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1.
J Prev Alzheimers Dis ; 11(3): 537-548, 2024.
Article in English | MEDLINE | ID: mdl-38706270

ABSTRACT

BACKGROUND: Monoclonal antibodies that target amyloid-beta and remove amyloid plaques can slow cognitive and functional decline in early Alzheimer's disease. Gantenerumab is a subcutaneously administered fully-human anti-amyloid-beta monoclonal antibody with highest affinity for aggregated amyloid-beta. Since the phase 3 GRADUATE trials did not meet the primary endpoint (change from baseline to Week 116 in Clinical Dementia Rating scale - Sum of Boxes), development of gantenerumab in sporadic Alzheimer's disease was stopped and all ongoing trials were terminated early due to sponsor decision. Subcutaneous administration at the clinic or at home by care partner would be an important option for other therapies in this class in order to increase flexibility and reduce overall burden. The insights obtained from the experience with gantenerumab home administration by care partner in the phase 2 GRADUATION trial will serve to guide the ongoing efforts with other anti-amyloid-beta antibodies. OBJECTIVES: To evaluate the pharmacodynamic effects on brain amyloid load of once weekly subcutaneous administration of gantenerumab and the safety and feasibility of home administration by care partners. DESIGN: Phase 2, open-label, single arm study. SETTING: Multicenter trial conducted in 33 sites in 8 countries from November 2020 to March 2023. PARTICIPANTS: Participants aged 50 to 90 with early symptomatic Alzheimer's disease (mild cognitive impairment/mild dementia due to Alzheimer's disease), and evidence of amyloid positron emission tomography positivity. INTERVENTION: Participants could receive up to 255 mg gantenerumab once-weekly, administered subcutaneously at site or at home by healthcare professionals or non-healthcare-professional care partners. MEASUREMENTS: The primary endpoint was the change from baseline to Week 52 and to Week 104 in brain amyloid load as measured by PET centiloid levels. The secondary endpoints were responses to the home administration questionnaire, plasma concentrations and safety. RESULTS: The overall number of participants enrolled was 192, with a mean (standard deviation) amyloid PET load at baseline of 101.80 (29.80) centiloids. At the time of early study termination by sponsor, 149 participants had valid Week 52 amyloid PET data (primary endpoint), and 12 participants had an early termination PET within the pre-defined time range of Week 104. The mean change in amyloid PET from baseline to Week 52 and Week 104 was -26.19 centiloids (range: -75.6-15.8; n=149) and -35.48 centiloids (range: -63.2--7.0; n=12), respectively. Responses to the home administration questionnaire at Week 52 (n=148) indicated that the majority of care partners (88-97%) considered administration of study drug at home easy (30.4%) or very easy (57.4%), and convenient (25.7%) or very convenient (70.9%). Care partners felt confident (31.1%) or very confident (62.2%) and satisfied (29.7%) or very satisfied (64.9%) with giving the injection at home. Responses by care partners at Week 36 (n=72), Week 76 (n=126) and Week 104 (n=29) and participant (patient) assessment of convenience and satisfaction at these time points were similar. There were no new safety findings associated with gantenerumab administered subcutaneously once weekly at 255 mg or safety issues associated with at-home injections by non-healthcare professional care partners. CONCLUSIONS: Once-weekly subcutaneous home administration of the anti-amyloid-beta antibody gantenerumab by non-healthcare-professional care partners to participants with early Alzheimer's disease was feasible, safe, well tolerated, and considered as a convenient option by both the care partners and participants with Alzheimer's disease. Although gantenerumab's development has been stopped due to lack of efficacy, this approach has the potential to reduce the frequency of hospital/outpatient clinic visits required for treatment with other anti-amyloid-ß antibodies and can increase flexibility of drug administration for people living with Alzheimer's disease and their families.


