Self-management-competency as a new target in Hidradenitis suppurativa care.

Background: Hidradenitis suppurativa affects approximately 1% of the population.Objective: Highlighting the relevance of self-management-competency as a new therapeutic target.Method: 258 patients from the 'Epidemiology and Care in Acne inversa (EpiCAi)' project were included in the study. Disease burden was measured by patient-rated questionnaires in terms of disease activity, pain, quality of life, depression and insomnia and correlated with the domains of the health education impact questionnaire (heiQ) measuring self-management-competency.Results: 66 male (25.6%) and 192 female (74.4%) patients, with a mean age of 40.3 ± 10.24 years were included. Mean scores of pain on the numeric rating scale (NRS), Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS) were 5.11 ± 2.68, 11.35 ± 7.79 and 13.71 ± 7.57, respectively. The Insomnia severity index (ISI) showed a mean of 9.58 ± 5.76. The HADS has the highest increased total risk across all heiQ domains. With respect to the heiQ domains, the highest exposure can be attributed to improving constructive attitudes and approaches as well as decreasing emotional distress.Conclusion: There is a clear association of self-management-competency with overall disease burden, which underlines the need for psychoeducational support. This study provides ideas to develop new possible strategies of care.

Impact of Baseline Mitral Regurgitation on Postoperative Outcomes After Left Ventricular Assist Device Implantation as Destination Therapy.

BACKGROUND: Currently, there are no guidelines for management of moderate to severe mitral regurgitation (MR) in patients undergoing left ventricular assist device (LVAD) implantation. The present study aimed to investigate the impact of baseline MR on short and midterm survival in patients who had LVAD as destination therapy (DT). METHODS: The DT-LVAD patients were classified into 2 groups based on baseline MR status: ≥ moderate MR and < moderate MR. Baseline clinical characteristics and post-LVAD implant adverse events were compared. Unadjusted mortality rates at 30 days, 1 year, and 2 years were analyzed. RESULTS: Of 91 patients studied, 62 (68%) had ≥ moderate MR before LVAD implantation; ≥ moderate MR patients had a higher incidence of concomitant pulmonary disease (11% vs 0%; P = .001) and ≥ moderate tricuspid regurgitation (55% vs 23%, P = .004) than < moderate MR patients. Other baseline clinical characteristics were similar in both groups. Post-LVAD adverse events did not differ between the 2 groups. Survival rates at 30 days, 1 year, and 2 years for both groups (≥ moderate MR vs < moderate MR) were 90% vs 100% (P = .03), 63% vs 90% (P = .001), and 52% vs 83% (P = .002), respectively. On multivariable analysis, age, female sex, ≥ moderate tricuspid regurgitation, and ≥ moderate MR at baseline were found to be independent predictors of overall all-cause mortality. Overall survival was significantly lower in the ≥ moderate MR group than the < moderate MR group (log-rank test, P = .03). CONCLUSION: In DT LVAD patients, ≥ moderate MR is common and is associated with worse survival at both short and midterm follow-up.

[Economic importance of postoperative urinary incontinence]. / Volkswirtschaftliche Bedeutung der postoperativen Harninkontinenz.

In the 22,160 patients treated in Germany for prostate cancer by prostatectomy, the costs for direct and indirect sequelae as the result of postoperative urinary incontinence are estimated to be 71.8 million €. This greatly exceeds the costs of 69.8 million € for the operation itself. This additional economic burden can, however, be decisively influenced by using a surgical technique that preserves the integrity of the urethral sphincter.

The role of cytoplasmic serine residues of the cell adhesion molecule L1 in neurite outgrowth, endocytosis, and cell migration.

1. The cell adhesion molecule L1 has been implicated in adhesion and migration of cells, in axon growth, guidance, and fasciculation, in myelination and synaptic plasticity. The cytoplasmic domain of neuronal L1 is highly conserved between species and has been shown to be phosphorylated at serine and tyrosine residues. 2. To investigate the significance of L1 serine phosphorylation, mutants of L1 were generated in which ser-1152, ser-1181, ser-1204, and ser-1248 were exchanged for leucine and rat B35 neuroblastoma cells were stably transfected with the L1-cDNA constructs. 3. Neurite outgrowth on poly-L-lysine (PLL) as substrate was determined either with or without differentiation into a neuronal phenotype with dbcAMP. In addition, antibody-induced endocytosis and cell migration were examined. 4. Our observations indicate that phosphorylation of single serine residues of the cytoplasmic domain of L1 contributes to neurite outgrowth through different mechanisms. Neurite growth is increased when ser-1152 or ser-1181 is replaced by a non-phosphorylatable leucine and decreased when ser-1204 or ser-1248 is mutated to leucine. Furthermore, mutation of ser-1181 to leucine results in strongly enhanced antibody-induced endocytosis of L1 and also in enhanced cell migration.

