Explore the vast range of titles available.

Background Neuroborreliosis represents a relevant infectious disease and can cause a variety of neurological manifestations. Different stages and syndromes are described and atypical symptoms can result in diagnostic delay or misdiagnosis. The aim of this retrospective study was to define the pivotal neurological deficits in patients with neuroborreliosis that were the reason for admission in a hospital. Methods We retrospectively evaluated data of patients with neuroborreliosis. Only patients who fulfilled the diagnostic criteria of an intrathecal antibody production against Borrelia burgdorferi were included in the study. Results Sixty-eight patients were identified with neuroborreliosis. Cranial nerve palsy was the most frequent deficit (50%) which caused admission to a hospital followed by painful radiculitis (25%), encephalitis (12%), myelitis (7%), and meningitis/headache (6%). In patients with a combination of deficits, back pain was the first symptom, followed by headache, and finally by cranial nerve palsy. Indeed, signs of meningitis were often found in patients with neuroborreliosis, but usually did not cause admission to a hospital. Unusual cases included patients with sudden onset paresis that were initially misdiagnosed as stroke and one patient with acute delirium. Cerebrospinal fluid (CSF) analysis revealed typical changes including elevated CSF cell count in all but one patient, a blood-CSF barrier dysfunction (87%), CSF oligoclonal bands (90%), and quantitative intrathecal synthesis of immunoglobulins (IgM in 74%, IgG in 47%, and IgA in 32% patients). Importantly, 6% of patients did not show Borrelia specific antibodies in the blood. Conclusion In conclusion, the majority of patients presented with typical neurological deficits. However, unusual cases such as acute delirium indicate that neuroborreliosis has to be considered in a wide spectrum of neurological diseases. CSF analysis is essential for a reliable diagnosis of neuroborreliosis.

The fibroblast growth factor (FGF) 23/Klotho axis is a principal regulator of phosphate hemostasis and vitamin D metabolism, but limited data is available on its role in the central nervous system. Here, we investigate soluble α-Klotho (sKlotho) and C-terminal as well as intact FGF23 in cerebrospinal fluid (CSF) and plasma and their relationship to mineral metabolism parameters in humans. In 39 children aged 0.3–16.8 years undergoing lumbar puncture for the exclusion of inflammatory neurological disease, sKlotho and FGF23 were investigated by Western blot analysis, followed by ELISA quantification in CSF and plasma. The percentage of intrathecal synthesis of both proteins was calculated by measuring both the expected and observed CSF/plasma ratios of sKlotho and FGF23. The secreted (KL1) and cleaved (KL1+KL2) isoforms of sKlotho, and FGF23 were clearly detected in CSF in all subjects, although protein levels were lower compared to those of plasma samples (each p  < 0.01). The intrathecal percentage of CSF sKlotho and FGF23 synthesis amounted to 98 and 99 %, respectively. CSF sKlotho levels were higher in boys than in girls ( p  < 0.01), and correlated positively with plasma C-terminal FGF23 concentrations ( p  < 0.05) and standardized height ( p  < 0.01). Importantly, there were no significant correlations between plasma and CSF levels of sKlotho or FGF23. Plasma sKlotho as well as C-terminal and intact FGF23, respectively, were associated with parameters of mineral metabolism These results provide evidence that cleaved and secreted sKlotho and FGF23 are present in CSF, mainly derived from brain and affected by sex, height, and mineral metabolism parameters in children. Nevertheless, the absence of significant associations between plasma and CSF levels of Klotho and FGF23, respectively, suggest that the regulation of Klotho and FGF23 may be different between organs secreting these hormones into blood and CSF.

Background Tuberous sclerosis complex (TSC), a multisystem genetic disorder, affects many organs and systems, characterized by benign growths. This German multicenter study estimated the disease-specific costs and cost-driving factors associated with various organ manifestations in TSC patients. Methods A validated, three-month, retrospective questionnaire was administered to assess the sociodemographic and clinical characteristics, organ manifestations, direct, indirect, out-of-pocket, and nursing care-level costs, completed by caregivers of patients with TSC throughout Germany. Results The caregivers of 184 patients (mean age 9.8 ± 5.3 years, range 0.7–21.8 years) submitted questionnaires. The reported TSC disease manifestations included epilepsy (92%), skin disorders (86%), structural brain disorders (83%), heart and circulatory system disorders (67%), kidney and urinary tract disorders (53%), and psychiatric disorders (51%). Genetic variations in TSC2 were reported in 46% of patients, whereas 14% were reported in TSC1 . Mean total direct health care costs were EUR 4949 [95% confidence interval (95% CI) EUR 4088–5863, median EUR 2062] per patient over three months. Medication costs represented the largest direct cost category (54% of total direct costs, mean EUR 2658), with mechanistic target of rapamycin (mTOR) inhibitors representing the largest share (47%, EUR 2309). The cost of anti-seizure drugs (ASDs) accounted for a mean of only EUR 260 (5%). Inpatient costs (21%, EUR 1027) and ancillary therapy costs (8%, EUR 407) were also important direct cost components. The mean nursing care-level costs were EUR 1163 (95% CI EUR 1027–1314, median EUR 1635) over three months. Total indirect costs totaled a mean of EUR 2813 (95% CI EUR 2221–3394, median EUR 215) for mothers and EUR 372 (95% CI EUR 193–586, median EUR 0) for fathers. Multiple regression analyses revealed polytherapy with two or more ASDs and the use of mTOR inhibitors as independent cost-driving factors of total direct costs. Disability and psychiatric disease were independent cost-driving factors for total indirect costs as well as for nursing care-level costs. Conclusions This study revealed substantial direct (including medication), nursing care-level, and indirect costs associated with TSC over three months, highlighting the spectrum of organ manifestations and their treatment needs in the German healthcare setting. Trial registration : DRKS, DRKS00016045. Registered 01 March 2019, http://www.drks.de/DRKS00016045.