Subject(s)
Alzheimer Disease , Antibodies, Monoclonal, Humanized , Feasibility Studies , Humans , Alzheimer Disease/drug therapy , Antibodies, Monoclonal, Humanized/administration & dosage , Antibodies, Monoclonal, Humanized/therapeutic use , Aged , Female , Male , Caregivers , Positron-Emission Tomography , Amyloid beta-Peptides/metabolism , Injections, Subcutaneous , Brain/drug effects , Brain/metabolism , Brain/diagnostic imaging , Middle Aged , Aged, 80 and over
2.
J Prev Alzheimers Dis ; 8(1): 3-6, 2021.
Article in English | MEDLINE | ID: mdl-33336218

ABSTRACT

Previous findings from the positron emission tomography (PET) substudy of the SCarlet RoAD and Marguerite RoAD open-label extension (OLE) showed gantenerumab doses up to 1200 mg every 4 weeks administered subcutaneously resulted in robust beta-amyloid (Aß) plaque removal over 24 months in people with prodromal-to-moderate Alzheimer's disease (AD). In this 36-month update, we demonstrate continued reduction, with mean (standard error) centiloid values at 36 months of -4.3 (7.5), 0.8 (6.7), and 4.7 (8.0) in the SCarlet RoAD (double-blind pooled placebo and active groups), Marguerite RoAD double-blind placebo, and Marguerite RoAD double-blind active groups respectively, representing a change of -57.0 (10.3), -90.3 (9.0), and -74.9 (10.5) centiloids respectively. These results demonstrate that prolonged gantenerumab treatment, at doses up to 1200 mg, reduces amyloid plaque levels below the amyloid positivity threshold. The ongoing GRADUATE Phase III trials will evaluate potential clinical benefits associated with gantenerumab-induced amyloid-lowering in people with early (prodromal-to-mild) AD.


Subject(s)
Alzheimer Disease/drug therapy , Amyloid beta-Peptides/drug effects , Antibodies, Monoclonal, Humanized/administration & dosage , Brain/drug effects , Aged , Aged, 80 and over , Alzheimer Disease/diagnostic imaging , Amyloid beta-Peptides/metabolism , Antibodies, Monoclonal, Humanized/pharmacology , Brain/diagnostic imaging , Brain/metabolism , Double-Blind Method , Female , Humans , Male , Middle Aged , Positron-Emission Tomography
3.
Osteoporos Int ; 31(8): 1445-1460, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32162014

ABSTRACT

This article provides an overview of the current knowledge on hypophosphatasia-a rare genetic disease of very variable presentation and severity-with a special focus on adolescents and adults. It summarizes the available information on the many known mutations of tissue-nonspecific alkaline phosphatase (TNSALP), the epidemiology and clinical presentation of the disease in adolescents and adults, and the essential diagnostic clues. The last section reviews the therapeutic approaches, including recent reports on enzyme replacement therapy (EnzRT).


Subject(s)
Hypophosphatasia , Adolescent , Adult , Alkaline Phosphatase/therapeutic use , Enzyme Replacement Therapy , Humans , Hypophosphatasia/diagnosis , Hypophosphatasia/epidemiology , Hypophosphatasia/therapy , Mutation
4.
J Acoust Soc Am ; 143(3): 1477, 2018 03.
Article in English | MEDLINE | ID: mdl-29604700

ABSTRACT

In this paper, a recently proposed approach to multizone sound field synthesis, referred to as joint pressure and velocity matching (JPVM), is investigated analytically using a spherical harmonics representation of the sound field. The approach is motivated by the Kirchhoff-Helmholtz integral equation and aims at controlling the sound field inside the local listening zones by evoking the sound pressure and particle velocity on surrounding contours. Based on the findings of the modal analysis, an improved version of JPVM is proposed, which provides both better performance and lower complexity. In particular, it is shown analytically that the optimization of the tangential component of the particle velocity vector, as is done in the original JPVM approach, is very susceptible to errors and thus not pursued anymore. Furthermore, the analysis provides fundamental insights as to how the spherical harmonics used to describe three-dimensional sound fields translate into two-dimensional basis functions as observed on the contours surrounding the zones. By means of simulations, it is verified that discarding the tangential component of the particle velocity vector ultimately leads to an improved performance. Finally, the impact of sensor noise on the reproduction performance is assessed.

