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Die Wahrnehmung unserer Umwelt erfolgt über verschiedene Sinnesmodalitäten, deren Informationen bevorzugt in bestimmten Hirnarealen verarbeitet werden und sich schließlich zu einem kohärenten Bild ergänzen. Wie diese Prozesse ablaufen und durch welche Vorgänge die Wahrnehmungen einen einheitlichen Sinneseindruck formen, sind fundamentale Fragen der kognitiven Neurowissenschaft. Ziel der vorliegenden Studie war es, diese sensorischen Verarbeitungsprozesse genauer zu untersuchen und bisherige Ergebnisse zu bestätigen sowie neue Erkenntnisse bezüglich audio-haptischer und audio-visuo-haptischer Integration zu gewinnen. Weiterhin sollten angemessene Kriterien für die Auswertung der Daten untersucht werden mit dem Schwerpunkt sinnvoller Kontrollbedingungen. Sechzehn Probanden wurden hierzu mittels fMRT während uni-, bi- und trimodaler Stimulation untersucht. Die Stimulation bestand aus der Darbietung von schwarz-weißen Tierbildern, Tierstimmen und Tierfiguren, die einzeln oder in unterschiedlichen Kombinationen präsentiert wurden. Weiterhin gab es eine motorische Kontrollbedingung ohne sensorische Stimulation. Die unisensorischen Ergebnisse fanden sich in den modalitätsspezifischen Kortexarealen und bestätigten zum großen Teil bisherige Erkenntnisse und die Existenz der Was- und Wo-Pfade. Bimodale audio-visuelle Stimulation führte zu Aktivierungen im Temporallappen um den STS/STG, welcher bei audio-visueller Integration von großer Bedeutung ist. Aktivierungen im Gyrus cinguli, Gyrus fusiformis und Precuneus spielen anscheinend eine Rolle bei der Präsentation von familiären Stimuli und kongruenten Darbietungskombinationen. Auf Ebene früher visueller und auditorischer Leitungsbahnen zeigte sich ebenfalls audio-visuelle Interaktion. Visuo-haptische Integration scheint sich nach den vorliegenden Daten im LOtv, IPS und ventralen Zerebellum abzuspielen. LOtv und IPS sind vermutlich insbesondere für die Verarbeitung von geometrischen Formen von Bedeutung. Im ventralen Zerebellum kommt es durch kortiko-zerebelläre Verschaltungen zur Beteiligung bei visuo-haptischer Informationsverarbeitung. Die Aktivationsmuster bei audio-haptischer Stimulation deuteten auf Verarbeitung bilateral im temporo-parietalen Bereich hin in Temporallappen, Parietallappen und der Insula. Die Aktivierungen kommen vermutlich durch Feedforward-Projektionen und Konnektivität zwischen auditorischem und somatosensorischem Kortex zustande, in der Insula durch Konvergenz der auditorischen und somatosensorischen Was-Informationen. Trimodale Stimulation zeigte bei Anwendung des Max-Kriteriums, bei welchem die audio-visuo-haptische Aktivität stärker als die einzelnen unisensorischen Signalantworten ausfallen sollte, ein Areal im linken temporo-parietalen Bereich. Bei weniger strenger Auswertung wurde eine weitere Region im rechten Zerebellum nachgewiesen. Beide konnten der Erweiterung des Max-Kriteriums zum Vergleich zwischen tri- und bisensorischer Aktivität nicht standhalten. Beim Affen existiert eine superior temporale polysensorische Region, welche auf visuelle, auditorische und haptische Reize reagiert. Ob ein integratives trisensorisches Areal beim Menschen existiert, sollte in weiteren Studien untersucht werden. Vielleicht liegt eine ausgeprägte interindividuelle Variabilität der Lokalisation des Konvergenzpunktes vor. Eine andere Möglichkeit ist, dass die Verarbeitung im Gehirn vermehrt bisensorisch gegliedert verläuft. Um dies in zukünftigen Studien besser zu untersuchen, könnte es von Vorteil sein simple sensorische Stimuli zu verwenden. Eine Reizdegradierung hätte verminderte Signalamplituden zur Folge, was multisensorische Interaktionen mit nachfolgendem Signalanstieg besser beurteilen ließe. Darüber hinaus könnte in den Studien fMRT-Adaptation angewendet werden. Über die repetitive Stimulusdarbietung kommt es ebenfalls zu verminderter BOLD-Signalantwort. Die vorliegende Studie hat weiterhin die Notwendigkeit der Einführung von Kontrollbedingungen demonstriert. Neben unisensorischen sollten bisensorische Kontrollbedingungen zur Beurteilung trisensorischer Aktivität herangezogen werden. Eine Kontrollbedingung zur Beurteilung des Ruhezustandes ohne sensorischen Reiz sollte ebenfalls vorhanden sein. Prinzipiell scheint das Max-Kriterium zur Detektion multisensorischer Integration angemessen zu sein.
