[COVID-19 in children and adolescents with chronic lung diseases]. / COVID-19 bei Kindern und Jugendlichen mit chronischen Lungenerkrankungen: Klinische Erfahrungen und Perspektiven.

Background: At the beginning of the SARS-CoV­2 pandemic the focus of attention was on children and adolescents with chronic lung diseases. Due to a lack of epidemiological data and clinical experience, it was feared that children with respiratory diseases were a risk group for particularly severe courses of COVID-19, as has been reported for adults. Objective: The currently available (epidemiological) data on this patient group are presented as well as a description of our own experiences based on three selected cases. Material and methods: A review of the literature was carried out and three selected case reports and a discussion of current recommendations are presented. Results: The incidence of COVID-19 is significantly lower in children than in adults. Furthermore, the known risk factors in adults cannot be simply transferred to pediatric patients. In the majority of cases, children and adolescents with chronic lung diseases show a milder course of SARS-CoV­2 infections. Conclusion: Although the hitherto available data show that children and adolescents have a lower risk for COVID-19 courses than adults, it should not be ignored that fatal outcomes have also been reported in pediatric patients. Moreover, late effects, such as the pediatric inflammatory multisystem syndrome (PIMS) can sometimes lead to a fatal outcome. Nevertheless, care must be taken that this vulnerable patient group does not suffer from avoidable negative side effects of restriction and isolation measures. As an example, the no-show behavior in outpatient departments during the lockdown might have led to a relevant undertreatment of underlying chronic health conditions.

Relative survival of patients with non-malignant central nervous system tumours: a descriptive study by the Austrian Brain Tumour Registry.

BACKGROUND: Unlike malignant primary central nervous system (CNS) tumours outcome data on non-malignant CNS tumours are scarce. For patients diagnosed from 1996 to 2002 5-year relative survival of only 85.0% has been reported. We investigated this rate in a contemporary patient cohort to update information on survival. METHODS: We followed a cohort of 3983 cases within the Austrian Brain Tumour Registry. All patients were newly diagnosed from 2005 to 2010 with a histologically confirmed non-malignant CNS tumour. Vital status, cause of death, and population life tables were obtained by 31 December 2011 to calculate relative survival. RESULTS: Overall 5-year relative survival was 96.1% (95% CI 95.1-97.1%), being significantly lower in tumours of borderline (90.2%, 87.2-92.7%) than benign behaviour (97.4%, 96.3-98.3%). Benign tumour survival ranged from 86.8 for neurofibroma to 99.7% for Schwannoma; for borderline tumours survival rates varied from 83.2 for haemangiopericytoma to 98.4% for myxopapillary ependymoma. Cause of death was directly attributed to the CNS tumour in 39.6%, followed by other cancer (20.4%) and cardiovascular disease (15.8%). CONCLUSION: The overall excess mortality in patients with non-malignant CNS tumours is 5.5%, indicating a significant improvement in survival over the last decade. Still, the remaining adverse impact on survival underpins the importance of systematic registration of these tumours.

Anatomical accuracy of abdominal lesion localization. Retrospective automatic rigid image registration between FDG-PET and MRI.

UNLABELLED: Software-based image registration can improve the diagnostic value of imaging procedures and is an alternative to hybrid scanners. The aim of this study was to evaluate the anatomical accuracy of automatic rigid image registration of independently acquired datasets of positron emission tomography with 18F-deoxyglucose and abdominal magnetic resonance imaging. PATIENTS, METHODS: Analyses were performed on 28 abdominal lesions from 20 patients. The PET data were obtained using a stand-alone PET camera in 14 cases and a hybrid PET/CT scanner in 9 cases. The abdominal T1- and T2-weighted MRI scans were acquired on 1.5 T MRI scanners. The mean time interval between MRI and PET was 7.3 days (0-28 days). Automatic rigid registration was carried out using a self-developed registration tool integrated into commercial available software (InSpace for Siemens Syngo). Distances between the centres of gravity of 28 manually delineated neoplastic lesions represented in PET and MRI were measured in X-, Y-, and Z-direction. The intra- (intraclass correlation 0.94) and inter- (intraclass correlation 0.86) observer repeatability were high. RESULTS: The average distance in all MRI sequences was 5.2±7.6 mm in X-direction, 4.0±3.7 mm in Y-direction and 6.1±5.1 mm in Z-direction. There was a significantly higher misalignment in Z-direction (p<0.05). The misalignment was not significantly different for the registration of T1- and T2- weighted sequences (p=0.7). CONCLUSION: The misalignment between FDG-PET and abdominal MRI registered using an automated rigid registration tool was comparable to data reported for software-based fusion between PET and CT. Although this imprecision may not affect diagnostic accuracy, it is not sufficient to allow for pixel-wise integration of MRI and PET information.

