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Objective: To investigate the efficacy of transcranial direct (tDCS) or alternating current stimulation (tACS) in boosting cognitive training efficiency in healthy older adults. We further explored whether such improvements depend on general cognitive performance or age., Methods: In this randomized, sham-controlled study, 59 healthy elderly participants (mean age 71.7) were assigned to receive computer-based cognitive training (10 sessions, 50 min, twice weekly) combined with tDCS (2 mA), tACS (5 Hz), or sham stimulation over the left dorsolateral prefrontal cortex (20 minutes). Cognitive performance was assessed with the Montreal Cognitive Assessment (MoCA), and a cognitive composite score derived from a broad neuropsychological test battery before and immediately after the intervention as well as at 6 and 12 months follow-ups., Results: Performance in the cognitive composite score improved significantly in all groups but was not further modulated by neurostimulation. Additional analyses revealed that participants with a low initial MoCA score (<1SD) improved significantly more in the tDCS than in the sham group., Conclusion: TDCS increased the efficacy of cognitive training, but only in participants with initially low general cognitive performance., Significance: Cognitive interventions including tDCS should address baseline performance as modulating factor of cognitive outcomes., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Computed tomography (CT) scans of gunshot wounds and their high sensitivity in detecting osseous lesions has often been reported in the literature. However, studies concerning in situ examinations of lodged projectiles with CT to determine the ammunition used are lacking. Projectile visualizations are hampered in standard CT due to the presence of metal artifacts and the limited range of Hounsfield units (HU). The use of special reconstruction algorithms can overcome these limitations. For instance, using extended CT scale (ECTS) reconstruction supports detailed visualizations of metallic objects. In addition to projectile visualizations, X-ray attenuation measurements (CT numbers) of metallic objects can be used to differentiate materials in CT. This study uses real forensic cases to demonstrate that-depending on the degree of deformation-a detailed visualization of lodged projectiles using ECTS can provide useful information regarding the ammunition used and allows accurate caliber measurements. Independent from the degree of deformation, the in situ classification of bullets, even fragmented bullets, according to their metallic components is feasible by dual-energy index (DEI) calculations. The assessment of a lodged projectile with CT images provides useful information on the case; thus, a close examination of lodged projectiles or bullet fragments should be a part of the overall radiological examination for cases of penetrating gunshot wounds., Competing Interests: Declaration of competing interest The authors have no financial conflicts of interest to disclose., (Copyright © 2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

The aim of this study was to compare three gunshot residue (GSR) collection methods used in conjunction with chemographic detection applied by different regional Swiss police services. The specimens were collected from the hands of a shooter with either filter paper (Filter method) or adhesive foil. The adhesive foil was then either applied against photographic paper during visualisation (AF Photo method) or coated with a layer of polyvinyl alcohol (AF PVAL method). The experiments involved two conditions of the examined hands, i.e. dry and humidified. The residues were revealed using the sodium rhodizonate test (SRT). Preliminary tests assessing the possibility of conducting a confirmatory Scanning Electron Microscopy coupled to Energy Dispersive X-ray spectroscopy (SEM/EDX) analysis after the chemographic test were performed on a number of specimens by cutting positive spots and mounting them on stubs. Obtained results were compared in terms of effectiveness - number of positive spots, time requirements, quality of subsequent SEM-EDX analysis, ease of use and cost. The Filter method generally yielded a high-quality detection with both dry and humidified hands, as well as a simple, quick and efficient confirmation by SEM/EDX. The AF Photo performed well on dry hands, but not on humidified hands. The AF PVAL method performance was lower compared to the other methods in both examined conditions of the hands. The SEM/EDX analysis showed that the Filter and AF PVAL method provided satisfactory results when a sufficient carbon coating thickness was applied to the cuttings. It was also observed that the thinner the PVAL layer, the better the quality of the spectra and obtained images in SEM/EDX. Furthermore, the surface of the photographic paper did not seem to be conductive, even after the application of a thick layer of carbon. In conclusion, the Filter method gave the best overall results, but its application required slightly more time and expertise than the two other methods., (Copyright © 2019 The Chartered Society of Forensic Sciences. Published by Elsevier B.V. All rights reserved.)

