead to inappropriate management and unfavorable outcomes. Increased awareness of the various minor features of 22q11.2DS may enable clinicians to diagnose this syndrome earlier and provide appropriate medical management.
Eine Stellungnahme zur Debatte über die „atypischen“ Antipsychotika
Authors: Schmied A. , Kissling W. , Davis J. M. , Leucht S.
Published: September 2018

Seit etwa zehn Jahren gibt es eine kontrovers geführte Debatte über die Antipsychotika der zweiten Generation („second generation antipsychotics“, SGA) in der Schizophreniebehandlung, die in der Publikation der sogenannten Effektivitätsstudien CATIE (Clinical Antipsychotic Trial of Intervention Effectiveness), CUtLASS (Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study) und EUFEST (European First-Episode Schizophrenia Trial) gipfelte. In der vorliegenden Übersicht fassen wir die Ergebnisse dreier aktueller systematischer Reviews zusammen, in denen die Antipsychotika der zweiten Generation (SGAs) mit Placebo, mit konventionellen Antipsychotika oder direkt miteinander verglichen wurden. Wir stellen die Metaanalysen in den Kontext anderer systematischer Reviews und beleuchten sie vor dem Hintergrund von CATIE, CUtLASS und EUFEST. Unserer Meinung nach sind viele Ergebnisse konsistent, sie werden aber von verschiedenen Experten und Interessensvertretern unterschiedlich interpretiert. Die Daten zeigen, dass SGAs keine homogene Gruppe darstellen und dass diese eher verwirrende Einteilung aufgegeben werden sollte. Unserer Meinung nach stellen die SGAs nicht den Durchbruch dar, den die Industrie gerne sehen würde. Ihre unterschiedlichen Eigenschaften erlauben aber eine bessere Ausrichtung des Behandlungsplans an den Problemen des individuellen Patienten. Diese Medikamente haben die Behandlungspalette deutlich erweitert und die meisten Psychiater, ganz zu schweigen von den Patienten, würden wohl nur sehr ungerne auf diese Präparate verzichten wollen.
A techno-economic analysis of the integration of energy storage technologies in electric power systems
Authors: Al-Foraih R. , Sreekanth K. J. , Al-Mulla A.
Published: September 2018

Energy storage plays a key role in enabling any country to develop a low-carbon, environmentally friendly energy system. Energy storage technology (EST) devices can supply more flexibility and balance to the main grid, providing a backup to intermittent energy needs. ESTs can provide an improvement in the transmission and distribution networks, which will improve energy efficiency. This in turn will considerably reduce the cost of energy transmission. In light of this, ESTs can not only accelerate the de-carbonization of the electricity grid, but also enhance the security and efficiency of electricity transmission and its distribution by reducing unplanned loop flows, grid congestion, and voltage and frequency variations. This can stabilize electricity market prices and correspondingly guarantee a higher security of energy supply to the consumers. ESTs can also pave the way to the introduction of renewable energy. In this study, the advantages of ESTs to meet the future energy demand for the arid region are investigated. The integration of the various ESTs that are suitable for arid region's power system is evaluated in terms of technical, environmental, and economic aspects to obtain the optimal EST for each position. Both Energy Storage Computational Tool and Energy Storage Select tools are used to evaluate and assess the ESTs and accordingly realize the optimum EST for each position. Based on the investigation and analysis, the rankings of ESTs suitable to an arid region are sodium sulphur batteries, lead acid batteries, and sodium nickel chloride batteries. These are ideal ESTs for the arid region's power sector as they are more probable to optimize the power supply and high demands at peak loads within the existing electrical power system.
Relationships between pre-slaughter rump flatness of Nelore cows and subsequent measures of carcass fatness
Authors: Pfeifer Luiz F. M. , Neves Paulo M. A.
Published: September 2018

This study aimed to evaluate the relationship between the internal angle of the rump (IAR), as a measure of rump fatness, and both the visual degree of finishing (VDF) and the subcutaneous fat thickness (SFT) of Nelore cows. In this study, 836 Nelore cows were examined. The IAR of all live cows was measured using a goniometer, and then the VDF of all carcasses was evaluated. Additionally, the SFT of a subset of carcasses (n = 225) was measured. Carcasses were divided into three groups based on the VDF, as follows: Inadequate VDF (I) for carcasses with a degree of finishing of 1 and 2; Adequate VDF (A) for carcasses with a degree of finishing of 3 and 4; and Excessive VDF (E) for carcasses with a degree of finishing of 5. There was a positive linear relationship between VDF and IAR (y = 98.29 + 5.78 × x; R
2 = 0.53; P < 0.001) and between VDF and SFT (y = 0.26 + 0.51× x; R
2 = 0.51; P < 0.001). Cows classified as having an Excessive degree of fatness according to the Inadequate – Adequate – Excessive (IAE) scale had higher IAR and SFT than cows classified as Inadequate or Adequate (P < 0.001). Similarly, cows classified as Adequate had higher IAR and SFT than cows classified as Inadequate (P < 0.001). These results demonstrate that the measure of IAR of a live Nelore cow can provide a good indication of the level of fatness of its carcass.
Impacts of Dengue Epidemics on Household Labor Market Outcomes
Authors: Walsh Amanda C.
Published: September 2018