Histopathological prognostic factors in medulloblastoma: high expression of survivin is related to unfavourable outcome.

Standard postoperative treatment of medulloblastoma consists of craniospinal irradiation and chemotherapy. Currently, only clinical factors are used for therapy stratification. To optimise treatment and patient outcome, biological prognostic markers are needed. In the present study we tested the prognostic influence of four histopathological parameters considered in recent publications as prognostic factors in medulloblastoma. We analysed a series of 82 Austrian medulloblastoma patients who were treated according to the consecutive HIT protocols for medulloblastoma conducted by the German Society of Paediatric Haematology and Oncology. Histological subtype and immunohistochemical expression of erbB-2, TRKC, and survivin were determined on paraffin embedded tumour tissue and correlated with patient outcome. Statistical analysis showed a significant correlation of high expression levels of survivin with decreased survival. None of the other investigated histopathological factors correlated significantly with patient outcome. Our data indicate that high survivin expression is related to unfavourable clinical outcome in medulloblastoma patients.

Distortion of symmetrical introgression in a hybrid zone: evidence for locus-specific selection and uni-directional range expansion.

The fate of species integrity upon natural hybridization depends on the interaction between selection and dispersal. The relative significance of these processes may be studied in the initial phase of contact before selection and gene flow reach equilibrium. Here we study a hybrid zone of two salamander species, Lyciasalamandra antalyana and Lyciasalamandra billae, at the initial phase of hybridization. We quantify the degree and mode of introgression using nuclear and mtDNA markers. The hybrid zone can be characterized as an abrupt transition zone, the central hybrid zone being only c. 400 m, but introgressed genes were traced up to 3 km. Introgression was traced in both sexes but gene flow may be slightly male-biased. Indirect evidence suggests that hybrid males are less viable than females. Introgression occurred at two levels: (1) locus-specific selection led to different allelic introgression patterns independent of species, while (2) asymmetrical species-level introgression occurred predominately from L. antalyana to L. billae due to range expansion of the former. This indicates that foreign genes can be incorporated into novel genomic environments, which in turn may contribute to the great diversity of morphological variants in Lyciasalamandra.

The role of swarming sites for maintaining gene flow in the brown long-eared bat (Plecotus auritus).

Bat-swarming sites where thousands of individuals meet in late summer were recently proposed as 'hot spots' for gene flow among populations. If, due to female philopatry, nursery colonies are genetically differentiated, and if males and females of different colonies meet at swarming sites, then we would expect lower differentiation of maternally inherited genetic markers among swarming sites and higher genetic diversity within. To test these predictions, we compared genetic variance from three swarming sites to 14 nursery colonies. We analysed biparentally (five nuclear and one sex-linked microsatellite loci) and maternally (mitochondrial D-loop, 550 bp) inherited molecular markers. Three mtDNA D-loop haplolineages that were strictly separated at nursery colonies were mixed at swarming sites. As predicted by the 'extra colony-mating hypothesis', genetic variance among swarming sites (V(ST)) for the D-loop drastically decreased compared to the nursery population genetic variance (V(PT)) (31 and 60%, respectively), and genetic diversity increased at swarming sites. Relatedness was significant at nursery colonies but not at swarming sites, and colony relatedness of juveniles to females was positive but not so to males. This suggests a breakdown of colony borders at swarming sites. Although there is behavioural and physiological evidence for sexual interaction at swarming sites, this does not explain why mating continues throughout the winter. We therefore propose that autumn roaming bats meet at swarming sites across colonies to start mating and, in addition, to renew information about suitable hibernacula.