Objective: Our purpose was twofold: to determine the distribution of the endogenous photosensitizer protoporphyrin IX in the uterus and to ascertain the time interval leading to maximal endometrial fluorescence after intrauterine instillation of 5-aminolevulinic acid., Study Design: One milliliter of a 400 mg/ml 5-aminolevulinic acid-Hyskon solution was instilled into the uterine cavity of 27 women before hysterectomy. On frozen sections of uterine samples 5-aminolevulinic acid-induced fluorescence was measured with fluorescence microscopy., Results: 5-Aminolevulinic acid-induced fluorescence could first be detected in the superficial endometrial glands 75 minutes after drug injection. In the endometrial gland stumps fluorescence intensity peaked 4 to 8 hours after 5-aminolevulinic acid instillation and was > 48 times higher than in the underlying myometrium., Conclusions: Fluorescence in the endometrial glands suggests that selective photodynamic destruction of the endometrium may be possible 4 to 8 hours after intrauterine 5-aminolevulinic acid instillation.

The aim of this study was to evaluate 5-Aminolevulinic acid (ALA)-induced fluorescence of normal and neoplastic endometrial epithelial cells for diagnosis and photodynamic treatment. Fluorescence of ALA-induced PpIX in vitro was measured by flow cytometry in two different human endometrial adenocarcinoma cell lines and in normal cells cultivated from fresh endometrial tissue of three premenopausal patients. The cells were analysed after incubation with different concentrations of ALA during 3, 6, or 24 hours. Both tumor cell lines showed a statistically significant higher fluorescence of PpIX than normal epithelial cells after incubation with 1 mg ALA per ml medium during 24 hours. The well-differentiated cancer cells produced significantly more PpIX than the poorly differentiated cancer cells. Relative PpIX intensity of the two cancer cell lines correlated with cell proliferation rate as measured by the doubling times of the cells. Higher accumulation of Pp IX in neoplastic endometrium compared to normal endometrial epithelial cells may provide targeted biopsies and selective photodynamic destruction of neoplastic micro-lesions.

Pimozide is a diphenylpiperidine neuroleptic with well characterized cardiovascular side effects including QT prolongation. So far, life-threatening cardiac arrhythmias, in particular torsades de pointes, have not been described in patients treated with pimozide. The authors describe a patient in whom torsades de pointes developed after the ingestion of 800 mg pimozide as a suicide attempt. After intravenous treatment with lidocaine and magnesium, the patient recovered completely and the QT interval had normalized 5 days after the intoxication. Potential mechanisms leading to torsades de pointes in patients treated with pimozide are discussed.

Objective: The goal of this study was to determine the optimal parameters for photodynamic endometrial destruction with topically applied 5-aminolevulinic acid, a precursor for the endogenous synthesis of the fluorescent photosensitizer protoporphyrin IX., Study Design: 5-Aminolevulinic acid pharmacokinetics were measured in rat and rabbit models by analyzing tissue frozen sections 3 to 12 hours after topical administration. Dose-response studies were conducted for 100 to 400 mg/ml 5-aminolevulinic acid. Photodynamic therapy was performed intraluminally, and tissue morphologic features were evaluated 3 and 7 days after treatment., Results: Peak fluorescence was observed 3 hours after topical administration. Glandular fluorescence significantly exceeded stromal and myometrial in all studies, particularly for 200 mg/ml 5-aminolevulinic acid. Histologic studies revealed persistent epithelial destruction with minimal regeneration., Conclusion: Topical 5-aminolevulinic acid photodynamic therapy can be used for highly effective, long-lasting destruction of endometrial epithelium. However, optical dosimetry can vary, particularly in the rabbit model, and this appears to have an impact on long-term reepithelialization.

Prompted by a report of Hrushesky et al. stating that women operated upon for breast cancer during their perimenstrual period showed a higher risk for developing future metastases than women operated upon during their mid-cycle, we examined the patients with breast carcinoma who were treated at the Gynaecological University Hospital Zürich between 1971 and 1988 with respect to the influence of menstrual cycle phase on certain factors. 104 patients underwent perimenstrual surgery, i.e., between days 1 and 6 or days 21 and 36 of the cycle. 120 women had mid-cycle surgery (i.e., days 7-20 of the cycle). In contrast to the experience of Hrushesky et al., we found no significant differences in the survival curves. The same was true when the proliferative phase (days 1-14; n = 109) was compared with the secretory phase (days 15-32; n = 108). We tested the different groups for homogeneity and found that 54% of the patients with perimenstrual surgery showed axillary lymph node involvement, whereas in the midcyclic group only 38% showed positive nodes. We have no plausible explanation for this difference. These findings indicate that there might be certain cycle-related differences with respect to lymph node status but that they do not affect survival. Hence, timing surgery to the menstrual cycle is not mandatory for the time being.