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ZUSAMMENFASSUNGSynkopen bilden bei älteren Menschen häufige Sturzursachen. Die beste Sturzprophylaxe besteht in der ätiologischen Abklärung und Behandlung des Synkopenleidens. Die aktuellen Synkopenleitlinien der Deutschen Gesellschaft für Neurologie empfehlen bei Synkopenverdacht zunächst eine hypothesenorientierte Basisdiagnostik, in deren Zentrum die Anamnese mit einer sorgfältigen Exploration der verschiedenen Phasen des Ablaufes einer vorübergehenden Bewusstlosigkeit steht. Zur Basisdiagnostik gehören ferner ein 12-Kanal-EKG und Blutdruckmessungen im Liegen und im Stehen (aktiver Stehtest). Vasovagale Synkopen können bereits nach Anamnese und ohne weitere Zusatzdiagnostik diagnostiziert werden, wenn die Ohnmachten in typischen Situationen (z. B. Verletzungskontext) auftreten und ihnen Prodromi wie Wärmegefühl oder Schwitzen vorausgehen. Bei älteren Patienten bilden orthostatische Blutdruckabfälle durch eine zentrale oder periphere Schädigung des autonomen Nervensystems einen häufigen Synkopenmechanismus, weshalb der aktive Stehtest besonders beim älteren Menschen oft weitere Zusatzdiagnostik überflüssig macht.

Background Even before the onset of psychotic symptoms, individuals with schizophrenia display cognitive impairments. Simultaneously, increasing amounts of individuals exhibit dysfunction of the blood–brain barrier (BBB). However, the impact of BBB dysfunction on neurocognitive impairment in people with first-episode psychosis has not yet been investigated. Aims To advance understanding of said relationship, we considered one of the largest first-episode psychosis cohorts with cerebrospinal fluid parameters available, and investigated whether BBB dysfunction is related to working memory, working speed and attention. Method We conducted a retrospective chart review of 121 in-patients diagnosed with a first episode of a schizophrenia spectrum disorder. Patients underwent neurocognitive testing and a lumbar puncture within routine clinical care. To define BBB dysfunction, albumin cerebrospinal fluid/serum quotients, immunoglobulin G ratios and oligoclonal band types were evaluated, and gender-specific differences investigated. Neurocognitive functioning was assessed by the Wechsler Adult Intelligence Scale, Test of Attentional Performance and Repeatable Battery for the Assessment of Neuropsychological Status. We performed simple and multiple linear regression analyses to interpret associations of interest. Results Of those tested, 16% showed an alteration in albumin quotients and 12% had an oligoclonal band type indicating BBB dysfunction. Notably, male patients were more likely to have an increased albumin quotient and a higher immunoglobulin G ratio than female patients. We found no significant association between BBB dysfunction and neurocognitive assessments. Conclusions The hypothesised relationship between BBB and neurocognitive impairments was not detectable in our retrospective cohort. Further cerebrospinal fluid-based studies with a longitudinal assessment of cognitive functioning and disease trajectory are urgently needed.

As the Citizen Science (CS) community flourishes, there is an opportunity to reflect on how practitioners can widen participation and work with participants as co-researchers to investigate and take action around global challenges. Through the lens of one CS case study, the X-Polli:Nation project, we report on how technologists, ecologists and education specialists repurposed older projects by cross-pollinating ideas with children and teachers in the UK and in Italy to create Artificial Intelligence enhanced tools appropriate for teaching sustainability in schools. Taking part in an actionable CS cycle, children learn about pollinating insects, record scientific data, create flowering habitats and communicate their importance. Through this process, X-Polli:Nation demonstrates relevance across a number of Sustainable Development Goals (e.g. SDG 4 Quality Education, 10 Reducing Inequality and 15 Life on Land), and applies the underlying SDG principle ‘leave no one behind’. We go on to investigate if, and how, young people would like to deepen their engagement with the SDGs, reporting that taking action and communicating the importance of the goals were of paramount interest. The challenge of building sustainability into an already crowded curriculum can be alleviated by understanding its value, considering the audience and adapting to new contexts. The considerable benefits include raising awareness about global sustainability issues and giving children the confidence to become passionate environmental stewards, all the while extending the life of older projects and thus making CS methods sustainable too.

The aim of this study was to describe atypical dyskinesias (AtypDs) occurring during treatment with antipsychotic drugs (APDs). AtypDs are dyskinesias showing either an unusual temporal relationship between onset of treatment and start of the adverse drug reaction (ADR) or an unusual presentation of clinical symptoms.Data on the utilisation of APDs and reports of severe APD-induced AtypDs were collected using data from the observational pharmacovigilance programme - 'Arzneimittelsicherheit in der Psychiatrie (English: drug safety in psychiatry)' (AMSP) - from 1993 to 2016.A total of 495,615 patients were monitored, of which 333,175 were treated with APDs. Sixty-seven cases (0.020%) of severe AtypDs under treatment with APDs were registered. The diagnoses of schizophrenic disorders as well as organic mental disorders were related to significantly higher rates of AtypDs. Second-generation antipsychotic drugs (SGAs) showed slightly higher rates of AtypDs (0.024%) than high-potency (0.011%) or low-potency first-generation antipsychotic drugs (FGAs; 0.006%). In 41 cases (61.2%), two or more drugs were found to cause AtypDs.Our study indicates that AtypDs are rare ADRs. SGAs may have a higher risk for the occurrence of AtypDs than FGAs. Clinicians should be aware of this ADR and patients should be monitored and examined carefully.

Exorbitant aldosterone is closely associated with various severe diseases, including congestive heart failure and chronic kidney disease. As aldosterone synthase is the pivotal enzyme in aldosterone biosynthesis, its inhibition constitutes a promising treatment for these diseases. Via a structure-based approach, a series of pyridyl substituted 3,4-dihydrobenzo[f][1,4]oxazepin-5(2H)-ones were designed as inhibitors of aldosterone synthase. Six compounds (5j, 5l, 5m 5w, 5x and 5y) distinguished themselves with potent inhibition (IC50

Previous research suggests a broad range of deficits in major depressive disorder. Our goal was to update the current assumptions and investigate the extent of cognitive impairment in depression in the acute and remitted state. A systematic review of the existing literature between 2009 and 2019 assessing the risk of bias within the included studies was performed. Of the 42 articles reviewed, an unclear risk of bias was shown overall. The risk of bias mainly concerned the sample selection, inadequate remedial measures, as well as the lack of blinding the assessors. In the acute phase, we found strong support for impairment in processing speed, learning, and memory. Follow-up studies and direct comparisons revealed less pronounced deficits in remission, however, deficits were still present in attention, learning and memory, and working memory. A positive correlation between the number of episodes and cognitive deficits as well as depression severity and cognitive deficits was reported. The results also demonstrate a resemblance between the cognitive profiles in bipolar disorder and depression. Comparisons of depression with schizophrenia led to unclear results, at times suggesting an overlap in cognitive performance. The main findings support the global deficit hypothesis and align with results from prior meta-analyses and reviews. Recommendations for future research are also presented.

