Exercise related versus non exercise related out of hospital cardiac arrest - A retrospective single-center study.

Background: Physical activity prevents cardiovascular disease, but it may also trigger acute cardiac events like sudden cardiac death in patients with underlying heart disease. The chance of surviving an out-of-hospital cardiac arrest remains low, despite improving medical treatment and rescue chain. Prior studies signaled increased survival in exercise related out-of-hospital cardiac arrest. Objective: The aim of this study was to evaluate the differences between exercise related out-of-hospital cardiac arrest and out-of-hospital cardiac arrest during daily activity in an urban setting. Methods: Retrospective analysis of all out-of-hospital cardiac arrests from 2014 to 2021 treated at a cardiac arrest center of a tertiary hospital. The primary outcome was survival to discharge. Secondary outcomes included differences in pre-hospital care, in-hospital treatment, hypoxic ischemic encephalopathy, and laboratory parameters. Results: 478 OHCA patients were reviewed of which 432 patients (exercise related 36 (8.4%) vs. daily activity 396 (91.6%)) were included in the analysis. Patients suffering an exercise related arrest were younger (57 vs 65 years, p = 0.002) and mostly male (88.9 vs 74.5%, p = 0.054).The exercise related cohort received bystander cardiopulmonary resuscitation (77.8 vs 53.4%, p = 0.005) to a higher extent and had a shorter no-flow time (1.5 vs 2 min, p = 0.049). Exercise related arrest patients more often presented with a shockable rhythm (80.6 vs 64.1%, p = 0.032).At hospital admission exercise related arrest patients had a higher initial pH (7.24 vs 7.19, p = 0.015). In the exercise related group, a cardiac cause was numerically more frequent compared to the daily activity group (80.6 vs 68.7%, p = 0.09). In both groups myocardial infarction (47.2 vs 43.2%) was the most common cause, but a primary arrhythmic event (33.3 vs 25.5%) was more often documented in exercise related arrest patients. Exercise related arrest was mostly related to endurance training (52.8%) followed by ball sports (19.4%) and occurred directly during exercise in 77.8% of cases. Patients suffering exercise related arrest had higher survival till discharge (66.7 vs 47.7%, p = 0.036). Conclusion: Based on this observational data from a highly selected group of out-of-hospital cardiac arrest patients treated at a cardiac arrest center, patients suffering an exercise related out-of-hospital cardiac arrest, differed in substantial characteristics and in the first line response compared to daily activity out-of-hospital cardiac arrest patients. The better survival to discharge of the exercise related out-of-hospital cardiac arrest group might be driven by these beneficial differences. This study underlines the need for public awareness for the importance of a fast first response and a broad distribution of automated external defibrillators in public sport areas since most of the exercise related out-of-hospital cardiac arrest patients presented with a cardiac cause and an initial shockable rhythm.

Longterm course of neuropsychological symptoms and ME/CFS after SARS-CoV-2-infection: a prospective registry study.

A significant proportion of patients after SARS-CoV-2 infection suffer from long-lasting symptoms. Although many different symptoms are described, the majority of patients complains about neuropsychological symptoms. Additionally, a subgroup of patients fulfills diagnostic criteria for ME/CFS. We analyzed a registry of all patients presenting in the out-patients clinic at a German university center. For patients with more than one visit, changes in reported symptoms from first to second visit were analyzed. A total of 1022 patients were included in the study, 411 of them had more than one visit. 95.5% of the patients reported a polysymptomatic disease. At the first visit 31.3% of the patients fulfilled ME/CFS criteria after a median time of 255 days post infection and and at the second visit after a median of 402 days, 19.4% still suffered from ME/CFS. Self-reported fatigue (83.7-72.7%) and concentration impairment (66.2-57.9%) decreased from first to second visit contrasting non-significant changes in the structured screening. A significant proportion of SARS-CoV-2 survivors presenting with ongoing symptoms present with ME/CFS. Although the proportion of subjective reported symptoms and their severity reduce over time, a significant proportion of patients suffer from long-lasting symptoms necessitating new therapeutic concepts.

Motor-cognitive dual-task performance: effects of a concurrent motor task on distinct components of visual processing capacity.

