[The informed decision as an aim of evidence-based health information: the example of cancer screening]. / Die informierte Entscheidung als Ziel von evidenzbasierten Gesundheitsinformationen: Das Beispiel Krebsfrüherkennung.

In order to enable people to make an informed decision about participating in cancer screening, disadvantages like medical risks have be communicated in addition to advantages. The information in the decision aids should be evidence-based, neutral, balanced, understandable, and adequate in scope. The Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (G-BA) in 2014 and 2015 to develop decision aids in the form of brochures on participation in mammography, colorectal cancer, and cervical cancer screening, which are now in use.This article describes the development of the decision aids, with a focus on the results of user tests, which were executed by an external provider. Of the testers, 10 to 20% changed their attitude toward taking part in the screening test within the three categories "willing to take part," "undecided," and "not willing to take part" after reading the brochures. This indicates that an informed decision is supported by the materials. The user tests helped to better adapt the decision aids to the information needs of target groups.

Cerebral Macro- and Microcirculation during Ephedrine versus Phenylephrine Treatment in Anesthetized Brain Tumor Patients: A Randomized Clinical Trial Using Magnetic Resonance Imaging.

BACKGROUND: This study compared ephedrine versus phenylephrine treatment on cerebral macro- and microcirculation, measured by cerebral blood flow, and capillary transit time heterogeneity, in anesthetized brain tumor patients. The hypothesis was that capillary transit time heterogeneity in selected brain regions is greater during phenylephrine than during ephedrine, thus reducing cerebral oxygen tension. METHODS: In this single-center, double-blinded, randomized clinical trial, 24 anesthetized brain tumor patients were randomly assigned to ephedrine or phenylephrine. Magnetic resonance imaging of peritumoral and contralateral hemispheres was performed before and during vasopressor infusion. The primary endpoint was between-group difference in capillary transit time heterogeneity. Secondary endpoints included changes in cerebral blood flow, estimated oxygen extraction fraction, and brain tissue oxygen tension. RESULTS: Data from 20 patients showed that mean (± SD) capillary transit time heterogeneity in the contralateral hemisphere increased during phenylephrine from 3.0 ± 0.5 to 3.2 ± 0.7 s and decreased during ephedrine from 3.1 ± 0.8 to 2.7 ± 0.7 s (difference phenylephrine versus difference ephedrine [95% CI], -0.6 [-0.9 to -0.2] s; P = 0.004). In the peritumoral region, the mean capillary transit time heterogeneity increased during phenylephrine from 4.1 ± 0.7 to 4.3 ± 0.8 s and decreased during ephedrine from 3.5 ± 0.9 to 3.3 ± 0.9 s (difference phenylephrine versus difference ephedrine [95%CI], -0.4[-0.9 to 0.1] s; P = 0.130). Cerebral blood flow (contralateral hemisphere ratio difference [95% CI], 0.3 [0.06 to 0.54]; P = 0.018; and peritumoral ratio difference [95% CI], 0.3 [0.06 to 0.54; P = 0.018) and estimated brain tissue oxygen tension (contralateral hemisphere ratio difference [95% CI], 0.34 [0.09 to 0.59]; P = 0.001; and peritumoral ratio difference [95% CI], 0.33 [0.09 to 0.57]; P = 0.010) were greater during ephedrine than phenylephrine in both regions. CONCLUSIONS: Phenylephrine caused microcirculation in contralateral tissue, measured by the change in capillary transit time heterogeneity, to deteriorate compared with ephedrine, despite reaching similar mean arterial pressure endpoints. Ephedrine improved cerebral blood flow and tissue oxygenation in both brain regions and may be superior to phenylephrine in improving cerebral macro- and microscopic hemodynamics and oxygenation.

[Development of Decision Aids for Organized Cervical Carcinoma Screening in Germany]. / Entwicklung von Entscheidungshilfen für das organisierte Zervixkarzinom-Screening in Deutschland.