Large changes in Pluto's atmosphere as revealed by recent stellar occultations.

Pluto's tenuous nitrogen atmosphere was first detected by the imprint left on the light curve of a star that was occulted by the planet in 1985 (ref. 1), and studied more extensively during a second occultation event in 1988 (refs 2-6). These events are, however, quite rare and Pluto's atmosphere remains poorly understood, as in particular the planet has not yet been visited by a spacecraft. Here we report data from the first occultations by Pluto since 1988. We find that, during the intervening 14 years, there seems to have been a doubling of the atmospheric pressure, a probable seasonal effect on Pluto.

Spacing of repetitions improves learning and memory after moderate and severe TBI.

Extensive research has determined that new learning in healthy individuals is significantly improved when trials are distributed over time (spaced presentation) compared to consecutive learning trials (massed presentation). This phenomenon known as the "spacing effect" (SE) has been shown to enhance verbal and nonverbal learning in healthy adults of different ages and in different memory paradigms (e.g., recognition, recall, etc.). The purpose of this study was to examine whether learning in adults with moderate and severe traumatic brain injury (TBI) is improved using a spacing-of-repetitions procedure. Using a within-groups design, participants with TBI (n = 20) were presented a list of 115 words that were presented either once (single condition), twice consecutively (massed condition), or twice with 11 words between presentations (spaced condition). Participants were required to rank each word from 1 to 10 according to their familiarity with the word; they were not asked to "memorize" words for a later test. Word list learning was measured with a free recall test immediately following list presentation and with free recall and recognition tests after a 30-min delay. Participants recalled and recognized significantly more spaced words than massed words during this word list learning task. These results strongly indicate that the spacing of repetitions improves learning and memory in individuals who have sustained moderate to severe TBI. Implications for rehabilitation are discussed.

Impaired delay eyeblink classical conditioning in individuals with anterograde amnesia resulting from anterior communicating artery aneurysm rupture.

Anterior communicating artery (ACoA) aneurysm rupture can lead to an anterograde amnesia syndrome similar to that observed after damage to the hippocampus and medial temporal lobes (MT). It is currently believed that ACoA amnesia results from basal forebrain damage that disrupts hippocampal processing without direct hippocampal damage. Converging evidence from animal studies and computational modeling suggests that qualitative differences may exist in the pattern of memory impairment after basal forebrain or MT damage. For example, animals with basal forebrain but not hippocampal damage are impaired at delay eyeblink classical conditioning (EBCC). In this study, individuals with ACoA amnesia were shown to be impaired at delay EBCC compared with matched controls; this contrasts with the spared delay EBCC previously observed in MT amnesia. This finding suggests the beginning of a possible dissociation between the memory impairments in MT versus ACoA amnesia.

The influence of cognitive impairment on driving performance in multiple sclerosis.

OBJECTIVE: To examine the influence of impaired cognitive processing on measures of driving skills in persons with MS. METHODS: Twenty-eight subjects with documented MS were divided into two groups-with [MS(+), n = 13] and without [MS(-), n = 15] cognitive impairment-based on neuropsychological performance. Healthy control (HC) subjects (n = 17) matched on age and driving experience were also studied. Driving-related skills were compared between the groups based on performance on two computerized driving tests: the Useful Field of Vision (UFOV) and the Neurocognitive Driving Test (NDT). RESULTS: The MS(+) group performed significantly worse than both the MS(-) and HC groups in the latency to perform several driving-specific functions on the NDT, but no overall group differences were observed in actual errors on the NDT. On the UFOV, when compared to MS(-) and HC subjects, the MS(+) group demonstrated poorer performance on two of the three subtests. Additionally, a significantly higher percentage of MS(+) individuals were rated within the high risk (probability of crash involvement) category, relative to the MS(-) and HC groups. CONCLUSIONS: Cognitive impairment can negatively affect driving-related skills in persons with MS and should be considered in the determination of driving ability.

