The current status of surgical pilonidal sinus disease therapy in Germany

European Surgery - Treatment of pilonidal sinus disease (PSD) requires a tailored approach. A national guideline was published in 2014. The current status of surgical PSD therapy...     

The age of second language acquisition determines the variability in activation elicited by narration in three languages in Broca’s and Wernicke’s area

It is generally accepted that the presence of a second language (L2) has an impact on the neuronal substrates build up and used for language processing; the influence of the age of L2 exposure, however, is not established. We tested the hypothesis that the age of L2 acquisition has an effect on the cortical representation of a multilingual repertoire in 44 multilinguals with different age of exposure to a L2 (simultaneous or covert simultaneous exposure to L1 and L2, sequential acquisition of L1 and L2 between 1 and 5 years, late learning of L2 after 9 years of age) and all fluent in a late learned L3. Regional activation in a language production task showed a high in-between-subject variability, which was higher than within-subject variability between L1, L2, and L3. We, therefore, performed a single subject analysis and calculated the within-subject variance in the numbers of activated voxels in Broca’s and Wernicke’s area. Subjects with early exposure to L2 showed low variability in brain activation in all three languages, in the two early as well as the late learned language. In contrast, late multilinguals exhibited higher variability. Thus, cerebral representation of languages is linked to the age of L2 acquisition: early exposure to more than one language gives rise to a language processing network that is activated homogeneously by early and late learned languages, while the inhomogeneous activation in late multilinguals indicates more independent access to the multilingual repertoire. Early passive exposure to L2 results in the same low variance as active bilingual upbringing. Variability in local brain activity increases progressively from the simultaneous to late L2 exposure, indicating a gradual transition from the mode of early bilingual language representation to that of late ones.     

Computational and experimental identification of novel human imprinted genes

Imprinted genes are essential in embryonic development, and imprinting dysregulation contributes to human disease. We report two new human imprinted genes: KCNK9 is predominantly expressed in the brain, is a known oncogene, and may be involved in bipolar disorder and epilepsy, while DLGAP2 is a candidate bladder cancer tumor suppressor. Both genes lie on chromosome 8, not previously suspected to contain imprinted genes. We identified these genes, along with 154 others, based on the predictions of multiple classification algorithms using DNA sequence characteristics as features. Our findings demonstrate that DNA sequence characteristics, including recombination hot spots, are sufficient to accurately predict the imprinting status of individual genes in the human genome.     

Zufriedenheit einweisender ?rzte als Qualit?tskriterium im Rettungsdienst

Background

Having published the outcome of his surgical work in 1914, Ernest Codman is seen as the founder of total quality management in medicine. Many publications on the quality of structure, process and outcome in emergency medical services followed at the turn of the millennium. In this work we examined the dimension of satisfaction of referring physicians as an instrument of quality assurance in emergency medical services.

Methods

A questionnaire was sent to referring physicians. Satisfaction about emergency call provider 144, time until arrival at the emergency scene, organization, treatment, expertise and interpersonal skills including cooperation with the referring physician were evaluated for three Swiss Emergency Medical Services.

Results

Detailed analysis brings strength and weaknesses to light. The overall satisfaction was high and reached a value of 88.0%.

Conclusions

Total quality management in medicine focused on effectiveness and efficiency in the past. Quality of structure, process and outcome will remain standard; however, it is time to broaden the concept with soft-skill factors.     