Dual tasking, or the simultaneous execution of two continuous tasks, is frequently associated with a performance decline that can be explained within a capacity sharing framework. In this study, we assessed the effects of a concurrent motor task on the efficiency of visual information uptake based on the 'theory of visual attention' (TVA). TVA provides parameter estimates reflecting distinct components of visual processing capacity: perceptual threshold, visual processing speed, and visual short-term memory (VSTM) storage capacity. Moreover, goodness-of-fit values and bootstrapping estimates were derived to test whether the TVA-model is validly applicable also under dual task conditions, and whether the robustness of parameter estimates is comparable in single- and dual-task conditions. 24 subjects of middle to higher age performed a continuous tapping task, and a visual processing task (whole report of briefly presented letter arrays) under both single- and dual-task conditions. Results suggest a decline of both visual processing capacity and VSTM storage capacity under dual-task conditions, while the perceptual threshold remained unaffected by a concurrent motor task. In addition, goodness-of-fit values and bootstrapping estimates support the notion that participants processed the visual task in a qualitatively comparable, although quantitatively less efficient way under dual-task conditions. The results support a capacity sharing account of motor-cognitive dual tasking and suggest that even performing a relatively simple motor task relies on central attentional capacity that is necessary for efficient visual information uptake.

Simulations of the kinematic dynamo onset of spherical Couette flows with smooth and rough boundaries.

We study numerically the dynamo transition of an incompressible electrically conducting fluid filling the gap between two concentric spheres. In a first series of simulations, the fluid is driven by the rotation of a smooth inner sphere through no-slip boundary conditions, whereas the outer sphere is stationary. In a second series a volume force intended to simulate a rough surface drives the fluid next to the inner sphere within a layer of thickness one-tenth of the gap width. We investigate the effect of the boundary layer thickness on the dynamo threshold in the turbulent regime. The simulations show that the boundary forcing simulating the rough surface lowers the necessary rotation rate, which may help to improve spherical dynamo experiments.

Deficits of spatial and task-related attentional selection in mild cognitive impairment and Alzheimer's disease.

Visual selective attention was assessed with a partial-report task in patients with probable Alzheimer's disease (AD), amnestic mild cognitive impairment (MCI), and healthy elderly controls. Based on Bundesen's "theory of visual attention" (TVA), two parameters were derived: top-down control of attentional selection, representing task-related attentional weighting for prioritizing relevant visual objects, and spatial distribution of attentional weights across the left and the right hemifield. Compared with controls, MCI patients showed significantly reduced top-down controlled selection, which was further deteriorated in AD subjects. Moreover, attentional weighting was significantly unbalanced across hemifields in MCI and tended to be more lateralized in AD. Across MCI and AD patients, carriers of the apolipoprotein E ε4 allele (ApoE4) displayed a leftward spatial bias, which was the more pronounced the younger the ApoE4-positive patients and the earlier disease onset. These results indicate that impaired top-down control may be linked to early dysfunction of fronto-parietal networks. An early temporo-parietal interhemispheric asymmetry might cause a pathological spatial bias which is associated with ApoE4 genotype and may therefore function as early cognitive marker of upcoming AD.

Visual context modulates the subjective vertical in neglect: evidence for an increased rod-and-frame-effect.

Patients with spatial hemi-neglect display systematic deviations of the subjective vertical. The magnitude of such deviations was shown to be modulated by internal factors mediating the perception of verticality, including head-orientation. The present study investigated whether and how spatial orientation deficits are modulated by external, contextual changes in neglect patients. In a classic rod-and-frame task, we analyzed effects of frame orientation on the subjective visual vertical (SVV) in neglect patients, control patients with left- or right-sided brain damage without neglect and healthy participants. We found that neglect patients, but not brain-damaged control patients, generally display a systematic counterclockwise (CCW) tilt in their SVV judgments. Furthermore, all participant groups displayed a typical rod-and-frame effect (RFE), that is, a modulation of the SVV as a function of frame tilt. However, in the control groups, this modulation was only moderate whereas in the neglect group SVV judgments were substantially and systematically modulated by frame orientation: with CCW frame tilts, the spatial bias of neglect patients increased as a function of the magnitude of the tilt whereas with clockwise (CW) frame tilts, the spatial bias was decreased in case of moderate frame tilts and even reversed in case of stronger frame tilts, resulting in a substantial CW spatial bias. This dramatically enhanced RFE might be caused by a pathologically increased influence of contextual cues on the subjective vertical in neglect patients as a consequence of impaired processing of gravitational information. The results indicate a systematic bias of the subjective vertical along with an impairment of spatial orientation constancy which leads to severe perturbations of subjective space as well as an increased reliance on internal and external cues mediating the perception of verticality in neglect.

