New Constraint on the Local Relic Neutrino Background Overdensity with the First KATRIN Data Runs.

We report on the direct search for cosmic relic neutrinos using data acquired during the first two science campaigns of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity molecular tritium gas source are analyzed by a high-resolution MAC-E filter around the end point at 18.57 keV. The analysis is sensitive to a local relic neutrino overdensity ratio of η<9.7×10^{10}/α (1.1×10^{11}/α) at a 90% (95%) confidence level with α=1 (0.5) for Majorana (Dirac) neutrinos. A fit of the integrated electron spectrum over a narrow interval around the end point accounting for relic neutrino captures in the tritium source reveals no significant overdensity. This work improves the results obtained by the previous neutrino mass experiments at Los Alamos and Troitsk. We furthermore update the projected final sensitivity of the KATRIN experiment to η<1×10^{10}/α at 90% confidence level, by relying on updated operational conditions.

Bound on 3+1 Active-Sterile Neutrino Mixing from the First Four-Week Science Run of KATRIN.

We report on the light sterile neutrino search from the first four-week science run of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are analyzed by a high-resolution MAC-E filter down to 40 eV below the endpoint at 18.57 keV. We consider the framework with three active neutrinos and one sterile neutrino. The analysis is sensitive to the mass, m_{4}, of the fourth mass state for m_{4}^{2}≲1000 eV^{2} and to active-to-sterile neutrino mixing down to |U_{e4}|^{2}≳2×10^{-2}. No significant spectral distortion is observed and exclusion bounds on the sterile mass and mixing are reported. These new limits supersede the Mainz results for m_{4}^{2}≲1000 eV^{2} and improve the Troitsk bound for m_{4}^{2}<30 eV^{2}. The reactor and gallium anomalies are constrained for 100<Δm_{41}^{2}<1000 eV^{2}.

Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN.

We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9}) eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation.

[Drug-induced seizures]. / Medikamentös induzierte epileptische Anfälle.

Drug-induced seizures are in view of a constantly ageing population and increasingly frequent polypharmacotherapy an increasing problem in daily routine praxis. Identification of potentially seizure-inducing drugs may help generating risk profiles for individual patients. Drug-induced seizures have often been seen as a complication of psychopharmacological therapy, but its occurrence has also been described in response to a great diversity of compounds such as antibiotics, sympathomimetics and anaesthetics. The present article outlines a synopsis of the most prevalent seizure-inducing drugs as well as strategies how to deal with a patient suffering from a drug-induced seizure.

The DeepTree Exhibit: Visualizing the Tree of Life to Facilitate Informal Learning.

In this paper, we present the DeepTree exhibit, a multi-user, multi-touch interactive visualization of the Tree of Life. We developed DeepTree to facilitate collaborative learning of evolutionary concepts. We will describe an iterative process in which a team of computer scientists, learning scientists, biologists, and museum curators worked together throughout design, development, and evaluation. We present the importance of designing the interactions and the visualization hand-in-hand in order to facilitate active learning. The outcome of this process is a fractal-based tree layout that reduces visual complexity while being able to capture all life on earth; a custom rendering and navigation engine that prioritizes visual appeal and smooth fly-through; and a multi-user interface that encourages collaborative exploration while offering guided discovery. We present an evaluation showing that the large dataset encouraged free exploration, triggers emotional responses, and facilitates visitor engagement and informal learning.

[Drug-induced tremor]. / Medikamentös-induzierter Tremor.

Drug-induced tremor is an important differential diagnosis for tremor syndromes. In view of a constantly ageing population and increasingly frequent polypharmacotherapy, identification of potentially tremor-inducing drugs may help generating risk profiles for individual patients. Drug-induced tremor has often been seen as a complication of antipsychotic therapy, but its occurrence has also been described in response to a great diversity of compounds such as antidepressants, sympathomimetics, antiarrhythmics, antiepileptics and other drugs. The present article presents a synopsis of the most prevalent tremor-inducing drugs as well as strategies to overcome drug-induced tremor, either by replacement of the causative drug or by symptomatic therapies.

[Zerebrale Amyloidangiopathie : Cerebral amyloid angiopathy]. / Zerebrale Amyloidangiopathie : Cerebral amyloid angiopathy.

Cerebral amyloid angiopathy (CAA) is defined by the accumulation of ß-amyloid in the walls of cortical arteries. The risk factors of CAA include advanced age and the presence of certain alleles of apolipoprotein E. CAA mostly remains asymptomatic, but the classical manifestation is intracerebral hemorrhage. A definite diagnosis can only be made on the basis of histopathological examination. Detection of lobar hemorrhages and lobar microhemorrhages in imaging investigations support the diagnosis of CAA as long as other causes can be excluded.

[Antiepileptic drug-induced encephalopathy]. / Antiepileptika-induzierte Enzephalopathie.