5.
Eur J Pain ; 22(1): 191-202, 2018 01.
Article in English | MEDLINE | ID: mdl-28940665

ABSTRACT

BACKGROUND: Psychological variables and acute post-operative pain are of proven relevance for the prediction of persistent post-operative pain. We aimed at investigating whether pain-specific psychological variables like pain catastrophizing add to the predictive power of acute pain and more general psychological variables like depression. METHODS: In all, 104 young male patients undergoing thoracic surgery for pectus excavatum correction were studied on the pre-operative day (T0) and 1 week (T1) and 3 months (T2) after surgery. They provided self-report ratings (pain-related: Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale = PASS, Pain Vigilance and Awareness Questionnaire = PVAQ; general psychological: Screening for Somatoform Symptoms, State-Anxiety Inventory-X1, Center for Epidemiologic Studies Depression Scale = CES-D). Additional predictors (T1) as well as criterion variables (T2) were pain intensity (Numerical Rating Scale) and pain disability (Pain Disability Index). RESULTS: Three months after surgery, 25% of the patients still reported clinically relevant pain (pain intensity ≥3) and over 50% still reported pain-related disability. Acute post-operative pain as well as general psychological variables did not allow for a significant prediction of persistent post-operative pain; in contrast, pain-related psychological variables did. The best single predictors were PASS for pain intensity and PVAQ for pain disability. CONCLUSIONS: Pain-related psychological variables derived from the fear-avoidance model contributed significantly to the prediction of persistent post-operative pain. The best possible compilation of these measures requires further research. More general psychological variables may become relevant predictors later in the medical history. SIGNIFICANCE: Our results suggest that pain-specific psychological variables such as pain anxiety and pain hypervigilance add significantly to the prediction of persistent post-operative pain and might even outperform established predictors such as acute pain and general psychological variables. Clinicians might benefit from the development of time-economic screening tools based on these variables.


Subject(s)
Catastrophization/psychology , Fear/psychology , Pain, Postoperative/diagnosis , Thoracic Surgical Procedures/psychology , Adolescent , Adult , Anxiety/psychology , Awareness , Depression/psychology , Disabled Persons , Funnel Chest/surgery , Humans , Male , Pain Measurement/methods , Pain, Postoperative/psychology , Risk Factors , Surveys and Questionnaires , Young Adult
6.
J Acoust Soc Am ; 142(5): 3025, 2017 11.
Article in English | MEDLINE | ID: mdl-29195439

ABSTRACT

In this work, analytic expressions for the spatial coherence of noise fields are derived in the modal domain with the aim of providing a sparse representation. For this purpose, the sound field in a region of interest is expressed in terms of a given pressure distribution on a virtual surrounding cylindrical or spherical surface. According to the Huygens-Fresnel principle, the sound pressure on this surface is represented by a continuous distribution of elementary line or point sources, where orthogonal basis functions characterize the spatial properties. To describe spatially windowed pressure distributions with arbitrary angular extensions, orthogonal basis functions of limited angular support are proposed. As special cases, circular and spherical pressure distributions with uncorrelated source modes of equal power are investigated. It is shown that these distributions result, respectively, in cylindrically isotropic and spherically isotropic, i.e., diffuse noise fields. The analytic expressions derived in this work allow for a prediction of the spatial coherence between arbitrary positions within the region of interest, such that no microphones need to be placed at the actual points of interest. Simulation results are presented to validate the derived relations.