Conflicting molecular phylogenies of European long-eared bats (Plecotus) can be explained by cryptic diversity.

Conflicting phylogenetic signals of two data sets that analyse different portions of the same molecule are unexpected and require an explanation. In the present paper we test whether (i) differential evolution of two mitochondrial genes or (ii) cryptic diversity can better explain conflicting results of two recently published molecular phylogenies on the same set of species of long-eared bats (genus Plecotus). We sequenced 1714bp of three mitochondrial regions (16S, ND1, and D-loop) of 35 Plecotus populations from 10 European countries. A likelihood ratio test revealed congruent phylogenetic signals of the three data partitions. Our phylogenetic analyses demonstrated that the existence of a previously undetected Plecotus lineage caused the incongruities of previous studies. This lineage is differentiated on the species level and lives in sympatry with its sister lineage, Plecotus auritus, in Switzerland and Northern Italy. A molecular clock indicates that all European Plecotus species are of mid or late Pliocene origin. Plecotus indet. was previously described as an intergrade between P. auritus and Plecotus austriacus since it shares morphological characters with both. It is currently known from elevations above 800 m a.s.l. in the Alps, the Dinarian Alps and the Pindos mountains in Greece. Since we could demonstrate that incongruities of two molecular analyses simply arose from the mis-identification of one lineage, we conclude that molecular phylogenetic analyses do not free systematists from a thorough inclusion of morphological and ecological data.

[Radiation exposure of health personnel and patients in the heart catheterization laboratory in during vascular brachytherapy]. / Untersuchungen zur Strahlenexposition von Beschäftigten und Patienten im Herzkatheterlabor und bei der vaskulären Brachytherapie.

Interventional radiological measures can lead to high radiation exposures for medical staff. In order to determine the radiation exposure to staff and patients, the resulting radiation exposures were directly measured for 52 measures at an cardiac catheterization laboratory with a new dosimetry system DIS (Direct Ion Storage). Beside the measurement of body dose behind the lead apron, measurements of radiation doses were performed in front of the lead apron and at the wrist of the physician. These measurements were taken as an approximation of the radiation exposure of the non-shielded body parts. The patients dose was estimated by placing a dosemeter close to the head of the patient and from the dose-area product. The mean value of body dose from 52 measurements for the physician behind the lead apron was 1.9 microSv per procedure with a range of 0-9 microSv. In front of the lead apron, a mean value of 53.9 microSv (3-233 microSv) per procedure was obtained. The mean value of partial body dose at the physician's wrist was determined to be 163.2 microSv (12-603 microSv) per procedure. It could be shown that measures combined with interventions lead to higher exposures compared with measures without interventions. For the medical technician, the mean value behind the lead apron was 3.9 microSv (0-58 microSv) per procedure. For the patient, a mean value of 800 microSv (119-8642 microSv) was measured close to the head. The mean dose to the skin of the patient at radiation entrance was determined to be 307 mGy (70-1190 mGy). From this data, the radiation dose per year for the physician performing 1000 measures, was determined to be 1.9 mSv/year. This is below the new dose limit of 20 mSv/year. Also the estimations for the dose to the eye lens and the hands of the physician show no conflicts with actual dose limits when obeying all radiation regulations. The results for vascular brachytherapy did not show significantly higher exposures, compared with conventional measures including interventions.

Glomangioma of the nasal cavity and paranasal sinuses.

The glomangioma, a benign vascular tumour, derived from the cutaneous glomus bodies, should not be confused with paragangliomas, which are occasionally also referred to as glomus tumours. Up to now, only eleven cases of a glomangioma of the nasal cavity and the paranasal sinuses have been published. We report the case of a patient with a glomangioma of the ethmoidal aircell system. The tumour was completely removed under endoscopic-microscopic vision via endonasal access. A tumour recurrence was not observed over a period of eighteen months. The clinical signs, diagnosis, therapy and histological features will be discussed with reference to the literature.

Determination of the cellular retinoic-acid-binding protein in dysplastic epithelia of the cervix uteri, differentiated into apo and holo forms.