AIM OF THE STUDY: The Federal Joint Committee has decided to introduce organized cervical carcinoma screening in 2020. The present work describes the development of decision aids that will be sent to women in this program. METHODS: A systematic search for qualitative studies and surveys was conducted to gather information on experiences, attitudes and information needs. Furthermore, we searched for systematic reviews on advantages and disadvantages of screening. An existing decision analysis for cervical carcinoma screening in Germany was used. The designs were subjected to a qualitative test (focus groups with 26 women and 8 expert interviews), to a quantitative user test (online survey n=2,014 women) and to a public hearing. RESULTS: Most women found the decision aids informative and helpful. The majority would recommend the use of these materials to others. For many women, part of the information was new, although they had been involved in cervical cancer screening for some time. The presentation of the advantages and disadvantages was judged to be balanced. However, 10% changed their attitude towards participation and 70% of women would attend screening. CONCLUSION: The decision aids found a high acceptance among the users. They can help to reduce knowledge deficits on cervical carcinoma screening and support a informed decision making.

[Cornerstones of evidence-based health information]. / Eckpunkte evidenzbasierter Gesundheitsinformationen.

Evidence-based health information is intended to empower people to make informed health decisions and include their personal goals and expectations by providing them with neutral and understandable content. To achieve this, a number of requirements must be followed in the production of health information, which are described in this article. These include, among other things, systematic research, a reasoned selection of appropriate evidence, and consideration of current evidence to communicate numbers, risks, and probabilities. Implementation must also take into account the issues, competencies and usage patterns of the groups for which the information is intended. A number of German-language information services demonstrate that implementation of these requirements is feasible for the general public.

Ephedrine versus Phenylephrine Effect on Cerebral Blood Flow and Oxygen Consumption in Anesthetized Brain Tumor Patients: A Randomized Clinical Trial.

BACKGROUND: Studies in anesthetized patients suggest that phenylephrine reduces regional cerebral oxygen saturation compared with ephedrine. The present study aimed to quantify the effects of phenylephrine and ephedrine on cerebral blood flow and cerebral metabolic rate of oxygen in brain tumor patients. The authors hypothesized that phenylephrine reduces cerebral metabolic rate of oxygen in selected brain regions compared with ephedrine. METHODS: In this double-blinded, randomized clinical trial, 24 anesthetized patients with brain tumors were randomly assigned to ephedrine or phenylephrine treatment. Positron emission tomography measurements of cerebral blood flow and cerebral metabolic rate of oxygen in peritumoral and normal contralateral regions were performed before and during vasopressor infusion. The primary endpoint was between-group difference in cerebral metabolic rate of oxygen. Secondary endpoints included changes in cerebral blood flow, oxygen extraction fraction, and regional cerebral oxygen saturation. RESULTS: Peritumoral mean ± SD cerebral metabolic rate of oxygen values before and after vasopressor (ephedrine, 67.0 ± 11.3 and 67.8 ± 25.7 µmol · 100 g · min; phenylephrine, 68.2 ± 15.2 and 67.6 ± 18.0 µmol · 100 g · min) showed no intergroup difference (difference [95% CI], 1.5 [-13.3 to 16.3] µmol · 100 g · min [P = 0.839]). Corresponding contralateral hemisphere cerebral metabolic rate of oxygen values (ephedrine, 90.8 ± 15.9 and 94.6 ± 16.9 µmol · 100 g · min; phenylephrine, 100.8 ± 20.7 and 96.4 ± 17.7 µmol · 100 g · min) showed no intergroup difference (difference [95% CI], 8.2 [-2.0 to 18.5] µmol · 100 g · min [P = 0.118]). Ephedrine significantly increased cerebral blood flow (difference [95% CI], 3.9 [0.7 to 7.0] ml · 100 g · min [P = 0.019]) and regional cerebral oxygen saturation (difference [95% CI], 4 [1 to 8]% [P = 0.024]) in the contralateral hemisphere compared to phenylephrine. The change in oxygen extraction fraction in both regions (peritumoral difference [95% CI], -0.6 [-14.7 to 13.6]% [P = 0.934]; contralateral hemisphere difference [95% CI], -0.1 [- 12.1 to 12.0]% [P = 0.989]) were comparable between groups. CONCLUSIONS: The cerebral metabolic rate of oxygen changes in peritumoral and normal contralateral regions were similar between ephedrine- and phenylephrine-treated patients. In the normal contralateral region, ephedrine was associated with an increase in cerebral blood flow and regional cerebral oxygen saturation compared with phenylephrine.

