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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.
Es sollte in dieser Schrift untersucht werden, inwieweit bei Änderungen im Bereich der Planung, Durchführung und Auswertung von klinischen Arzneimittelprüfungen die Bewertung mit wissenschaftlichen oder politischen Begründungen erfolgt und inwieweit wissenschaftliche Regeln für politische Zwecke genutzt werden.
Geleitwort
(2012)
Das 20. Jahrhundert ist geprägt von Aufsehen erregenden medizintechnischen Durchbrüchen: Von der ersten erfolgreichen Herztransplantation über die Entdeckung des Penicillins, vom Kampf gegen Infektionskrankheiten bis hin zu ersten Röntgenaufnahmen und Computer-Scans. Die Technologie und die medizinische Forschung haben in der Welt zu umwälzenden Fortschritten geführt. Krankheiten können gelindert oder sogar geheilt werden. Die Entwicklung von künstlichen Hüftgelenken, Cochlea-Implantaten sowie Herzschrittmachern sind in unserer Zeit zu alltäglichen Errungenschaften geworden. Auch die Behandlung neurologischer Bewegungsstörungen ist in den Fokus des technisch-medizinischen Fortschritts gelangt: „Hirnschrittmachersysteme“ – symptomfrei auf Knopfdruck. Ein Eingriff in das Gehirn, um gezielt elektrische Impulse abzugeben, um die Symptome beispielsweise von pharmakoresistenter Parkinsonpatienten effektiv zu behandeln. Dieses Therapieverfahren stellt für viele Patienten die letzte Möglichkeit dar, ein mehr oder weniger beschwerdefreies Leben führen zu können. Gleichzeitig ist dieses Verfahren ethisch heftig umstritten, zumal der Eingriff in das Gehirn gleichbedeutend mit einem Eingriff in den ‚Sitz des Selbst‘, der Persönlichkeit eines Patienten, verbunden ist.
Cardiac resynchronisation therapy (CRT) is a promising treatment option in patients with chronic heart failure. In this article the roles of semi-invasive esophageal left-heart electrocardiography and functional cardiac nuclear imaging in the field of CRT are highlighted, as the combination of both could be a favourable diagnostic approach in special cardiac situations. Also original esophageal left heart electrogram data of exemplary CRT patients is presented.
Whiplash injury
(2012)
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.
In the brain-cell microenvironment, diffusion plays an important role: apart from delivering glucose and oxygen from the vascular system to brain cells, it also moves informational substances between cells. The brain is an extremely complex structure of interwoven, intercommunicating cells, but recent theoretical and experimental works showed that the classical laws of diffusion, cast in the framework of porous media theory, can deliver an accurate quantitative description of the way molecules are transported through this tissue. The mathematical modeling and the numerical simulations are successfully applied in the investigation of diffusion processes in tissues, replacing the costly laboratory investigations. Nevertheless, modeling must rely on highly accurate information regarding the main parameters (tortuosity, volume fraction) which characterize the tissue, obtained by structural and functional imaging. The usual techniques to measure the diffusion mechanism in brain tissue are the radiotracer method, the real time iontophoretic method and integrative optical imaging using fluorescence microscopy. A promising technique for obtaining the values for characteristic parameters of the transport equation is the direct optical investigation using optical fibers. The analysis of these parameters also reveals how the local geometry of the brain changes with time or under pathological conditions. This paper presents a set of computations concerning the mass transport inside the brain tissue, for different types of cells. By measuring the time evolution of the concentration profile of an injected substance and using suitable fitting procedures, the main parameters characterizing the tissue can be determined. This type of analysis could be an important tool in understanding the functional mechanisms of effective drug delivery in complex structures such as the brain tissue. It also offers possibilities to realize optical imaging methods for in vitro and in vivo measurements using optical fibers. The model also may help in radiotracer biomarker models for the understanding of the mechanism of action of new chemical entities.
Die “Selbstbetrachtungen” des Marc Aurel – medizinisch-ethische Betrachtungen des Menschseins
(2013)
Hybrid SPECT/US
(2014)
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.
Who is Who? Joseph Fourier
(2015)
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.
Concussions in sports and during recreational activities are a major source of traumatic brain injury in our society. This is mainly relevant in adolescence and young adulthood, where the annual rate of diagnosed concussions is increasing from year to year. Contact sports (e.g., ice hockey, American football, or boxing) are especially exposed to repeated concussions. While most of the athletes recover fully from the trauma, some experience a variety of symptoms including headache, fatigue, dizziness, anxiety, abnormal balance and postural instability, impaired memory, or other cognitive deficits. Moreover, there is growing evidence regarding clinical and neuropathological consequences of repetitive concussions, which are also linked to an increased risk for depression and Alzheimer’s disease or the development of chronic traumatic encephalopathy. With little contribution of conventional structural imaging (computed tomography (CT) or magnetic resonance imaging (MRI)) to the evaluation of concussion, nuclear imaging techniques (i.e., positron emission tomography (PET) and single-photon emission computed tomography (SPECT)) are in a favorable position to provide reliable tools for a better understanding of the pathophysiology and the clinical evaluation of athletes suffering a concussion.
Kommentar zu "Intracortical microstimulation of human somatosensory cortex" von Sharlene N. Flesher et al., veröffentlicht in Science Translational Medicine, Vol. 8, No. 361, Seite 361ra141 (DOI: 10.1126/scitranslmed.aaf8083)