Search

Background and purpose: We aimed to assess the course and predictors of functional outcome after single and multiple intracerebral hemorrhage (ICH) in pediatric patients with cerebral cavernous malformations (CCMs) and to conduct a risk assessment of a third bleed during the first follow-up year after second ICH. Methods: We included patients aged ≤18 years with complete baseline characteristics, a magnetic resonance imaging dataset, ≥1 CCM-related ICH and ≥1 follow-up examination, who were treated between 2003 and 2021. Neurological functional status was obtained using modified Rankin Scale scores at diagnosis, before and after each ICH, and at last follow-up. Kaplan–Meier analysis was performed to determine the cumulative 1-year risk of third ICH. Results: A total of 55 pediatric patients (median [interquartile range] age 12 [11] years) were analyzed. Univariate analysis identified brainstem cavernous malformation (BSCM; p = 0.019) as a statistically significant predictor for unfavorable outcome after second ICH. Outcome after second ICH was significantly worse in 12 patients (42.9%; p = 0.030) than after first ICH and in five patients (55.6%; p = 0.038) after a third ICH compared to a second ICH. Cumulative 12-month risk of rebleeding during the first year after a second ICH was 10.7% (95% confidence interval 2.8%–29.37%). Conclusions: Pediatric patients with a BSCM have a higher risk of worse outcome after second ICH. Functional outcome improves over time after an ICH but worsens following each ICH compared to baseline or previous ICH. Second bleed was associated with neurological deterioration compared to initial ICH, and this deteriorated further after a third ICH. in press

Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der Schleimhäute von Nase und Nasennebenhöhlen. Eine eosinophile Entzündung wird als häufiger Endotyp beschrieben. Der Anti-IL-5-Antikörper Mepolizumab ist seit November 2021 als Zusatztherapie zu intranasalen Glukokortikosteroiden für die Behandlung Erwachsener mit schwerer chronischer Rhinosinusitis mit Nasenpolypen zugelassen, wenn systemische Glukokortikosteroide oder eine Operation keine ausreichende Krankheitskontrolle bewirken. Während nationale und internationale Empfehlungen für den Einsatz von Mepolizumab bei CRSwNP existieren, ist bislang nicht hinreichend festgelegt worden, wie diese Therapie überwacht wird, welche Folgedokumentation notwendig ist und wann sie ggf. beendet werden sollte. Methoden In einer Literatursuche wurden die bisherigen Daten zur Behandlung der CRSwNP mit Mepolizumab analysiert und die vorhandene Evidenz durch Recherchen in MEDLINE, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library ermittelt. Es wurden Humanstudien berücksichtigt, die im Zeitraum bis einschließlich 10/2022 publiziert wurden. Ergebnis Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen und eventuelle Therapiepausen sowie eine Beendigung der Therapie bei Anwendung von Mepolizumab für die Indikation CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue, nichtoperative Therapieansätze mit Biologika für Patient*innen mit schweren, unkontrollierten Verlaufsformen. Hier geben wir Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen, eventuelle Therapiepausen oder eine Beendigung der Therapie bei einer Mepolizumab-Behandlung als Zusatztherapie mit intranasalen Glukokortikosteroiden zur Behandlung von erwachsenen Patient*innen mit schwerer CRSwNP, die mit systemischen Glukokortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden kann.

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic acts as a recent driver for telework on a global scale. While visual display unit (VDU) workplaces are usually subject to regulatory requirements or occupational health and safety controls, mobile workplaces may increase the risk of developing work-related musculoskeletal complaints (MSCs). OBJECTIVE: This study aimed to explore the influence of work from home (WFH) on musculoskeletal complaints in the context of German municipal administrations. METHODS: This paper is based on an online survey conducted as part of the Health and Digital Change project in cooperation with three municipal administrations in North Rhine-Westphalia, Germany. A multivariate model was constructed to calculate the odds ratio for MSCs including various control variables. RESULTS: While bivariate analysis showed a 0.96-fold risk for employees who work from home, the multivariate model with a split between occasional (OR = 0.79) and frequent (OR = 1.59) WFH revealed a more complex effect. Both odds did not reach the significance level. However, the influence of being female (OR = 3.34) and being overweight (OR = 1.51) was confirmed. Regarding age the OR increases by 1.02 per year of life. Other control variables were the municipal affiliation, university entrance qualification, working hours and feeling overstrained. The regression model improved by 0.07 (McFadden R2) compared to the null model. CONCLUSION: Although WFH is discussed as a rising risk factor for MSCs, the findings in this study indicate, that occasional WFH acts as a rather protective factor against work related MSCs.