Cobalt(III) Metallacryptates and Their Guest Cation-Exchange in Solution Monitored by 59Co NMR.

One-pot reactions of the catechol-scaffolding aroylbis(N,N-diethylthiourea) H2Lcat with mixtures of CoCl2 and MCl (M+ = Cs+, Rb+, K+, Tl+, or NH4+) or with a Co(NO3)2/TlNO3 mixture lead to the self-assembly of a series of cationic Co(III) metallacryptates of the general formula [M ⊂ {Co2(Lcat)3}]+ (M+ = Cs+, Rb+, K+, Tl+, or NH4+). Crystalline PF6- salts were obtained after workup with (n-Bu4N)(PF6), and the single-crystal structures of all five metallacryptates have been determined. Depending on the nature of the guest cations, the directional interactions between guest cations and the metallacryptand {Co2(Lcat)3} are either weak coordination contacts or hydrogen bonds. The bonding mode and the size of the guest ions slightly influence the molecular skeleton of the host molecule. These small structural variations also exist in solution and could be detected by means of 59Co NMR spectroscopy, which is shown to be a unique tool for an easy characterization of such compounds. 59Co NMR chemical shifts are extraordinarily sensitive to the guest cation in the metallacryptates, and time-arrayed 59Co NMR experiments show that cation-exchange processes in biphasic organic/aqueous systems can be studied in detail. This leads to insights into the relative rates of cation exchange, as well as the relative conditional distribution coefficients of such Co(III) metallacryptates between the aqueous and organic phases. Thus, the extent and the relative rate of the NH4+ ion exchange in [NH4 ⊂ {Co2(Lcat)3}](PF6) by Cs+ and K+ ions across the organic/aqueous phase boundary at room temperature have been studied by in situ 59Co NMR experiments. Preliminary 59Co NMR experiments show that the K+ ion in [K ⊂ {Co2(Lcat)3}](PF6) can be removed by its competitive complexation with the highly potassium-selective [2.2.2]cryptand, to give a transient 59Co NMR signal of the relatively unstable "empty" {Co2(Lcat)3} complex, which slowly decomposes in solution.

195Pt NMR and Molecular Dynamics Simulation Study of the Solvation of [PtCl6]2- in Water-Methanol and Water-Dimethoxyethane Binary Mixtures.

The experimental 195Pt NMR chemical shift, δ(195Pt), of the [PtCl6]2- anion dissolved in binary mixtures of water and a fully miscible organic solvent is extremely sensitive to the composition of the mixture at room temperature. Significantly nonlinear δ(195Pt) trends as a function of solvent composition are observed in mixtures of water-methanol, or ethylene glycol, 2-methoxyethanol, and 1,2-dimethoxyethane (DME). The extent of the deviation from linearity of the δ(195Pt) trend depends strongly on the nature of the organic component in these solutions, which broadly suggests preferential solvation of the [PtCl6]2- anion by the organic molecule. This simplistic interpretation is based on an accepted view pertaining to monovalent cations in similar binary solvent mixtures. To elucidate these phenomena in detail, classical molecular dynamics computer simulations were performed for [PtCl6]2- in water-methanol and water-DME mixtures using the anionic charge scaling approach to account for the effect of electronic dielectric screening. Our simulations suggest that the simplistic model of preferential solvation of [PtCl6]2- by the organic component as inferred from nonlinear δ(195Pt) trends is not entirely accurate, particularly for water-DME mixtures. The δ(195Pt) trend in these mixtures levels off for high DME mole fractions, which results from apparent preferential location of [PtCl6]2- anions at the borders of water-rich regions or clusters within these inherently micro-heterogeneous mixtures. By contrast in water-methanol mixtures, apparently less pronounced mixed solvent micro-heterogeneity is found, suggesting the experimental δ(195Pt) trend is consistent with a more moderate preferential solvation of [PtCl6]2- anions. This finding underlines the important role of solvent-solvent interactions and micro-heterogeneity in determining the solvation environment of [PtCl6]2- anions in binary solvent mixtures, probed by highly sensitive 195Pt NMR. The notion that preferential solvation of [PtCl6]2- results primarily from competing ion-solvent interactions as generally assumed for monatomic ions, may not be appropriate in general.

