Experiential grounding of abstract concepts: Processing of abstract mental state concepts engages brain regions involved in mentalizing, automatic speech, and lip movements.

concepts like mental state concepts lack a physical referent, which can be directly perceived. Classical theories therefore claim that abstract concepts require amodal representations detached from experiential brain systems. However, grounded cognition approaches suggest an involvement of modal experiential brain regions in the processing of abstract concepts. In the present functional magnetic resonance imaging study, we investigated the relation of the processing of abstract mental state concepts to modal experiential brain systems in a fine-grained fashion. Participants performed lexical decisions on abstract mental state as well as on verbal association concepts as control category. Experiential brain systems related to the processing of mental states, generating verbal associations, automatic speech as well as hand and lip movements were determined by corresponding localizer tasks. Processing of abstract mental state concepts neuroanatomically overlapped with activity patterns associated with processing of mental states, generating verbal associations, automatic speech and lip movements. Hence, mental state concepts activate the mentalizing brain network, complemented by perceptual-motor brain regions involved in simulation of visual or action features associated with social interactions, linguistic brain regions as well as face-motor brain regions recruited for articulation. The present results provide compelling evidence for the rich grounding of abstract mental state concepts in experiential brain systems related to mentalizing, verbal communication and mouth action.

Reward is not reward: Differential impacts of primary and secondary rewards on expectation, outcome, and prediction error in the human brain's reward processing regions.

According to their nature, rewarding stimuli are classified as primary (e.g., food, sex) and secondary (e.g., money) rewards. Neuroimaging studies have provided valuable insights in neural reward processing and its various aspects including reward expectation, outcome and prediction error encoding. However, there is only limited evidence of whether the two different types of rewards are processed in common or distinct brain areas, in particular when considering the different functions of reward processing. We analyzed a sample of 42 healthy, male participants using task-based functional magnetic resonance imaging (fMRI) during a variant of the monetary incentive delay task. We aimed to investigate the effects of three different rewarding stimuli-two primary (food and sex) and one secondary (money)-on the various functions of reward processing. To provide a thorough description, we focused on 12 brain regions of interest and utilized the Bayes factor bound (BFB) to express stimulus-related main effects and pairwise differences at different levels of evidence, ranging from weak to decisive. Our results revealed a dominance of sexually charged stimuli in engaging the brain's reward structures for all investigated aspects of reward processing. Nevertheless, the ventral tegmental area, amygdala, ventral caudate, ventromedial prefrontal cortex, subgenual anterior cingulate cortex, and lateral orbitofrontal cortex were activated by both primary and secondary reward outcomes. For other reward processing functions, i.e., reward expectation and the prediction error, effects of the different stimuli were weaker, and effects from one reward type cannot easily be generalized to the other.

Academic training increases grounding of scientific concepts in experiential brain systems.

Scientific concepts typically transcendent our sensory experiences. Traditional approaches to science education therefore assume a shift towards amodal or verbal knowledge representations during academic training. Grounded cognition approaches, in contrast, predict a maintenance of grounding of the concepts in experiential brain networks or even an increase. To test these competing approaches, the present study investigated the semantic content of scientific psychological concepts and identified the corresponding neural circuits using functional magnetic resonance imaging (fMRI) in undergraduate psychology students (beginners) and in graduated psychologists (advanced learners). During fMRI scanning, participants were presented with words denoting scientific psychological concepts within a lexical decision task (e.g. "conditioning", "habituation"). The individual semantic property content of each concept was related to brain activity during abstract concept processing. In both beginners and advanced learners, visual and motor properties activated brain regions also involved in perception and action, while mental state properties increased activity in brain regions also recruited by emotional-social scene observation. Only in advanced learners, social constellation properties elicited brain activity overlapping with emotional-social scene observation. In line with grounded cognition approaches, the present results highlight the importance of experiential information for constituting the meaning of abstract scientific concepts during the course of academic training.

Role of the right anterior insula for the emergence of flow-A combined task-based fMRI activation and connectivity study.