[Therapy for cerebral visual perception disturbances]. / Therapie zerebraler visueller Wahrnehmungsstörungen.

Cerebral visual disorders are frequent after brain damage (20-40%). Among them, homonymous field defects and associated reading and visual exploration disorders, reduced visual acuity, contrast sensitivity and light/dark adaptation, fusional disorders, visuospatial deficits, multimodal hemineglect, and Balint-Holmes syndrome are the most common. Prototypical symptoms are the omission of obstacles and hemianopic alexia in visual field disorders, blurred vision in reduced acuity and/or contrast sensitivity or impaired fusion, blinding in impaired light adaptation and dark vision in impaired dark adaptation, and impaired action and orientation in visuospatial deficits. Neglect is characterized by omissions of stimuli on the contralesional side in space or the body. Patients with Balint-Holmes syndrome show severe spatial and attentional deficits. Systematic treatments can be categorized as restitution, compensation, and substitution approaches. Hemineglect can be ameliorated by novel, more effective treatment approaches, whereas only initial stages of treatment are available for Balint-Holmes syndrome.

Induction of growth rate and transcriptional modulation of growth promoters and growth inhibitors in epithelial cells by EBV-LMP1.

LMP1 is a genuine oncogene encoded by the Epstein-Barr virus (EBV). The cellular response to expression of the EBV-encoded gene LMP1 in the epithelial cell line Wish was studied. Cells were stably transfected with pCEP-LMP, an expression vector for LMP1. On transcript level a transient expression of the LMP1-gene with a maximum 2 days post transfection was observed. Six days post transfection the rate of DNA synthesis of LMP1-transfected Wish cells was increased by 80% compared to control cells, after 2 further days the number of cells was increased by 32%. A human cDNA-array was screened with probes from LMP1-transfected and control cells showing induction of transcription for proliferation associated genes and repression for growth suppressor genes.

Hemispheric dominance in the processing of J.S. Bach fugues: a transcranial Doppler sonography (TCD) study with musicians.

Although the majority of studies on musical processing in musicians observed a left hemisphere dominance which has usually been explained by a proficient analytical strategy used by these subjects, the findings are still inconsistent. Changes in hemispheric activity induced by listening to music (J. S. Bach fugues) and by recognizing the repetitions of the fugue theme were examined, using the technique of bilateral transcranial Doppler sonography (TCD) of the left and right middle cerebral artery (MCA). Subjects were 32 right-handed musicians, half of whom were members of an orchestra or members of a choir. The fugues were presented in two versions: a-cappella and instrumental. During passive listening to the a-cappella version, a weak left-dominant asymmetry of blood flow acceleration was observed, while there was no hemispheric asymmetry during listening to the instrumental version. During the task of fugue theme recognition, a highly significant asymmetry in favour of the right MCA was observed with both versions. It is concluded that when the processing of complex musical material has to be based on the analysis of melodic contour features and calls for working memory capacities a right hemisphere dominance is observed even in musically sophisticated subjects.

A second trimeric complex containing homologs of the Sec61p complex functions in protein transport across the ER membrane of S. cerevisiae.

Yeast microsomes contain a heptameric Sec complex involved in post-translational protein transport that is composed of a heterotrimeric Sec61p complex and a tetrameric Sec62-Sec63 complex. The trimeric Sec61p complex also exists as a separate entity that probably functions in co-translational protein transport, like its homolog in mammals. We have now discovered in the yeast endoplasmic reticulum membrane a second, structurally related trimeric complex, named Ssh1p complex. It consists of Ssh1p1 (Sec sixty-one homolog 1), a rather distant relative of Sec61p, of Sbh2p, a homolog of the Sbh1p subunit of the Sec61p complex, and of Sss1p, a component common to both trimeric complexes. In contrast to Sec61p, Ssh1p is not essential for cell viability but it is required for normal growth rates. Sbh1p and Sbh2p individually are also not essential, but cells lacking both proteins are impaired in their growth at elevated temperatures and accumulate precursors of secretory proteins; microsomes isolated from these cells also exhibit a reduced rate of post-translational protein transport. Like the Sec61p complex, the Ssh1p complex interacts with membrane-bound ribosomes, but it does not associate with the Sec62-Sec63p complex to form a heptameric Sec complex. We therefore propose that it functions exclusively in the co-translational pathway of protein transport.