PURPOSE: The appearance of the cervical mucosa is regulated by different factors including retinoic acid. Hormone-dependent alteration of the cervix uteri mucosa is accompanied by a decrease or increase of cytoplasmatic retinoic-acid-binding protein (CRABP). To elucidate whether this hormone-dependent alteration of CRABP is preserved in the case of neoplasms of the cervix uteri, we measured the level of total and apo-CRABP in normal and neoplastically transformed cervical cells. METHODS: In a prospective pilot study, standardised biopsies of normal epithelium and cervical intra-epithelial neoplasm grade 3 (CIN III) were taken from 24 patients. A newly developed method was used to determine the intra-epithelial level of apo- and total CRABP. RESULTS: The concentration of total CRABP in normal squamous epithelium compared with that in intra-epithelial neoplasm grade 3 is very significantly lower in the CIN III areas (normal: 3.66 +/- 1.46 pmol/ mg wet weight +/- SD; CIN III 1.43 +/- 0.59 pmol/mg P < 0.01). In addition CRABP in the apo form is lower in normal than in neoplastic epithelium (Wilcoxon test for paired non-parametric values: P < 0.05; mean for all patients: normal: 1.65 + 0.82 pmol/mg; CIN III: 1.14 +/- 0.23 pmol/mg). CONCLUSION: From our results we conclude that, in neoplastically transformed cells, the hormone-dependent CRABP cycle is interrupted. Whether this has consequences for the further development of the neoplastic cells has to be elucidated.

[Depression and aggression. A control group study on the aggression hypothesis in depressive disorders based on the Buss-Durkee Questionnaire]. / Depression und Aggression. Eine Kontrollgruppenuntersuchung zur Aggressionshypothese bei depressiven Erkrankungen anhand des Buss-Durkee-Fragebogens.

PURPOSE: The aim of this study was to prove the hypothesis that covert or inhibited aggression/hostility as described in psychoanalytic literature is part of the psychogenetic development of depression. METHOD: We compared 50 consecutively admitted depressed inpatients to 50 healthy people of the regionally living general population, matched by sex and age, using the Buss-Durkee Hostility Inventory. RESULTS: Depressed patients have significantly higher values in the BDHI subscales "total aggression", especially in irritability, negativism, resentment, suspicion and guilt, also in "attitudional component", "inhibited aggression" and "covert hostility". No differences were found in "assault" and "indirect aggression", controls got significantly higher values in "verbal aggression". A comparison of depressed patients with suicide attempts versus depressed patients without such behaviour showed no significant differences. CONCLUSION: The psychoanalytic hypothesis seems to be useful for depression but not for the suicidal behaviour of depressive patients.

In-plane motion correction for MR spectroscopic imaging.

A motion-detection method is described that is specifically suited for MR spectroscopic imaging (MRSI) studies. Information on in-plane rotation and translation of the subject was obtained using external spatial reference markers that are uniquely identified via their chemical shift. The marker locations were obtained directly from the acquired data at each encoding step, and no additional data acquisition was required. This method was applied to brain 1H MRSI studies that include subcutaneous lipid signals, which otherwise result in enhanced sensitivity to subject motion.

Multiple-echo proton spectroscopic imaging using time domain parametric spectral analysis.

A multiple-echo MR spectroscopic imaging (MRSI) method is presented that enables improved metabolite imaging in the presence of local field inhomogeneities and measurement of transverse relaxation parameters. Short echo spacing is used to maximize signal energy from inhomogeneously line-broadened resonances, and time domain parametric spectral analysis of the entire echo train is used to obtain sufficient spectral resolution from the shortened sampling periods. Optimal sequence parameters for 1H MRSI are determined by computer simulation, and performance is compared with conventional single-echo acquisition using phantom studies at a field strength of 4.7 T. A preliminary example for use at 1.5 T is also presented using phantom and human brain MRSI studies. This technique is shown to offer improved performance relative to single-echo MRSI for imaging of metabolites with shortened T2* values due to the presence of local field inhomogeneities. Additional advantages are the intrinsic measurement of metabolite T2 values and determination of metabolite integrals without T2 weighting, thereby facilitating quantitative metabolite imaging.

Synergy of the human spine in neutral postures.