7.
J Pain Res ; 10: 1787-1800, 2017.
Article in English | MEDLINE | ID: mdl-28814894

ABSTRACT

BACKGROUND: Empirical evidence suggests that affective responses to pain are changed in chronic pain. The investigation of startle responses to pain might contribute to clarifying whether such alterations also expand to motivational defensive reactions. We aimed at comparing startle responses to tonic heat pain with high threat (HT) or low threat (LT) in patients with chronic musculoskeletal pain and controls. As pain-related anxiety and catastrophizing are typically elevated in chronic pain, we expected to find stronger startle responses in patients specifically under experimental HT. METHODS: Patients with chronic musculoskeletal, preferentially, back pain (N = 19) and matched pain-free controls (N = 19) underwent two pain-related threat conditions (high and low) in balanced order. Only, in the HT condition, 50% of the trials were announced to include a short further noxious temperature increase at the end. Startle responses to loud tones were always assessed prior to a potential temperature increase in the phase of anticipation and were recorded by surface electromyogram. RESULTS: Surprisingly, we observed no differences in startle responses and ratings of emotional and pain responses between patients and controls despite significantly higher pain-related anxiety and catastrophizing in the patients. Overall, startle was potentiated in the HT condition, but only in participants who started with this condition. CONCLUSION: Our results suggest that, in general, patients with pain are not more responsive emotionally to experimental threat manipulations despite elevated pain anxiety and catastrophizing. Instead, exaggerated responses in patients might be triggered only by individual concerns relating to pain, which are not sufficiently mirrored by our threat paradigm.

8.
Int J Behav Med ; 24(2): 260-271, 2017 04.
Article in English | MEDLINE | ID: mdl-27481106

ABSTRACT

PURPOSE: The way individuals attend to pain is known to have a considerable impact on the experience and chronification of pain. One method to assess the habitual "attention to pain" is the Pain Vigilance and Awareness Questionnaire (PVAQ). With the present study, we aimed to test the psychometric properties of the German version of the PVAQ across pain-free samples and across patients with acute and chronic pain. METHOD: Two samples of pain-free individuals (student sample (N = 255)/non-student sample (N = 362)) and two clinical pain samples (acute pain patients (N = 105)/chronic pain patients (N = 36)) were included in this cross-sectional evaluation of the German PVAQ. Factor structure was assessed using exploratory and confirmatory factor analyses. Reliability was assessed using internal consistency (Cronbach's alpha). Construct validity was tested by assessing correlations between PVAQ and theoretically related constructs. RESULTS: Exploratory factor analysis (non-student sample) and confirmatory factor analysis (student sample, acute pain patient sample) suggested that a two-factor solution best fitted our data ("attention to pain," "attention to changes in pain"). Internal consistency ranged from acceptable to good in all four samples. As hypothesized, the PVAQ correlated significantly with theoretically related constructs in all four samples, suggesting good construct validity in pain-free individuals and in pain patients. CONCLUSION: The German PVAQ shows good psychometric properties across samples of pain-free individuals and patients suffering from pain that are comparable to PVAQ versions of other languages. Thus, the German PVAQ seems to be a measure of pain vigilance equally valid as found in other countries.


Subject(s)
Acute Pain/psychology , Chronic Pain/psychology , Surveys and Questionnaires , Adolescent , Adult , Awareness , Cross-Sectional Studies , Factor Analysis, Statistical , Female , Humans , Language , Male , Middle Aged , Pain Measurement/methods , Psychometrics/methods , Reproducibility of Results , Young Adult
9.
J Exp Biol ; 220(Pt 4): 573-581, 2017 02 15.
Article in English | MEDLINE | ID: mdl-27913599

ABSTRACT

Poor environmental conditions experienced during early development can have negative long-term consequences on fitness. Animals can compensate for negative developmental effects through phenotypic plasticity by diverting resources from non-vital to vital traits such as spatial memory to enhance foraging efficiency. We tested in young feral pigeons (Columba livia) how diets of different nutritional value during development affect the capacity to retrieve food hidden in a spatially complex environment, a process we refer to as 'spatial memory'. Parents were fed with either high- or low-quality food from egg laying until young fledged, after which all young pigeons received the same high-quality diet until memory performance was tested at 6 months of age. The pigeons were trained to learn a food location out of 18 possible locations in one session, and then their memory of this location was tested 24 h later. Birds reared with the low-quality diet made fewer errors in the memory test. These results demonstrate that food quality during development has long-lasting effects on memory, with a moderate nutritional deficit improving spatial memory performance in a foraging context. It might be that under poor feeding conditions resources are redirected from non-vital to vital traits, or pigeons raised with low-quality food might be better in using environmental cues such as the position of the sun to find where food was hidden.


