scholarly journals NeuroTec Sitem-Insel Bern: Closing the Last Mile in Neurology

2021 ◽  
Vol 5 (2) ◽  
pp. 13
Author(s):  
Kaspar A. Schindler ◽  
Tobias Nef ◽  
Maxime O. Baud ◽  
Athina Tzovara ◽  
Gürkan Yilmaz ◽  
...  
Keyword(s):  
Diagnostic Tests ◽  
Current Model ◽  
Disease Process ◽  
Therapeutic Interventions ◽  
Sleep Studies ◽  
Last Mile ◽  
Specialized Equipment ◽  
The One ◽  
Treatment Procedures ◽  
Digital Biomarkers

Neurology is focused on a model where patients receive their care through repeated visits to clinics and doctor’s offices. Diagnostic tests often require expensive and specialized equipment that are only available in clinics. However, this current model has significant drawbacks. First, diagnostic tests, such as daytime EEG and sleep studies, occur under artificial conditions in the clinic, which may mask or wrongly emphasize clinically important features. Second, early detection and high-quality management of chronic neurological disorders require repeat measurements to accurately capture the dynamics of the disease process, which is impractical to execute in the clinic for economical and logistical reasons. Third, clinic visits remain inaccessible to many patients due to geographical and economical circumstances. Fourth, global disruptions to daily life, such as the one caused by COVID-19, can seriously harm patients if access to in-person clinical visits for diagnostic and treatment purposes is throttled. Thus, translating diagnostic and treatment procedures to patients’ homes will convey multiple substantial benefits and has the potential to substantially improve clinical outcomes while reducing cost. NeuroTec was founded to accelerate the re-imagining of neurology and to promote the convergence of technological, scientific, medical and societal processes. The goal is to identify and validate new digital biomarkers that can close the last mile in neurology by enabling the translation of personalized diagnostics and therapeutic interventions from the clinic to the patient’s home.

scholarly journals Tick-borne zoonoses and commonly used diagnostic methods in human and veterinary medicine

2021 ◽  
Author(s):  
Andrea Springer ◽  
Antje Glass ◽  
Julia Probst ◽  
Christina Strube
Keyword(s):  
Veterinary Medicine ◽  
Diagnostic Tests ◽  
One Health ◽  
Animal Health ◽  
Diagnostic Techniques ◽  
Diagnostic Methods ◽  
Diagnostic Tools ◽  
Zoonotic Pathogens ◽  
Health Concept ◽  
The One

AbstractAround the world, human health and animal health are closely linked in terms of the One Health concept by ticks acting as vectors for zoonotic pathogens. Animals do not only maintain tick cycles but can either be clinically affected by the same tick-borne pathogens as humans and/or play a role as reservoirs or sentinel pathogen hosts. However, the relevance of different tick-borne diseases (TBDs) may vary in human vs. veterinary medicine, which is consequently reflected by the availability of human vs. veterinary diagnostic tests. Yet, as TBDs gain importance in both fields and rare zoonotic pathogens, such as Babesia spp., are increasingly identified as causes of human disease, a One Health approach regarding development of new diagnostic tools may lead to synergistic benefits. This review gives an overview on zoonotic protozoan, bacterial and viral tick-borne pathogens worldwide, discusses commonly used diagnostic techniques for TBDs, and compares commercial availability of diagnostic tests for humans vs. domestic animals, using Germany as an example, with the aim of highlighting existing gaps and opportunities for collaboration in a One Health framework.

Measuring Disease Modification in Alzheimer's Disease

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S1) ◽  
pp. 11-14
Author(s):  
Jeffrey L. Cummings
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Immunoglobulin A ◽  
Disease Process ◽  
Underlying Disease ◽  
Therapeutic Interventions ◽  
Disease Modification ◽  
Amyloid Disease ◽  
Therapeutic Modalities ◽  
Disease Modifying

AbstractWe appear to be on the brink of a new epoch of treatment for Alzheimer's disease. Compelling evidence suggests that Aβ42 secretion is the triggering event in the pathogenesis of Alzheimer's disease, and that tau aggregation may be an important secondary event linked to neurodegeneration. Prophylactic administration of anti-amyloid agents designed to prevent Aβ accumulation in persons with subclinical disease is likely to be more effective than therapeutic interventions in established Alzheimer's disease. Drug development programs in Alzheimer's disease focus primarily on agents with anti-amyloid disease-modifying properties, and many different pharmacologic approaches to reducing amyloid pathology and tauopathy are being studied. Classes of therapeutic modalities currently in advanced-stage clinical trial testing include forms of immunotherapy (active β -amyloid immunoconjugate and human intravenous immunoglobulin), a γ-secretase inhibitor, the selective Aβ42-lowering agent R-flurbiprofen, and the anti-aggregation agent tramiprosate. Non-traditional dementia therapies such as the HMG-CoA reductase inhibitors (statins), valproate, and lithium are now being assessed for clinical benefit as anti-amyloid disease-modifying treatments. Positive findings of efficacy and safety from clinical studies are necessary but not sufficient to demonstrate that a drug has disease-modifying properties. Definitive proof of disease-modification requires evidence from validated animal models of Alzheimer's disease; rigorously controlled clinical trials showing a significantly improved, stabilized, or slowed rate of decline in cognitive and global function compared to placebo; and prospectively obtained evidence from surrogate biomarkers that the treatment resulted in measurable biological changes associated with the underlying disease process.