We report here the crystal structure of yeast copper thionein (Cu-MT), determined at 1.44-A resolution. The Cu-MT structure shows the largest known oligonuclear Cu(I) thiolate cluster in biology, consisting of six trigonally and two digonally coordinated Cu(I) ions. This is at variance with the results from previous spectroscopic determinations, which were performed on MT samples containing seven rather than eight metal ions. The protein backbone has a random coil structure with the loops enfolding the copper cluster, which is located in a cleft where it is bound to 10 cysteine residues. The protein structure is somewhat different from that of Ag7-MT and similar, but not identical, to that of Cu7-MT. Besides the different structure of the metal cluster, the main differences lie in the cysteine topology and in the conformation of some portions of the backbone. The present structure suggests that Cu-MT, in addition to its role as a safe depository for copper ions in the cell, may play an active role in the delivery of copper to metal-free chaperones.

Objective Antiseizure medications (ASMs) remain the mainstay of epilepsy treatment. These ASMs have mainly been tested in trials in adults with epilepsy, which subsequently led to market authorization (MA). For treatment of – especially young – children with epilepsy, several ASMs do not have a MA and guidelines are lacking, subsequently leading to “off‐label” use of ASMs. Even though “off‐label” ASM prescriptions for children could lead to more adverse events, it can be clinically appropriate and rational if the benefits outweigh the risks. This could be the case if “on‐label” ASM, in mono‐ or polytherapy, fails to achieve adequate seizure control. Methods The Medical Therapies Task Force of the International League Against Epilepsy (ILAE) Commission for Pediatrics performed a survey to study the current treatment practices in six classic, early life epilepsy scenarios. Our aim was not only to study first‐ and second‐line treatment preferences but also to illustrate the use of “off‐label” drugs in childhood epilepsies. Results Our results reveal that several ASMs (e.g. topiramate, oxcarbazepine, benzodiazepines) are prescribed “off‐label” in distinct scenarios of young children with epilepsy. In addition, recent scientific guidelines were not always adopted by several survey respondents, suggesting a potential knowledge gap. Significance We report the relatively common use of “off‐label” prescriptions that underlines the need for targeted and appropriately designed clinical trials, including younger patients, which will also result in the ability to generate evidence‐based guidelines.

It is the aim of this study to analyse how different crop growth model routines affect the simulation of water flow and nitrogen transport of a crop rotation in agricultural fields. The model system Expert-N is briefly described and used to test the crop growth sub-models against data of a six-year field experiment on sandy soils. Expert-N is a modular soil-plant-atmosphere model system, which comprises different sub-models to simulate one-dimensional vertical transport of water, solute and heat in the unsaturated zone. It includes several sub-models to describe organic matter turnover and has three generic crop growth sub-models. The latter are derived from the crop models CERES, SPASS and SUCROS. Simulations were performed using the different sub-models for each of the cereal crops in the sugar beet, winter wheat, winter barley, winter rye crop rotation. Results show the impact of crop model choice on simulated water balances and turnover of C and N. It is concluded that the simulation of root growth and plant residue mineralisation needs some improvement.