Objective Childhood hydrocephalus patients treated by ventriculo-peritoneal (v.-p.) shunting are sometimes referred years after this therapy for evaluation of suspicious pituitary enlargement. Since pituitary size has been shown to depend on cerebrospinal fluid (CSF) pressure, we assume this phenomenon to be caused by shunt overdrainage. Therefore, we studied pituitary size and morphology in shunted hydrocephalus patients with radiological signs of high CSF drainage. Patients and methods Retrospective study of pituitary size and morphology in 15 shunted patients with non-tumoral hydrocephalus and 7 shunted hydrocephalus patients due to childhood brain tumor compared to a population mean. In five brain tumor patients also pre- and postsurgical comparisons were performed. Results Pituitary mid-sagittal size and pituitary volume were significantly higher in both hydrocephalus groups, compared to the population mean (midsagittal size t = 5.91; p 3 vs. 368.9 ± 57.9 mm3 post-surgery). Conclusion Our results confirmed a significant increase in pituitary size and volume, mimicking pituitary pathology, after v.-p. shunt insertion. This phenomenon can be explained by the Monro–Kellie doctrine, stating that intracranial depletion of CSF—as caused by v.p. shunting—leads to compensatory intracranial hyperemia, especially in the venous system, with the consequence of engorged venous sinuses, most likely responsible for enlargement of the pituitary gland.

Small molecule heterojunction nanoparticles based on a phenoxazine photosensitizer and a non-fullerene acceptor ITIC have been developed for photocatalytic hydrogen production.

Many policies target the economic and social consequences of regional inequality. This study experimentally investigates factors explaining the public degree of consent to financial transfers to disadvantaged regions. The main hypothesis of this study is that most people use the deservingness-heuristic not only to judge individuals but also to judge regions. We argue that people advocate interregional transfers based on perceived deservingness determined by recipient region’s need, lack of responsibility for the need, likelihood of reciprocity, and by a shared identity. To support this hypothesis, we conducted a factorial survey in Germany asking respondents to rate transfers to needy regions under different hypothetical conditions. We demonstrate, as predicted by the deservingness hypothesis, that consent to transfers to other regions is positively influenced by the extent of need and, in particular, past effort of the recipient region as well as by a shared identity. The results suggest that regional policies are particularly accepted when they target needs caused by factors beyond the control of recipient regions.

Background and purpose: To assess the impact of posterior fossa pilocytic astrocytoma (PA) removal in pediatric patients, with special focus on postoperative neurological outcome after repeated surgery for tumor remnants. Methods: Our institutional database was screened for patients with PA treated between 2000 and 2019. Patients ≤ 18 years of age with complete clinical records, preoperative contrast enhanced magnetic resonance imaging (MRI) and postoperative follow-up time of ≥ 6 months were suitable for study inclusion. Functional outcome was quantified with the modified Ranking Scale (mRS) score and assessed at admission, at discharge and at every follow-up investigation. Predictors of hydrocephalus, cranial nerve deficits and tumor recurrence were evaluated. Results: A total of 57 pediatric patients with a mean age of 7.7 ± 4.8 years were included in the analysis. 27 (47.3%) children suffered from hydrocephalus at diagnosis, out of which 19 (33.3%) required a subsequent VP-Shunt. 22 (39.3%) patients had a partial resection, of which 9 (40.9%) went through second-look surgery. 2 patients with initially radiological confirmation of complete resection, had a tumor recurrence at FU and needed second-look surgery. Among the children requiring second-look surgery, 7 (63.6%) had a complete resection. Favorable outcome (mRS≤2) after initial and second-look surgery was observed in 52 patients (91.2%). Univariate analysis identified tumor location in the floor of the 4th ventricle (p = 0.030), and repeated surgery for tumor remnant removal (p = 0.043) as predictors for post-operative cranial nerve deficits. Multivariate analysis confirmed this independent association. The incidence of tumor recurrence occurred more often in patients with previous partial resection (p = 0.009) as well as in lesions located in the cerebellar peduncles (p = 0.043). Partial resection remained an independent predictor after multivariate logistic regression analysis (p = 0.045). Conclusions: Incomplete resection of posterior fossa PA is a risk factor for tumor recurrence and repeated surgery to remove tumor remnants increases the risk of new postoperative deficits. Thus, the risk of iatrogenic deterioration due to second look surgery should be implemented in the primary pre- and intraoperative decision-making. CA Santos

With the perspective on applications of AI-technology, especially data intensive deep learning approaches, the need for methods to control and understand such models has been recognized and gave rise to a new research domain labeled explainable artificial intelligence (XAI). In this overview paper we give an interim appraisal of what has been achieved so far and where there are still gaps in the research. We take an interdisciplinary perspective to identify challenges on XAI research and point to open questions with respect to the quality of the explanations regarding faithfulness and consistency of explanations. On the other hand we see a need regarding the interaction between XAI and user to allow for adaptability to specific information needs and explanatory dialog for informed decision making as well as the possibility to correct models and explanations by interaction. This endeavor requires an integrated interdisciplinary perspective and rigorous approaches to empirical evaluation based on psychological, linguistic and even sociological theories.

We focus on examining the impact of machine translation (MT) error rate on adequacy and fluency in machine-translated journalistic texts. German is the source language, with significant polysynthetic features in the formation of composites, and the target language is Slovak, with predominantly inflected features. We analyse twelve error categories, which are incorporated into the categorical framework for the analysis of MT errors and correspond to the four-member core MQM-DQF error typology. The results show that the most significant errors are in the categories of lexical semantics, syntactic-semantic correlativeness and grammar.