Subject(s)
Appetitive Behavior , Columbidae/growth & development , Food Quality , Spatial Learning , Animal Feed/analysis , Animal Nutritional Physiological Phenomena , Animals , Columbidae/physiology , Female , Male , Memory Consolidation , Spatial Memory
10.
Drugs Today (Barc) ; 52(5): 271-85, 2016 May.
Article in English | MEDLINE | ID: mdl-27376160

ABSTRACT

Hypophosphatasia (HPP) is a rare disease caused by loss-of-function mutations in the tissue-nonspecific alkaline phosphatase (TNAP, TNSALP) gene. HPP causes a multisystemic syndrome with a predominant bone phenotype. The clinical spectrum ranges from high lethality in early onset (<6 months) HPP to mild late-onset syndromes. HPP management so far has been only supportive. Subcutaneous asfotase alfa, a first-in-class bone-targeted human TNAP enzyme replacement therapy, is the first compound to be approved for long-term treatment of bone manifestations in pediatric-onset HPP. In noncomparative clinical trials (treatment up to 7 years), this treatment was associated with skeletal, respiratory and functional improvement in perinatal, infantile and childhood-onset HPP. Compared with age-matched historical controls, patients with life-threatening perinatal and infantile HPP treated with asfotase alfa had substantially improved bone mineralization, survival and ventilation-free survival. In childhood HPP, asfotase alfa improved growth, gross motor function, strength and agility and decreased pain. The compound was well tolerated and most adverse events were of mild to moderate intensity. To date, data and experience concerning its efficacy and safety in long-term treatment are not yet available. Further studies to evaluate risks and benefits of enzyme replacement therapy with asfotase alfa in adults are in progress and are also strongly needed.


Subject(s)
Alkaline Phosphatase/therapeutic use , Bone Diseases/drug therapy , Enzyme Replacement Therapy , Hypophosphatasia/complications , Immunoglobulin G/therapeutic use , Recombinant Fusion Proteins/therapeutic use , Alkaline Phosphatase/adverse effects , Humans , Immunoglobulin G/adverse effects , Recombinant Fusion Proteins/adverse effects
11.
Ophthalmologe ; 113(8): 675-83, 2016 Aug.
Article in German | MEDLINE | ID: mdl-26906154

ABSTRACT

BACKGROUND: Congenital nasolacrimal duct obstruction (dacryostenosis) with a persisting membrane at Hasner's valve is the most common cause of persistent tear and ocular discharge in infants. PURPOSE: To evaluate whether there is an association between congenital dacryostenosis and delivery via cesarean section. MATERIAL AND METHODS: In a prospective study we examined 107 children (mean age 9.2 ± 7.1 months) with congenital dacryostenosis. We evaluated data about the mode of delivery (vaginal delivery versus cesarean section) and gestational age at the time of birth. Within the first 8 months of life children were treated by probing using local anesthesia, whereas older children were treated using general anesthesia. After the age of 11 months treatment included nasolacrimal duct intubation with a bicanalicular stent. Statistical analyses were performed using binomial tests, Fisher's exact test and the t-test. RESULTS: In this study 51 children delivered by cesarean section were compared with 56 children delivered by spontaneous vaginal delivery. A total of 44 age-matched pairs from both groups were evaluated in order to eliminate confounding factors due to gestational age at delivery. Based on the published rate of cesarean sections from the same region of the State of Hesse between 2002-2004 we observed a statistically significant association between congenital dacryostenosis and delivery by cesarean section among the 88 age-matched patients (P = 0.009). Moreover, subgroup analysis revealed a significant association between congenital dacryostenosis and delivery by primary cesarean section (P = 0.00004). The prevalence of surgical treatment was not statistically different between both groups based on the mode of delivery (P = 0.8). CONCLUSION: Our results suggest that delivery via cesarean section is associated with a significantly higher prevalence of congenital dacryostenosis.