Isotope effects in (195)Pt NMR spectroscopy: unique (35/37)Cl- and (16/18)O-resolved "fingerprints" for all [PtCl6-n(OH)n](2-) (n = 1-5) anions in an alkaline solution and the implications of the trans influence.

A detailed analysis of the intrinsic (1)Δ(195)Pt((37/35)Cl) and (1)Δ(195)Pt((18/16)O) isotope 128.8 MHz (195)Pt NMR profiles of the series of kinetically inert [PtCl6-n(OH)n](2-) (n = 1-5) anions generated in strongly alkaline aqueous solutions shows that each (195)Pt NMR resonance of the [Pt(35/37)Cl6-n((16/18)OH)n](2-) (n = 1-5) anions is resolved only into [(6 - n) + 1 for n = 1-5] (35/37)Cl isotopologues at 293 K. Evidently, the greater trans influence of the hydroxido ligand in the order OH(-) > Cl(-) > H2O in [PtCl6-n(OH)n](2-) (n = 1-5) complexes results in somewhat longer Pt-Cl bond displacements trans to the hydroxido ligands, resulting in the absence of isotopomer effects in the [PtCl6-n(OH)n](2-) (n = 1-5) anions in contrast to that observed in the corresponding [PtCl6-n(H2O)n]((2-n)-) (n = 1-5) complexes. In suitably (18)O-enriched sodium hydroxide solutions, additional intrinsic (1)Δ(195)Pt((18/16)O) isotope effects are remarkably well-resolved into unique isotopologue- and isotopomer-based (195)Pt NMR profiles, ascribable to the higher trans influence of the OH(-) ligand. The consequent significantly shorter Pt-OH bonds in these anions emphasize (16/18)O isotopomer effects in the (195)Pt NMR peaks of [Pt(35/37)Cl6-n((16/18)OH)n](2-) (n = 1-5) for magnetically nonequivalent (16/18)OH isotopomers statistically possible in some isotopologues. These (195)Pt NMR profiles constitute unique NMR "fingerprints", useful for the unambiguous assignment of the series of [PtCl6-n(OH)n](2-) anions including their possible cis/trans/fac/mer stereoisomers in such solutions, without a need for accurate chemical shift measurements.

Speciation of [Pt(IV) Cl6-n Brn]2- (n = 0-6) and some of their mono-aquated [Pt(IV) Cl5-n Brn (H2O)]- (n = 0-5) anions in solution at low concentrations by means of ion-pairing reversed-phase ultra-high-performance liquid chromatography coupled to electrospray ionization quadrupole time-of-flight mass spectrometry.