Embolism as a cause of stroke is widely neglected in Moyamoya angiopathy (MMA), and recommendations for use of antiplatelet therapy (APT) vary. We examined the presence of microembolic signals (MES) during transcranial Doppler (TCD) monitoring and assessed the effects of APT on the occurrence of MES in MMA.We retrospectively analysed patients with MMA treated at our centre between 2011 and 2021. TCD was performed at first presentation and at most visits, while number of visits varied between individual patients. TCD was performed for 30 min bilaterally. Patient demographics, vascular risk factors, and antiplatelet treatment were collected from each clinic visit and ischemic and haemorrhagic episodes were captured as recorded during follow-up visits.209 patients were included in the analysis (mean age 38.7 ± 15.3, 28% male). 21 patients with 27 MES-positive TCD examinations were identified (10%). Patient characteristics were similar in MES-positive and MES-negative groups. However, recent ischemic events were detected at a significantly higher rate in MES-positive patients (42.9% vs 4.8%, p 0.001). After MES detection, change of antiplatelet drug regime was performed, leading to loss of MES in all cases. Dual APT was preferably used in the MES-positive group (p 0.001) but no significant difference of haemorrhage during follow-up-visits was observed. Reduction of APT before bypass-surgery triggered MES in four patients.APT is required in patients with MMA. MES monitoring may help to identify risk patients in need of intensified APT.

Background: Currently available data on the prescription practice among patients with major depressive disorder (MDD) reflect the outpatient setting. This is the first study to provide information on time trends of psychotropic drug utilization in psychiatric inpatients. Method: Data stems from German-speaking psychiatric hospitals collected by the program “Drug Safety in Psychiatry” (Arzneimittelsicherheit in der Psychiatrie, AMSP) between 2001 and 2017. 44,418 psychiatric inpatients with MDD were included. Time trends in drug utilization were analyzed by comparing the first (2001–2003) and last time point (2015–2017) using risk ratios (RR). Results: Antidepressant drugs (ADD) were the most used psychotropic drug class with utilization decreasing slightly from 2001–2003 (89.7%) to 2015–2017 (85.5%). Use of tricyclic ADDs showed the greatest decline (RR 0.35), while use of selective serotonin-noradrenaline reuptake inhibitors (RR 1.72) and “other ADDs” increased the most. Use of antipsychotic drugs (APD), especially second-generation antipsychotic drugs (RR 1.46), increased. Use of tranquilizing (RR 0.71) and hypnotic drugs (RR 0.43) both decreased. Most patients were treated with more than one psychotropic drug, most often ADD + APD, which was utilized more often in 2015–2017 (51.1%) than in 2001–2003 (45.1%; RR 1.13). Combination of two ADDs increased from 2001–2003 (24.5%) to 2015–2017 (33.0%; RR 1.35). Limitations: The cross-sectional design does not allow conclusions to be drawn about causal relationship of findings. Further, only certain clinical and sociodemographic data was available. Conclusion: Treatment of MDD has shown significant changes from 2001 to 2017.

Objectives Drug-induced liver injury (DILI) has been associated with various antipsychotic drugs (APDs). Comparative studies between individual APDs are largely not available. Methods Antipsychotic drug utilisation data and reports of severe antipsychotic DILI were assessed by using data from an observational pharmacovigilance programme-Arzneimittelsicherheit in der Psychiatrie (AMSP)-during the period 1993-2016. Results Of the 333,175 patients treated with APDs, a total of 246 (0.07%) events of severe DILI were identified. Phenothiazines were associated with significantly higher rates of severe DILI (0.03%, 95% CI = 0.02-0.04) than thioxanthenes (0.01%, 95% CI = 0.00-0.02) or butyrophenones (0.01%, 95% CI = 0.00-0.01). Among individual drugs, olanzapine (0.12%, 95% CI = 0.10-0.16), perazine (0.09%, 95% CI = 0.05-0.15) and clozapine (0.09%, 95% CI = 0.10-0.12 ranked highest. In 78 cases (31.7%), combination therapies with antipsychotic and antidepressant drugs or with two or more APDs were considered responsible. Male sex and a diagnosis of mania were associated with significantly higher rates of severe DILI while older patients (≥65 years old) were significantly less often affected. Conclusions In the present analysis of a representative psychiatric inpatient cohort, olanzapine, perazine, and clozapine were the most common individual APDs associated with severe DILI.

We summarize and discuss a self-consistent screening and magneto-transport theory, developed to understand the results of scanning-force-microscope experiments on the current distribution in a two-dimensional electron system (2DES), located in a narrow Hall bar under the conditions of the integer quantum Hall effect (IQHE) and its breakdown. The theory explains why, at low temperatures, at certain intervals of the applied perpendicular magnetic field, the current density is confined to “incompressible stripes” (ISs), in which a fixed number of Landau levels is occupied, and the longitudinal and Hall resistivity assume quantized values. The theory also explains, how the position and shape of these ISs depend on magnetic field and temperature, and why the confinement of the current density on these ISs leads to precisely quantized values of the macroscopic longitudinal and Hall resistance. The theory, which leads, at high temperatures, to the well known Drude results for current density and resistance, shows that the IQHE is a consequence of the peculiar screening properties of a 2DES in a strong magnetic field at low temperatures, and that it can be understood without assumptions about special localization effects.

AimsThe Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI) are the most frequently used observer-rated and self-report scales of depression, respectively. It is important to know what a given total score or a change score from baseline on one scale means in relation to the other scale.MethodsWe obtained individual participant data from the randomised controlled trials of psychological and pharmacological treatments for major depressive disorders. We then identified corresponding scores of the HAMD and the BDI (369 patients from seven trials) or the BDI-II (683 patients from another seven trials) using the equipercentile linking method.ResultsThe HAMD total scores of 10, 20 and 30 corresponded approximately with the BDI scores of 10, 27 and 42 or with the BDI-II scores of 13, 32 and 50. The HAMD change scores of −20 and −10 with the BDI of −29 and −15 and with the BDI-II of −35 and −16.ConclusionsThe results can help clinicians interpret the HAMD or BDI scores of their patients in a more versatile manner and also help clinicians and researchers evaluate such scores reported in the literature or the database, when scores on only one of these scales are provided. We present a conversion table for future research.

Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies.