Influenza A (H1N1) 2009 : impact on Frankfurt in due consideration of health care and public health
(2010)
Background: In April 2009 a novel influenza A H1N1/2009 virus was identified in Mexico and in the United States which quickly spread around the world. Most of the countries established infection surveillance systems in order to track the number of (laboratory-confirmed) H1N1 cases, hospitalizations and deaths. Methods: The impact of the emergence of the novel pandemic (H1N1) 2009 virus on Frankfurt was statistically evaluated by the Health Protection Authority, City of Frankfurt am Main. Vaccination rates of the health care workers (HCWs) of the University Hospital Frankfurt were measured by the Occupational Health Service. Results: Although the virulence of pandemic (H1N1) 2009 seems to be comparable with seasonal influenza, a major patient load and wave of hospital admissions occurred in the summer of 2009. Even though the 2009 vaccination rate of the University Hospital Frankfurt (seasonal influenza [40.5%], swine flu [36.3%]) is better than the average annual uptake of influenza vaccine in the German health care system (approximately 22% for seasonal and 15% for swine flu), vaccination levels remain insufficient. However, physicians were significantly (p < 0.001) more likely to have been vaccinated against swine flu and seasonal influenza than nurses. Conclusions: The outbreak of the pandemic (H1N1) 2009 in April 2009 provided a major challenge to health services around the world. Nosocomial transmission of H1N1/2009 has been documented. Present experience should be used to improve pandemic preparedness plans and vaccination programs ought to target as many HCWs as possible.
Due to an increasing awareness of the potential hazardousness of air pollutants, new laws, rules and guidelines have recently been implemented globally. In this respect, numerous studies have addressed traffic-related exposure to particulate matter using stationary technology so far. By contrast, only few studies used the advanced technology of mobile exposure analysis. The Mobile Air Quality Study (MAQS) addresses the issue of air pollutant exposure by combining advanced high-granularity spatial-temporal analysis with vehicle-mounted, person-mounted and roadside sensors. The MAQS-platform will be used by international collaborators in order 1) to assess air pollutant exposure in relation to road structure, 2) to assess air pollutant exposure in relation to traffic density, 3) to assess air pollutant exposure in relation to weather conditions, 4) to compare exposure within vehicles between front and back seat (children) positions, and 5) to evaluate "traffic zone"- exposure in relation to non-"traffic zone"-exposure. Primarily, the MAQS-platform will focus on particulate matter. With the establishment of advanced mobile analysis tools, it is planed to extend the analysis to other pollutants including including NO2, SO2, nanoparticles, and ozone.
Background: Hemorrhagic shock/resuscitation is associated with aberrant neutrophil activation and organ failure. This experimental porcine study was done to evaluate the effects of Fas-directed extracorporeal immune therapy with a leukocyte inhibition module (LIM) on hemodynamics, neutrophil tissue infiltration, and tissue damage after hemorrhagic shock/resuscitation. Methods: In a prospective controlled double-armed animal trial 24 Munich Mini Pigs (30.3 +/- 3.3 kg) were rapidly haemorrhaged to reach a mean arterial pressure (MAP) of 35 +/- 5 mmHg, maintained hypotensive for 45 minutes, and then were resuscitated with Ringer's solution to baseline MAP. With beginning of resuscitation 12 pigs underwent extracorporeal immune therapy for 3 hours (LIM group) and 12 pigs were resuscitated according to standard medical care (SMC). Haemodynamics, haematologic, metabolic, and organ specific damage parameters were monitored. Neutrophil infiltration was analyzed histologically after 48 and 72 hours. Lipid peroxidation, and apoptosis were specifically determined in lung, bowel, and liver. Results: In the LIM group, neutrophil counts were reduced versus SMC during extracorporeal immune therapy. After 72 hours, the haemodynamic parameters MAP and cardiac output (CO) were significantly better in the LIM group. Histological analyses showed reduction of shock-related neutrophil tissue infiltration in the LIM group, especially in the lungs. Lower amounts of apoptotic cells and lipid peroxidation were found in organs after LIM treatment. Conclusions: Transient Fas-directed extracorporeal immune therapy may protect from posthemorrhagic neutrophil tissue infiltration and tissue damage.
Objective: To summarise the benefits and harms of treatments for women with gestational diabetes mellitus. Design: Systematic review and meta-analysis of randomised controlled trials. Data sources: Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR, CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, several publishers’ databases, and reference lists of relevant secondary literature up to October 2009. Review methods: Included studies were randomised controlled trials of specific treatment for gestational diabetes compared with usual care or "intensified" compared with "less intensified" specific treatment. Results: Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a two step approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of direct clinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less common (odds ratio 0.40, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48 (0.38 to 0.62). In the 13 randomised controlled trials of different intensities of specific treatments, meta-analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31, 0.14 to 0.70). Conclusions: Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take into account that the evidence of benefit is derived from trials for which women were selected with a two step strategy (glucose challenge test/screening for risk factors and oral glucose tolerance test).
Background: Previously, we showed that glioma pathogenesis related protein (GliPR) is induced in CEM T cells upon HIV-1 infection in vitro. To examine whether GliPR plays a role as HIV dependency factor (HDF), we tested the effect of GliPR suppression by siRNA on HIV-1 replication. Results: Induction of GliPR expression by HIV-1 was confirmed in P4-CCR5 cells. When GliPR was suppressed by siRNA, HIV-1 replication was significantly reduced as measured by HIV-1 transcript levels, HIV-1 p24 protein levels, and HIV-1 LTR-driven reporter gene expression, suggesting that GliPR is a cellular co-factor of HIV-1. Microarray analysis of uninfected HeLa cells following knockdown of GliPR revealed, among a multitude of gene expression alterations, a down-regulation of syndecan-1, syndecan-2, protein kinase C alpha (PRKCA), the catalytic subunit beta of cAMP-dependent protein kinase (PRKACB), nuclear receptor co-activator 3 (NCOA3), and cell surface protein CD59 (protectin), all genes having relevance for HIV-1 pathology. Conclusions: The up-regulation of GliPR by HIV-1 and the early significant inhibition of HIV-1 replication mediated by knockdown of GliPR reveal GliPR as an important HIV-1 dependency factor (HDF), which may be exploited for HIV-1 inhibition.