9-Methyl-ß-carboline inhibits monoamine oxidase activity and stimulates the expression of neurotrophic factors by astrocytes.

ß-Carbolines (BC) are pyridoindoles, which can be found in various exogenous and endogenous sources. Recent studies revealed neurostimulative, neuroprotective, neuroregenerative and anti-inflammatory effects of 9-methyl-BC (9-Me-BC). Additionally, 9-me-BC increased neurite outgrowth of dopaminergic neurons independent of dopamine uptake into these neurons. In this study, the role of astrocytes in neurostimulative, neuroregenerative and neuroprotective properties of 9-me-BC was further explored.9-Me-BC exerted anti-proliferative effects without toxic properties in dopaminergic midbrain and cortical astrocyte cultures. The organic cation transporter (OCT) but not the dopamine transporter seem to mediate at least part the effect of 9-me-BC on astrocytes. Remarkably, 9-me-BC stimulated the gene expression of several important neurotrophic factors for dopaminergic neurons like Artn, Bdnf, Egln1, Tgfb2 and Ncam1. These factors are well known to stimulate neurite outgrowth and to show neuroprotective and neuroregenerative properties to dopaminergic neurons against various toxins. Further, we show that effect of 9-me-BC is mediated through phosphatidylinositol 3-kinase (PI3K) pathway. Additionally, 9-me-BC showed inhibitory properties to monoamine oxidase (MAO) activity with an IC50 value of 1 µM for MAO-A and of 15.5 µM for MAO-B. The inhibition of MAO by 9-me-BC might contribute to the observed increased dopamine content and anti-apoptotic properties in cell culture after 9-me-BC treatment in recent studies. Thus, 9-me-BC have a plethora of beneficial effects on dopaminergic neurons warranting its exploration as a new multimodal anti-parkinsonian medication.

[Accreditation and digitization - just a load of crap? Systematic risk analysis among medical employees - today and 12 years ago]. / Zertifizierung und Digitalisierung - alles nur Quatsch? Systematische Risikoanalyse des medizinischen Personals aktuell und vor 12 Jahren.

BACKGROUND: The aim of this study was to elucidate whether measures of quality management and digitization have the potential to reduce treatment risks in patients of a surgical clinic. METHODS: All health professional involved in the treatment of patients were asked to participate in a systematic, process-orientated and anonymous survey to assess the probability of occurrence of 69 treatment risks in stationary patients. The surveys were conducted in 2006 before establishing quality management (QM) and digitization, and recently after various certification activities have been performed and the digitization has been completed. RESULTS: According to the survey respondents, QM measures and digitization have led to a significant reduction of the probability of occurrence of 20 treatment risks, although the number of surgeries performed rose 1.8-fold while the number of employees increased by just 1.2-fold to 1.4-fold. The risk reduction was most pronounced regarding mistaken patient identity errors, while complex process risks like insufficient postoperative aftercare or patient dissatisfaction with ineffective communication remained unchanged. DISCUSSION: An increase in process risks that may be due to an increased workload can be mitigated by QM and digitization measures. This requires a quality and risk management system that is organized by the administration, supported by responsible and risk-aware employees and not imposed. CONCLUSION: Health professionals estimate that digitization and QM measures have the potential to reduce patients' treatment risks and help offset the increased workload. In particular, accreditations can help implement and maintain quality management measures.

Restoration of ankle movements with the ActiGait implantable drop foot stimulator: a safe and reliable treatment option for permanent central leg palsy.

OBJECT The ActiGait drop foot stimulator is a promising technique for restoration of lost ankle function by an implantable hybrid stimulation system. It allows ankle dorsiflexion by active peroneal nerve stimulation during the swing phase of gait. In this paper the authors report the outcome of the first prospective study on a large number of patients with stroke-related drop foot. METHODS Twenty-seven patients who experienced a stroke and with persisting spastic leg paresis received an implantable ActiGait drop foot stimulator for restoration of ankle movement after successful surface test stimulation. After 3 to 5 weeks, the stimulator was activated, and gait speed, gait endurance, and activation time of the system were evaluated and compared with preoperative gait tests. In addition, patient satisfaction was assessed using a questionnaire. RESULTS Postoperative gait speed significantly improved from 33.9 seconds per 20 meters to 17.9 seconds per 20 meters (p < 0.0001), gait endurance from 196 meters in 6 minutes to 401 meters in 6 minutes (p < 0.0001), and activation time from 20.5 seconds to 10.6 seconds on average (p < 0.0001). In 2 patients with nerve injury, surgical repositioning of the electrode cuff became necessary. One patient showed a delayed wound healing, and in another patient the system had to be removed because of a wound infection. Marked improvement in mobility, social participation, and quality of life was confirmed by 89% to 96% of patients. CONCLUSIONS The ActiGait implantable drop foot stimulator improves gait speed, endurance, and quality of life in patients with stroke-related drop foot. Regarding gait speed, the ActiGait system appears to be advantageous compared with foot orthosis or surface stimulation devices. Randomized trials with more patients and longer observation periods are needed to prove the long-term benefit of this device.