In species exhibiting differential migration by sex and age, understanding what differences exist, and the adaptive reasons for these differences is critical for determining how demographic groups will respond to environmental variability and anthropogenic perturbations. We used satellite-telemetered movement and diving data to investigate differential migration and its ontogeny in a highly migratory North Pacific Ocean predator, the northern fur seal (Callorhinus ursinus; NFS), with a focus on understudied juvenile (1- to 2-year-old) animals. We instrumented 71 juvenile NFS in two years (2006–07 and 2007–08) at three major North American breeding sites and compared their migratory strategies with pups and adults. Although sexual dimorphism is strong in adult NFS, only weak differences in body mass between sexes were found in juveniles, which had similar body mass to pups (~3–4 months). However, unlike widely-dispersed pups, juvenile male and female NFS dispersed in different directions, and used different habitats characterized by distinct hydrography and prey assemblages during migration, similar to breeding adults. Juvenile diving behavior differed only modestly among habitats and between sexes, consistent with weak differences in body mass. Evidence of habitat sexual segregation by juvenile NFS contradicts previous hypotheses that physiological differences predominantly drive the ontogeny of differential migration.

The aim of the study was to assess rates of severe parkinsonism related to different antipsychotic drugs (APDs) using data from an observational pharmacovigilance programme in German-speaking countries—Arzneimittelsicherheit in der Psychiatrie (AMSP). Data on APD utilization and reports of severe APD-induced parkinsonism were collected in 99 psychiatric hospitals in Austria, Germany and Switzerland during the period 2001–2016. Of 340,099 patients under surveillance, 245,958 patients were treated with APDs for the main indications of schizophrenic disorders, depression, mania and organic mental disorders. A total of 200 events of severe APD-induced parkinsonism were identified (0.08%). First-generation low-potency APDs were significantly less often implicated (0.02%) than second-generation APDs (0.07%) and first-generation high-potency APDs (0.16%). Among the second-generation APDs, amisulpride and risperidone ranked highest. The phenothiazines were associated with significantly lower rates of severe parkinsonism (0.02%) than those of the butyrophenones (0.11%) and thioxanthenes (0.12%). In 71 cases (35.5%), more than 1 drug was considered responsible for the induction of severe parkinsonism. In 44 patients (22.0%), the symptoms were extremely severe, leading to complete immobility and/or massive complications such as pneumonia and severe injuries due to falls. Higher age (> 60 years) was associated with significantly higher rates of severe parkinsonism, as were the diagnoses of schizophrenic disorder or mania. The large number of patients included in the present survey allows for the comparison of severe parkinsonism rates related to different APD classes and single APDs. The first-generation low-potency APDs had significantly reduced risk of severe parkinsonism compared not only to high potency but also to second-generation APDs.

Background Cardiovascular diseases are still the leading cause of global mortality. Some antipsychotic agents can show severe cardiovascular side effects and are also associated with metabolic syndrome. Methods This observational study was based on data of AMSP (Arzneimittelsicherheit in der Psychiatrie), a multicenter drug surveillance program in Austria, Germany and Switzerland, that recorded severe drug reactions in psychiatric inpatients. Results A total of 404 009 inpatients were monitored between 1993 and 2013, whereas 291 510 were treated with antipsychotics either in combination or alone. There were 376 cases of severe cardiovascular adverse reactions reported in the given timespan, yielding a relative frequency of 0.13%. The study revealed that incidence rates of cardiovascular adverse reactions were highest during treatment with ziprasidone (0.35%), prothipendyl (0.32%), and clozapine (0.23%). The lowest rate of cardiovascular symptoms occurred during treatment with promethazine (0.03%) as well as with aripiprazole (0.06%). The most common clinical symptoms were orthostatic collapse and severe hypotonia, sinustachycardia, QTc prolongation, myocarditis, and different forms of arrhythmia. The dosage at the timepoint when severe cardiovascular events occurred was not higher in any of the given antipsychotics than in everyday clinical practice and was in average therapeutic ranges. In terms of subclasses of antipsychotics, no significant statistical difference was seen in the overall frequencies of adverse reactions cases, when first-generation high potency, first-generation low potency, and second-generation antipsychotics were compared. Thirty percent of adverse events among second-generation antipsychotics were induced by clozapine. Conclusions Our findings on cardiovascular adverse reactions contribute to a better understanding of cardiovascular risk profiles of antipsychotic agents in inpatients.

The discrimination of malignant melanoma from benign nevi may be difficult in some cases. For this reason, immunohistological and molecular techniques are included in the differential diagnostic toolbox for these lesions. These methods are time consuming when applied subsequently and, in some cases, no definitive diagnosis can be made. We studied both lesions by imaging mass spectrometry (IMS) in a large cohort (n = 203) to determine a different proteomic profile between cutaneous melanomas and melanocytic nevi. Sample preparation and instrument setting were tested to obtain optimal results in term of data quality and reproducibility. A proteomic signature was found by linear discriminant analysis to discern malignant melanoma from benign nevus (n = 113) with an overall accuracy of &gt, 98%. The prediction model was tested in an independent set (n = 90) reaching an overall accuracy of 93% in classifying melanoma from nevi. Statistical analysis of the IMS data revealed mass-to-charge ratio (m/z) peaks which varied significantly (Area under the receiver operating characteristic curve &gt, 0.7) between the two tissue types. To our knowledge, this is the largest IMS study of cutaneous melanoma and nevi performed up to now. Our findings clearly show that discrimination of melanocytic nevi from melanoma is possible by IMS.

Data on drug prescription for outpatients with major depressive disorder (MDD) suggest women are more likely to be treated with psychotropic drugs, while data on sex differences regarding pharmacological treatment of psychiatric inpatients are currently not available. Drug utilization data from the program “Drug Safety in Psychiatry” (German: Arzneimittelsicherheit in der Psychiatrie, AMSP) of 44,418 psychiatric inpatients with MDD were analyzed for sex differences between 2001 and 2017. Sex differences were analyzed using relative risks (RR) and 95% confidence intervals (95% CI). Time trends were analyzed by comparing the first (2001–2003) with the last time period (2015–2017). In general, men and women were equally likely to use psychotropic drugs. Monotherapy was more common in men. Women were more likely to utilize ≥ 4 psychotropic drugs. Antidepressant drugs (ADDs) were the most prescribed drug class. Men had a higher utilization of noradrenergic and specific serotonergic antidepressants (RR 1.15; 95% CI 1.12–1.19), especially mirtazapine (RR 1.16; 95% CI 1.12–1.19), but also of other ADDs such as bupropion (RR 1.50; 95% CI 1.35–1.68). Males had a slightly higher utilization of second-generation antipsychotic drugs (RR 1.06; 95% CI 1.03–1.09) and were less often treated with low-potency first-generation antipsychotic drugs (RR 0.86; 95% CI 0.83–0.90). Tranquilizing (e.g., benzodiazepines; RR 0.89; 95% CI 0.86–0.92) and hypnotic drugs (e.g., Z-drugs; RR 0.85; 95% CI 0.81–0.89) were less utilized in the treatment of male patients. Not all sex differences were stable over time. More sex differences were detectable in 2015–2017 than in 2001–2003. Findings suggest that certain psychotropic drugs are preferred in the treatment of men vs. women, however, sex differences found in this study are not as large as in ambulatory settings. To make evidence-based sex-specific recommendations in the treatment of MDD, differences in drug response and tolerability need to be further researched.

