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A survey in 2000 revealed that only about 30% of the prescriptions in the European pediatric population were on the basis of evidence-based medicine (EbM). Less for radiopharmaceuticals and principally for diagnostics, radiologists throughout Europe are referred to the pediatric guidelines of the European Association of Nuclear Medicine (EANM), as none of the frequently used tracers have been evaluated in clinical trials in the different pediatric subgroups. Following a resolution to address the lack of EbM in children, the European Commission published the Pediatric Regulation EC 1901/2006 and its amendment EC 1902/2006, effective from 2007. This regulation foresees the development of evidence-based medicine in the pediatric population. This is effected through a set of principles like the mandatory pediatric investigation plan (PIP) to be included with the market authorization application (MAA), and the pediatric use market authorization (PUMA) for off-patent pharmaceuticals, and to a very small part radiopharmaceuticals with funding possibilities for pediatric-specific research through the 7th Framework Programme (7FP) of the European Union.
Routine nuclear cardiology examinations indicate heart rate, cardiac rhythm, the height of cardiac pulse and respiration rhythm. It would be of interest to study whether these data, especially if the same tests are repeated, can indicate patients’ well being in the future and perhaps patients’ life span, other factors being equal. Related old theories and suggestions are mentioned. Furthermore, some drugs like I-f channel antagonists and stress tests testing cardiac reserves could support such a study.
The study from Mehrazin et al. in HJNM 2011; 14(3): 243-50 on the neuropsychology, morphological computerized tomography (CT) and functional neuroimaging with 99mTc-labelled ethylene cystein-ate dimer single-photon emission tomography (SPET) in mild trau-matic brain injury (MTBI) is an interesting new approach to a disease condition which is often neglected or denied. Related to the above, we may note that the French composer Maurice Ravel (1875-1937), who suffered from Pick ́s disease with primary progressive apha-sia, had a taxi accident in 1932, with a mild concussion, perhaps an MTBI. Apart from the dysphasia and beginning apraxia, which Rav-el had already 5 years prior to the taxi accident, these symptoms exacerbated-the dysphasia became a progressive aphasia-and he developed additional severe deficits in concentration and atten-tion after the accident. It has also been suspected that this accident may have triggered Ravel ́s agraphia the unability to write down any new composition beyond the date of the taxi accident, a condi-tion that Ravel himself described as unacceptable and which made him feel very sad as his mind was full of ideas. Due to the deterio-ration of his health, which can also be seen in his appearance on late photographs, Ravel consulted the famous neurosurgeon Prof. Clovis Vincent. Vincent, who suspected a hydrocephalus, opened Ravel ́s skull on December 19, 1937, showing a normal brain. Soon after surgery Ravel died. In conclusion, a SPET/CT approach com-bined with a brain perfusion analysis using statistical parametric mapping might be the recommendable approach today for mild traumatic brain injury.
This paper presents new measurements of a bronze cast from the right hand of the famous Italian violin virtuoso Nicolò Paganini (1782-1840). These are compared to anthropometric standard values. In addition, detailed dorsal and palmar views of the cast are shown. With a middle finger length of 75 mm, the palm width is 60 mm and the hand length 152 mm, which is significantly below the 5% percentile of today's standard values. Also the finger length index (0.55), the ratio of finger length to palm length (0.98) and the ratio of finger length to palm width (1.25) are significantly above normal limits. Hence, Paganini had abnormal hand measurements with a very small palm and relatively "long" fingers. This remarkable constellation, among others, could have been advantageous for his amazing skills as a violinist.
Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that chronic insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep–wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions.
Serendipities in der Medizin
(2016)
Zufälle begleiten unser Leben. Auch bei wichtigen Entdeckungen und Entwicklungen in der Medizin spielt der „Zufall“ (engl. „serendipity“) eine Rolle. Hierzu gehören u. a. die Mendelschen Gesetze, die Ermittlung der menschlichen Chromosomenzahl, die Entdeckung der DNS durch Watson und Crick, der PAP-Test oder die Entdeckung der Röntgenstrahlung und der Radioaktivität. Aber auch und gerade in der Pharmakologie gibt es viele Beispiele für Serendipitäten. Einige gehen eng mit Zufällen bei der Entdeckung der Bakteriologie einher.