Summary of the current state of the pathogenesis of glaucoma

1927 ◽  
Vol 23 (8) ◽  
pp. 839-845
Author(s):  
V. P. Roshchin
Keyword(s):  
Single Case ◽  
Disease Process ◽  
The Other ◽  
Medical Attention ◽  
Blind People ◽  
Current State ◽  
Constant State ◽  
The One

The problem of glaucoma has, for many reasons, occupied and continues to occupy a prominent place in the ophthalmic press. It is enough to recall that 19% of all blind people owe their misfortune to glaucoma to understand why interest in this affliction has never faded among ophthalmologists. Furthermore, no ophthalmologist is quite sure that a certain method of treatment, even if the patient has timely applied for medical attention, can definitely prevent a sad outcome in every single case. This plus the absence of a unified and correct view of the essence of glaucoma keeps ophthalmologists in a constant state of flux, constantly striving to uncover the hidden springs of the disease process on the one hand, and to find a more radical means to combat it on the other.

Central sensitization in chronic lumbar spine pain – possibilities of therapeutic interventions

Ból ◽  
2020 ◽  
Vol 21 (2) ◽  
pp. 45-53
Author(s):  
Barbara Kosińska ◽  
Paweł Turczyn ◽  
Krzysztof Wesołowski ◽  
Beata Tarnacka ◽  
Małgorzata Malec-Milewska
Keyword(s):  
Low Back Pain ◽  
Central Sensitization ◽  
Diagnostic Tests ◽  
Multimodal Therapy ◽  
Underlying Mechanism ◽  
Therapeutic Interventions ◽  
Low Back ◽  
Pain Mechanisms ◽  
Factors Affecting ◽  
Spine Pain

Patients with chronic low back pain are a heterogeneous group. Therapeutic management of these patients should address the underlying mechanism of pain, which can be revealed after performing diagnostic tests. The management of patients with the predominant central sensitization component of includes multimodal therapy consisting of pharmacological and non-pharmacological treatment. An important element is also the identification and exclusion of the most important pathophysiological factors affecting the maintenance of central sensitization mechanisms in each patient. The paper describes pharmacological and non-pharmacological therapeutic options in patients with central sensitization component, considering that these methods may differ significantly in the patients. It should be stated that despite the individualized, multimodal therapy based on pain mechanisms, in some patients substantial pain relief may not be achieved.

Ureterocele as a cause of chronic intractable abdominal pain

2021 ◽  
Vol 14 (11) ◽  
pp. e245262
Author(s):  
Gaurav Chauhan ◽  
Isaiah Levy ◽  
Samuel Wadie Samuel
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Tests ◽  
Clinical Characteristics ◽  
Incidental Finding ◽  
Obstructive Uropathy ◽  
Therapeutic Interventions ◽  
Pain Clinic ◽  
Diagnostic Challenge ◽  
Underlying Disorder ◽  
Chronic Pain Clinic

A ureterocele is a submucosal, cystic dilation of the terminal ureter, either congenital or acquired, as it enters the bladder. It is a rare clinical entity that can be entirely asymptomatic and present as an incidental finding or can manifest in the form of distressing symptoms such as unremitting abdominal pain, haematuria, obstructive uropathy, to name a few. The authors present a case of abdominal pain in a 43-year-old woman who was presumptively attributed to various clinical entities and was finally referred to the chronic pain clinic. The patient underwent numerous diagnostic tests, psychological evaluations and therapeutic interventions, including surgeries, over the years that failed to mitigate her symptoms until urologic imaging reported intravesical ureterocele as the underlying disorder. The case report entails the diagnostic challenge faced by the authors along with the clinical characteristics of ureterocele.

scholarly journals Diagnostic challenges in chronic inflammatory demyelinating polyradiculoneuropathy