Background Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care. © The Author(s) 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Food availability is a key concern for the conservation of marine top predators, particularly during a time when they face a rapidly changing environment and continued pressure from commercial fishing activities. Northern fur seals (Callorhinus ursinus) breeding on the Pribilof Islands in the eastern Bering Sea have experienced an unexplained population decline since the late-1990s. Dietary overlap with a large U.S. fishery for walleye pollock (Gadus chalcogrammus) in combination with changes in maternal foraging behavior and pup growth has led to the hypothesis that food limitation may be contributing to the population decline. We developed age- and sex-specific bioenergetic models to estimate fur seal energy intake from May–December in six target years, which were combined with diet data to quantify prey consumption. There was considerable sex- and age-specific variation in energy intake because of differences in body size, energetic costs, and behavior; net energy intake was lowest for juveniles (18.9 MJ sea-day–1, 1,409.4 MJ season–1) and highest for adult males (66.0 MJ sea-day–1, 7,651.7 MJ season–1). Population-level prey consumption ranged from 255,232 t (222,159 – 350,755 t, 95% CI) in 2006 to 500,039 t (453,720 – 555,205 t) in 1996, with pollock comprising between 41.4 and 76.5% of this biomass. Interannual variation in size-specific pollock consumption appeared largely driven by the availability of juvenile fish, with up to 81.6% of pollock biomass coming from mature pollock in years of poor age-1 recruitment. Relationships among metabolic rates, trip durations, pup growth rates, and energy intake of lactating females suggest the most feasible mechanism to increase pup growth rates is by increasing foraging efficiency through reductions in maternal foraging effort, which is unlikely to occur without increases in localized prey density. By quantifying year-specific fur seal consumption of pollock, our study provides a pathway to incorporate fur seals into multispecies pollock stock assessment models, which is critical for fur seal and fishery management given they were a significant source of mortality for both juvenile and mature pollock.

Galactorrhea is a well-known adverse drug reaction (ADR) of numerous antipsychotic drugs (APD) and is often distressing for those affected. Methodological problems in the existing literature make it difficult to determine the prevalence of symptomatic hyperprolactinemia in persons treated with APDs. Consequently, a large sample of patients exposed to APDs is needed for more extensive evaluation. Data on APD utilization and reports of galactorrhea caused by APDs were analyzed using data from an observational pharmacovigilance program in German-speaking countries—Arzneimittelsicherheit in der Psychiatrie (AMSP)—from 1993 to 2015. 320,383 patients (175,884 female inpatients) under surveillance were treated with APDs for schizophrenia and other indications. A total of 170 events of galactorrhea caused by APDs were identified (0.97 cases in 1000 female inpatient admissions). Most cases occurred during the reproductive age with the highest incidence among patients between 16 and 30 years (3.81 cases in 1000 inpatients). The APDs that were most frequently imputed alone for inducing galactorrhea were risperidone (52 cases and 0.19% of all exposed inpatients), amisulpride (30 resp. 0.48%), and olanzapine (13 resp. 0.05%). In three cases, quetiapine had a prominent role as a probable cause for galactorrhea. High dosages of the imputed APDs correlated with higher rates of galactorrhea. Galactorrhea is a severe and underestimated condition in psychopharmacology. While some APDs are more likely to cause galactorrhea, we identified a few unusual cases. This highlights the importance of alertness in clinical practice and of taking a patient’s individual situation into consideration.

BackgroundEndurance exercise in general and marathon running in particular have become increasingly popular over the past decades. Recent investigations about personality structures in this cohort and comparisons to non-active cohorts are lacking. MethodsIn the ReCaP study (Running effects on Cognition and Plasticity), a total of 100 marathon runners and 46 sedentary controls were recruited. After elimination of Minnesota Multiphasic Personality Inventory 2 Restructured Form (MMPI-2-RF) profiles with insufficient validity, 79 marathon runners (MA) and 27 sedentary controls (SC) remained for final analyses. Depressive symptoms were evaluated with Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAMD). ResultsMarathon runners had lower scores in scales measuring somatic and cognitive complaints, stress, demoralization, hopelessness and distrust. Within the marathon group, committed runners exhibited hypomanic traits compared to regular runners. Discussion and ConclusionPersonality differences could be summarized as (sub-)depressive personality traits in SC compared to MA rather than typical (sub-) depressive symptoms in the meaning of depressive disorders. Future studies should further evaluate cause and consequence of endurance training and hypomanic or euthymic symptoms, as a two-way interaction exists. Trial Registrationhttp://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00012496.

Anfallartige Ereignisse bei Patienten gehoren zu den haufigsten Grunden fur die Konsultation von Notarzten oder die Vorstellung in Kliniknotaufnahmen oder sonstigen Notfallambulanzen. Oft ist dann in der Untersuchungssituation der Anfall bereits abgeklungen, sodass der Arzt fur eine erste Einschatzung des Ereignisses auf die Schilderung des Patienten angewiesen ist oder im glucklichen Falle auch auf eine Fremdanamnese zuruckgreifen kann. Bei vielen Attackenformen ermoglichen die anamnestischen Angaben dem Notarzt bereits eine Verdachtsdiagnose oder zumindest eine Zuordnung zu einer bestimmten klinischen Disziplin. So verweist etwa bei Anfallen, bei denen das Symptom „Schmerz“ im Vordergrund steht, die Angabe der Schmerzlokalisation bzw. des Schmerzcharakters (z. B. stechende Schmerzen im linken Brustraum bei akutem Koronarsyndrom) oft schon auf die Ursache. Weitere zugig verfugbare medizinische Informationen (korperlicher Befund, Notfalllabor, EKG, Vitalparameter) konnen dann die Diagnose sichern und zur raschen Therapieeinleitung und Zuweisung zur zustandigen Fachdisziplin fuhren. Haufig aber fallt es dem Notarzt schwer, aus der Anamnese eine Krankheitsentitat zu erkennen, insbesondere wenn die Angaben diffus und unprazise sind oder wenn zu bestimmten Merkmalen der Attacke (z. B. Dauer einer Ohnmacht) keine Informationen vorliegen. Dies betrifft z. B. Schwindelanfalle, die vom Patienten oft schwer verbalisierbar sind und deren anamnestische Abklarung durch gezielte Fragen bereits eine besondere Expertise des Diagnostikers erfordert. Vor allem solche Anfallssymptome, die sich als Veranderungen neurologischer oder psychischer Funktionen manifestieren, konnen oft vom Notarzt nicht adaquat eingeschatzt werden oder fuhren zu einer der beiden grosen „Schubladen“ von Verdachtsdiagnosen „TIA“ (transitorisch ischamische Attacke) oder „Krampfanfall“. Immerhin wird der Patient mit diesen Verdachtsdiagnosen, auch wenn diese spater nicht bestatigt werden, an den Neurologen ubergeben. Auch wenn nicht jeder Anfall mit neurologischer Symptomatik auch neurologische Ursachen hat (man denke etwa an die Hypoglykamie, die nahezu jedes fokal-neurologische Defizit hervorrufen kann), ist doch der Neurologe in der Regel derjenige arztliche Kollege im Notaufnahmeteam, der die breitesten differenzialdiagnostischen Kenntnisse in Bezug auf Schwindel, Ohnmachtsanfalle, attackenartige Seh- oder Sensibilitatsstorungen oder paroxysmale psychische Veranderungen mitbringt. Der Neurologe als traditionell interdisziplinar orientierter Arzt sollte sich insbesondere auch mit solchen Differenzialdiagnosen auskennen, die schon grenzuberschreitend im Gebiet von Nachbardisziplinen liegen (z. B. der Morbus Meniere als Schwindelursache in der HNO-Heilkunde oder die Panikattacke als Ursache von thorakalen Beklemmungen in der Psychiatrie). Der Neurologe ist damit dazu pradestiniert, bei unklaren Anfallen fruhzeitig in die Abklarung involviert zu werden oder diese selber federfuhrend zu ubernehmen. Der Fokus des vorliegenden Kapitels soll dementsprechend in der Differenzialdiagnose unterschiedlicher Anfallsleiden liegen und nicht in der umfassenden Abhandlung dieser Krankheitsbilder, die zum Teil ja in anderen Kapiteln dieses Buches erfolgt. Ausgeklammert werden hier solche Attackenformen, mit denen der Neurologe selten konfrontiert wird (etwa das akute Koronarsyndrom) oder Schmerzanfalle (z. B. Kopfschmerzen), die unter differenzialdiagnostischem Blickwinkel andernorts in diesem Buch abgehandelt werden.