The famous violin virtuoso Nicolò Paganini (born on 27 October 1782 in Genoa, died on 27 May 1840 in Nice) left us with many puzzles. An interesting aspect is his hair: In the 19th century, hair given away as a token of friendship or romantic love became very popular, and Paganini also seems to have made use of this fad. In 2009, a lock of hair, purportedly that of Paganini, kept in a locked presentation box together with a bilingual autograph inscription saying: "Alla Signora Chatterton avec les compliments de Nicolò Paganini" was bought at an auction. From this hair lock a sample was taken and was investigated morphologically by using digital light microscopy (digital microscope VHX-100, Keyence) in reflected and transmitted light with and without polarization at different magnifications up to 1:5,000. The sample was then compared with a hair sample from the possession of the Paganini family, which had been microscopically examined in 2012 by the co-author of this paper yielding numerous figures with measurement results that had been stored and could be retrieved for direct comparison. The hair sample consisted of ten strands of hair or hair fragments and was investigated with great effort for the following parameters: exogenous hair damage, especially feeding traces caused by parasites, modeling and angulation of hairs, hair thickness, medulla and pigmentation, curling and mercury load on the trace material. After evaluation of all findings not only a non-exclusion of identity can be determined, but due to the broad match of also rare findings there is no reasonable doubt about their identity. In addition, the findings suggest that the studied hair samples are in fact from Paganini's head. The present case of Nicolò Paganini's hair lock is also an excellent starting point for reflections on the probative value of trace hair investigations. This point is also critically discussed in the paper. Finally, this study shows that said lock of hair had probably really been dedicated and given to Eliza Davenport Latham (born on 25 November 1806, died on 9 January 1877), the future wife of the, at that time, best-known and most famous English harpist John Balsir Chatterton (born on 25 November 1804, died on 9 April 1871). Paganini must have met her on his concert tour 1831/32, where he had travelled to Paris, London, the rest of England, Scotland and Ireland.
There is increasing evidence of central hyperexcitability in chronic whiplash-associated disorders (cWAD). However, little is known about how an apparently simple cervical spine injury can induce changes in cerebral processes. The present study was designed (1) to validate previous results showing alterations of regional cerebral blood flow (rCBF) in cWAD, (2) to test if central hyperexcitability reflects changes in rCBF upon non-painful stimulation of the neck, and (3) to verify our hypothesis that the missing link in understanding the underlying pathophysiology could be the close interaction between the neck and midbrain structures. For this purpose, alterations of rCBF were explored in a case-control study using H215O positron emission tomography, where each group was exposed to four different conditions, including rest and different levels of non-painful electrical stimulation of the neck. rCBF was found to be elevated in patients with cWAD in the posterior cingulate and precuneus, and decreased in the superior temporal, parahippocampal, and inferior frontal gyri, the thalamus and the insular cortex when compared with rCBF in healthy controls. No differences in rCBF were observed between different levels of electrical stimulation. The alterations in regions directly involved with pain perception and interoceptive processing indicate that cWAD symptoms might be the consequence of a mismatch during the integration of information in brain regions involved in pain processing.
All you need is sleep
(2016)
In 21st century, the century when the humanity hopes to embark on interplanetary travel, we are yet to fully reach an understanding of our very own idiosyncratic terra incognita – the human sleep. Sleep is a highly conserved evolutionary process that constitutes approximately one third of our life, and the lack or inadequate sleep may lead to impairment across multiple cognitive domains (Tononi and Cirelli, 2014; Lim and Dinges, 2010). Sleep deprivation also leads to aberrant brain functioning, immunological and metabolic collapse, and if it is sufficiently prolonged it will ultimately lead to death (Tononi and Cirelli, 2014).