Repression of cyclin D1: a novel function of MYC.

Constitutive expression of human MYC represses mRNA levels of cyclin D1 in proliferating BALB/c-3T3 fibroblasts. We expressed a series of mutant alleles of MYC and found that downregulation of cyclin D1 is distinct from previously described properties of MYC. In particular, we found that association with Max is not required for repression of cyclin D1 by MYC in vivo. Conversely, the integrity of a small amino-terminal region (amino acids 92 to 106) of MYC is critical for repression of cyclin D1 but dispensable for transformation of established RAT1A cells. Runoff transcription assays showed that repression occurs at the level of transcription initiation. We cloned the promoter of the gene for human cyclin D1 and found that it lacks a canonical TATA element. Transcription starts at an initiator element similar to that of the adenovirus major late promoter; this element can be directly bound by USF in vitro. Expression of MYC represses the cyclin D1 promoter via core promoter elements and antagonizes USF-mediated transactivation. Taken together, our data define a new pathway for gene regulation by MYC and show that the cyclin D1 gene is a target gene for repression by MYC.

Differential modulation of cyclin gene expression by MYC.

We have investigated the effects of deregulated expression of the human c-MYC protooncogene on cyclin gene expression and on the transcription factor E2F. We found that constitutive expression of MYC or activation of conditional MycER chimeras led to higher levels of cyclin A and cyclin E mRNA. Activation of cyclin A expression by MYC led to a growth factor-independent association of cyclin A and cdk2 with the transcription factor E2F and correlated with an increase in E2F transcriptional activity. In contrast, expression of the G1 phase cyclin D1 was strongly reduced in MYC-transformed cells. In synchronized cells, repression of cyclin D1 by MYC occurred very early in the G1 phase of the cell cycle.

Three years of experience with the swan-neck Tenckhoff catheter.

In a retrospective study over three years, 23 patients were provided with a swan-neck Tenckhoff catheter (SNC) and 49 patients (control group) with a straight Tenckhoff catheter (STC) at the beginning of CAPD and were observed over a follow-up period of 608 patient-months. The aim of the study was to examine the reduction of complications in the course of CAPD with SNC resulting from technical causes, such as catheter dislocations, infections at the catheter's point of exit, the tunnel and the peritoneum. The causes of renal insufficiency, the reasons for choosing CAPD as a dialytic procedure, the causes of catheter loss as well as the frequency of infections associated with CAPD were analyzed. The main reasons for catheter loss were peritonitis and dislocations. In the SNC group a significant reduction of dislocations to 8.7% was observed as against 26.5% with STC. On the other hand, with SNC significantly more cases of peritonitis were observed in terms of statistics, with 1.1 episodes per patient-year (EOP/PY) compared with 0.3 EOP/PY with STC. The frequency of the exit site and tunnel infections and the cumulative survival probability of the catheters did not differ. The SNC is an interesting alternative to the STC; however, the expectations were only partly met.

[Mexiletine in terminal renal failure and various dialysis procedures]. / Mexiletin bei terminaler Niereninsuffizienz und verschiedenen Dialyseverfahren.

We monitored the plasma levels of mexiletine in 20 dialysis patients with severe cardiac arrhythmias after repeated oral administration and the elimination by various dialysis procedures. The levels of mexiletine in plasma and dialysate were assayed by high-pressure liquid chromatography. After repeated administration of mexiletine 400-600 mg/day trough levels were in the range from 500-2,000 ng/ml. Treatment controlled by Holter monitoring was effective in 13/20 patients. Doses of 600 mg/day and more often were not tolerated by patients with dialysis after some weeks. There was no important removal of mexiletine from plasma during hemodialysis, hemofiltration, peritoneal dialysis, or plasmapheresis. In conclusion, we recommend a slightly reduced dosage of 400-600 mg mexiletine/day (usually 600-800 mg) for patients with end-stage renal insufficiency, irrespective of dialysis.