Die Entwicklung der Dopplersonografie eroffnet die Moglichkeit, nichtinvasiv sowohl extra- als auch intrakranielle Gefasprozesse zu diagnostizieren und die zerebrale Hamodynamik zu beurteilen. Mithilfe der B-Bild-(Duplex-)Sonografie gelingt die direkte Untersuchung arteriosklerotischer Gefasveranderungen, bevor diese hamodynamische Relevanz erlangen. Die Analyse des Dopplerfrequenzspektrums ermoglicht auserdem die Beurteilung langsamer Schwankungen der Hirndurchblutung in Abhangigkeit von Korperlage, CO2-Partialdruck, Hirndruck und kognitiver Beanspruchung. Inzwischen konnen sogar Mikroembolien im Blutstrom aus dem Frequenzspektrum identifiziert werden.

Die Dopplersonografie eroffnet die Moglichkeit, nichtinvasiv sowohl extra- als auch intrakranielle Gefasprozesse zu diagnostizieren und die zerebrale Hamodynamik zu beurteilen. Mithilfe der B-Bild-Sonografie gelingt die Darstellung arteriosklerotischer Gefasveranderungen, bevor diese hamodynamische Relevanz erlangen. Die Analyse des Dopplerfrequenzspektrums ermoglicht auserdem die Beurteilung langsamer Schwankungen der Hirndurchblutung in Abhangigkeit von Korperlage, CO2-Partialdruck, Hirndruck und kognitiver Beanspruchung. Mikroembolien konnen im Blutstrom aufgrund ihres Signalverhaltens aus dem Frequenzspektrum identifiziert werden.

Objectives: The study aimed to assess seizure rates related to different antipsychotic drugs (APDs) in a clinical setting using data from the drug safety programme Arzneimittelsicherheit in der Psychiatrie (AMSP).Methods: Psychotropic drug use data and reports of APD-related seizures were collected in 89 psychiatric hospitals in Austria, Germany and Switzerland from 1993 to 2015.Results: Of 475,096 patients under surveillance, 320,383 patients were treated with APDs for the main indications of schizophrenic disorders, mood disorders and organic disorders. A total of 144 APD-related tonic clonic seizures were identified (0.04%). The butyrophenones ranked slightly lower (0.03%) compared to the phenothiazines, thioxanthenes and second-generation APDs (0.05% each). No significant differences were observed when comparing first- and second-generation APDs. Clozapine was related to the highest seizure rate (0.18%). In 107 cases (74.3%), more than one drug was considered responsible for seizure induction....

Introduction Implantable loop recorders (ILR) are leadless subcutaneous devices that allow cardiac monitoring for up to 3 years and are a valuable tool in the diagnosis of arrhythmias, cryptogenic stroke and unexplained syncope. The Biotronik BioMonitor 2 is a novel, insertable ILR allowing long-term continuous monitoring with wireless telemetry options. Methods A single-center, prospective, observational study investigating the reliability of sensing quality and detection performance in the BioMonitor 2 ILR, as well as post-implantation patient satisfaction. R-wave amplitude was recorded immediately post implantation and 1 day post implantation, followed by extensive patient instruction. Follow-up was scheduled after 3 months, or after an event. Data from the ILR were retrieved, with documentation of all episodes, R-wave amplitude and noise burden. The anatomical position of the ILR was determined 1 day post implantation and after 3 months. A patient questionnaire was conducted after 3 months. Results 30 consecutive patients (mean age 71 ± 12 years, 56% male) were analyzed. Indications for ILR implantation were: unexplained syncope (n = 24, 80%), suspected atrial fibrillation (n = 4, 13%), cryptogenic stroke (n = 1, 3%) and palpitations (n = 1, 3%). Median time from skin cut to suture was 8 min. No complications occurred. Mean R-wave amplitude at implantation was 0.84 ± 0.32 mV, at day 1 post implantation 0.96 ± 0.31 mV, and after a mean follow-up of 85 ± 24 days 1.02 ± 0.47 mV (p = 0.01). The mean noise burden was 1.4 ± 2%. Conclusion Implantation of the novel BioMonitor 2 ILR is fast and uncomplicated. Initial sensing values are good and improve over time.