Subject(s)
Cesarean Section/statistics & numerical data , Gestational Age , Infant, Newborn, Diseases/epidemiology , Lacrimal Duct Obstruction/congenital , Lacrimal Duct Obstruction/epidemiology , Adult , Female , Germany/epidemiology , Humans , Infant , Infant, Newborn , Male , Pregnancy , Prevalence , Risk Factors , Young Adult
12.
Biomed Tech (Berl) ; 60 Suppl 1: s345-60, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26360479
13.
Exp Clin Endocrinol Diabetes ; 123(2): 80-7, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25654671

ABSTRACT

BACKGROUND: Studies postulate an involvement of adipokines in inflammatory gastrointestinal diseases. Leptin-deficient ob/ob mice as well as TLR9-deficient mice have a more moderate course of chronic DSS-induced colitis (DSS-CC) and adipocytes do express functional TLR9 molecules. MATERIAL AND METHODS: Adipokine mRNA expression in visceral adipose tissue of mice before and after the induction of DSS-CC was investigated. Experiments were performed in both TLR9(wt/wt) and TLR9(-/-) mice. In vitro, the effect of TLR9 blocking peptide on leptin and visfatin protein secretion was studied in 3T3-L1 adipocytes. RESULTS: Induction of DSS-CC led to an upregulation of leptin mRNA expression in TLR9(wt/wt) mice, while TLR9(-/-) animals showed a significant reduction of leptin expression even below baseline. While visfatin expression remained unchanged in TLR9(wt/wt) animals, TLR9(-/-) mice exhibited a significant induction during DSS-CC. CTRP-3 expression was reduced after colitis induction only in TLR9(-/-) animals. Of note, IL-6 expression levels remained unchanged, while CXCL1/KC and cyclophilin A expression was reduced in DSS-CC. Inhibition of TLR9 signaling by using TLR9 blocking peptide led to reduced leptin protein secretion into cell culture supernatants in 3T3-L1 adipocytes, while visfatin protein secretion was enhanced. CONCLUSIONS: DSS-CC leads to differential adipokine expression profiles in the visceral fat pad in TLR9(wt/wt) vs. TLR9(-/-) mice. In vitro, inhibition of TLR9 signaling induces visfatin secretion while inhibiting leptin secretion in adipocytes. Thus, visceral adipokines are regulated by intact TLR9 signaling pathway and a specific interplay between the leptin- and the TLR9-pathways might be of pathophysiological importance in chronic intestinal inflammation.


Subject(s)
Adipokines/metabolism , Colitis/metabolism , Intra-Abdominal Fat/metabolism , Toll-Like Receptor 9/metabolism , 3T3-L1 Cells , Animals , Colitis/chemically induced , Cytokines/metabolism , Female , Leptin/metabolism , Mice , Mice, Knockout , Nicotinamide Phosphoribosyltransferase/metabolism , Toll-Like Receptor 9/genetics
14.
Eur J Pain ; 19(2): 216-24, 2015 Feb.
Article in English | MEDLINE | ID: mdl-24917170

ABSTRACT

BACKGROUND: Previous studies have indicated that the startle reflex is potentiated by phasic, but not by tonic, heat pain, although the latter is seen as more strongly associated with emotional responses and more similar to clinical pain. The threat value of pain might be a decisive variable, which is not influenced alone by stimulus duration. OBJECTIVE: This study aimed at comparing startle responses to tonic heat pain stimulation with varying degrees of threat. We hypothesized that the expectation of unpredictable temperature increases would evoke higher threat and thereby potentiate startle compared with the expectation of constant stimulation. METHODS: Healthy, pain-free subjects (n = 40) underwent painful stimulation in two conditions (low/high threat) in balanced order. The only difference between the two conditions was that in the high-threat condition 50% of the trials were announced to include a short further noxious temperature increase at the end. Startle tones were presented prior to this temperature increase still in the phase of anticipation. RESULTS: We observed startle potentiation in the high-threat compared with the low-threat condition, but only in those participants who took part first in the high-threat condition. Habituation could not account for these findings, as we detected no significant decline of startle responses in the course of both conditions. CONCLUSIONS: Our results suggest that subjective threat might indeed be decisive for the action of pain on startle; the threat level appears not only influenced by actual expectations but also by previous experiences with pain as threatening or not.