Brain ◽  
2020 ◽  
Vol 143 (11) ◽  
pp. 3214-3224
Author(s):  
Filip Eftimov ◽  
Ilse M Lucke ◽  
Luis A Querol ◽  
Yusuf A Rajabally ◽  
Camiel Verhamme
Keyword(s):  
Peripheral Nerves ◽  
Diagnostic Tests ◽  
High Sensitivity ◽  
Nerve Biopsy ◽  
Chronic Inflammatory Demyelinating Polyradiculoneuropathy ◽  
Control Group ◽  
Nerve Ultrasound ◽  
Hand Performance ◽  
The One ◽  
Csf Examination

Abstract Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) consists of a spectrum of autoimmune diseases of the peripheral nerves, causing weakness and sensory symptoms. Diagnosis often is challenging, because of the heterogeneous presentation and both mis- and underdiagnosis are common. Nerve conduction study (NCS) abnormalities suggestive of demyelination are mandatory to fulfil the diagnostic criteria. On the one hand, performance and interpretation of NCS can be difficult and none of these demyelinating findings are specific for CIDP. On the other hand, not all patients will be detected despite the relatively high sensitivity of NCS abnormalities. The electrodiagnostic criteria can be supplemented with additional diagnostic tests such as CSF examination, MRI, nerve biopsy, and somatosensory evoked potentials. However, the evidence for each of these additional diagnostic tests is limited. Studies are often small without the use of a clinically relevant control group. None of the findings are specific for CIDP, meaning that the results of the diagnostic tests should be carefully interpreted. In this update we will discuss the pitfalls in diagnosing CIDP and the value of newly introduced diagnostic tests such as nerve ultrasound and testing for autoantibodies, which are not yet part of the guidelines.

scholarly journals Persistently activated, proliferative memory autoreactive B cells promote inflammation in rheumatoid arthritis

2020 ◽  
Vol 12 (570) ◽  
pp. eaaz5327
Author(s):  
Hendy Kristyanto ◽  
Nienke J. Blomberg ◽  
Linda M. Slot ◽  
Ellen I. H. van der Voort ◽  
Priscilla F. Kerkman ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
B Cells ◽  
Autoimmune Disease ◽  
Clinical Remission ◽  
Immune Cell ◽  
Disease Process ◽  
Therapeutic Interventions ◽  
Autoreactive B Cells ◽  
Autoimmune Pathology ◽  
Activated State

Autoreactive B cells mediate autoimmune pathology, but exactly how remains unknown. A hallmark of rheumatoid arthritis (RA), a common autoimmune disease, is the presence of disease-specific anticitrullinated protein antibodies (ACPAs). Here, we showed that ACPA-positive B cells in patients with RA strongly expressed T cell–stimulating ligands, produced abundant proinflammatory cytokines, and were proliferative while escaping inhibitory signals. This activated state was found at different degrees in different stages of disease: highest in patients with recent-onset RA, moderate in patients with established RA, and far less pronounced in ACPA-positive individuals “at risk” for developing disease. The activated autoreactive B cell response persisted in patients who achieved clinical remission with conventional treatment. ACPA-positive B cells in blood and synovial fluid secreted increased amounts of the chemoattractant interleukin-8, which attracted neutrophils, the most abundant immune cell in arthritic joints. Tetanus toxoid–specific B cells from the same patients exhibited properties of memory B cells without the activation and proliferation phenotype, but these cells transiently acquired a similar proliferative phenotype upon booster vaccination. Together, these data indicated that continuous antigenic triggering of autoreactive B cells occurs in human autoimmune disease and support the emerging concept of immunological activity that persists under treatment even in clinical remission, which may revise our current concept of treatment targets for future therapeutic interventions. In addition, our data pointed to a pathogenic role of ACPA-positive B cells in the inflammatory disease process underlying RA and favor approaches that aim at their antigen-specific inactivation or depletion.

Introduction: Amyloid-Based Interventions in Alzheimer's Disease

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S1) ◽  
pp. 2-3 ◽  
Author(s):  
Gary J. Kennedy
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Immunoglobulin A ◽  
Disease Process ◽  
Underlying Disease ◽  
Therapeutic Interventions ◽  
Amyloid Disease ◽  
Therapeutic Modalities ◽  
Reductase Inhibitors ◽  
Disease Modifying