Existing research on household‐level dengue impacts only assesses families of individuals with disease. However, behavioral and economic factors affect all households within an epidemic region. I assess changes in work hours among males and females in Iquitos, Peru, during intermittent dengue epidemics from 2005–2010. Epidemics are associated with large decreases in work hours for men and women who work. Females reduce hours more than males, and reduce hours when no household members report illness. The findings suggest that current government interventions aimed at reducing transmission during epidemics may inadvertently deter labor market activity. This research contributes to the infectious disease literature by separately assessing the impacts of epidemics on males and females in all households in an affected region.
Reconfiguration of Dynamic Functional Connectivity in Sensory and Perceptual System in Schizophrenia
Authors: Dong Debo , Duan Mingjun , Wang Yulin , Zhang Xingxing , Jia Xiaoyan , Li Yingjia , Xin Fei , Yao Dezhong , Luo Cheng
Published: September 2018

Schizophrenia is thought as a self-disorder with dysfunctional brain connectivity. This self-disorder is often attributed to high-order cognitive impairment. Yet due to the frequent report of sensorial and perceptual deficits, it has been hypothesized that self-disorder in schizophrenia is dysfunctional communication between sensory and cognitive processes. To further verify this assumption, the present study comprehensively examined dynamic reconfigurations of resting-state functional connectivity (rsFC) in schizophrenia at voxel level, region level, and network levels (102 patients vs. 124 controls). We found patients who show consistently increased rsFC variability in sensory and perceptual system, including visual network, sensorimotor network, attention network, and thalamus at all the three levels. However, decreased variability in high-order networks, such as default mode network and frontal–parietal network were only consistently observed at region and network levels. Taken together, these findings highlighted the rudimentary role of elevated instability of information communication in sensory and perceptual system and attenuated whole-brain integration of high-order network in schizophrenia, which provided novel neural evidence to support the hypothesis of disrupted perceptual and cognitive function in schizophrenia. The foci of effects also highlighted that targeting perceptual deficits can be regarded as the key to enhance our understanding of pathophysiology in schizophrenia and promote new treatment intervention.
FA01.04: HIGH HOSPITAL VOLUME IS ASSOCIATED WITH SHORTER LEARNING CURVES AND LESS LEARNING ASSOCIATED MORBIDITY AFTER MINIMALLY INVASIVE ESOPHAGECTOMY
Authors: Workum Frans , Claassens Linda , Rovers Maroeska , Rosman Camiel
Published: September 2018

Background

Ivor Lewis totally minimally invasive esophagectomy (TMIE) is associated with a long learning curve and high learning associated morbidity. Factors that are associated with a shorter learning curve and less associated morbidity have not been investigated from clinical data. The aim of this study was to investigate whether there is a relationship between hospital volume and the length of the learning curve and learning associated morbidity.

Methods

Prospectively collected data were retrospectively analyzed of all consecutive patients undergoing Ivor Lewis TMIE in expert centers in Sweden, Denmark and the Netherlands. The primary outcome parameter was anastomotic leakage requiring reoperation or reintervention. Learning curves were plotted using weighted moving average and CUSUM analysis was used to determine after how many cases the plateau was reached. Learning associated morbidity was calculated with area under the curve analysis. The length of the learning curve and learning associated morbidity were compared between hospitals < 50 procedures per year (normal volume) and hospitals performing > 50 procedures (high volume) per year.

Results

Nine centers participated and 906 patients were included. The mean number of Ivor Lewis TMIE performed per center per year was 41 (range 22–60). The overall length of the learning curve was 136 cases and this was 148 cases in the normal volume group versus 122 cases in the high volume group. Learning associated anastomotic leakage occurred in 10 patients (7.4% of all patients operated during the learning curve) and this was 13 patients (8.5%) in the normal volume group versus 6 patients (5.2%) in the high volume group.

Conclusion

Learning curves were shorter and learning associated morbidity was lower in centers with higher case volume. This is the first study demonstrating this effect from clinical data. Patient safety can be significantly compromised during surgical learning curves and probably, patient safety can be increased if surgeons learn technically challenging procedures in higher volume centers. Our data can guide the design of implementation programs for technically challenging procedures. This abstract was submitted on behalf of the esophagectomy learning curve collaborative group.

Disclosure

All authors have declared no conflicts of interest.