Die Namen Cormack und Hounsfield sind für den Radiologen zu einem wichtigen Synonym für die Computertomographie (CT) geworden. Der mathematische Wegbereiter für die CT, Johann Radon, kommt in der radiologischen Diskussion und den historischen Rückblicken hingegen oft zu Unrecht zu kurz. Die folgende Kurzübersicht möchte daher dem interessierten Leser die wichtigsten historischen Eckdaten zu dem in vielerlei Hinsicht bewegenden Leben und Wirken dieses großen Mathematikers näherbringen.
This is a commentary note on the situation of functional neuroimaging in psychiatry. With this we would like to encourage psychiatrists and the journal editors of psychiatric and related journals to at least rethink the role of functional neuroimaging in this discipline and use these imaging techniques in their various aspects of clinical diagnosis and therapy regimens,respectively.
Im Jahr 1504 verlor der deutsche Ritter Gottfried („Götz“) von Berlichingen seine
rechte Hand. Schon während seiner Genesung dachte er daran, die Hand zu ersetzen,
und beauftragte bald darauf die erste Handprothese, die sogenannte „Eiserne Hand“.
Jahre später wurde die aufwändigere zweite „Eiserne Hand“ gebaut. Wir haben die erste
Prothese auf der Basis früherer Literaturdaten von
Quasigroch (1982) mit Hilfe von 3-D
Computer-Aided Design (CAD) rekonstruiert. Dazu mussten einige Abmessungen angepasst
und ein paar Annahmen für das CAD-Modell gemacht werden. Die historische passive
Prothese des Götz von Berlichingen ist für die moderne Neuroprothetik interessant, da sie
eine Alternative zu komplexen invasiven Brain-Machine-Interface-Konzepten darstellen
könnte, wo diese Konzepte nicht notwendig, möglich oder vom Patienten gewünscht sind.
In the past two decades much has been published on whiplash injury, yet both the confusion regarding the condition, and the medicolegal discussion about it have increased. In this paper, functional imaging research results are summarized using MRIcroGL3D visualization software and assembled in an image comprising regions of cerebral activation and deactivation.
Streustrahlung in der Ultraschall-Computertomographie zur Verifizierung der Echtheit von Perlen
(2017)
This paper describes a new analysis method developed to distinguish real from fake
pearls using non-ionizing, non-destructive ultrasound computed tomography (USCT): In the USCT Shepp-Logan-filtered time-of-flight image, a fake pearl shows irregular, asymmetric
scattering of ultrasound, whereas the pattern in a natural pearl is regular and symmetric.
We strongly assume that pattern recognition of the scattering of ultrasound cannot only
play an important role in verifying pearls, but also in testing other materials and tissues in
(bio-)medical engineering. Furthermore, and most importantly, this new approach could
be helpful for a variety of clinical diagnoses using high-resolution 3D-USCT, such as the
detection of X-ray-negative micro-calcifications in early breast cancer. Moreover looking
at scattering patterns in dedicated positron emission tomography systems may promote
new developments in nuclear medicine diagnostics.
In this study, we tested the function of a replica of the over 500-year-old original of the
famous Franconian Imperial Knight Götz von Berlichingen’s first “iron hand”, which we
reconstructed by computer-aided design (CAD) and recently printed using a multi-material
3D printer. In different everyday tasks, the artificial hand prosthesis proved to be remarkably
helpful. Thus, the hand could hold a wine glass, some grapes, or a smartphone. With a
suitable pencil, even writing was possible without any problem. Although for all these
functions the healthy other hand was necessary to assist at the beginning, the artificial hand
is an astonishing mechanical aid with many possibilities. Therefore, in certain cases, the
non-invasive approach of a passive mechanical hand replacement, which is an individual,
quick and cheap solution due to modern 3D printing, may always be worth considering
also for today’s requirements.
Auf Grundlage der Computer-Aided-Design (CAD)-rekonstruierten ersten „Eisernen Hand“ des Götz von Berlichingen wird ein umgebautes, controllergesteuertes sensomotorisches Fingersystem auf seine Funktionalität beim Greifen von unterschiedlichen Gegenständen beschrieben und geprüft. Die elektronischen Finger, die den „Pinzettengriff“ nachahmen und automatisch bei dem zuvor eingestellten Anpressdruck abschalten, bewiesen eine bemerkenswerte Alltagstauglichkeit. Das vorgestellte Grundkonzept könnte eine Alternative bei der Entwicklung einfacher und kostengünstiger, aber dennoch gut einsatzfähiger bionischer Hände sein und zeigt einmal mehr, wie historische Ideen in die Gegenwart transferiert werden können.