The emergence of flow is a situation of high salience because externally oriented attention on the task and access to resources for goal-directed behavior are enhanced, while internally oriented or self-related cognition is decreased. The right anterior insula has been reported as a causal out-flow hub of the salience resting-state network, orchestrating the engagement of the central executive network (CEN) and the disengagement of the default-mode network (DMN) during a functional challenge. In the present study, we employed a combined task-based activation and connectivity analysis to investigate the role of the right anterior insula during the emergence of flow. A sample of 41 healthy male subjects was confronted with a functional challenge that permitted the emergence of flow during BOLD-based functional magnetic resonance imaging. Comparing connectivity changes in the right anterior insula during the flow condition against connectivity changes associated with control conditions of boredom and overload, relatively increased couplings were observed with the left and right dorsolateral prefrontal cortex. Activation data for these regions did, however, not show the flow-typical inverted U-shaped (invU) response pattern. Relatively decreased functional couplings encompassed ventral aspects of the striatum, but neither the amygdala nor the medial prefrontal cortex (MPFC). For the ventral striatum, activation data were consistent with the flow-typical U-shaped activation pattern, which supports the notion that under the high salience of autotelic situations, the anterior insula is much less positively coupled with the ventral striatum than under boundary conditions of boredom and overload. Taken together, present functional connectivity results were in alignment with the assumed role of the right anterior insula under conditions of different salience. However, this particular region does not appear to mediate the most typical flow-associated activation patterns.

[Pandemic and value change?] / Pandemie und Wertewandel?: Verschiebungen von Wertprioritäten in der österreichischen Bevölkerung und in einzelnen Wähler*innenschichten als Reaktion auf die COVID-19-Pandemie.

Recent sociological diagnoses suggest that profound social crises such as the COVID-19 pandemic challenge our value orientations and could change them even in the relatively short term. Based on this observation, we investigate whether significant shifts in value priorities according to the Shalom Schwartz scale took place in Austria in the period May 2020 to March/April 2021. The first two waves of the Values in Crisis panel study serve as data material. Two theoretical assumptions are central to the interpretation of the results: first, the thesis of a trend toward conservatism and second, the thesis of the effective power of political discourses in times of (re)emerging populism. The article also pays special attention to a methodological discussion of changes in the meaning of questionnaire items due to the COVID-19 pandemic.The empirical analyses confirm a clear stability of value orientations. Above all, the value of conformity has changed, becoming more important for a significant part of the population; at the same time, the desire for a hedonistic lifestyle lost some of its importance. Conformity became more important, particularly for voters of the governing political parties, while this trend was not apparent, especially among voters of the FPÖ. Since the observed shift in value priorities mainly concerns "pandemic-sensitive" value dimensions, the results suggest a short-term reaction to the crisis rather than a long-term change in values.

Methylphenidate Differentially Affects Intrinsic Functional Connectivity of the Salience Network in Adult ADHD Treatment Responders and Non-Responders.

Positron emission tomography (PET) studies have shown involvement of the striatum when treating adult attention-deficit/hyperactivity disorder (ADHD) with methylphenidate (MPH). Results from resting-state functional magnetic resonance imaging (rs-fMRI) for the same issue were less unequivocal. Here, a new analytical framework was set up to investigate medication effects using seed-based rs-fMRI analysis to infer brain regions with alterations in intrinsic functional connectivity (IFC) corresponding with ADHD symptom reduction. In a within-subjects study design, 53 stimulant-naïve adult ADHD patients were investigated before and after 6 weeks of MPH treatment, using two major clinical symptom scales and rs-fMRI. The same data were acquired in a sample of 50 age- and sex-matched healthy controls at baseline. A consensual atlas provided seeds for five predefined major resting-state networks. In order to avoid biasing of medication effects due to putative treatment failure, the entire ADHD sample was first categorized into treatment Responders (N = 36) and Non-Responders (N = 17) using machine learning-based classification with the clinical scales as primary data. Imaging data revealed medication effects only in Responders. In that group, IFC of bilateral putamen changed significantly with medication and approached almost normal levels of IFC. Present results align well with results from previous PET studies, with seed-based rs-fMRI as an entirely different neuroimaging method.

