RepoMed (Medizinische Hochschule Hannover)
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Same Same but Different: A Clinical Characterization of Men with Hypersexual Disorder in the Sex@Brain Study
No full textProblems arising from hypersexual behavior are often seen in clinical settings.
We aimed to extend the knowledge about the clinical characteristics of
individuals with hypersexual disorder (HD). A group of people who fulfilled the
proposed diagnostic criteria for HD (men with HD, n = 50) was compared to a group
of healthy controls (n = 40). We investigated differences in sociodemographic,
neurodevelopmental, and family factors based on self-report questionnaires and
clinical interviews. Men with HD reported elevated rates of sexual activity,
paraphilias, consumption of child abusive images, and sexual coercive behavior
compared to healthy controls. Moreover, rates of affective disorders, attachment
difficulties, impulsivity, and dysfunctional emotion regulation strategies were
higher in men with HD. Men with HD seem to have experienced various forms of
adverse childhood experiences, but there were no further differences in
sociodemographic, neurodevelopmental factors, and family factors. Regression
analyses indicated that attachment-related avoidance and early onset of
masturbation differentiated between men with HD and healthy controls. In
conclusion, men with HD appear to have the same neurodevelopment, intelligence
levels, sociodemographic background, and family factors compared to healthy
controls, but they report different and adverse experiences in childhood,
problematic sexual behavior, and psychological difficultie
Dilatation Therapy and Demographic Characteristics Significantly Influence the Amount of Propofol for Therapeutic Endoscopic Retrograde Cholangiography
No full textBackground and Study Aims: Patients undergoing therapeutic endoscopic retrograde
cholangiography (ERC) may require different amounts of sedative agents depending
on demographic characteristics, indication of ERC, and/or endoscopic
intervention. Patients and Methods: We retrospectively analyzed all patients
undergoing therapeutic ERC from 2008 - 2014 who received deep sedation with
propofol +/- midazolam. Results: A total of 2448 ERC procedures were performed in
781 patients. The cumulative per procedure propofol dose in the different groups
was as follows: PSC 479 mg (+/-256), bile duct stones 356 mg (+/-187), benign
stenosis/cholestasis 395 mg (+/-228), malignant stenosis 401 mg (+/-283), and
postliver transplant complications 391 mg (+/-223) (p < 0.05). Multivariable
analysis showed that dilatation therapy (p = 0.001), age (p = 0.001), duration of
the intervention (p = 0.001), BMI (p = 0.001), gender (p = 0.001), platelet count
(p = 0.003), and bilirubin (p = 0.043) influence independently the propofol
consumption. Conclusions: Demographic characteristics and endoscopic
interventions have a distinct influence on the amount of sedation required for
therapeutic ERC. Although the sedation-associated complication rate is low
optimization of sedative regimens is a prime goal to further reduce adverse
events of therapeutic ER
Two-Chambered Chitosan Nerve Guides With Increased Bendability Support Recovery of Skilled Forelimb Reaching Similar to Autologous Nerve Grafts in the Rat 10 mm Median Nerve Injury and Repair Model
No full textTension-free surgical reconstruction of transected digital nerves in humans is regularly performed using autologous nerve grafts (ANGs) or bioartificial nerve grafts. Nerve grafts with increased bendability are needed to protect regenerating nerves in highly mobile extremity parts. We have recently demonstrated increased bendability and regeneration supporting properties of chitosan nerve guides with a corrugated outer wall (corrCNGs) in the common rat sciatic nerve model (model of low mobility). Here, we further modified the hollow corrCNGs into two-chambered nerve guides by inserting a perforated longitudinal chitosan-film (corrCNG[F]s) and comprehensively monitored functional recovery in the advanced rat median nerve model. In 16 adult female Lewis rats, we bilaterally reconstructed 10 mm median nerve gaps with either ANGs, standard chitosan nerve guides (CNGs), CNGs (CNG[F]s), or corrCNG[F]s (n = 8, per group). Over 16 weeks, functional recovery of each forelimb was separately surveyed using the grasping test (reflex-based motor task), the staircase test (skilled forelimb reaching task), and non-invasive electrophysiological recordings from the thenar muscles. Finally, regenerated tissue harvested from the distal part of the nerve grafts was paraffin-embedded and cross-sections were analyzed regarding the number of Neurofilament 200-immunopositive axons and the area of newly formed blood vessels. Nerve tissue harvested distal to the grafts was epon-embedded and semi-thin cross-sections underwent morphometrical analyses (e.g., number of myelinated axons, axon and fiber diameters, and myelin thicknesses). Functional recovery was fastest