RATIONALE: The speciation of the purely inorganic [PtCl6-n Brn](2-) (n = 0-6) anions and their corresponding mono-aquated [PtCl5-n Brn (H2O)](-) (n = 0-5) anions is of considerable importance to the precious metal refining and recycling industry, to ensure optimum recovery and separation efficiencies. Speciation of platinum complexes present in precursor solutions used for the preparation of precious metal nano-crystals of defined size and morphology appears also to be important. The various possible Pt(IV) complex anions in dilute aqueous can be characterized using ion-pairing reversed-phase high-performance liquid chromatography coupled to electrospray ionization quadrupole time-of-flight mass spectrometry (ESI-Q-TOFMS). METHODS: Ion-pairing reversed-phase ultra-high-performance LC separation of the Pt(IV) complex anions present in aqueous solutions prior to detection by means of high-resolution ESI-Q-TOFMS using a low ESI source cone voltage (5 V) allows for the clear identification of all the platinum complexes from the characteristic pattern of fragment ions (m/z), presumably generated by 'reductive conversion' in the ESI source of the mass spectrometer. Sufficient chromatographic resolution for the series of Pt(IV) complexes is achieved using the (n-butyl)3 NH(+) ion generated in a formic acid/water/methanol (pH ~3.5) mobile phase. This mobile phase composition facilitates a low-background for optimal ESI-Q-TOFMS detection with enhanced sensitivity. RESULTS: Direct-infusion mass spectrometry of the inorganic platinum complexes in aqueous solution is impractical due to their low volatility, but more importantly as a result of the very extensive series of fragment ions generated in the ESI source, which leads to virtually uninterpretable mass spectra. However, with prior separation, and by using low ESI cone voltages (5 V), the mass spectra of the separated analyte ions show simpler and systematic fragmentation patterns [Pt(IV) X5](-) → [Pt(III) X4 ](-) → [Pt(II) X3](-) → [Pt(I)X2 ](-) (X = Cl(-) and Br(-)), resulting in clear assignments. This methodology facilitates the characterization of the partially aquated [PtCl5-n Brn (H2O)](-) (n = 0-5) anions derived from the homo- and heteroleptic [PtCl6-n Brn](2-) (n = 0-6) anions, in equilibrated solutions at low concentrations. CONCLUSIONS: Speciation of homo- and heteroleptic [PtCl6-n Brn](2-) (n = 0-6) anions, together with some of their partially aquated [PtCl5-n Brn (H2O)](-) (n = 0-5) species in dilute solution, can successfully be carried out by means of prior ion-pairing reversed-phase LC separation coupled to high-resolution ESI-Q-TOFMS at low ESI cone-voltage settings.

Probing isotope shifts in 103Rh and 195Pt NMR spectra with density functional theory.

Zero-point vibrationally averaged (rg(0)) structures were computed at the PBE0/SDD/6-31G* level for the [Pt(35)Cln(37)Cl5-n(H2(18)O)](-) (n = 0-5), cis-Pt(35)Cln(37)Cl4-n(H2(18)O)(H2(16)O) (n = 0-4), fac-[Pt(35)Cln(37)Cl3-n(H2(18)O)(H2(16)O)2](+) (n = 0-3), [Pt(35)Cln(37)Cl5-n((16/18)OH)](2-) (n = 0-5), cis-[Pt(35)Cln(37)Cl4-n((16/18)OH)2](2-) (n = 0-4), fac-[Pt(35)Cln(37)Cl3-n((16/18)OH)3](2-) (n = 0-3), cis-[Pt(35)Cln(37)Cl2-n((16/18)OH)4](2-) (n = 0-2), [Pt(35)Cln(37)Cl1-n((16/18)OH)5](2-) (n = 0-1), [Rh(35)Cln(37)Cl5-n(H2O)](2-) (n = 0-5), cis-[Rh(35)Cln(37)Cl4-n(H2O)2](-) (n = 0-4), and fac-Rh(35)Cln(37)Cl3-n(H2O)3 (n = 0-3) isotopologues and isotopomers. Magnetic shielding constants, computed at the ZORA-SO/PW91/QZ4P/TZ2P level, were used to evaluate the corresponding (35/37)Cl isotope shifts on the (195)Pt and (103)Rh NMR spectra, which are known experimentally. While the observed effects are reproduced reasonably well computationally in terms of qualitative trends and the overall order of magnitude (ca. 1 ppm), quantitative agreement with experiment is not yet achieved. Only small changes in M-Cl and M-O bonds upon isotopic substitution, on the order of femtometers, are necessary to produce the observed isotope shifts.

[Screening for prostate cancer]. / Die Früherkennung von Prostatakrebs.

Prostate cancer screening has been a controversial for decades. The recently published findings of large trials have further intensified the debate. The prospect of reducing mortality from prostate cancer is measured against the risk of over-diagnosing the disease. In individual cases, the trade-off between possible benefits and harms is possible to ascertain, so general recommendations in favor of or against PSA tests for individuals cannot be made. The majority of men, however, are not well-informed on the possible advantages and drawbacks of screening. This situation urgently needs to be corrected. The PSA test is promoted to healthy men, who need to be provided with especially detailed information. If not provided with clear and unbiased information on the risks associated with the test (above all over-diagnosis and over-treatment), these men cannot be considered to be fully informed.