The clinical features of an antiepileptic drug-induced encephalopathy (ADE) are confusion, reduction of vigilance, neurological deficits or an increase of the seizure frequency. In the electroencephalogram a general slowing or epileptic discharges are found. Characteristic are non-toxic blood levels of the antiepileptic drugs. So far an ADE was reported under phenytoin, carbamazepine or valproatic acid (valproate) therapy. More seldom, an ADE has been described after the intake of vigabatrine, lamotrigine und topiramate. Potential pathogenic mechanisms of AED are hyperammonemia, intrinsic effects on cerebral receptors, drug interactions, hepatic enzyme interactions, metabolic reasons or paradoxical proconvulsive effects of antiepileptic drugs. The medicamentous therapy consists of an immediate discontinuation of the antiepileptic drug.

[Acute spinal cord ischemia following deep injection therapy of the neck]. / Akuter zervikaler Rückenmarkinfarkt nach paravertebraler Infiltrationsbehandlung.

We report the case of a 40-year-old woman suffering from neck pain due to mild cervical spine injury. During conventional faceted infiltration therapy with crystalline steroids, the patient developed weakness in both arms and paresthesia of the left arm. While the weakness resolved within a few seconds, a mild deficit in motor coordination and paresthesia of the left arm were still present after 2 months. T2-weighted magnetic resonance imaging of the cervical spine depicted a small hyperintense lesion at the C6 level most likely reflecting embolic infarction due to injection of crystalline steroids into a myelon-feeding artery, which has of late repeatedly been reported. We discuss potential pathomechanisms of this very rare complication and give a review of the literature.

[Clinical picture of spinal tumors]. / Klinik spinaler Raumforderungen.

Spinal tumors may present with symptoms such as pain and motor and sensory deficits. Sphincter dysfunction may also occur. The clinical picture depends upon the size and localization of the tumor in relation to the cross section and the height along the longitudinal axis of the spinal cord. Typical symptoms due to transverse damage of the spinal cord are complete lesion, Brown-Sequard syndrome, a lesion of the central spinal cord, and posterior cord syndrome. Tetraparesis, spastic, or flaccid paraparesis result from lesions at the cervical spine, thoracic spine, or below the first lumbar vertebral body, respectively.

[Disorders of the cerebellopontine angle]. / Klinik der Kleinhirnbrückenwinkelerkrankungen.

Disorders of the cerebellopontine angle may present by symptoms like vertigo, hearing problems, affection of the trigeminal or facial nerve. Ipsilateral ataxia and contralateral hemiparesis develop in case of a rather large tumor in this region and display an involvement of the cerebellum and/or brainstem. However, some of these typical symptoms are not recognized by the patient. Thus, in case of a suspicion of a disorder of the cerebellopontine angle the relevant functions have to be tested clinically. In addition, electrophysiology can confirm dysfunction of these cranial nerves. Mainstay of the therapy should be the treatment of the underlying cause. Nevertheless, not seldom it is necessary to treat symptoms like vertigo or facial pain.

[Heated car seats--a potential burn risk for paraplegics]. / Die Autositzheizung--eine potenzielle Verbrennungsgefahr für den Querschnittsgelähmten.

The comfort of heated car seats has gained popularity worldwide. We present a rare case of severe second- and third-degree burn in the lower back and sacral region of a 42-year-old post-traumatic paraplegic patient while using a heated car seat. The patient was admitted to our burn unit and required several reconstructive surgery procedures. Inadvertent thermal injury is a constant potential hazard for individuals with impaired sensibility such as paraplegics and other neurologically impaired patients. Early education of patients, manufacturers, and health care personnel is of eminent importance to prevent severe burn injuries in this risk population.

Inflammation in areas of remote changes following focal brain lesion.

Focal brain lesions can lead to metabolic and structural changes in areas distant from but connected to the lesion site. After focal ischemic or excitotoxic lesions of the cortex and/or striatum, secondary changes have been observed in the thalamus, substantia nigra pars reticulata, hippocampus and spinal cord. In all these regions, inflammatory changes characterized by activation of microglia and astrocytes appear. In the thalamus, substantia nigra pars reticulata and hippocampus, an expression of proinflammatory cytokine like tumor necrosis factor-alpha and interleukin-1beta is induced. However, time course of expression and cellular localisation differ between these regions. Neuronal damage has consistently been observed in the thalamus, substantia nigra and spinal cord. It can be present in the hippocampus depending on the procedure of induction of focal cerebral ischemia. This secondary neuronal damage has been linked to antero- and retrograde degeneration. Anterograde degeneration is associated with somewhat later expression of cytokines, which is localised in neurons. In case of retrograde degeneration, the expression of cytokines is earlier and is localised in astrocytes. Pharmacological intervention aiming at reducing expression of tumor necrosis factor-alpha leads to reduction of secondary neuronal damage. These first results suggest that the inflammatory changes in remote areas might be involved in the pathogenesis of secondary neuronal damage.