In this paper pathophysiological interrelated deactivation/activation phenomena are set out in the example of whiplash injury. These phenomena could have been underestimated in previous positron emission tomography studies as their focus was on hypoperfusion rather than hyperperfusion. In addition, statistical parametric mapping analysis of cerebral studies is normally not fine-tuned to special interesting areas rather than to obvious clusters of difference.
The Baroque composer Johann Sebastian Bach (1685–1750) has left us with many puzzles. The well-known oil painting by Elias Gottlob Haußmann is the only painting for which Bach actually posed in person. According to this portrait, Bach must have been quite obese. The cheeks and nose are flushed – possibly as signs of hypertension – and the eye lids are narrow – a sign of myopia. Furthermore, there is a thinning of the lateral third of the right eyebrow, which is known as Hertoghe’s sign, and indicated periorbital edema. Both signs are compatible with hypothyroidism. Bach might have been suffering from type-2 diabetes as the origin of his final illness, and the obituary reports two cataract surgeries by oculist John Taylor in March/April 1750, and, four months later, “apoplexy” followed by a high fever, of which Bach died. It may be speculated, however, that Bach’s entire illness was the result of his presumed obesity, possibly in combination with hypothyroidism.
Diese Arbeit beschäftigt sich mit der Biomechanik der Halswirbelsäule (HWS) beim Umgang mit dem Smartphone. Die Kräfte, die auf Wirbelkörper, Wirbelgelenke, Bandscheiben, Muskeln und Bänder wirken, werden mit steigendem Flexionswinkel der HWS größer. Die Beschwerden hingegen, welche der Smartphone-Nacken hervorruft, sind meist akut und mit regelmäßiger Bewegung und der Stärkung der Nackenmuskulatur gut zu behandeln. Eine Therapie ist somit auch zur Vorbeugung geeignet. Doch die Langzeitauswirkungen sind nicht außer Acht zu lassen, denn durch die steigenden Nutzungsmöglichkeiten der Smartphones steigt auch der durchschnittliche tägliche Gebrauch stärker an. So wird vor allem die tägliche Bildschirmzeit bei Jugendlichen immer länger. Das aktuell noch akute Krankheitsbild des Smartphone-Nackens, das nur selten einen chronischen Verlauf nimmt und Langzeitschäden verursacht, könnte sich durch fehlende oder zu späte Maßnahmen zu einem größeren chronischen Krankheitsbild entwickeln.
Knight Götz von Berlichingen (1480–1562) lost his right hand distal to the wrist due to a cannon ball splinter injury in 1504 in the Landshut War of Succession at the age of 24. Early on, Götz commissioned a gunsmith to build the first “Iron Hand,” in which the artificial thumb and two finger blocks could be moved in their basic joints by a spring mechanism and released by a push button. Some years later, probably around 1530, a second “Iron Hand” was built, in which the fingers could be moved passively in all joints. In this review, the 3D computer-aided design (CAD) reconstructions and 3D multi-material polymer replica printings of the first “Iron hand“, which were developed in the last few years at Offenburg University, are presented. Even by today’s standards, the first “Iron Hand”—as could be shown in the replicas—demonstrates sophisticated mechanics and well thought-out functionality and still offers inspiration and food for discussion when it comes to the question of an artificial prosthetic replacement for a hand. It is also outlined how some of the ideas of this mechanical passive prosthesis can be translated into a modern motorized active prosthetic hand by using simple, commercially available electronic components.