Radiotherapy of Breast Cancer in Laterally Tilted Prone vs. Supine Position: What about the Internal Mammary Chain?

BACKGROUND: In the multimodal breast-conserving curative therapy of some high-risk breast cancer patients, extended external beam radiotherapy (EBRT) not only to the breast but also to the supraclavicular fossa and the internal mammary chain (parasternal region (PSR)) is indicated. We report a dosimetric study on the EBRT of the breast ("B") and the breast including PSR ("B + PSR"), comparing the supine and the laterally tilted prone patient positions in free breathing. METHODS: The planning CT scans of 20 left- and 20 right-sided patients were analyzed. EBRT plans were calculated with 3D conformal EBRT (3D) and with intensity-modulated EBRT (IMRT) for "B" and "B + PSR" in the prone and supine positions. The mean and threshold doses were computed. The quality of EBRT plans was compared with an overall plan assessment factor (OPAF), comprising three subfactors, homogeneity, conformity, and radiogenic exposure of OAR. RESULTS: In the EBRT of "B", prone positioning significantly reduced the exposure of the OARs "heart" and "ipsilateral lung" and "lymphatic regions". The OPAF was significantly better in the prone position, regardless of the planning technique or the treated breast side. In the EBRT of "B + PSR", supine positioning significantly reduced the OAR "heart" exposure but increased the dose to the OARs "ipsilateral lung" and "lymphatic regions". There were no significant differences for the OPAF, independent of the irradiated breast side. Only the IMRT planning technique increased the chance of a comparatively good EBRT plan. CONCLUSION: Free breathing prone positioning significantly improves plan quality in the EBRT of the breast but not in the EBRT of the breast + PSR.

Lower fractional anisotropy of the corticothalamic tract and increased response time variability in adult patients with ADHD.

BACKGROUND: Intraindividual intertrial variability has been suggested as an endophenotype of attention-deficit/hyperactivity disorder (ADHD). It is usually evaluated as response time variability (RTV) in reaction time tasks, and RTV has emerged as a robust and stable feature of ADHD. Among attempts to elucidate the neurobiological underpinnings of RTV, it has been suggested that alterations in white matter microstructure may explain RTV. METHODS: We used diffusion tensor imaging (DTI) in a group of 53 adults with ADHD and 50 healthy controls. We obtained RTV parameters from a simple reaction-time task, in which participants were asked to respond to the appearance of white crosses on a screen using button presses. RESULTS: We observed significant between-group differences for the ex-Gaussian parameter τ, indicating that the mean of extremely slow responses was greater for adults with ADHD than controls. Fractional anisotropy (FA) derived from DTI was significantly different between groups in 2 clusters of the corticothalamic tract. In the ADHD group, relatively decreased FA values were significantly associated with the parameter τ, such that lower FA values in the corticothalamic tract predicted greater τ as an index of RTV. We did not observe this association in healthy controls. LIMITATIONS: For comparison with previous studies, we used FA as a dependent variable of interest. However, although this metric is sensitive to white matter structural properties, there are ambiguities in its interpretation. CONCLUSION: Even in a simple reaction-time task, RTV proved again to be a stable feature of ADHD. It was associated with altered white matter structural properties of the corticothalamic tract in adults with ADHD.

Endocannabinoid system reactivity during stress processing in healthy humans.

Stress underlies the development of various psychiatric disorders. Rodent studies suggest an involvement of the endocannabinoid system in the modulation of the stress response, which needs to be translated to humans. In this study, 22 healthy males (mean age: M = 22.7 years) were exposed to a thermal heat stressor in a fear conditioning paradigm and blood samples of the circulating endocannabinoids anandamide and 2-arachidonoylglycerol (2-AG) were assessed. Additionally, electrodermal activity (EDA), task-related anxiety ratings and data on critical life experiences (CLE) were recorded. Interestingly, increases in 2-AG from pre-to-post stress correlated with: smaller stress responses (EDA), by trend more CLE, and greater conditioned anxiety. Smaller stress responses correlated with more CLE. We demonstrate a relation between endocannabinoid level changes from pre-to-post acute stress and the stress response. Our results suggest that investigating the role of 2-AG in the response to stress could be promising in finding treatments in the immediate aftermath of traumatic events.