[Neurological diseases and pregnancy: what must the family physician heed?]. / Neurologische Erkrankungen in der Schwangerschaft. Welche Untersuchung und welche Therapie istjetzt noch erlaubt?

A woman in child-bearing age could principally contract a neurological disease during a pregnancy. The diseases are differentiated between those that existed before, such as migraines, epilepsy, multiple sclerosis or myasthenia gravis and diseases that have an increased incidence during pregnancy, for example stroke, thrombosis of a sinus, subarachnoid hemorrhage, restless legs syndrome or thoracic outlet syndromes and pregnancy specific diseases. The diagnostics and therapy of these diseases are limited by the pregnancy; contraindications must be observed.

[Severe burn as a consequence of an epileptic seizure while showering]. / Grossflächige Verbrühung nach einem epileptischen Anfall während des Duschens.

We report a case of a 17-year-old patient who experienced an epileptic seizure while showering. The patient suffered full-thickness scald injuries involving thorax, abdomen and both arms and legs. The burn, which included 35% of the patient's body surface area, will cause life-long secondary functional and aesthetic deformities. By installing adjustable shower equipment with a maximal temperature limit, this devastating accident could have been prevented.

[Primary progressive aphasia]. / Primär progressive Aphasie.

Primary progressive aphasia is a rare disease characterised by slow deterioration of language, which remains the leading symptom whereas other cognitive functions such as memory, orientation, judgement, and visual-spatial skills are relatively spared and mostly not affected until 5 to 7 years after disease onset. Structural imaging displays atrophy of the left temporal region which can also affect the frontal region or both hemispheres. Reduced neuronal activity in the left temporal lobe can be seen using functional imaging even before structural anomalies are detected. Neuropathological examination reveals neuronal cell loss and gliosis in the regions of atrophy which are sometimes accompanied by spongiform changes. T-positive neurons or plaques and neurofibrillary tangles are present in rare cases. A specific therapy is not known. Logopaedic therapy focussed on the main symptoms seems to stabilise linguistic abilities.

[Diagnosis of an initial infratentorial central nervous system B-cell lymphoma during prolonged cortisone medication]. / Diagnose eines initial infratentoriellen primären B-Zell-Lymphoms des ZNS unter prolongierter Kortisonmedikation.

We present a patient with primary central nervous system B-cell lymphoma. He had suffered from slowly developing weight loss and presented to us with disorientation, seizures, and a supranuclear gaze disturbance. The patient was dismissed with the primary diagnosis of autoimmune encephalitis of the brainstem and put on oral corticosteroids. Four months later, his health status had deteriorated, and at that time diagnostic methods pointed to a cerebral lymphoma. Stereotactic biopsy with subsequent immunohistochemistry and polymerase chain reaction analysis revealed a highly malignant B-cell lymphoma of the CNS, despite prolonged corticosteroid treatment. The patient was treated with whole brain radiotherapy.

Association between inflammation and nigral neuronal damage following striatal excitotoxic lesion.

We examined the expression of TNF-alpha within the substantia nigra pars reticulata (SNR) following intrastriatal injection of quinolinic acid (QA) and studied the effect of rolipram, a TNF-alpha-inhibitor, on the secondary neuronal damage. QA (240 nmol in 1 microl) was injected stereotactically into the striatum of male Wistar rats. After survival of 1, 3 or 10 days, the animals were sacrificed and immunohistochemical staining with an antibody against TNF-alpha was performed. From day 1 to day 10 after striatal QA injection TNF-alpha positive cells were observed within ipsilateral substantia nigra which were neither present on the contralateral side nor in sham-operated controls. Double labeling with antibodies against TNF-alpha and NeuN, keratan sulfate proteoglycan or GFAP displayed a good overlap between TNF-alpha and NeuN, which suggests that TNF-alpha positive cells are neurons. For the pharmacological approach, three groups of QA rats were treated intraperitoneally with either solvent (n=5), the NMDA receptor antagonist MK 801 (4 mg/kg, n=6) or the TNF-alpha inhibitor rolipram (0.3 mg/kg, n=6), which was started 24 h after QA-injection and continued with daily applications for 14 days. The amount of striatal damage did not differ between the three groups. The number of intact neurons within the ipsilateral substantia nigra of the solvent treated group was reduced by approximately 30% compared to the contralateral side. Both MK 801 and rolipram ameliorated this secondary damage and reduced the number of TNF-alpha positive cells. The observed association between expression of TNF-alpha and secondary neuronal damage within the substantia nigra induced by intrastriatal QA application might hint towards an involvement of this cytokine in transneuronal degeneration.