Background and purpose: The purpose of this study was to investigate the 5-year risk of a third bleeding event in cavernous malformations (CMs) of the central nervous system. Methods: Patients with cerebral or spinal CMs treated between 2003 and 2021 were screened using our institutional database. Patients with a complete magnetic resonance imaging dataset, clinical baseline characteristics, and history of two bleeding events were included. Patients who underwent surgical CM removal were excluded. Neurological functional status was obtained using the modified Rankin Scale score at the second and third bleeding. Kaplan–Meier and Cox regression analyses were performed to determine the cumulative 5-year risk for a third haemorrhage. Results: Forty-two patients were included. Cox regression analysis adjusted for age and sex did not identify risk factors for a third haemorrhage. 37% of patients experienced neurological deterioration after the third haemorrhage (p = 0.019). The cumulative 5-year risk of a third bleeding was 66.7% (95% confidence interval [CI] 50.4%–80%) for the whole cohort, 65.9% (95% CI 49.3%–79.5%) for patients with bleeding at initial diagnosis, 72.7% (95% CI 39.3%–92.7%) for patients with a developmental venous anomaly, 76.9% (95% CI 55.9%–90.3%) for patients with CM localization to the brainstem and 75% (95% CI 50.6%–90.4%) for patients suffering from familial CM disease. Conclusions: During an untreated 5-year follow-up after a second haemorrhage, a significantly increased risk of a third haemorrhage compared to the known risk of a first and second bleeding event was identified. The third bleeding was significantly associated with neurological deterioration. These findings may justify a surgical treatment after a second bleeding event. in press

OBJECTIVE The objective of this study was to analyze the impact of medication intake on hemorrhage risk in patients with familial cerebral cavernous malformation (FCCM). METHODS The authors’ institutional database was screened for patients with FCCM who had been admitted to their department between 2003 and 2020. Patients with a complete magnetic resonance imaging (MRI) data set, evidence of multiple CCMs, clinical baseline characteristics, and follow-up (FU) examination were included in the study. The authors assessed the influence of medication intake on first or recurrent intracerebral hemorrhage (ICH) using univariate and multivariate logistic regression adjusted for age and sex. The longitudinal cumulative 5-year risk of hemorrhage was calculated by applying Kaplan-Meier and Cox regression analyses adjusted for age and sex. RESULTS Two hundred five patients with FCCMs were included in the study. Multivariate Cox regression analysis revealed ICH as a predictor for recurrent hemorrhage during the 5-year FU. The authors also noted a tendency toward a decreased association with ICH during FU in patients on statin medication (HR 0.22, 95% CI 0.03–1.68, p = 0.143), although the relationship was not statistically significant. No bleeding events were observed in patients on antithrombotic therapy. Kaplan-Meier analysis and log-rank test showed a tendency toward a low risk of ICH during FU in patients on antithrombotic therapy (p = 0.085), as well as those on statin therapy (p = 0.193). The cumulative 5-year risk of bleeding was 22.82% (95% CI 17.33%–29.38%) for the entire cohort, 31.41% (95% CI 23.26%–40.83%) for patients with a history of ICH, 26.54% (95% CI 11.13%–49.7%) for individuals on beta-blocker medication, 6.25% (95% CI 0.33%–32.29%) for patients on statin medication, and 0% (95% CI 0%–30.13%) for patients on antithrombotic medication. CONCLUSIONS ICH at diagnosis was identified as a risk factor for recurrent hemorrhage. Although the relationships were not statistically significant, statin and antithrombotic medication tended to be associated with decreased bleeding events.

The vagal nerve stimulator (VNS) is a nonpharmacological treatment for refractory epilepsy. A side effect of the VNS is sleep-disordered breathing. The purpose of this study was to demonstrate how a surface electrode placed over the VNS lead can help distinguish whether sleep-disordered breathing is due to VNS discharge.Seven pediatric patients (aged 7.7 ± 2.2 years) with a VNS underwent a polysomnogram with an additional surface electrode on the left anterolateral neck to detect VNS discharge. The VNS-associated apnea-hypopnea index was calculated by determining the number of hypopneas and apneas occurring during VNS discharge. We evaluated the veracity of the VNS electrode by comparing signal duration and total number to those expected by programmed settings. We compared these findings to chin electromyogram signal change.Three patients had an obstructive pattern with VNS discharge, and 3 had an increase in respiratory rate without gas exchange abnormalities, including 1 with both patterns; 1 patient experienced no respiratory abnormalities. The mean obstructive apnea-hypopnea index was 8.2 ± 8.3 events/h. The mean VNS-associated apnea-hypopnea index was 4.8 ± 6.2 events/h and accounted for 46.9 ± 30.2% of the total obstructive apnea-hypopnea index. The additional electrode captured a statistically high percentage of expected discharges (94.7 ± 6.5%) compared to chin electromyogram (36.1 ± 35.8%;We demonstrated that a surface electrode on the VNS lead can temporally coregister VNS discharges and enabled us to attribute sleep-disordered breathing to VNS stimulation in 4 patients. We propose that this sensor be standard procedure in patients with VNS undergoing polysomnogram.Chan JHM, DelRosso LM, Ruth C, Wrede JE. A surface electrode adjacent to vagal nerve stimulator lead can aid in characterizing vagal nerve stimulator-mediated pediatric sleep-disordered breathing: a case series of 7 patients.

Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der Schleimhäute von Nase und Nasennebenhöhlen. Eine Typ-2-Inflammation als immunologischer Mechanismus wird als häufigster Endotyp beschrieben. Der Anti-IL-4-/-IL-13-Antikörper Dupilumab ist seit Oktober 2019 als Zusatztherapie zu intranasalen Glukokortikosteroiden für die Behandlung Erwachsener mit schwerer chronischer Rhinosinusitis mit Nasenpolypen zugelassen, wenn systemische Glukokortikosteroide oder eine Operation keine ausreichende Krankheitskontrolle bewirken. Während nationale und internationale Empfehlungen für den Einsatz von Dupilumab bei CRSwNP existieren, ist bislang nicht hinreichend festgelegt worden, wie diese Therapie überwacht und wann sie ggf. beendet werden sollte. Methoden In einer Literatursuche wurden die bisherigen Daten zur Behandlung der CRSwNP mit Dupilumab analysiert und die vorhandene Evidenz durch Recherchen in MEDLINE, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library ermittelt. Es wurden Humanstudien berücksichtigt, die im Zeitraum bis einschließlich 05/2022 publiziert wurden. Ergebnis Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen und eventuelle Therapiepausen sowie eine Beendigung der Therapie bei Anwendung von Dupilumab für die Indikation CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue nichtoperative Therapieansätze mit Biologika für Patienten mit schweren, unkontrollierten Verlaufsformen. Wir geben hier Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen, eventuelle Therapiepausen oder eine Beendigung der Therapie bei einer Dupilumab-Behandlung als Zusatztherapie mit intranasalen Glukokortikosteroiden zur Behandlung von erwachsenen Patienten mit schwerer CRSwNP, die mit systemischen Glukokortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden können.

We analyze the relationship between the party affiliation of politicians at different levels of government and the spatial distribution of funding for research, development and innovation projects. In particular, we are investigating whether more federal grants are being granted in Germany for projects in federal states whose government is led by the same political party as the responsible ministry at federal level. Our dataset contains detailed information on publicly funded projects in Germany in the period 2010–2019. Using a fixed-effects estimation approach, we find a link between grant allocation and party affiliation of funding for research, development and innovation projects, in particular smaller ones. For these projects, political alignment is associated with an average increase in public funding by almost 10,000 euro. Our results suggest that public funds for research, development and innovation projects could be used more efficiently than they are.

Zusammenfassung Hintergrund Die transiente epileptische Amnesie (TEA) ist ein seltenes Phänomen bei Temporallappenepilepsien, das häufig nicht erkannt oder als transiente globale Amnesie (TGA) fehldiagnostiziert wird. Als Ursache werden iktale und postiktale Störungen der Gedächtnisbildung postuliert, was auch durch das Ansprechen auf Antiepileptika gestützt wird. Angesichts der zunehmenden Zahl neu auftretender Epilepsien im höheren Lebensalter ist auch mit einer Zunahme der TEA zu rechnen. Ziel der Arbeit Analyse typischer Merkmale der TEA in einer monozentrischen Fallserie. Material und Methoden Mittels interner Datenbankanalyse wurden unter 7899 Patient*innen über einen Zeitraum von 8 Jahren 10 Patient*innen mit TEA identifiziert. Klinische Merkmale sowie Befunde der Zusatzdiagnostik wurden retrospektiv untersucht. Die Daten sind als Mittelwert ± SD angegeben. Ergebnisse Bei allen 10 Patient*innen wurde die Diagnose einer Temporallappenepilepsie gestellt. Das Lebensalter bei Erstmanifestation der TEA lag bei 59,1 ± 6,7 Jahren, die Diagnose wurde mit einer Latenz von 21,9 ± 26,3 Monaten gestellt. Eine TEA-Episode dauerte 56 ± 37 min an und trat pro Jahr 16 ± 9,9-mal auf; 6 von 10 Patient*innen berichteten über häufiges Auftreten direkt nach dem Erwachen. Bei 9 von 10 Patient*innen wurde über weitere Anfallstypen bzw. weitere semiologische Elemente während der TEA berichtet. Hinweise auf neuropsychologische Störungen temporaler Funktionen ergaben sich bei 8 von 10 Patient*innen, Hinweise auf eine depressive Störung bei 6 von 10 Patient*innen. Im Schlaf aktivierte epilepsietypische Aktivität wurde bei 4 Patient*innen temporal links sowie bei 2 Patient*innen temporal beidseits nachgewiesen. Bei 3 Patient*innen wurden mittels Kernspintomographie typische Auffälligkeiten im Bereich der temporomesialen Strukturen (bei 2 links, bei 1 rechts) nachgewiesen. Eine antiepileptische Therapie verbesserte die Anfallskontrolle bei 7 von 10 Patient*innen (Anfallsfreiheit bei 6 Patienten), bei 3 Patienten ist die therapeutische Wirkung unbekannt. Diskussion TEA sind selten, treten im höheren Erwachsenenalter auf und werden erst nach etwa 2 Jahren korrekt als epileptisches Phänomen diagnostiziert. Die gründliche Erfassung von Begleitsymptomen, die Umstände und das rezidivierende Auftreten sowie Hinweise auf eine Temporallappenepilepsie in den apparativen Zusatzuntersuchungen ermöglichen die Differenzierung zur TGA.