In the field of neuroprosthetics, the current state-of-the-art method involves controlling the prosthesis with electromyography (EMG) or electrooculography/electroencephalography (EOG/EEG). However, these systems are both expensive and time consuming to calibrate, susceptible to interference, and require a lengthy learning phase by the patient. Therefore, it is an open challenge to design more robust systems that are suitable for everyday use and meet the needs of patients. In this paper, we present a new concept of complete visual control for a prosthesis, an exoskeleton or another end effector using augmented reality (AR) glasses presented for the first time in a proof-of-concept study. By using AR glasses equipped with a monocular camera, a marker attached to the prosthesis is tracked. Minimal relative movements of the head with respect to the prosthesis are registered by tracking and used for control. Two possible control mechanisms including visual feedback are presented and implemented for both a motorized hand orthosis and a motorized hand prosthesis. Since the grasping process is mainly controlled by vision, the proposed approach appears to be natural and intuitive.
In der vorliegenden Arbeit werden fotografische Aufnahmen zweier verschiedener Abgüsse von Paganinis rechter Hand vorgestellt und näher beschrieben. Es handelt sich um einen mutmaßlich originalen Bronzeabguss, der vermutlich kurz nach Paganinis Tod auf dessen Totenbett abgenommen wurde, und eine in heutiger Zeit angefertigte Kopie aus Fiberplastik mit goldfarbenem Anstrich. Die Hand ist im proximalen Handgelenk stark abgewinkelt, was dafür spricht, dass die Hand des Toten auf einem Kissen gelegen haben könnte, um den Abguss vorzunehmen. Überdies zeigt sich eine verkrampfte Stellung der Finger und Hand, am ehesten infolge Totenstarre. Man findet zudem arthrotische Veränderungen sowie hervortretende Sehnen und atrophierte Muskulatur. Beim Bronzeabguss sind die beschriebenen Auffälligkeiten deutlicher zu erkennen. Ein 3D-Scan des Bronzeabgusses der rechten Hand Paganinis mit einem Strukturlichtscanner würde die Möglichkeit eröffnen, Messdaten der Hand zu erhalten.
Neurostimulation durch Musik
(2020)
Was ist die Musik und wie wirkt sie sich auf den menschlichen Körper aus? Historisch betrachtet wird die Musik als etwas Göttliches aufgefasst, da sie eine äußerst große Wirkung auf die Emotionen des Menschen besitzt. Dieser Effekt wirkt sich auch psychosomatisch aus und kann das Denken und Handeln des Zuhörers beeinflussen und steuern. So lässt sich beispielsweise das Kaufverhalten allein durch die musikalische Begleitung deutlich manipulieren. Selbst die Motivation lässt sich mit passender Vertonung entweder steigern oder reduzieren. In der heutigen Zivilisation begleitet die Musik den Menschen alltäglich und wird zu vielen verschiedenen Zwecken verwendet. Somit ist die musikalische Stimulation als eine Art Psychotherapie zu werten, die häufig gezielt angewendet wird, aber im Beeinflussten unterbewusst stattfindet. Da natürlich immer noch offene Fragen bezüglich der genauen Wirkung von Musik auf das Gehirn bestehen, werden derzeit im Bereich der Neurowissenschaften viele Studien durchgeführt, um dieses Phänomen nachvollziehen zu können.
A new concept for robust non-invasive optical activation of motorized hand prostheses by simple and non-contactcommands is presented. In addition, a novel approach for aiding hand amputees is shown, outlining significantprogress in thinking worth testing. In this, personalized 3D-printed artificial flexible hands are combined withcommercially available motorized exoskeletons, as they are used e.g. in tetraplegics.