Heat exposure of Cannabis sativa extracts affects the pharmacokinetic and metabolic profile in healthy male subjects

The most important psychoactive constituent of CANNABIS SATIVA L. is Δ (9)-tetrahydrocannabinol (THC). Cannabidiol (CBD), another important constituent, is able to modulate the distinct unwanted psychotropic effect of THC. In natural plant extracts of C. SATIVA, large amounts of THC and CBD appear in the form of THCA-A (THC-acid-A) and CBDA (cannabidiolic acid), which can be transformed to THC and CBD by heating. Previous reports of medicinal use of cannabis or cannabis preparations with higher CBD/THC ratios and use in its natural, unheated form have demonstrated that pharmacological effects were often accompanied with a lower rate of adverse effects. Therefore, in the present study, the pharmacokinetics and metabolic profiles of two different C. SATIVA extracts (heated and unheated) with a CBD/THC ratio > 1 were compared to synthetic THC (dronabinol) in a double-blind, randomized, single center, three-period cross-over study involving 9 healthy male volunteers. The pharmacokinetics of the cannabinoids was highly variable. The metabolic pattern was significantly different after administration of the different forms: the heated extract showed a lower median THC plasma AUC (24 h) than the unheated extract of 2.84 vs. 6.59 pmol h/mL, respectively. The later was slightly higher than that of dronabinol (4.58 pmol h/mL). On the other hand, the median sum of the metabolites (THC, 11-OH-THC, THC-COOH, CBN) plasma AUC (24 h) was higher for the heated than for the unheated extract. The median CBD plasma AUC (24 h) was almost 2-fold higher for the unheated than for the heated extract. These results indicate that use of unheated extracts may lead to a beneficial change in metabolic pattern and possibly better tolerability.     

Multi-center study finds postoperative residual non-enhancing component of glioblastoma as a new determinant of patient outcome

Introduction

The aim of the present study is to assess whether postoperative residual non-enhancing volume (PRNV) is correlated and predictive of overall survival (OS) in glioblastoma (GBM) patients.

Methods

We retrospectively analyzed a total 134 GBM patients obtained from The University of Texas MD Anderson Cancer Center (training cohort, n?=?97) and The Cancer Genome Atlas (validation cohort, n?=?37). All patients had undergone postoperative magnetic resonance imaging immediately after surgery. We evaluated the survival outcomes with regard to PRNV. The role of possible prognostic factors that may affect survival after resection, including age, sex, preoperative Karnofsky performance status, postoperative nodular enhancement, surgically induced enhancement, and postoperative necrosis, was investigated using univariate and multivariate Cox proportional hazards regression analyses. Additionally, a recursive partitioning analysis (RPA) was used to identify prognostic groups.

Results

Our analyses revealed that a high PRNV (HR 1.051; p-corrected?=?0.046) and old age (HR 1.031; p-corrected?=?0.006) were independent predictors of overall survival. This trend was also observed in the validation cohort (higher PRNV: HR 1.127, p-corrected??=?0.002; older age: HR 1.034, p-corrected??=?0.022). RPA analysis identified two prognostic risk groups: low-risk group (PRNV?<?70.2 cm³; n?=?55) and high-risk group (PRNV?≥?70.2 cm³; n?=?42). GBM patients with low PRNV had a significant survival benefit (5.6 months; p?=?0.0037).

Conclusion

Our results demonstrate that high PRNV is associated with poor OS. Such results could be of great importance in a clinical setting, particularly in the postoperative management and monitoring of therapy.

     

Genome-wide prediction of imprinted murine genes

Imprinted genes are epigenetically modified genes whose expression is determined according to their parent of origin. They are involved in embryonic development, and imprinting dysregulation is linked to cancer, obesity, diabetes, and behavioral disorders such as autism and bipolar disease. Herein, we train a statistical model based on DNA sequence characteristics that not only identifies potentially imprinted genes, but also predicts the parental allele from which they are expressed. Of 23,788 annotated autosomal mouse genes, our model identifies 600 (2.5%) to be potentially imprinted, 64% of which are predicted to exhibit maternal expression. These predictions allowed for the identification of putative candidate genes for complex conditions where parent-of-origin effects are involved, including Alzheimer disease, autism, bipolar disorder, diabetes, male sexual orientation, obesity, and schizophrenia. We observe that the number, type, and relative orientation of repeated elements flanking a gene are particularly important in predicting whether a gene is imprinted.