Background and purpose: Data on the temporal distribution of the bleeding time of intracranial aneurysms are limited to a few small studies. With this study, the aim was to analyze time patterns of the occurrence of aneurysmal subarachnoid hemorrhage (SAH), particularly focusing on the impact of patients' socio-demographic and clinical characteristics on the ictus timing. Methods: The study is based on an institutional SAH cohort with 782 consecutive cases treated between January 2003 and June 2016. Data were collected on the ictus time, patients' socio-demographic and clinical characteristics, as well as the initial severity and outcome. Univariate and multivariate analyses were performed on the bleeding timeline. Results: There were two peaks in the circadian rhythm of SAH, one in the morning (7–9 a.m.) and the other in the evening (7–9 p.m.). The strongest alterations in the bleeding time patterns were observed for weekdays, patients' age, sex and ethnicity. Individuals with chronic alcohol and painkiller consumption showed a higher bleeding peak between 1 and 3 p.m. Finally, the bleeding time showed no impact on the severity, clinically relevant complications and the outcome of SAH patients. Conclusions: This study is one of the very few detailed analyses of the impact of specific socio-demographic, ethnic, behavioral and clinical characteristics on the rupture timing of aneurysms. Our results point to the possible relevance of the circadian rhythm for the rupture event, and therefore might be useful in the elaboration of preventive measures against aneurysm rupture.

Tutkimme Suomessa asuvien ikääntyvien venäjänkielisten ylirajaista terveyspalvelujen käyttöä ja käytön syitä. Analysoimme vuonna 2019 kerättyä CHARM-kyselyaineistoa ja syvennämme tuloksia haastatteluaineiston temaattisen analyysin avulla. Lähes 30 prosenttia yli 50-vuotiaista Suomessa asuvista venäjänkielisistä oli käynyt kyselyä edeltävän vuoden aikana Suomen ulkopuolella lääkärissä. Ulkomailla lääkärissä käynti oli yleisempää naisilla, työttömillä, korkeasti koulutetuilla sekä vastaajilla, joiden kotitalouden nettotulot olivat yli 2 500 euroa kuukaudessa. Kansalaisuus jossain muussa maassa kuin Suomessa lisäsi käytön todennäköisyyttä ja pidempi asumisaika Suomessa puolestaan vähensi sitä. Eläminen kroonisen sairauden kanssa sekä täyttämätön hoidontarve olivat yhteydessä ylirajaiseen palveluiden käyttöön. Kyselyaineistossa tärkeimmiksi syiksi palveluiden ylirajaiselle käytölle nousivat halvempi hinta, nopeampi hoitoon pääsy ja omankieliset palvelut. Haastatteluaineistossa esiintyivät nämä samat syyt, mutta esiin nousivat myös koetut pettymykset suomalaisessa terveydenhuollossa. Tulokset osoittavat, että ikääntyvät venäjänkieliset kohtaavat monenlaisia esteitä hoitoon pääsylle ja toimivalle hoidolle Suomessa. Sivuutetuksi tulemisen kokemukset ja väärinymmärrykset voivat johtaa avun hakemiseen Suomen ulkopuolelta. Terveyspalvelujen laatua ja saavutettavuutta tulisi kehittää vastaamaan moninaistuvan ikääntyvän väestön tarpeita. In this article, we examine the transnational use of health services and the reasons given for their use by older Russian-speaking migrants living in Finland. We analyse the CHARM survey data collected in 2019, and elaborate the results with thematic analysis of the interview data. Almost 30 per cent of Russian-speakers over the age of 50 living in Finland had seen a doctor outside Finland in the year before the survey. Visiting a doctor abroad was more common among women, the unemployed, the highly educated and respondents with a net household income of more than 2,500 euros per month. Having citizenship in a country other than Finland increased the likelihood of use and having a longer period of residence in Finland reduced it. People living with a chronic illness and those who had an unmet need for care used more health services abroad. In the survey data, the main reasons for the cross-border use of services were cheaper prices, faster access to treatment and the delivery of services in one’s own language. These same reasons appeared in the interview material, but the interviewees also mentioned perceived disappointments with Finnish health care. The results show that older Russian-speakers face a variety of barriers to accessing and navigating care in Finland. Experiences of misunderstanding and of being ignored can lead to seeking help from outside Finland. The quality and accessibility of health services should be developed to meet the needs of a diversifying ageing population.