Despite the consensus on the necessity of revascularizing surgery in Moyamoya angiopathy in Asia, the indication in Caucasian Moyamoya patients is discussed controversially. The safety of revascularizing surgery in Europe should be clarified. This study retrospectively analyzed the rate of complications as well as clinical symptoms within the first 3 months after bypass surgery between superficial temporal artery and middle cerebral artery (STA–MCA). 64 direct bypass procedures in 45 patients (95.5% Caucasians) were analyzed. The magnetic resonance imaging at day 6 showed subdural hematoma in 60.3%. The mean diameter of these hematomas on magnetic resonance imaging was 5.1 mm (SD 3.4 mm) and increased in 25% at follow-up. No difference was found between those patients with early (day 1) or late (day 7) restarts of antiplatelet therapy. Magnetic resonance imaging at day 6 revealed hyperperfusion syndrome after six of 64 procedures (9.3%). Three of these six had clinical symptoms; two-thirds were transient within seconds. Magnetic resonance imaging depicted stroke after seven procedures (10.9%). Five of these seven patients had no new symptoms. Altogether, after ten procedures (15%), patients complained about clinical symptoms. These were all transient. No new transient ischemic attacks occurred during the 3 month follow-up and no new lesions were detected in magnetic resonance imaging. Only two patients underwent surgery for asymptomatic subdural hematoma. All other subdural hematomas resolved spontaneously. Revasculating surgery is a safe procedure in Caucasian patients with Moyamoya angiopathy. The observed complications have a good prognosis.

Background Suicidal ideations, suicide attempts, and fatal suicides are rare adverse drug reactions to antidepressant drugs, but they essentially are clinically relevant. Drawing on a larger dataset of the European drug surveillance program, the present naturalistic study updates a previous contribution (Stübner et al., 2010). Methods First an analysis of the comprehensive data collected in 81 psychiatric hospitals from 1993 to 2014 by the European drug surveillance program Arzneimittelsicherheit in der Psychiatrie was made. All documented single cases of suicidal ideations or behavior judged as adverse drug reactions to antidepressant drugs were carefully assessed as to their clinical features and drug prescriptions. Results Among 219,635 adult hospitalized patients taking antidepressant drugs under surveillance, 83 cases of suicidal adverse drug reactions occurred (0.04%): 44 cases of suicidal ideation, 34 attempted suicides, and 5 committed suicides were documented. Restlessness was present in 42 patients, ego-dystonic intrusive suicidal thoughts or urges in 39 patients, impulsiveness in 22 patients, and psychosis in 7 patients. Almost all adverse drug reactions occurred shortly after beginning antidepressant drug medication or increasing the dosage. Selective serotonin reuptake inhibitors caused a higher incidence of suicidal ideation and suicidal behavior as adverse drug reactions than noradrenergic and specific serotonergic antidepressants or tricyclic antidepressants, as did monotherapy consisting of one antidepressant drug, compared to combination treatments. Conclusions The study supports the view that antidepressant drug-triggered suicidal ideation and suicidal behavior (primarily with selective serotonin reuptake inhibitors) are rare. Special clinical features (restlessness, ego-dystonic thoughts or urges, impulsiveness) may be considered as possible warning signs. A combination therapy might be preferable to antidepressant drug monotherapy when beginning treatment.

ZusammenfassungWissenschaftliche Fachkongresse müssen finanziell und inhaltlich unabhängig von kommerziellen Interessen sein. In diesem Debattenbeitrag argumentiert die Initiative NeurologyFirst für eine stärkere professionelle Autonomie und die Rückführung des Einflusses der Industrie auf den Jahreskongress der deutschen Neurologie. Unser Kernanliegen ist der Verzicht auf Industriesymposien, die vornehmlich kommerzielle Ziele verfolgen und das Produkt des Sponsors regelhaft in ein günstiges Licht setzen. Die bei Industriesymposien präsentierten Zulassungsstudien neuer Medikamente weisen oft erhebliche methodische Mängel auf, insbesondere die Selektion günstiger Studiendaten. Auch die Industrieausstellung des Kongresses erscheint problematisch, da sie im wissenschaftlichen Gewand eine werbende Absicht verfolgt. Die Lösung von der Industrie wird dazu beitragen, die Pharmakotherapie neurologischer Erkrankungen vermehrt aus der kritischen Perspektive der evidenzbasierten Medizin zu bewerten und damit den Interessen unserer Patienten besser gerecht zu werden. Dass sich auch große Kongresse ohne Unterstützung der Industrie organisieren und zu moderaten Preisen anbieten lassen, zeigen nationale und internationale Beispiele.

Background The Hamilton Depression Rating Scale (HAM-D) and the Montgomery Asberg Depression Rating Scale (MADRS) are scales used frequently to rate the symptoms of depression. There are many situations in which it is important to know what a given total score or a percent reduction from baseline score of one scale means in relation to the other scale. Method We used the equipercentile linking method to identify corresponding scores of simultaneous HAM-D and MADRS ratings in 4388 patients from 31 mirtazapine trials in major depressive disorder. Data were collected at baseline and at weeks 1, 2 and 4. Results HAM-D scores of 10, 20, 30 and 40 roughly corresponded to MADRS scores of 13, 26, 39 and 52–53, respectively. An absolute HAM-D improvement of 10, 20, 25 points corresponded to a MADRS improvement of 12, 26, and 34. A percentage improvement from baseline of the HAM-D was approximately the same as a percentage improvement on the MADRS. Conclusion These results are important for the comparison of trials that used the HAM-D and MADRS. We present conversion tables for future research.

Zusammenfassung Einführung Eine Vielzahl von Erkrankungen können das Bild einer Multiplen Sklerose (MS) imitieren. Bei der Erstdiagnose der MS wird der Ausschluss von Differenzialdiagnosen gefordert. Die Leitlinien der Deutschen Gesellschaft für Neurologie empfehlen die Analyse von 13 obligaten und 9 fakultativen Laborparametern. Zu den obligaten Empfehlungen gehören die Bestimmung der antinukleären Antikörper (ANA) und der Antikörper gegen Doppelstrang-DNS (ds-DNA-AK). Methodik In der Kohorte einer MS-Ambulanz wurden diejenigen Datensätze ausgewertet, bei denen zumindest teilweise die empfohlenen Laborparameter analysiert wurden. Daneben wurden MRT-Daten, Familienanamnese, klinische Präsentation, evozierte Potenziale und Liquorbefunde erfasst. Prospektiv wurde ein Fragebogen zu differenzialdiagnostisch relevanten rheumatologischen Symptomen eingesetzt. Ergebnisse Von 554 Patienten, die sich mit Verdacht auf MS in einer MS-Ambulanz vorstellten, waren bei 197 Patienten zumindest teilweise die differenzialdiagnostisch geforderten Laborparameter analysiert worden. Bei 124 Patienten konnte eine MS bestätigt werden. Bei 117 Patienten (59 %) des Gesamtkollektivs mit 197 Patienten waren die ANA mit mindestens einem Titer von 1:80 auffällig. Von den 124 MS-Patienten hatten 68 (55 %) einen positiven ANA-Titer von mindestens 1:80. Weder ANA noch ANCA oder ds-DNA-AK konnten zwischen MS und Nicht-MS unterscheiden. MS-Patienten mit einem positiven ANA-Titer von 1:80 litten häufiger an Autoimmunerkrankungen und hatten eine positive Familienanamnese für MS. Von den 73 Patienten ohne MS waren 49 (67 %) ANA-positiv. In dieser Patientengruppe waren die ANA-positiven Patienten häufiger psychiatrisch erkrankt. Bei den befragten Patienten mit einem ANA-Titer > 1:160 war innerhalb von durchschnittlich 1,9 Jahren keine rheumatologische Erkrankung diagnostiziert worden. Zusammenfassung In Anlehnung an die amerikanischen „choosing wisely“-Empfehlungen für rheumatologische Erkrankungen erscheint ein obligates breites Laborscreening bei der Erstdiagnose der Multiplen Sklerose ohne konkrete differenzialdiagnostische Verdachtsdiagnose nicht sinnvoll.