AbstractWe appear to be on the brink of a new epoch of treatment for Alzheimer's disease. Compelling evidence suggests that Aβ secretion is the triggering event in the pathogenesis of Alzheimer's disease, and that tau aggregation may be an important secondary event linked to neurodegeneration. Prophylactic administration of anti-amyloid agents designed to prevent Aβ accumulation in persons with subclinical disease is likely to be more effective than therapeutic interventions in established Alzheimer's disease. Drug development programs in Alzheimer's disease focus primarily on agents with anti-amyloid disease-modifying properties, and many different pharmacologic approaches to reducing amyloid pathology and tauopathy are being studied. Classes of therapeutic modalities currently in advanced-stage clinical trial testing include forms of immunotherapy (active β-amyloid immunoconjugate and human intravenous immunoglobulin), a γ-secretase inhibitor, the selective Aβ42-lowering agent R-flurbiprofen, and the anti-aggregation agent tramiprosate. Non-traditional dementia therapies such as the HMG-CoA reductase inhibitors (statins), valproate, and lithium are now being assessed for clinical benefit as anti-amyloid disease-modifying treatments. Positive findings of efficacy and safety from clinical studies are necessary but not sufficient to demonstrate that a drug has disease-modifying properties. Definitive proof of disease-modification requires evidence from validated animal models of Alzheimer's disease; rigorously controlled clinical trials showing a significantly improved, stabilized, or slowed rate of decline in cognitive and global function compared to placebo; and prospectively obtained evidence from surrogate biomarkers that the treatment resulted in measurable biological changes associated with the underlying disease process.

scholarly journals A Near-Shore Linear Wave Model with the Mixed Finite Volume and Finite Difference Unstructured Mesh Method

Fluids ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 199
Author(s):  
Yong G. Lai ◽  
Han Sang Kim
Keyword(s):  
Finite Difference ◽  
Finite Volume ◽  
Current Model ◽  
Wave Model ◽  
Wave Action ◽  
New Wave ◽  
Near Shore ◽  
The One ◽  
Geographical Space ◽  
Model Approach

The near-shore and estuary environment is characterized by complex natural processes. A prominent feature is the wind-generated waves, which transfer energy and lead to various phenomena not observed where the hydrodynamics is dictated only by currents. Over the past several decades, numerical models have been developed to predict the wave and current state and their interactions. Most models, however, have relied on the two-model approach in which the wave model is developed independently of the current model and the two are coupled together through a separate steering module. In this study, a new wave model is developed and embedded in an existing two-dimensional (2D) depth-integrated current model, SRH-2D. The work leads to a new wave–current model based on the one-model approach. The physical processes of the new wave model are based on the latest third-generation formulation in which the spectral wave action balance equation is solved so that the spectrum shape is not pre-imposed and the non-linear effects are not parameterized. New contributions of the present study lie primarily in the numerical method adopted, which include: (a) a new operator-splitting method that allows an implicit solution of the wave action equation in the geographical space; (b) mixed finite volume and finite difference method; (c) unstructured polygonal mesh in the geographical space; and (d) a single mesh for both the wave and current models that paves the way for the use of the one-model approach. An advantage of the present model is that the propagation of waves from deep water to shallow water in near-shore and the interaction between waves and river inflows may be carried out seamlessly. Tedious interpolations and the so-called multi-model steering operation adopted by many existing models are avoided. As a result, the underlying interpolation errors and information loss due to matching between two meshes are avoided, leading to an increased computational efficiency and accuracy. The new wave model is developed and verified using a number of cases. The verified near-shore wave processes include wave shoaling, refraction, wave breaking and diffraction. The predicted model results compare well with the analytical solution or measured data for all cases.

scholarly journals A Neurosurgeon's Guide to Cognitive Dysfunction in Adult Glioma

Neurosurgery ◽  
2020 ◽  
Author(s):  
Ramin A Morshed ◽  
Jacob S Young ◽  
Arlena A Kroliczek ◽  
Mitchel S Berger ◽  
David Brang ◽  
...  
Keyword(s):  
Cognitive Dysfunction ◽  
Disease Process ◽  
High Grade Glioma ◽  
Cognitive Outcomes ◽  
Therapeutic Interventions ◽  
Contextual Understanding ◽  
Network Disruption ◽  
Neurocognitive Tasks ◽  
The Impact

Abstract Cognitive decline is common among patients with low- and high-grade glioma and can significantly impact quality of life. Although cognitive outcomes have been studied after therapeutic interventions such as surgery and radiation, it is important to understand the impact of the disease process itself prior to any interventions. Neurocognitive domains of interest in this disease context include intellectual function and premorbid ability, executive function, learning and memory, attention, language function, processing speed, visuospatial function, motor function, and emotional function. Here, we review oncologic factors associated with more neurocognitive impairment, key neurocognitive tasks relevant to glioma patient assessment, as well as the relevance of the human neural connectome in understanding cognitive dysfunction in glioma patients. A contextual understanding of glioma-functional network disruption and its impact on cognition is critical in the surgical management of eloquent area tumors.

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