Background Storage mites are frequently found in our daily environment. Nevertheless, storage mite allergy is often neglected in allergological diagnostics and possible allergies requiring therapy are thus overlooked. Methods Recommendations for action are made based on a literature review from March 2021 to August 2021 in PubMed, Medline, and GoogleScholar. Results This review article provides an overview of the species of storage mites, sensitization rates in different countries and occupations, and co-sensitization rates to house dust mite. Recommendations for diagnosis as well as therapy are given. The importance of provocation testing as well as causal therapy by allergen immunotherapy (AIT) is presented. Conclusion The position paper gives recommendations for the diagnosis and therapy of allergic rhinitis in case of storage mite allergy. AIT is recommended in symptomatic allergy and proven storage mite allergy. Reliable detection by provocation testing is advised in this persistent allergy. The therapy should be carried out independently of the treatment of a possible house dust mite allergy.

Objectives Previously, based on 6 months of follow-up, we showed that HPV self-sampling improved participation in cervical screening compared to a reminder letter for Pap testing for never- and under-screened women. Here, we report follow-up and related screening outcomes for women who participated in the initial self-sampling over two screening rounds. Setting The randomised controlled trial was conducted in Australia. Methods Never- and under-screened women were randomly allocated to the HPV self-sampling or the reminder for Pap test arm and followed at 6 and 36 months since the kits were first mailed. Results The first round of HPV self-sampling kits were mailed from May–July 2014 to 12 572 women. After 36 months, 19% of never-screened and 9% of under-screened women returned a kit for HPV testing; 2.7% were HPV 16/18 and 5.8% non-16/18 HPV positive. Compliance with first round follow-up was 84% (95% CI: 77.1–89.5%). Non-compliant and cytology triage negative women were mailed another kit at 12 months. Compliance at 12-month follow-up was 59.3% (49.4 to 68.6%). Of 37 women with a 12-month repeat HPV, 70% were positive. Of women who tested negative for HPV in the first round (n = 1573), 25% attended regular screening in the next round and none had CIN2 + detected. The overall prevalence of CIN2 + was 8.5 per 1000 screened (4.8 to 13.9 per 1000). Conclusion While self-sampling can successfully engage women, compliance with repeat testing may require monitoring. The clinician-supported self-collection pathway now in use in Australia will likely improve women's engagement with follow-up.

Purpose We aimed to investigate treatment effect of endovascular thrombectomy (EVT) on the change of National Institutes of Health Stroke Scale (NIHSS) scores in acute ischemic stroke (AIS) patients with anterior large vessel occlusion (LVO). Predictors of early neurological improvement (ENI) were assessed in those with successful reperfusion. Methods Data on stroke patients from January 2018 to December 2020 were retrospectively analyzed. Anterior LVO was defined as occlusion of internal carotid artery and/or M1/M2 branch of middle cerebral artery. A reduction of at least 8 NIHSS points at 24 h after EVT or NIHSS score ≤ 1 at discharge was defined as ENI. In patients with successful reperfusion (TICI score of 2b/3) and available CT perfusion (CTP) imaging, 20 variables were tested in a smoothed ridge regression for their association with ENI. Results One hundred seventy two out of 211 patients had successful perfusion with 54 patients achieving ENI. Impact of successful EVT on reducing NIHSS score grew continuously on a daily basis up to the date of discharge. 105 out of 172 patients were included in final regression model. Short time from onset to admission and from groin-puncture to reperfusion, young age, low prestroke disability, high baseline CTP ASPECTS and high follow-up non-contrast CT (NCCT) ASPECTS were significantly associated with ENI. Neither baseline NCCT ASPECTS nor the volume of penumbra or ischemic core measured on CTP were associated with ENI. Conclusion CTP ASPECTS might better predict ENI than non-contrast CT at baseline in patients with successful reperfusion following EVT.

Background and Purpose: The purpose of this study was to investigate the natural course of cerebral cavernous malformations (CCM) in the pediatric population, with special emphasis on the risk of first and recurrent bleeding over a 5-year period. Methods: Our institutional database was screened for patients with CCM treated between 2003 and 2020. Patients ≤18 years of age with complete magnetic resonance imaging data set, clinical baseline characteristics, and ≥1 follow-up examination were included. Surgically treated individuals were censored after CCM removal. We assessed the impact of various parameters on first or recurrent intracerebral hemorrhage (ICH) at diagnosis using univariate and multivariate logistic regression adjusted for age and sex. Kaplan-Meier and Cox regression analyses were performed to determine the cumulative 5-year risk for (re)hemorrhage. Results: One hundred twenty-nine pediatric patients with CCM were analyzed. Univariate logistic regression identified brain stem CCM (odds ratio, 3.15 [95% CI, 1.15−8.63]; P =0.026) and familial history of CCM (odds ratio, 2.47 [95% CI, 1.04−5.86]; P =0.041) as statistically significant predictors of ICH at diagnosis. Multivariate logistic regression confirmed this correlation (odds ratio, 3.62 [95% CI, 1.18−8.99]; P =0.022 and odds ratio, 2.53 [95% CI, 1.07−5.98]; P =0.035, respectively). Cox regression analysis identified ICH as mode of presentation (hazard ratio, 14.01 [95% CI, 1.80−110.39]; P =0.012) as an independent predictor for rehemorrhage during the 5-year follow-up. The cumulative 5-year risk of (re)bleeding was 15.9% (95% CI, 10.2%−23.6%) for the entire cohort, 30.2% (20.2%−42.3%) for pediatric patients with ICH at diagnosis, and 29.5% (95% CI, 13.9%−51.1%) for children with brain stem CCM. Conclusions: Pediatric patients with brain stem CCM and familial history of CCM have a higher risk of ICH as mode of presentation. During untreated 5-year follow-up, they revealed a similar risk of (re)hemorrhage compared to adult patients. The probability of (re)bleeding increases over time, especially in cases with ICH at presentation or brain stem localization.

Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der paranasalen Schleimhäute, der als häufigstem Endotyp eine eosinophile Inflammation zugrunde liegt. Der Anti-IL-5-Antikörper Mepolizumab wurde im November 2021 für die Therapie der schweren CRSwNP zugelassen. Methoden In einer Literatursuche wurde die Immunologie der CRSwNP analysiert und die vorhandene Evidenz ermittelt durch Recherchen in Medline, PubMed sowie den nationalen und internationalen Studien- und Leitlinien-Registern und der Cochrane Library. Es wurden Humanstudien berücksichtigt, die bis einschließlich 12/2021 publiziert wurden und in denen die Wirkung von Mepolizumab bei CRSwNP untersucht wurde. Ergebnis Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Anwendung von Mepolizumab bei CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue nichtoperative Therapieansätze mit Biologika für Patienten mit schweren Verlaufsformen. Mepolizumab ist seit November 2021 zugelassen zur Zusatztherapie mit intranasalen Kortikosteroiden zur Behandlung von erwachsenen Patienten mit schwerer CRSwNP, die mit systemischen Kortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden können.

in press Background and Purpose Analyze and compare the natural course of confirmed familial cerebral cavernous malformation (FCCM), assumed FCCM and non-familial multiple cerebral cavernous malformation (CCM) disease over a 5-year period. Methods Our institutional database was screened for patients with CCM admitted between 2003 and 2020. Patients with complete magnetic resonance imaging dataset, evidence of multiple CCM, clinical baseline characteristics, and follow-up examination were included. Patients were separated into confirmed familial cases, assumed familial cases or non-familial multiple cavernous malformations. Kaplan-Meier and Cox regression analyses were performed to determine the cumulative 5-year risk for hemorrhage and recurrent hemorrhage. Results A total of 238 patients with multiple CCM were analyzed; 90 individuals had a confirmed FCCM disease, 115 an assumed FCCM, and 33 were allocated to the non-FCCM group. Univariate Cox regression analysis identified intracerebral hemorrhage (ICH) as mode of presentation (p = 0.001) as a predictor for occurrence of recurrent hemorrhage during the 5-year follow-up (FU). The cumulative 5-year risk of (re)bleeding was 21.6% for the entire cohort, 30.7% for patients with ICH at diagnosis, 22.1% for those patients with a confirmed diagnosis of FCCM, 23.5% for those with an assumed FCCM, and 21% for the non-FCCM cases. Conclusions FCCM patients with ICH at diagnosis are prone to develop rebleeding. During untreated 5-year FU, FCCM patients and patients with sporadic multiple CCM reveal an almost equal susceptibility for (re)hemorrhage. Moreover, confirmed, assumed and non-FCCM patients showed an equal cumulative 5-year risk of symptomatic ICH. The probability of hemorrhage tends to increase over time, particularly in cases with ICH at presentation.

A 42-year-old female patient with epilepsy and a co-morbid migraine suffered from the severe cognitive side effects of topiramate (TPM) for more than 16 years with detrimental consequences for her daily functioning, career, and social interaction. Even a prodromal stage of dementia was suggested, giving rise to fears of developing a neurodegenerative disease. Recently, cognitive monitoring of attention and executive function before and after withdrawal of TPM revealed a significant recovery from the severe negative cognitive side effects of the long-standing and inefficacious antiseizure medication (ASM). Whereas the side effects were reversible after cessation, their consequences for the patient`s biography were permanent. A considerable increase in quality of life, however, was observed without TPM and family members were impressed by the improvements. This case illustrates the potentially severe consequences of negative cognitive side effects which affect daily functioning, career and social life, thus underscoring the importance of being knowledgeable of the potential cognitive risks when prescribing an ASM. Because cognitive side effects may not depend solely on ASM choice and drug load, but also on individual idiosyncratic intolerances, and patients might stay on their treatment for many years, cognitive monitoring is highly recommended.