Background A variety of diseases can mimic the presentation of multiple sclerosis (MS). Diagnosing MS requires the exclusion of conditions considered in the differential diagnosis of MS. The guidelines of the German Society of Neurology (DGN) recommend analyzing 13 mandatory and 9 optional laboratory parameters. The mandatory recommendations include antinuclear antibodies (ANA) as well as antibodies against double-stranded DNA (anti-dsDNA Abs)). Methods In a cohort of MS outpatients, those patient records were analyzed in which test results for all or at least some of the recommended laboratory parameters were available. In addition to these laboratory parameters, MRI data, family history, clinical presentation, evoked potentials, and CSF findings were analyzed. Furthermore, a questionnaire was used to prospectively collect information about rheumatological symptoms relevant to the differential diagnosis of MS. Results In 197 of the included 554 patients, at least some of the recommended differential diagnostic laboratory parameters were available. In 59.4% of these patients, ANA titers ≥ 1:80 were detected. Neither ANA nor ANCA nor anti-dsDNA abs were able to distinguish between MS and non-MS. In 124 MS patients, 54.8% had positive ANA titers ≥1:80. MS patients with these titers suffered more frequently from autoimmune diseases and were more likely to have a family history of MS. Of the remaining 73 patients without MS, 67.1% were ANA positive. In this patient population, the ANA-positive patients were more frequently diagnosed with psychiatric diseases. In the prospectively surveyed MS patients with an ANA titer >1:160, no rheumatologic disease was diagnosed during the average follow-up period of 1.9 years. Conclusion In line with the "Choosing Wisely" recommendations of the American College of Rheumatology, mandatory laboratory screening appears to offer no benefit to the initial diagnosis of multiple sclerosis, unless a specific differential diagnosis is to be excluded.

The spectrum of prenatal cortical hyperostosis includes a mild phenotype that typically presents after 35 weeks of gestation, and a severe form that presents earlier. The skeletal and systemic manifestations of the severe phenotype remain unexplained. A review of reported cases indicates that older mothers and firstborn infants are overrepresented. This combination suggests decreased fertility. Fourteen years after the birth of the present case, his mother presented with renal failure from multiple myeloma raising the possibility that a maternal antibody may play a role in the etiology of severe prenatal Caffey disease. The present case report is also intended to alert clinicians to potential difficulties with tracheal intubation secondary to micrognathia from mandibular involvement during a critical growth period.

Recent low-temperature scanning-force-microscopy experiments on narrow Hall bars, under the conditions of the integer quantum Hall effect (IQHE) and its breakdown, have revealed an interesting position dependence of the Hall potential, which changes drastically with the applied magnetic field and the strength of the imposed current through the sample. The present paper shows, that inclusion of Joule heating into an existing self-consistent theory of screening and magneto-transport, which assumes translation invariant Hall bars with a homogeneous background charge due to doping, can explain the experimental results on the breakdown of the IQHE in the so called edge-dominated regime.

This study was supported by the Morris Animal Foundation (grant D09ZO-019), whose mission is to advance the science of animal health, and the NOAA Oceans and Human Health Graduate Traineeship Program. Additional support was provided by the Alaska Fisheries Science Center Marine Mammal Laboratory and the US Fish and Wildlife Service. JAH and MH were supported by UKRI-BBSRC awards BBS/E/I/00007030, BBS/E/I/00007037, BBS/E/I/00007038 and BBS/E/I/00007039. Climate change-driven alterations in Arctic environments can influence habitat availability, species distributions and interactions, and the breeding, foraging, and health of marine mammals. Phocine distemper virus (PDV), which has caused extensive mortality in Atlantic seals, was confirmed in sea otters in the North Pacific Ocean in 2004, raising the question of whether reductions in sea ice could increase contact between Arctic and sub-Arctic marine mammals and lead to viral transmission across the Arctic Ocean. Using data on PDV exposure and infection and animal movement in sympatric seal, sea lion, and sea otter species sampled in the North Pacific Ocean from 2001–2016, we investigated the timing of PDV introduction, risk factors associated with PDV emergence, and patterns of transmission following introduction. We identified widespread exposure to and infection with PDV across the North Pacific Ocean beginning in 2003 with a second peak of PDV exposure and infection in 2009; viral transmission across sympatric marine mammal species; and association of PDV exposure and infection with reductions in Arctic sea ice extent. Peaks of PDV exposure and infection following 2003 may reflect additional viral introductions among the diverse marine mammals in the North Pacific Ocean linked to change in Arctic sea ice extent. Publisher PDF

Background Endurance exercise in general and marathon running in particular have become increasingly popular over the past decades. Recent investigations about personality structures in this cohort and comparisons to non-active cohorts are lacking. Methods In the ReCaP study (Running effects on Cognition and Plasticity), a total of 100 marathon runners and 46 sedentary controls were recruited. After elimination of Minnesota Multiphasic Personality Inventory 2 Restructured Form (MMPI-2-RF) profiles with insufficient validity, 79 marathon runners (MA) and 27 sedentary controls (SC) remained for final analyses. Depressive symptoms were evaluated with Beck Depression Inventory (BDI) and Hamilton Depression Scale (HAMD). Results Marathon runners had lower scores in scales measuring somatic and cognitive complaints, stress, demoralization, hopelessness and distrust. Within the marathon group, committed runners exhibited hypomanic traits compared to regular runners. Discussion and Conclusion Personality differences could be summarized as (sub-)depressive personality traits in SC compared to MA rather than typical (sub-) depressive symptoms in the meaning of depressive disorders. Future studies should further evaluate cause and consequence of endurance training and hypomanic or euthymic symptoms, as a two-way interaction exists. Trial Registration http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00012496.