Health information for hard-to-reach target groups: A qualitative needs assessment.

INTRODUCTION: Reaching socially disadvantaged families and older people with health information can be challenging. A needs assessment was conducted to learn more about their health-related needs and preferences and derive recommendations for health information. METHODS: Focus groups were conducted with socially disadvantaged families, older people and suitable disseminators, like counsellors from various types of counselling centres or welfare facilities (81 participants), and analysed using content analysis. RESULTS: Socially disadvantaged and hard-to-reach people want to understand health problems, become active in dealing with them themselves, and be involved in medical decision-making. Health information should consider the challenging everyday lives, the limited time available and the short attention span of socially disadvantaged families. There is a preference for short texts and videos. Older people may favour more comprehensive print products for complex topics. Matching photos and illustrations are vital to attract attention. Health information is preferably received via personal contact. Furthermore, online services and social media channels are popular. DISCUSSION: Some recommendations can be helpful for all target groups of health information, like more illustrations. Others are more specific to the groups investigated and require conceptual groundwork and greater resources, for example, a specific service for disseminators. CONCLUSION: Hard-to-reach target groups want to understand their health issues, and be proactive and involved in decision-making. Personal contact is of utmost importance. Disseminators play a crucial role and need information they can customize for their clients.

Correlation Between Cerebral Tissue Oxygen Saturation and Oxygen Extraction Fraction During Anesthesia: Monitoring Cerebral Metabolic Demand-supply Balance During Vasopressor Administration.

BACKGROUND: The speculation that cerebral tissue oxygen saturation (SctO 2 ) measured using tissue near-infrared spectroscopy reflects the balance between cerebral metabolic rate of oxygen and cerebral oxygen delivery has not been validated. Our objective was to correlate SctO 2 with cerebral oxygen extraction fraction (OEF) measured using positron emission tomography; OEF is the ratio between cerebral metabolic rate of oxygen and cerebral oxygen delivery and reflects the balance between these 2 variables. MATERIALS AND METHODS: This cohort study was based on data collected in a previously published trial assessing phenylephrine versus ephedrine treatment in anesthetized patients undergoing brain tumor surgery. The variables of interest were measured twice over the healthy hemisphere before surgery: the first measurement performed after anesthesia induction and the second measurement performed after induction of a ∼20% increase in blood pressure using either phenylephrine or ephedrine. RESULTS: Data from 24 patients were analyzed. The overall vasopressor-induced relative changes in SctO 2 (ΔSctO 2 ) and OEF (ΔOEF) were 3.16% [interquartile range, -0.73% to 6.04%] and -12.5% [interquartile range, -24.0% to -6.19%], respectively. ΔSctO 2 negatively correlated with ΔOEF after phenylephrine treatment (Spearman rank correlation coefficient [ rs ]=-0.76; P =0.007), ephedrine treatment ( rs =-0.76; P =0.006), and any treatment ( rs =-0.79; P <0.001). ΔSctO 2 significantly associated with ΔOEF based on multivariable analysis with ΔOEF, relative changes in mean arterial pressure, arterial blood oxygen tension, and the bispectral index as covariates ( P =0.036). CONCLUSIONS: The negative correlation between changes in SctO 2 and OEF suggests that SctO 2 may reflect the cerebral metabolic demand-supply balance during vasopressor treatment. The generalizability of our findings in other clinical scenarios remains to be determined.

Blood-brain Barrier Permeability May Influence Vasopressor Effects in Anesthetized Patients With Brain Tumor: An Analysis of Magnetic Resonance Imaging Data.