FAAH polymorphism (rs324420) modulates extinction recall in healthy humans: an fMRI study.

Gold standard treatments for anxiety- and trauma-related disorders focus on exposure therapy promoting extinction learning and extinction retention. However, its efficacy is limited. Preclinical and particularly animal research has been able to demonstrate that homozygosity for the fatty acid amide hydrolase (FAAH) C385A allele, similar to FAAH inhibition, is associated with elevated concentrations of anandamide (AEA) and facilitates extinction learning and extinction recall. However, in humans, the underlying neurobiological processes are less well understood, and further knowledge might enhance the development of more effective therapies. In this functional magnetic resonance imaging (fMRI) study, a fear conditioning, fear extinction and extinction recall paradigm was conducted with 55 healthy male adults. They were genotyped for the FAAH single-nucleotide polymorphism (SNP) rs324420 to investigate differences related to extinction recall in neural activation and State-Trait Anxiety Inventory (STAI) ratings between AC heterozygotes and CC homozygotes (FAAH C385A SNP). Differential brain activation upon an unextinguished relative to an extinguished stimulus, was greater in AC heterozygotes as compared to CC homozygotes in core neural structures previously related to extinction recall, such as the medial superior frontal gyrus, the dorsal anterior cingulate and the anterior and middle insular cortex. Furthermore, AC heterozygotes displayed higher AEA levels and lower STAI-state ratings. Our data can be interpreted in line with previous suggestions of more successful extinction recall in A-allele carriers with elevated AEA levels. Data corroborate the hypothesis that the endocannabinoid system, particularly AEA, plays a modulatory role in the extinction of aversive memory.

Direct voluntary control of pupil constriction and dilation: Exploratory evidence from pupillometry, optometry, skin conductance, perception, and functional MRI.

We present a single case who can change pupil size on command with dilation of pupil diameter of around 0.8 mm, and constriction of around 2.4 mm. Using modern pupillometric and optometric techniques in combination with measuring electrodermal activity, various indirect mechanisms possibly mediating this phenomenon were tested: accommodation, brightness, increases in arousal by increased mental effort. None of these behavioral tests could support an indirect strategy as the mode of action, although it seems plausible that the case could have learned to gain control over the pupillary response by decoupling pupil size changes from accommodation and vergence in the near triad: Even at maximal accommodation, the case voluntarily constricted his pupil without changing vergence and could improve visual acuity by >6 diopters. Using task-based functional magnetic resonance imaging we found involvement of brain regions generating and mediating volitional impulses. Changes of the left pupil size were associated with increased activation of parts of the left dorsolateral prefrontal cortex, adjacent premotor areas, and supplementary motor area. It still remains open where these neural signals enter the final pathway, either innervating the pupil's dilator directly, or more indirectly by inhibiting the parasympathetically innervated antagonistic sphincter, and vice versa for constriction. To conclude, so far none of potential - conscious or unconscious - indirect strategies, may it be accommodative or vergence efforts or mental efforts and imaginations, could be observed or inferred to be fully responsible, suggesting direct voluntary control of pupil size in the present case.

Fear extinction learning and anandamide: an fMRI study in healthy humans.