In der vorliegenden Arbeit wurde die von Wilhelm His Sr. angefertigte und im Jahr 1895 publizierte Fotografie des mutmaßlichen Skeletts von Johann Sebastian Bach auf ihre Abbildungsqualität untersucht. Dies erfolgte durch direkte Messungen an einem digitalen Scan der Fotografie. Dabei wurde der von His der Fotografie beigelegte Lineal-Maßstab in mehrere 10-cm-Stücke unterteilt und die Länge dieser Abschnitte im Digitalisat mit dem Messinstrument von Adobe Acrobat ausgemessen. Darüber hinaus wurden die Längen der Femora ermittelt und mit den Maßen verglichen, die 1895 an den tatsächlichen (realen) Knochen ermittelt wurden. In dem Digitalisat entsprachen 190 cm im Lineal 244,48 mm. Der Mittelwert der 19 bestimmten 10-cm-Abschnitte betrug 100,49 mm (Median 100,49 mm, Standardabweichung 0,49 mm). Die historische Femurlänge links betrug 443,5 mm, rechts 451,0 mm. Die im Digitalisat ermittelte Femurlänge betrug links 443,8 mm, rechts 451,1 mm. Zusätzlich wurden die projizierten Centrum-Collum-Diaphysen-Winkel bestimmt. Die Daten lassen den Schluss zu, dass die Oben/unten-Verzerrung sowie die Rechts/links-Verzerrung nicht nennenswert sind und das von His angefertigte Foto mit einer hohen Genauigkeit der Abbildungsqualität und des Linsenapparats der Kamera angefertigt wurde, die es ermöglicht, bestimmte Skelettanteile aussagekräftig zu beurteilen und auszumessen.
In this editorial, a topic for general discussion in the field of neuroprosthetics of the upper limb is addressed: which way—invasive or non-invasive—is the right one for the future in the development of neuroprosthetic concepts. At present, two groups of research priorities (namely the invasive versus the non-invasive approach) seem to be emerging, without taking a closer look at the wishes but also the concerns of the patients. This piece is intended to stimulate the discussion on this.
Background: This paper presents a novel approach for a hand prosthesis consisting of a flexible, anthropomorphic, 3D-printed replacement hand combined with a commercially available motorized orthosis that allows gripping.
Methods: A 3D light scanner was used to produce a personalized replacement hand. The wrist of the replacement hand was printed of rigid material; the rest of the hand was printed of flexible material. A standard arm liner was used to enable the user’s arm stump to be connected to the replacement hand. With computer-aided design, two different concepts were developed for the scanned hand model: In the first concept, the replacement hand was attached to the arm liner with a screw. The second concept involved attaching with a commercially available fastening system; furthermore, a skeleton was designed that was located within the flexible part of the replacement hand.
Results: 3D-multi-material printing of the two different hands was unproblematic and inexpensive. The printed hands had approximately the weight of the real hand. When testing the replacement hands with the orthosis it was possible to prove a convincing everyday functionality. For example, it was possible to grip and lift a 1-L water bottle. In addition, a pen could be held, making writing possible.
Conclusions: This first proof-of-concept study encourages further testing with users.
Fünf Jahre vor seinem Tod, im Jahr 1932, wurde der berühmte französische Komponist Maurice Ravel (1875–1937), der an einer frontotemporalen Demenz (M. Pick) mit primär progressiver Aphasie litt, bei einem Unfall verletzt, als er in einem Pariser Taxi saß. In diesem Fallbericht wird der Unfallmechanismus unter bestimmten Annahmen dargestellt und diskutiert. Ausgehend von diesen Überlegungen ist ein Unfall bei geringer Kollisionsgeschwindigkeit wahrscheinlich. Trotz eines Unfalls mit nur geringer Geschwindigkeit ist nicht von der Hand zu weisen, dass dieser Unfall zumindest zu einer deutlichen Verschlimmerung der Krankheitssymptome geführt haben könnte, da Ravel seit diesem Taxiunfall bis zu seinem Tod keine weiteren Kompositionen mehr vollendet hat.
In dieser Arbeit wird ein historischer Fallbericht des bis heute weit über seine Landesgrenzen bekannten italienischen Kriminalanthropologen Cesare Lombroso (1835–1909) vorgestellt. In diesem Fallbericht wird der berüchtigte und psychisch auffällige Dieb Pietro Bersone mit Hilfe eines sog. Hydrosphygmographen überführt, einem zur damaligen Zeit neuartigen technischen Gerät, das den Puls nicht-invasiv aufzeichnen konnte. Lombroso ist vermutlich einer der ersten, wenn nicht sogar der erste, der durch den Einsatz eines solchen Geräts die Idee zum „Lügendetektor“ vorweggenommen hat. Die vorgestellte Textstelle aus Lombrosos Buch „Neue Fortschritte in den Verbrecherstudien“ ist daher ein besonderes Fundstück auch für die Geschichte der Polygraphie.