and most complete in the ANG group (100% recovery rate regarding all parameters), but corrCNG[F]s accelerated the recovery of all functions evaluated in comparison to the other nerve guides investigated. Furthermore, corrCNG[F]s supported recovery of reflex-based grasping (87.5%) and skilled forelimb reaching (100%) to eventually significantly higher rates than the other nerve guides (grasping test: CNGs: 75%, CNG[F]s: 62.5%; staircase test: CNGs: 66.7%, CNG[F]s: 83.3%). Histological and nerve morphometrical evaluations, in accordance to the functional results, demonstrated best outcome in the ANG group and highest myelin thicknesses in the corrCNG[F] group compared to the CNG and CNG[F] groups. We thus clearly demonstrate that corrCNG[F]s represent promising innovative nerve grafts for nerve repair in mobile body parts such as digit
Untersuchung der ERCC1-Expression in Speicheldrüsenkarzinomen und Metaanalyse zur zielgerichteten Therapie
No full textDevelopment of endothelialisation methods & in vitro testing systems for vascular stents
No full textImpact of maternal education on the outcome of newborns requiring surgery for congenital malformations
Get PDFOBJECTIVE: Numerous studies established a link between socioeconomic status (SES) and several dimensions of general health. This study examines the association between maternal education as a widely used indicator of SES and outcome in newborns requiring surgical correction of congenital anomalies. METHODS: Ambispective data analysis of newborns with esophageal atresia (EA), intestinal atresia (IA), congenital diaphragmatic hernia (CDH), omphalocele (OC), gastroschisis (GS) undergoing surgery between 01/2008-11/2017 accessing the clinical databases Neodat and Viewpoint. Maternal education was determined according to the validated education classification CASMIN and stratified into "low" SES and "high" SES group. Endpoints were incidence of postoperative complications, length of mechanical ventilation, and readmission to NICU. RESULTS: Inclusion of 169 patients with EA (n = 32), IA (n = 24), CDH (n = 47), OC (n = 19), GS (n = 47). Women of low SES (n = 67, 40%) attended fewer prenatal screenings (total, 4.6 vs. 7.9, P<0.0001; EA, 3.7 vs. 7.1, P = 0.0002; IA, 3.5 vs. 9.4, P = 0.0006; OC, 2.5 vs. 8.8, P = 0.009; GS, 4.1 vs. 7.0, P = 0.002). Low SES was associated with higher incidence of patients born small for gestational age (37% vs. 20%, P = 0.019), with additional congenital malformations (37% vs. 15%, P = 0.001), being born in a peripheral center (7% vs. 0%, P = 0.008), and with higher incidence of 5 APGAR scores <7 (23% vs. 7%, P = 0.004). Moreover, low SES was associated with higher incidence of postoperative complications (total 70% vs. 32%, P<0.0001; EA, 60% vs. 23%, P = 0.04; IA, 67% vs. 11%, P = 0.008; CDH, 83% vs. 46%, P = 0.009; GS, 74% vs. 25%, P = 0.001), and higher readmission rate to NICU (IA, 33% vs. 0%, P = 0.043; GS, 32% vs. 4%, P = 0.007). CONCLUSIONS: Low maternal education is associated with a reduced uptake of prenatal screenings, adverse neonatal outcomes, and higher incidence of postoperative complications in newborns with congenital anomalies. Primary prevention and specific support should be provided prenatally for families with low SES to avoid adverse outcomes
A Comparison of Metacognitive Therapy in Current Versus Persistent Depressive Disorder - A Pilot Outpatient Study.
No full textBackground: Metacognitive therapy (MCT) is a modern approach with demonstrated efficacy in current major depressive disorder (MDD). The treatment aims to modify thinking styles of rumination and worry and their underlying metacognitions, which have been shown to be involved in the initiation and perpetuation of MDD. We hypothesized that metacognitive therapy may also be effective in treating persistent depressive disorder (PDD). Methods: Thirty depressed patients (15 with MDD; 15 with PDD) were included. Patients in both groups were comparable on depression severity and sociodemographic characteristics, but PDD was associated with more former treatments. Metacognitive therapy was applied by trained psychotherapists for a mean of 16 weeks. Results: We observed a significant improvement of depressive symptoms in both groups, and comparable remission rates at the end of treatment and after 6 months follow-up. Furthermore, we observed significant and similar levels of improvement in rumination, dysfunctional metacognitions, and anxiety symptoms in both groups. Limitations: The study is limited by the small sample size and a missing independent control group. The effect of the therapeutic alliance was not controlled. The quality of depression rating could have been higher. Conclusions: We demonstrated that metacognitive therapy can successfully be applied to patients with PDD. The observed results were comparable to those obtained for patients with current major depressive disorder. Further studies with larger groups and a randomized design are needed to confirm these promising initial findings