Anxiety- and trauma-related disorders are severe illnesses with high prevalence. Current treatment options leave room for improvement and the endocannabinoid system (ECS) has become a key target in psychopharmacological research. Rodent models suggest an anxiolytic effect of endocannabinoids and demonstrated that the ECS is involved in the modulation of fear learning and aversive memory consolidation. So far, one prominent target was inhibition of fatty acid amino hydrolase (FAAH), the degrading enzyme of the endocannabinoid anandamide (AEA). Research in humans remains scarce, but genetic studies have found that the single-nucleotide polymorphism (SNP) FAAH C385A (rs324420) is associated with lower catabolic performance of FAAH and increased levels of AEA. Translational research on the ECS in fear learning processes is rare, yet crucial to understand the mechanisms involved. To address this lack of research, we designed a fear conditioning, extinction learning paradigm with 51 healthy, male humans who underwent functional magnetic resonance imaging (fMRI) before analysing baseline and task-related changes of AEA, as well as the FAAH polymorphism (rs324420). The results indicate higher AEA levels in AC-heterozygotes than in CC-individuals (SNP rs324420), but no difference between the groups during extinction learning. However, neural activation of the anterior cingulate cortex and anterior insular cortex during extinction learning correlated positively with AEA baseline levels, and task-related changes in AEA were found particularly during fear extinction, with a modulatory effect on neural activation related to extinction learning. Results indicate a putative role for AEA in fear extinction learning. Pre-treatment with AEA-enhancing drugs could promote extinction learning during psychotherapeutic interventions.

The grounding of abstract concepts in the motor and visual system: An fMRI study.

The grounding of concepts in the sensorimotor brain systems is controversially discussed. Grounded cognition models propose that concepts are represented in modality-specific sensorimotor, but also emotional and introspective brain areas depending on specific experiences during concept acquisition. Accumulating evidence suggests that concrete concepts are closely linked to modality-specific systems, whereas the mere existence of abstract concepts seems to contradict grounded cognition approaches. Here, using functional magnetic resonance imaging, we adopted a theory-driven approach frequently used for investigating concrete concepts to the domain of abstract concepts: We compared brain activation to abstract concepts with a known motor versus visual feature content as determined by a previous property listing study. Carefully matched motor (e.g., fitness) and visual (e.g., beauty) abstract words were presented to 24 participants along with pseudowords while performing a lexical decision task. Furthermore, participants performed two localizer tasks by actually moving their hands (motor localizer) and by looking at real pictures (visual localizer). Processing of motor abstract words specifically activated frontal and parietal motor areas, whereas processing of visual abstract words specifically elicited higher activity in temporo-occipital visual areas, albeit at a more lenient statistical threshold. According to inclusive masking analyses, this differential activity pattern to motor and visual abstract concepts overlapped with brain activations observed during hand movements (pre- and postcentral gyrus) and object perception (fusiform and lingual gyrus). Thus, consistent with the grounded cognition framework, our results suggest that, similar to concrete concepts, abstract concepts related to action and vision are grounded in modality-specific brain systems typically engaged in actual perception and action depending on their conceptual feature content.

M. Peroneus Quartus Causing Chronic Peroneal Compartment Syndrome in a Runner Treated by Endoscopic Fasciotomy: A Case Report.

We present the rare case of a 47-year-old male long-distance runner who was referred to our hospital with a longstanding pain in his left calf. Clinical history, as well as ultrasound and magnetic resonance imaging scans, showed an accessory peroneal muscle. This muscle was identified as a peroneus quartus muscle. On ultrasound, controlled intracompartmental pressure measurement, a chronic peroneal compartment syndrome, was diagnosed. We performed an endoscopic-assisted fasciotomy of the peroneal compartment. This resolved the patient's symptoms completely and allowed the runner to return to competition shortly after the surgery.

The neural correlates of flow experience explored with transcranial direct current stimulation.