Subject(s)
Anxiety/psychology , Fear , Pain/psychology , Reflex, Startle/physiology , Acoustic Stimulation , Adult , Fear/psychology , Female , Hot Temperature , Humans , Male , Middle Aged , Pain Measurement/methods
15.
Schmerz ; 28(5): 513-9, 2014 Oct.
Article in German | MEDLINE | ID: mdl-25155032

ABSTRACT

INTRODUCTION: The present study was performed to investigate the effect of multidimensional psychological prophylaxis training focusing on coping with cognitive-emotional pain on recovery within the first 12 months after surgery. The training included the following three components: (1) education about pain, analgesia and psychological aspects of coping with pain, (2) training for coping with pain and (3) body-centered relaxation. MATERIAL AND METHODS: In the study 48 young male patients (surgical correction of a chest malformation) were assessed 1 day before surgery, at discharge and 3, 6 and 12 months postoperatively concerning postoperative pain intensity and pain disability as well as pain anxiety, pain catastrophizing and pain hypervigilance. Additionally, 24 of these patients received training on cognitive-emotional coping with pain 1 day before surgery and 1-3 days after surgery (each session 1 h). RESULTS: The proportion of patients with clinically relevant improvement was significantly higher in the training group compared to the control group. This was the case for acute pain intensity (approximately 1 week after surgery), pain disability 3 months later and pain anxiety 12 months after surgery. CONCLUSION: The resurgence of pain anxiety after 12 months could only be found in the control group and could be due to the upcoming surgical removal of the transsternal metal implant. The prophylaxis training can therefore be seen as a protective factor for long-term management of surgery-related consequences and future pain experiences.


Subject(s)
Adaptation, Psychological , Cognitive Behavioral Therapy/methods , Funnel Chest/psychology , Funnel Chest/surgery , Pain Management/methods , Pain Measurement/psychology , Pain, Postoperative/prevention & control , Pain, Postoperative/psychology , Patient Education as Topic/methods , Relaxation Therapy , Adolescent , Adult , Anxiety/prevention & control , Anxiety/psychology , Arousal , Catastrophization/prevention & control , Catastrophization/psychology , Combined Modality Therapy/methods , Combined Modality Therapy/psychology , Follow-Up Studies , Humans , Male , Young Adult
16.
Phys Rev Lett ; 112(1): 013002, 2014 Jan 10.
Article in English | MEDLINE | ID: mdl-24483893

ABSTRACT

We experimentally study the full counting statistics of few-body Rydberg aggregates excited from a quasi-one-dimensional atomic gas. We measure asymmetric excitation spectra and increased second and third order statistical moments of the Rydberg number distribution, from which we determine the average aggregate size. Estimating rates for different excitation processes we conclude that the aggregates grow sequentially around an initial grain. Direct comparison with numerical simulations confirms this conclusion and reveals the presence of liquidlike spatial correlations. Our findings demonstrate the importance of dephasing in strongly correlated Rydberg gases and introduce a way to study spatial correlations in interacting many-body quantum systems without imaging.

17.
Mucosal Immunol ; 7(1): 188-99, 2014 Jan.
Article in English | MEDLINE | ID: mdl-23757302

ABSTRACT

Basophils have been recognized as important inducers of T helper type 2 (Th2) responses. Using the colitis model of adoptive transfer of CD4(+) CD62L(+) T cells into lymphopenic hosts, we have analyzed how basophils regulate T-cell responses and modulate disease activity. Transferred T cells rapidly proliferate, produce large amounts of interleukin (IL)-3, and expand the number of basophils in an IL-3-dependent manner. Depletion of basophils with two different antibodies substantially upregulated Th1 cytokines in transferred T cells at day 8. Increased Th1 cytokine expression persisted until the end of the experiment when basophil-depleted mice showed exacerbation of colitis with more severe loss of weight, histological damage, colonic leukocyte infiltration, and expression of pro-inflammatory cytokines. In vitro, we show that basophil-derived IL-4 and IL-6 downregulates expression of interferon-γ, IL-2, and tumor necrosis factor in T cells. These data show a beneficial role of basophils in a T-cell driven model of autoimmunity.