The neutral position of the spine is the posture most commonly sustained throughout daily activities. Previous investigations of the spine focused mainly on maximal exertions in various symmetric and asymmetric postures. This report proposes a new synergetic approach for analysis of the spine in neutral postures and evaluates its performance. The model consists of passive components, the osteoligamentous spine, and active components, the spinal muscles. The muscle architecture includes 60 muscles inserting onto both the rib cage and lumbar vertebral bodies. The passive spine is simulated by a finite element model, while kinematic constraints and optimization are used for resolution of a redundant muscle recruitment problem. Although the passive spine alone exhibits little resistance to a vertical load, its load-bearing capacity in neutral posture is significantly enhanced by the muscles, i.e., the passive spine and its muscles must be considered as a synergetic system. The proposed method is used to investigate the response of the spine when the T1 vertebra displaces 40 mm anteriorly and 20 mm posteriorly from its initial position. The sacrum is fixed at all times and the T1 displacements are achieved by the action of muscles. The results suggest that relatively small muscle activations are sufficient to stabilize the spine in neutral posture under the body weight. The results also indicate that muscles attaching onto the rib cage are important for control of the overall spinal posture and maintenance of equilibrium. The muscles inserting onto the lumbar vertebrae are found mainly to enhance the stability of the spine. The proposed method also predicts forces and moments carried by the passive system. Flexion moments ranging from 8000 Nmm to 15,000 Nmm, corresponding to decreases in lordosis of 6 degrees and 7.5 degrees respectively, are found to be carried by the passive spine at the thoracolumbar junction when the T1 vertebra is 40 mm anterior to its initial position.

Characterization of LY344864 as a pharmacological tool to study 5-HT1F receptors: binding affinities, brain penetration and activity in the neurogenic dural inflammation model of migraine.

LY344864 is a selective receptor agonist with an affinity of 6 nM (Ki) at the recently cloned 5-HT1F receptor. It possesses little affinity for the 56 other serotonergic and non-serotonergic neuronal binding sites examined. When examined for its ability to inhibit forskolin-induced cyclic AMP accumulation in cells stably transfected with human 5-HT1F receptors, LY344864 was shown to be a full agonist producing an effect similar in magnitude to serotonin itself. After an intravenous dose of 1 mg/kg, rat plasma LY344864 levels declined with time whereas brain cortex levels remained relatively constant for the first 6 hours after injection. Oral and intravenous LY344864 administration potently inhibited dural protein extravasation caused by electrical stimulation of the trigeminal ganglion in rats. Taken together, these data demonstrate that LY344864 is a selective 5-HT1F receptor agonist that can be used to explore both the in vitro and in vivo functions of this receptor.

Stability of the human spine in neutral postures.

The present study aimed to identify some of the mechanisms affecting spinal compressive load-bearing capacity in neutral postures. Two spinal geometries were employed in the evaluation of the stabilizing mechanisms of the spine in standing neutral postures. Large-displacement finite-element models were used for parametric studies of the effect of load distribution, initial geometry, and pelvic rotation on the compression stability of the spine. The role of muscles in stabilization of the spine was also investigated using a unique muscle model based on kinematic conditions. The model with a realistic load configuration supported the largest compression load. The compressive load-bearing capacity of the passive thoracolumbar spine was found to be significantly enhanced by pelvic rotation and minimal muscular forces. Pelvic rotation and muscle forces were sensitive to the initial positioning of T1 and the spinal curvatures. To sustain the physiological gravity load, the lordotic angle increased as observed in standing postures. These predictions are in good agreement with in vitro and in vivo observations. The load-bearing potential of the ligamentous spine in compression is substantially increased by controlling its deformation modes through minimal exertion of selected muscles and rotation of the pelvis.

[Quantitative determination of alpha-peroxyachifolide in yarrow by HPLC with amperometric detection]. / Quantitative Bestimmung von alpha-Peroxyachifolid in der Schafgarbe durch HPLC mit amperometrischer Detektion.

A HPLC method with amperometric detection is established for the contact allergen alpha-peroxyachifolid (1) from yarrow (Achillea millefolium L., s. str.). The amounts of 1 are between 0.25 and 0.60% in blossoms, dried 2 h at room temperature, and between 0.01 and 0.05% in the leaves. In completely dried material and in some preparations from the market 1 could also be quantified.