The experience of flow ensues when humans engage in a demanding task while task demands are balanced with the individual's level of skill or ability. Here, we further tested the hypothesis that the medial prefrontal cortex (MPFC) plays a causal role in mediating flow experience using transcranial direct current stimulation (tDCS) to interfere with MPFC's deactivation evoked by a flow paradigm and measured by magnetic resonance (MR)-based perfusion imaging. In a balanced, within-subjects repeated measure design, three treatments of tDCS (sham, anodal, cathodal) were applied in a sample of 22 healthy male participants. tDCS-modulatory effects on flow-specific regional cerebral blood flow (rCBF) and subjective flow experience significantly depended on participants' baseline level of flow experience during sham tDCS. Those participants with lower-flow experience during sham tDCS (LF) benefitted from tDCS, particularly from the anodal polarity, whereas both active treatments did not substantially affect subjects with relatively higher baseline flow experience (HF). Functionally, in LF subjects, relative deactivation of the right amygdala got more pronounced under anodal and cathodal tDCS, and changed inconsistently in HF subjects. Inter-individual regression analyses of rCBF data suggested that involvement of the subgenual anterior cingulate cortex appears crucial for affecting the response pattern in the right amygdala and can be modulated by tDCS. Present data support the notion that valuable insights into the neural mechanism of flow can be obtained using tDCS. However, a clearer understanding of tDCS' baseline dependency in terms of individual variations in brain connectivity states appears a necessary prerequisite to exploit this technique further.

Preserving the lower extremity after severe devolving injuries to meet the patient's demand in two cases: (Limb salvage after degloving injury).

BACKGROUND: Severe injuries of the foot are a life-changing event. They often lead to some form of disability, and are therefore very challenging to manage. Injuries of the extremity, especially the foot and ankle, are distinct predictors of poor outcome in polytrauma patients.Degloving injuries of the lower extremity involving the heel and foot are a rare and unique subgroup of severe foot injuries.Treating degloving injuries is challenging. The surgical approach has to take into consideration both osseous and massive soft tissue injuries aiming to preserve the unique architecture of the lower limb and reconstruct the soft tissue.There are several surgical approaches for treating degloving injuries of the lower limb. CASE PRESENTATION: We would like to share our experience with two cases of young very active patients who suffered from a complex injury of the lower limb that included a massive degloving injury. It was of paramount importance to salvage the lower limb and keep it functional.Both patients were treated while using the degloved skin as a defatted full thickness skin flap that was replanted on the injured limb followed by application of VAC-therapy. CONCLUSION: We treated two patients suffering a severe degloving injury of the lower extremity with degloved skin as a full thickness flap in order to preserve both the extremity itself as well as the function of the lower limb according to the individual requirements of the patients. Consequently, we could enable the patient to pursue their professional musical training requiring subtle use of the lower extremity as well as ensuring sufficient function of the lower extremity in everyday use.

Glucose Modulates Human Ventral Tegmental Activity in Response to Sexual Stimuli.

BACKGROUND: Attribution of salience to sexual stimuli is mediated by the dopaminergic midbrain, including the ventral tegmental area (VTA). The existence of glucose-sensing neurons in the VTA, as suggested by animal studies, offers the opportunity to modulate aberrant salience coding involved in sexual disorders such as sexual addiction. Recent neuroimaging work supported that VTA activity in humans can be modulated by intravenously infusing a small bolus of glucose. However, that study used appetitive food stimuli, leaving the possibility that glucose modulation of VTA-mediated salience coding might be bound to this class of stimuli. AIM: To test whether glucose-modulatory effects generalize to food-unrelated stimuli despite being in the class of primary reinforcers. METHODS: During functional imaging, 37 healthy men were exposed to images showing nude or clothed female upper bodies. At the end of the 1st quarter (∼6 minutes) of the experiment, 18 participants received a small amount of intravenously infused glucose. RESULTS: Before glucose administration, VTA activity was higher for nude than for clothed female stimuli. After infusion of glucose, this pattern reversed such that VTA activity was higher for clothed than for nude female stimuli. The effect was at its maximum approximately 7 to 12 minutes after glucose infusion, changing back during the experiment's 4th phase. In another 19 participants not treated with glucose, VTA activity was consistently higher for nude than for clothed female stimuli throughout the experiment. CONCLUSION: The present findings show that glucose modulates VTA-mediated salience coding of sexual stimuli. These results suggest that glucose might affect salience coding in a stimulus-general way. However, future studies are necessary to address the question of whether glucose modulation also affects the VTA's salience coding of secondary reinforcers. Ulrich M, Stauß P, Grön G. Glucose Modulates Human Ventral Tegmental Activity in Response to Sexual Stimuli. J Sex Med 2018;15:20-28.