Subject(s)
Basophils/immunology , Colitis/immunology , T-Lymphocytes/immunology , Adoptive Transfer , Animals , Basophils/metabolism , Colitis/genetics , Colitis/metabolism , Cytokines/blood , Cytokines/metabolism , Disease Models, Animal , Female , Lymphopenia/immunology , Lymphopenia/metabolism , Male , Mice , Mice, Knockout , Phenotype , T-Lymphocytes/metabolism , Th1 Cells/immunology , Th1 Cells/metabolism
18.
Science ; 342(6161): 954-6, 2013 Nov 22.
Article in English | MEDLINE | ID: mdl-24200814

ABSTRACT

Electronically highly excited (Rydberg) atoms experience quantum state-changing interactions similar to Förster processes found in complex molecules, offering a model system to study the nature of dipole-mediated energy transport under the influence of a controlled environment. We demonstrate a nondestructive imaging method to monitor the migration of electronic excitations with high time and spatial resolution, using electromagnetically induced transparency on a background gas acting as an amplifier. The continuous spatial projection of the electronic quantum state under observation determines the many-body dynamics of the energy transport.

19.
Bone ; 55(1): 150-7, 2013 Jul.
Article in English | MEDLINE | ID: mdl-23454488

ABSTRACT

Hypophosphatasia (HPP) is a heterogeneous rare, inherited disorder of bone and mineral metabolism caused by different mutations in the ALPL gene encoding the isoenzyme, tissue-nonspecific alkaline phosphatase (TNAP). Prognosis is very poor in severe perinatal forms with most patients dying from pulmonary complications of their skeletal disease. TNAP deficiency, however, may also result in neurological symptoms such as neonatal seizures. The exact biological role of TNAP in the human brain is still not known and the pathophysiology of neurological symptoms due to TNAP deficiency in HPP is not understood in detail. In this report, we describe the clinical features and functional studies of a patient with severe perinatal HPP which presented with rapidly progressive encephalopathy caused by new compound heterozygous mutations in the ALPL gene which result in a functional ALPL "knock out", demonstrated in vitro. In contrast, an in vitro simulation of the genetic status of his currently asymptomatic parents who are both heterozygous for one mutation, showed a residual in vitro AP activity of above 50%. Interestingly, in our patient, the fatal outcome was due to progressive encephalopathy which was refractory to antiepileptic therapy including pyridoxine, rather than hypomineralization and respiratory insufficiency often seen in HPP patients. The patient's cranial MRI showed progressive cystic degradation of the cortex and peripheral white matter with nearly complete destruction of the cerebrum. To our knowledge, this is the first MRI-based report of a deleterious neurological clinical outcome due to a progressive encephalopathy in an infant harboring a functional human ALPL "knock out". This clinical course of disease suggests that TNAP is involved in development and may be responsible for multiple functions of the human brain. According to our data, a certain amount of residual TNAP activity might be mandatory for normal CNS function in newborns and early childhood.


Subject(s)
Alkaline Phosphatase/genetics , Brain Diseases/genetics , Genetic Association Studies , Genetic Predisposition to Disease , Heterozygote , Hypophosphatasia/genetics , Mutation/genetics , Fatal Outcome , HEK293 Cells , Humans , Hypophosphatasia/enzymology , Infant , Infant, Newborn , Magnetic Resonance Imaging , Male , Mutant Proteins/metabolism , Protein Transport , Subcellular Fractions/enzymology
20.
Phys Chem Chem Phys ; 15(12): 4415-21, 2013 Mar 28.
Article in English | MEDLINE | ID: mdl-23420379

ABSTRACT

We studied charge transport in a field-effect transistor based on an anthracene crystal by single-molecule spectroscopy at cryogenic temperatures. When applying a control voltage to the gate, source and drain electrodes, we observe spectral drifts of the probe molecules' lines, which follow strongly non-exponential (stretched) kinetics, from seconds to tens of minutes. Applying a gate voltage alone, we find a dependence of the spectral shift as the logarithm of time. When an additional source-drain voltage is applied, the spectral shift follows a power law of time, similar to the elementary step of conduction in amorphous solids, postulated in the continuous-time random walk theory of Scher and Montroll.

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