[Angiotensin-converting enzyme and 1,25-dihydroxyvitamin D3 in hypercalcemia of unknown origin]. / Angiotensin-converting-Enzym und 1,25-Dihydroxy-Vitamin D3 bei unklarer Hypercalcämie.

Sarcoidosis of the kidneys and liver without radiologically demonstrable lung involvement in a 44-year-old woman was shown to be the cause of a hypercalcaemia syndrome. The hypercalcaemia was presumably due to an increased production of 1,25-(OH)2-vitamin D3 which--like the increased angiotensin converting enzyme--is produced in the epithelioid and giant cells. Corticoid treatment normalized serum calcium and ACE levels and improved renal function. These observations demonstrate that measurement of ACE and 1,25-(OH)2-vitamin D3 levels is helpful in the differential diagnosis of hypercalcaemia, in view of the possibility of sarcoidosis, and should be among the diagnostic tests.

Analysis of cardiovascular risk factors in chronic hemodialysis patients with special attention to the hyperlipoproteinemias.

A group of 252 chronic hemodialysis patients was examined for various risk factors. Special emphasis was placed upon the comparison of patients who had marked cardiovascular alterations with the remainder of the group. The seriousness of the risk factors was determine by hypertension and hyperlipoproteinemia, 78% of the patients received antihypertensive medication or had changes in the fundus of the eye or both. In 74% of the patients there were pathological changes in the plasma lipids or lipoproteins or both. Hypertriglyceridemia (49%) and a HDL cholesterol decrease (61%) were the most striking findings. The average VLDL cholesterol value was significantly higher and the HDL cholesterol significantly lower in the coronary heart disease group than in the remaining group. These results show that hyperlipoproteinemia and a decrease in HDL, together with other risk factors such as hypertension and anemia, play an important role in the accelerated development of atherosclerosis in a hemodialysis group.

[Increased cardiovascular arteriosclerosis risk in patients with analgesic nephropathy (author's transl)]. / Erhöhtes kardiovaskuläres Arteriosklerose-Risiko bei Analgetika-Nephropathie.

The retrospective investigation of 54 patients with analgesic nephropathy showed the relatively early occurrence of coronary sclerosis and an increased frequency of arteriosclerotic renal artery stenosis. Angina pectoris was found in 14 patients with a mean age of 48 1/2 years. Summation of risk factors is the probable cause of the tendency for arteriosclerosis: hypercholesterolaemia and hypertriglyceridaemia was found in 29 patients, arterial hypertension in 42 patients, which was so severe in half of the patients that combined treatment with two or more drugs was necessary. The causes of lipid metabolism disturbances as well as the pathogenesis of arterial hypertension are not known. Arteriosclerotic renal artery stenoses observed in 8 patients are not likely to be the cause of hypertension.

[Results of renal transplantation 1968-1979 (author's transl)]. / Ergebnisse der Nierentransplantation 1968-1979.

173 renal transplantations were done over a period of 12 years. Among these were 162 first, 10 second and one third transplantation. The one year survival rate of transplanted kidneys (all cases) was around 50%, patient survival was 81.6%. Survival rates did not depend statistically on tissue compatibility, immediate function of kidney, duration of kidney conservation, donor age, commencement of graft versus host reaction, and duration of preoperative dialysis. Although the number of HLA identity has increased during the observation period, there was no increase of transplant survival rate. This may possibly be explained by the negative influence of the steady increase of conservation time during the same period.

[The clinical picture of panateritis nodosa]. / Das klinische Bild der Panarteriitis nodosa.

The clinical picture of the panarteritis nodosa is characterized by vague early symptoms, manifestations in various organs and a changing prognosis. In seven patients with histologically proven panarteritis nodosa the clinical course was followed up over a long period. The commonest early symptoms were fever of unknown origin and a considerable loss of weight. Three out of seven patients showed in the initial phase a hypertension, in two other patients the blood pressure rose as the disease progressed. Those patients, whose renal function was impaired when the diagnosis was established, had a poor prognosis in spite of immunosuppressive therapy and dialysis. The life expectancy of these patients was between two and 16 months (in average 6,4 months). On the other side the clinical course in two patients without renal failure was more favourable; they are alive eight months and 15 years respectively after the diagnosis was confirmed.