Theta-burst modulation of mid-ventrolateral prefrontal cortex affects salience coding in the human ventral tegmental area.

In the context of hedonic (over-)eating the ventral tegmental area (VTA) as a core part of the dopaminergic reward system plays a central role in coding incentive salience of high-caloric food. In the present study, we used functional magnetic resonance imaging (fMRI) to investigate whether transcranial magnetic theta-burst stimulation (TBS) over the right mid-ventrolateral prefrontal cortex (mid-VLPFC) can induce modulation of calorie-sensitive brain activation in the VTA. The prefrontal location for TBS had been predetermined by seed-based resting-state fMRI with a functionally defined portion of the VTA serving as seed region obtained from an independent second fMRI experiment. In a sample of 15 healthy male participants, modulation of calorie-sensitive VTA activation did not significantly differ between the two TBS protocols. Comparisons with baseline revealed that both TBS protocols significantly affected calorie-sensitive neural processing of the mid-VLPFC in a rather similar way. In the VTA significant modulation of calorie-sensitive activation was observed after continuous TBS, whereas the modulatory effect of intermittent TBS was less reliable but also associated with a decrease of activation for high-caloric food images. Neurostimulation of right mid-VLPFC is suggestive as a main entry point of downstream signal changes for high- and low-caloric food cues that could enforce a shift in valuating stimuli of initially different incentive salience.

Low-dose external beam radiotherapy for greater trochanteric pain syndrome : Target volume definition and treatment outcome.

PURPOSE: Low-dose external beam radiotherapy (ED-EBRT) is frequently used in the therapy of refractory greater trochanteric pain syndrome (GTPS). As studies reporting treatment results are scarce, we retrospectively analyzed our own patient collectives. PATIENTS AND METHODS: In all, 60 patients (74 hips) received LD-EBRT (6 × 0.5 Gy in 29 hips, 6 × 1 Gy in 45). The endpoint was the patient's reported subjective response to treatment. The influence of different patient and treatment characteristics on treatment outcome was investigated. RESULTS: At the end of LD-EBRT, 69% reported partial remission, 4% complete remission, no change 28%. A total of 3 months later (n = 52 hips), the results were 37, 33, and 30% and 18 months after LD-EBRT (n = 47) 21, 51, and 28%. In univariate analysis "inclusion of the total femoral head into the PTV" and "night pain before LD-EBRT" were correlated with symptom remission at the end of LD-EBRT, while "initial increase in pain during LD-EBRT" was significantly associated with treatment failure. In multivariable modeling "initial increase in pain" was identified as a risk factor for treatment failure (p = 0.007; odds ratio [OR] 0.209; 95% confidence interval [CI] 0.048-0.957), while "night pain" was an independent factor for remission (p = 0.038; OR 3.484; 95% CI 1.004-12.6). Three months after LD-EBRT "night pain" and "inclusion of the complete femoral neck circumference into the PTV" were predictive for remission. CONCLUSION: LD-EBRT represents a useful treatment option for patients suffering from GTPS. Three months after therapy two-thirds of the patients reported a partial or complete symptom remission. Especially patients who suffered from nocturnal pain seemed to benefit. Treatment appeared to be more effective when the entire circumference of the femoral neck was encompassed.

Shining into the White: The Spectrum of Epithelial Tumors from Actinic Keratosis to Squamous Cell Carcinoma.

Actinic keratosis, Bowen disease, and invasive squamous cell carcinoma represent different steps within the disease continuum of squamous neoplasia. Although these stages of squamous neoplasia share common findings, reflectance confocal microscopy may be applied for their differentiation and distinction from other benign or malignant lesions. Hyperkeratosis represents the most important limitation in the evaluation of squamous neoplasia as it may impair the analysis of deeper epidermal and dermal structures significantly.