The pathogenesis of choroid plexus papillomas, intraventricular papillary neoplasms most often occurring sporadically in children and young adults, remains poorly understood. To identify pathways operative in the development of choroid plexus papillomas, gene expression profiles obtained from laser-microdissected human choroid plexus papilloma cells (n = 7) were compared with that of normal choroid plexus epithelial cells laser microdissected from autopsy tissue (n = 8). On DNA microarray data analysis, 53 probe sets were differentially expressed in choroid plexus papilloma tumor cells (>7-fold). Up-regulation of TWIST1, WIF1, TRPM3, BCLAF1, and AJAP1, as well as down-regulation of IL6ST was confirmed using quantitative reverse transcription-PCR. Knockdown of Twist1 gene expression in the rat choroid plexus epithelial cell line Z310 significantly reduced proliferation as assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and cell invasion in a Matrigel assay, whereas cell migration was not affected. Screening for expressional changes of cancer-related genes upon Twist1 knockdown revealed up-regulation of Cdkn1a, Cflar, and Serpinb2 and down-regulation of Figf. To conclude, using gene expression profiling, several genes differentially expressed in human choroid plexus papillomas could be identified. Among those, TWIST1 is highly expressed in choroid plexus papillomas and promotes proliferation and invasion. [Cancer Res 2009;69(6):2219–23]

Supplementary Table 1 from TWIST-1 Is Overexpressed in Neoplastic Choroid Plexus Epithelial Cells and Promotes Proliferation and Invasion

Within the pulmonary acini ventilation and blood perfusion are brought together on a huge surface area separated by a very thin blood-gas barrier of tissue components to allow efficient gas exchange. During ventilation pulmonary acini are cyclically subjected to deformations which become manifest in changes of the dimensions of both alveolar and ductal airspaces as well as the interalveolar septa, composed of a dense capillary network and the delicate tissue layer forming the blood-gas barrier. These ventilation-related changes are referred to as micromechanics. In lung diseases, abnormalities in acinar micromechanics can be linked with injurious stresses and strains acting on the blood-gas barrier. The mechanisms by which interalveolar septa and the blood-gas barrier adapt to an increase in alveolar volume have been suggested to include unfolding, stretching, or changes in shape other than stretching and unfolding. Folding results in the formation of pleats in which alveolar epithelium is not exposed to air and parts of the blood-gas barrier are folded on each other. The opening of a collapsed alveolus (recruitment) can be considered as an extreme variant of septal wall unfolding. Alveolar recruitment can be detected with imaging techniques which achieve light microscopic resolution. Unfolding of pleats and stretching of the blood-gas barrier, however, require electron microscopic resolution to identify the basement membrane. While stretching results in an increase of the area of the basement membrane, unfolding of pleats and shape changes do not. Real time visualization of these processes, however, is currently not possible. In this review we provide an overview of septal wall micromechanics with focus on unfolding/folding as well as stretching. At the same time we provide a state-of-the-art design-based stereology methodology to quantify microarchitecture of alveoli and interalveolar septa based on different imaging techniques and design-based stereology.

ObjectiveEvaluation of the antiseizure efficacy, side effects and neuropsychological effects of Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT). ANT-DBS is a treatment option for patients with difficult-to-treat epilepsy. Though several works outline the cognitive and/or mood effects of ANT-DBS for the treatment of epilepsy, data on the intersection between antiseizure efficacy, cognitive and undesired effects are scarce.MethodsWe retrospectively analyzed the data of our cohort of 13 patients. Post-implantation seizure frequencies were measured at 6 months, 12 months and last follow-up, as well as averaged throughout follow-up. These values were then compared with mean seizure frequencies in the 6 months before implantation. To address acute cognitive effects of DBS a baseline assessment was performed after implantation and before stimulation, and a follow-up assessment was conducted under DBS. The long-term effects of DBS on cognition were assessed by comparing the preoperative neuropsychological profile with a long-term follow-up under DBS.ResultsIn the entire cohort, 54.5% of patients were responders, with an average seizure reduction of 73.6%. One of these patients achieved temporary seizure freedom and near-total seizure reduction during the entire follow-up. Seizure reduction of SignificanceIn our cohort, more than half of patients were responders. Psychiatric side effects seem to have been more prevalent compared to other published cohorts. This may be partially explained by a relatively high occurrence of off-target electrodes.

PurposeMultimodal endovascular therapy (EVT) of carotid cavernous fistula (CCF) with different approaches and a variety of available embolization material enable high occlusion rates with good clinical and functional outcome but until now there is still little evidence available. This retrospective single-center study aims to evaluate EVT of CCF with different neuroendovascular techniques regarding occlusion rates, complications and outcomes.Materials and methodsFrom 2001 to 2021 59 patients with CCF were treated at our tertiary university hospital. Patient records and all imaging data including angiograms were reviewed for demographic and epidemiological data, symptoms, fistula type, number of EVTs, complications of EVT, type of embolic materials, occlusion rates and recurrences.ResultsEtiology of the CCF were spontaneous (41/59, 69.5%) post-traumatic (13/59, 22%) and ruptured cavernous aneurysms (5/59, 8.5%). Endovascular therapy was completed in one session in 74.6% (44/59). Transvenous access was most frequent (55.9% 33/59) followed by transarterial catheterization in 33.9% (20/59) and a combination of both (6/59, 10.2%). Exclusively coils were used in 45.8% (27/59), a combination of ethylene vinyl alcohol (EVOH) copolymer (Onyx) and coils in 42.4% (25/59). Complete obliteration was achieved in 96.6% of patients (57/59) with an intraprocedural-related complication rate of 5.1% (3/59) and no mortality.ConclusionEndovascular therapy of CCF has been shown to be safe and effective with high cure rates and low rates of intraprocedural complications and morbidity even in complex scenarios.