NOAA Technical Memorandum NMFS-AFSC ; 393

Attention deficit hyperactivity disorder (ADHD) frequently persists into adulthood. A reduction in visual short-term memory (vSTM) storage capacity was recently suggested as a potential neuro-cognitive endophenotype, i.e., a testable marker of an individual's liability for developing ADHD. This study aimed at identifying markers of the brain abnormalities underlying vSTM reductions in adult ADHD. We combined behavioral parameter-based assessment with electrophysiology in groups of adult ADHD patients and healthy age-matched controls. Amplitudes of ERP markers of vSTM storage capacity, the contralateral delay activity (CDA) and the P3b, were analyzed according to (i) differences between individuals with higher vs. lower storage capacity K and (ii) differences between ADHD patients and control participants. We replicated the finding of reduced storage capacity in adult ADHD. Across groups, individuals with higher relative to lower storage capacity showed a larger CDA and P3b. We further found differences between the patient and control groups in the ERPs: The CDA amplitude was attenuated in an early time window for ADHD patients compared to control participants, and was negatively correlated with ADHD patients' symptom severity ratings. Furthermore, the P3b was larger in ADHD patients relative to control participants. These electrophysiological findings indicate altered brain mechanisms underlying visual storage capacity in ADHD, which are characterized by deficient encoding and maintenance, and increased recruitment of control processes. Accordingly, (quantifiable) ERP markers of vSTM in adult ADHD bear candidacy as neuro-cognitive endophenotypes of the disease.

Environmental microplastics are widely documented in marine life and bioaccumulation may present risks to marine predators. Investigations of microplastics in marine mammals are increasing, though none have examined animals routinely consumed by humans. Here, we investigate microplastic exposure in the northern fur seal (Callorhinus ursinus), a species consumed by humans, using fecal material. We examined 44 feces (scat) at sites encompassing the seals' eastern Pacific range. Multiple contamination control measures were implemented, including field and laboratory controls. Fragments were the most common microplastic recovered, in 55% (24/44) of scat and no controls (range 1 to 86 fragments/scat, mean 16.6, sd 19.1). Microplastic fibers were recovered from 41% of scats (18/44), though some controls contained fibers confounding fiber results. Fecal analysis documented northern fur seal exposure to microplastics throughout their eastern Pacific range.

Prior methods evaluating the changes in cerebral arterial blood volume (∆CaBV) assumed that brain blood transport distal to big cerebral arteries can be approximated with a non-pulsatile flow (CFF) model. In this study, a modified ∆CaBV calculation that accounts for pulsatile blood flow forward (PFF) from large cerebral arteries to resistive arterioles was investigated. The aim was to assess cerebral hemodynamic indices estimated by both CFF and PFF models while changing arterial blood carbon dioxide concentration (EtCO2) in healthy volunteers. Continuous recordings of non-invasive arterial blood pressure (ABP), transcranial Doppler blood flow velocity (CBFVa), and EtCO2 were performed in 53 young volunteers at baseline and during both hypo- and hypercapnia. The time constant of the cerebral arterial bed (τ) and critical closing pressure (CrCP) were estimated using mathematical transformations of the pulse waveforms of ABP and CBFVa, and with both pulsatile and non-pulsatile models of ∆CaBV estimation. Results are presented as median values ± interquartile range. Both CrCP and τ gave significantly lower values with the PFF model when compared with the CFF model (p ≪ 0.001 for both). In comparison to normocapnia, both CrCP and τ determined with the PFF model increased during hypocapnia [CrCPPFF (mm Hg): 5.52 ± 8.78 vs. 14.36 ± 14.47, p = 0.00006; τPFF (ms): 47.4 ± 53.9 vs. 72.8 ± 45.7, p = 0.002] and decreased during hypercapnia [CrCPPFF (mm Hg): 5.52 ± 8.78 vs. 2.36 ± 7.05, p = 0.0001; τPFF (ms): 47.4 ± 53.9 vs. 29.0 ± 31.3, p = 0.0003]. When the CFF model was applied, no changes were found for CrCP during hypercapnia or in τ during hypocapnia. Our results suggest that the pulsatile flow forward model better reflects changes in CrCP and in τ induced by controlled alterations in EtCO2.

Model calculations for commensurability oscillations of the low-field magnetoresistance of two-dimensional electron systems (2DES) in lateral superlattices, consisting of unit cells with an internal structure, are compared with recent experiments. The relevant harmonics of the effective modulation potential depend not only on the geometrical structure of the modulated unit cell, but also strongly on the nature of the modulation. While higher harmonics of an electrostatically generated surface modulation are exponentially damped at the position of the 2DES about 90 nm below the surface, no such damping appears for strain-induced modulation generated, e.g., by the deposition of stripes of calixarene resist on the surface before cooling down the sample.

Shame and guilt can be described as 'self-conscious emotions' and are an essential part of the psychopathology in obsessive-compulsive disorder (OCD). Our primary aim was to explore whether individuals with OCD are processing shame and guilt differently from healthy individuals (N = 20 in both groups; 50% female; age: 20-40 years) on the behavioural and neurobiological level. For the experimental task, participants were scanned with functional magnetic resonance tomography (functional magnetic resonance imaging, 3 T) while imagining neutral, shame inducing and guilt inducing scenarios. In addition to clinical questionnaires, participants were asked to complete questionnaires measuring shame and guilt. The functional data indicate an increased activity in OCD patients in the shame condition in the limbic, temporal and sub-lobar (hypothalamus) areas, in the guilt condition inter alia in frontal, limbic and temporal areas. In summary we found activity in OCD patients in neural networks which are responsible for stimulus filtering, emotion regulation, impulse control and memory. The results from our study may contribute to a better understanding of the origins and maintenance of OCD in association with the pathological processing of shame and guilt on different functional levels.

In vitro experiments have suggested that respiratory oscillations (R waves) in cerebral blood flow velocity are reduced as soon as the intracranial pressure–volume reserve is exhausted. Could R waves hence, provide indication for increasing ICP after traumatic brain injury (TBI)? On days 1 to 4 after TBI, 22 sedated and ventilated patients were monitored for intracranial pressure (ICP) in brain parenchyma, Doppler flow velocity (FV) in the middle cerebral arteries (MCA), and arterial blood pressure (ABP). The analysis included the transfer function gains of R waves (respiratory rate of 9–20 cpm) between ABP and FV (GainFv) as well as between ABP and ICP (GainICP). Also, the index of the intracranial pressure–volume reserve (RAP) was calculated. The rise of ICP (day 1: 14.10 ± 6.22 mmHg; to day 4: 29.69 ± 12.35 mmHg) and increase of RAP (day 1: 0.72 ± 0.22; to day 4: 0.85 ± 0.18) were accompanied by a decrease of GainFv (right MCA; day 1: 1.78 ± 1.0; day 4: 0.84 ± 0.47; left MCA day 1: 1.74 ± 1.10; day 4: 0.86 ± 0.46; p < 0.01) but no significant change in GainICP day 1: 1.50 ± 0.77; day 4: 1.15 ± 0.47; p = 0.07). The transfer of ventilatory oscillations to the intracerebral arteries after TBI appears to be dampened by increasing ICP and exhausted intracranial pressure–volume reserves. Results warrant prospective studies of whether respiratory waves in cerebral blood flow velocity may anticipate intracranial hypertension non-invasively.