Acquisition versus retrieval deficits in traumatic brain injury: implications for memory rehabilitation.

OBJECTIVE: To examine whether impaired memory in persons with traumatic brain injury (TBI) is caused by impaired initial acquisition or compromised retrieval from long-term storage. DESIGN: Prospective matched controlled trial. SETTING: Postacute rehabilitation institute. PARTICIPANTS: Patients with moderate to severe TBI (n = 28) and 21 matched, healthy controls (HCs). MAIN OUTCOME MEASURES: Patients with TBI and HC subjects were equated on initial acquisition on a verbal list-learning task. Recall and recognition performance was then evaluated at 30- and 90-minutes after learning. RESULTS: All HC subjects and 20 subjects with TBI (TBI-MET) were able to meet the learning criterion, but the TBI-MET group took significantly more trials than HC subjects to do so. However, after equating groups on acquisition, the TBI-MET group did not differ from controls on recall and recognition at both the 30- and 90-minute delays. Eight TBI subjects showed severe learning deficits (TBI-NOT MET) because they never learned the task, and showed significantly impaired recall and recognition performance. The 2 TBI groups did not differ on measures of severity of injury, but the TBI-NOT MET group performed significantly below the TBI-MET group on executive functioning. Rate of forgetting did not differ across the 3 groups. CONCLUSIONS: Results suggest that memory impairment after TBI is caused primarily by deficiencies in initial acquisition of verbal information rather than in compromised retrieval. The findings have significant implications for the rehabilitation and treatment of individuals with TBI.

Fractioning the Hooper: a multiple-choice response format.

The Hooper Visual Organization Test (HVOT) provides an excellent illustration of the multifactorial nature of most neuropsychological tests. Although the HVOT clearly requires certain visual perceptual skills, the test also demands that the subject produce an overt verbal response - i.e., the name of the object that has been cut up and rearranged. Thus, individuals with disorders of confrontation naming may obtain low scores on the HVOT by virtue of their anomia, even if the primary perceptual skills that the HVOT purports to assess are intact. The present study was designed to minimize the demands of object naming on HVOT performance, by using a multiple choice format of the HVOT. Fourteen individuals with lateralized injury resulting from either cerebral vascular accident or cerebral contusion were administered the Boston Naming Test (BNT) and the standard version of the HVOT. Approximately 24 hours later, subjects were administered the Multiple-Choice Hooper Visual Organization Test (MC-HVOT). The MC-HVOT consisted of the 30 original HVOT stimuli presented with four response choices, including the correct response and three foils. A paired sample t test revealed that anomic subjects achieved a significantly greater number of correct responses on the MC-HVOT then under the standard HVOT administration. Subjects with both right and left hemisphere involvement benefited from diminished naming demands. Overall HVOT performance significantly improved when the object naming demand was reduced, resulting in a clearer assessment of visual integration skills. These findings may have significant implications for both interpretation of impairment and formulation of treatment recommendations.

An interpretive table for the Visual Form Discrimination Test.

The capacity to analyze complex visual stimuli is susceptible to several forms of brain dysfunction. The Visual Form Discrimination test is a 16-item multiple-choice measure requiring visual discrimination and matching. Published normative observations provide frequency counts of various raw scores but lack certain critical information, e.g., standard deviations, needed for clinical interpretation of performance in individual cases. The purpose of this study was to improve the clinical utility of the test by (1) reporting the standard deviation of the normative sample and (2) using this index to create a table to foster interpretation in single cases. We provide T scores, percentile equivalents, and clinical descriptors for various raw scores, permitting clinicians to make more precise use of the Visual Form Discrimination.

Dominant lethality in Xenopus laevis induced with triethylenemelamine (TEM).

Adult male South African clawed toads, Xenopus laevis, were injected intraperitoneally with triethylenemelamine (TEM) dissolved in water over a dose range of 13-1,300 micrograms/kg or with water (controls). Mating of the treated males with untreated females was induced seven days later by injection of human chorionic gonadotropic hormone (HCG). Accumulated lethality one week after fertilization among progeny was dose related. Morphological abnormalities among embryos that survived to hatching were similarly dose related. Because anatomically anomalous embryos may have impaired behavior, swimming capacity was tested, and anomalies in swimming behavior were also found to be dose related. Finally, short-term cell cultures were made on minced embryos to obtain chromosome spreads. Structural aberrations, rings, dicentrics, etc of somatic chromosomes were also dose related.