OBJECTIVE: This is a secondary analysis of data from a previous study of anesthetized brain tumor patients receiving ephedrine or phenylephrine infusions. 18 patients with magnetic imaging verified tumor contrast enhancement were included. We hypothesized that vasopressors induce microcirculatory flow changes, characterized by increased capillary transit time heterogeneity (CTH) and decreased mean transit time (MTT), in brain regions exhibiting BBB leakage. METHODS: This is a secondary analysis of data from a previous study of anesthetized brain tumor patients receiving ephedrine or phenylephrine infusions. 18 patients with magnetic imaging verified tumor contrast enhancement were included. Postvasopressor to prevasopressor ratios of CTH, MTT, relative transit time heterogeneity (RTH), cerebral blood flow (CBF), cerebral blood volume, and oxygen extraction fraction (OEF) were calculated in tumor, peritumoral, hippocampal, and contralateral grey matter regions. Comparisons were made between brain regions and vasopressors. RESULTS: During phenylephrine infusion, ratios of CTH, RTH, and CBF were greater, and ratios of MTT and OEF were lower, in the tumor region with contrast leakage compared with corresponding contralateral grey matter ratios. During ephedrine infusion, ratios of CTH, MTT, RTH, CBF, and cerebral blood volume were higher in the tumor region with leakage compared with contralateral grey matter ratios. In addition, the ratio of CBF was higher in all regions, the ratio of RTH was lower in the leaking tumor region, and the ratio of OEF was lower in peritumoral, hippocampal, and grey matter regions with ephedrine compared with phenylephrine. CONCLUSIONS: Vasopressors can induce distinct microcirculatory flow alterations in regions with compromised brain tumor barrier or BBB. Ephedrine, a combined α and ß-adrenergic agonist, appears to result in fewer flow alterations and less impact on tissue oxygenation compared with phenylephrine, a pure α-adrenergic agonist.

Comparative study of platinum electroplating to improve micro gold electrode arrays with LCP laminate.

Decoding the cellular network interaction of neurons and glial cells are important in the development of new therapies for diseases of the central nervous system (CNS). Electrophysiological in vivo studies in mice will help to understand the highly complex network. In this paper, the optimization of epidural liquid crystal polymer (LCP) electrodes for different platinum electroplating parameters are presented and compared. Constant current and pulsed current electroplating varied in strength and duration was used to decrease the electrode impedance and to increase the charge storage capacity (CSCC). In best cases, both methods generated similar results with an impedance reduction of about 99%. However, electroplating with pulsed currents was less parameter-dependent than the electroplating with constant current. The use of ultrasound was essential to generate platinum coatings without plating defects. Electrode model parameters extracted from the electrode impedance reflected the increase in surface porosity due to the electroplating processes.

Moving towards patient-centered care and shared decision-making in Germany.

The main focus of this paper is to describe the development and current state of policy, research and implementation of patient-centered care (PCC) and shared decision-making (SDM) in Germany. What is the current state in health policy? Since 2013, the Law on Patients' Rights has standardized all rights and responsibilities regarding medical care for patients in Germany. This comprises the right to informed decisions, comprehensive and comprehensible information, and decisions based on a clinician-patient partnership. In addition, reports and action plans such as the German Ethics Council's report on patient well-being, the National Health Literacy Action Plan, or the National Cancer Plan emphasize and foster PCC and SDM on a policy level. There are a number of public organizations in Germany that support PCC and SDM. How are patients and the public involved in health policy and research? Publishers and funding agencies increasingly demand patient and public involvement. Numerous initiatives and organizations are involved in publicizing ways to engage patients and the public. Also, an increasing number of public and research institutions have established patient advisory boards. How is PCC and SDM taught? Great progress has been made in introducing SDM into the curricula of medical schools and other health care providers' (HCPs) schools (e.g., nursing, physical therapy). What is the German research agenda? The German government and other public institutions have constantly funded research programs in which PCC and SDM are important topics. This yielded several large-scale funding initiatives and helped to develop SDM training programs for HCPs in different fields of health care and information materials. Recently, two implementation studies on SDM have been conducted. What is the current uptake of PCC and SDM in routine care, and what implementation efforts are underway? Compared to the last country report from 2017, PCC and SDM efforts in policy, research and education have been intensified. However, many steps are still needed to reliably implement SDM in routine care in Germany. Specifically, the further development and uptake of decision tools and countrywide SDM trainings for HCPs require further efforts. Nevertheless, an increasing number of decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care. Also, recent implementation efforts are promising. For example, reimbursement by health insurance companies of hospital-wide SDM implementation is being piloted. A necessary next step is to nationally coordinate the gathering and provision of the many PCC and SDM resources available.

Early effect of NEURAPAS® balance on current source density (CSD) of human EEG.

UNLABELLED: Psychiatric patients often suffer from stress, anxiety and depression. Various plant extracts are known to fight stress (valerian), anxiety (passion flower) or depression (St. John's wort). NEURAPAS® balance is a mixture of these three extracts and has been designed to cover this complex of psychiatric conditions. The study was initiated to quantitatively assess the effect of this combination on brain electric activity. METHOD: Quantitative electroencephalogram (EEG) current source density (CSD) recording from 16 healthy male and female human volunteers (average age 49 years) was used in a randomized, placebo-controlled cross over study. Recordings were performed 0. 5, 1. 5, 3 and 4 hours after administration of the preparations under the conditions of 6 min eyes open and 5 min d2 concentration test, mathematical calculation test and memory test, respectively. All variables (electric power within 6 frequency ranges at 17 electrode positions) were fed into a linear discriminant analysis (eyes open condition). In the presence of mental load these variables were used to construct brain maps of frequency changes. RESULTS: Under the condition of mental load, centro-parietal spectral power remained statistically significantly lower within alpha1, alpha2 and beta1 frequencies in the presence of verum in comparison to placebo. Discriminant analysis revealed a difference to placebo 3 and 4 hours after intake of 6 tablets of NEURAPAS® balance. Data location within the polydimensional space was projected into the area of the effects of sedative and anti-depressive reference drugs tested earlier under identical conditions. Results appeared closer to the effects of fluoxetine than to St. John's wort. CONCLUSIONS: Analysis of the neurophysiological changes following the intake of NEURAPAS® balance revealed a similarity of frequency changes to those of calming and anti-depressive drugs on the EEG without impairment of cognition. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01047605.

New backstrap vagus electrode for continuous intraoperative neuromonitoring in thyroid surgery.

INTRODUCTION: Continuous intraoperative neuromonitoring (CIONM) via vagal nerve stimulation allows real-time surveillance of the recurrent laryngeal nerve during thyroid surgery. However, for effective CIONM, subtle changes in recurrent laryngeal nerve conductivity have to be detected. A newly developed stimulation electrode that provides stable nerve stimulation and safe application is presented. METHODS: For electrode validation, current distribution was simulated with the finite element method. Mechanical characteristics were assessed through bench testing. Clinical evaluation was initiated with 11 thyroid surgeries. RESULTS: Experimental and clinical results led to the development of a tripolar gold/polyimide electrode mounted onto a backstrap-shaped silicone body. It facilitated rapid electrode implantation and extraction (median implantation time 4 ± 19 seconds). Peak extraction force was 570 mN. Median supramaximal stimulation currents were 2.00 ± 0.95 mA and resulted in reliable electromyogram responses (median 3.1 ± 3.0 mV). No intraoperative electrode dislocations occurred, and no postoperative nerve palsy was observed. CONCLUSION: The new backstrap vagal stimulation electrode meets the requirements for reliable CIONM.

Therapeutic maps for a sensor-based evaluation of deep brain stimulation programming.

Programming in deep brain stimulation (DBS) is a labour-intensive process for treating advanced motor symptoms. Specifically for patients with medication-refractory tremor in multiple sclerosis (MS). Wearable sensors are able to detect some manifestations of pathological signs, such as intention tremor in MS. However, methods are needed to visualise the response of tremor to DBS parameter changes in a clinical setting while patients perform the motor task finger-to-nose. To this end, we attended DBS programming sessions of a MS patient and intention tremor was effectively quantified by acceleration amplitude and frequency. A new method is introduced which results in the generation of therapeutic maps for a systematic review of the programming procedure in DBS. The maps visualise the combination of tremor acceleration power, clinical rating scores, total electrical energy delivered to the brain and possible side effects. Therapeutic maps have not yet been employed and could lead to a certain degree of standardisation for more objective decisions about DBS settings. The maps provide a base for future research on visualisation tools to assist physicians who frequently encounter patients for DBS therapy.