Objective To review the available literature concerning the definition of neonatal status epilepticus (SE) and/or seizure burden. Methods The International League Against Epilepsy Neonatal Task Force performed a scoping review of the definitions of neonatal SE. Following a systematic literature review, articles were screened and data were ed regarding: (1) article characteristics (author identification, publication year, journal name, digital object identifier, title, objective, and study design); (2) cohort characteristics (sample size, gestational age, seizure etiology); (3) definition of SE and/or seizure burden; and (4) the method used to identify and classify SE, including routine EEG (EEG), continuous EEG monitoring (cEEG), amplitude‐integrated EEG (aEEG), or clinical features. Results The scoping review yielded 44 articles containing a definition of neonatal SE. Studies mainly included infants with hypoxic–ischemic encephalopathy or neonates considered at risk for seizures. SE identification and classification most often relied on cEEG. The majority of studies based the definition of SE on seizure duration, including summed duration of seizures comprising ≥50% of any 1‐h epoch, recurrent seizures for >50% of the total recording time, or either electrographic seizures lasting >30 min and/or repeated electrographic seizures totaling >50% in any 1‐h period. Seizure burden was reported in 20 studies, and the most commonly used approach assessed total seizure burden, defined as total duration of EEG seizures in minutes. Sixteen studies assessed the relationship between seizure burden and outcomes, and most identified a significant association between higher seizure burden and unfavorable outcomes. Significance This scoping review demonstrates a substantial variation in neonatal SE definitions across the literature. The most common definitions were based around a 30‐min seizure duration criterion, but evidence was insufficient to support that 30 min was a cutoff defining prolonged seizures or that seizures exceeding this burden were more likely to be pharmacoresistant or associated with worse outcomes. As a next step, the Neonatal Task Force intends to develop a standardized approach to assessing and describing neonatal seizure burden and defining neonatal SE. Plain Language Summary Prolonged seizures are a neurologic emergency, if untreated, can lead to permanent injury or death. In adults and children, seizures lasting longer than 30 min are believed to cause brain damage. However, it is not clear if this definition can be applied to neonates. The International League Against Epilepsy Neonatal Taskforce performed a scoping literature review which identified 44 articles containing a definition of neonatal status epilepticus. In this article, the authors reviewed the current used definitions for prolonged seizures in neonates to establish a relationship between seizure duration and neurological outcome. As a next step, the Neonatal Task Force intends to develop a standardized approach to assessing and describing neonatal seizure burden and defining neonatal SE.

Background Recent decades have unravelled the molecular background of a number of inborn errors of metabolism (IEM) causing vitamin B 6 -dependent epilepsy. As these defects interfere with vitamin B 6 metabolism by different mechanisms, the plasma vitamin B 6 profile can give important clues for further molecular work-up. This has so far been investigated in only a small number of patients. Methods We evaluated the vitamin B 6 vitamers pyridoxal 5’-phosphate (PLP), pyridoxal (PL), pyridoxamine (PM), pyridoxine (PN) and the catabolite pyridoxic acid (PA) in the so far largest patient cohort: reference ( n  = 50); pyridox(am)ine 5’-phosphate oxidase (PNPO) deficiency ( n  = 6); antiquitin (ATQ) deficiency ( n  = 21); tissue non-specific alkaline phosphatase (TNSALP) deficiency ( n  = 2) and epileptic encephalopathy (EE) of unknown etiology tested negative for ATQ and PNPO deficiency ( n  = 64). Results High plasma PM concentration was found in all patients with PNPO deficiency irrespective of vitamin B 6 supplementation. Their PM concentration and the PM/PA ratio was significantly higher ( p  < 0.0001), compared to any other patients analysed. One patient with TNSALP deficiency and sampling prior to PN supplementation had markedly elevated plasma PLP concentration. On PN supplementation, patients with TNSALP deficiency, ATQ deficiency and patients of the EE cohort had similar plasma vitamin B 6 profiles that merely reflect the intake of supra-physiological doses of vitamin B 6 . The interval of sampling to the last PN intake strongly affected the plasma concentrations of PN, PL and PA. Conclusions PM concentrations and the PM/PA ratio clearly separated PNPO-deficient patients from the other cohorts. The plasma PM/PA ratio thus represents a robust biomarker for the selective screening of PNPO deficiency.

A prey–predator experimental setup was conducted in a shallow coastal ecosystem characterized by a bare intertidal mudflat to test if benthic biofilm resuspension causing microalgae inputs and carbon export toward nanoflagellates would favour the highest planktonic trophic level (i.e. mesozooplankton) when nutrient concentrations are high in the water column. Mesozooplankton predation and somatic production were studied by comparing the evolution of the prey assemblage (diversity and abundances) in the presence and absence of these predators during 24 h experiments. The results were then statistically analysed according to the cross-calculation method. Biofilm resuspension caused (i) a direct input of benthic microorganisms that had changed prey structure in term of diversity and/or size and (ii) a differential growth ability between prey taxa. Both reasons implied a bottom-up control on both micro- and mesozooplankton. The carbon export toward heterotrophic nanoflagellates favoured pelagic ciliate growth while mesozooplankton benefited from largest diatoms with high growth rates, both benthic and R-strategist pelagic species. Even if these microbial and herbivorous pathways are controlled by benthic inputs, they seemed to be totally disconnected since ciliates represented only a small part of mesozooplankton diet. The sensitivity of mesozooplankton production appeared species-dependent with the most tolerant taxa dominating the zooplankton assemblages. This suggests a role of the intensities and the frequencies of biofilm resuspension on the spatio-temporal structuring of mesozooplankton in macrotidal coastal ecosystems.

Ashes from biomass heat (and power) plants that apply untreated woody biofuels may be suitable for use as fertilizers if certain requirements regarding pollutant and nutrient contents are met. The aim of this study was to examine if both bottom and cyclone ashes from 17 Bavarian heating plants and one ash collection depot are suitable as fertilizers (n = 50). The range and average values of relevant nutrients and pollutants in the ashes were analyzed and evaluated for conformity with the German Fertilizer Ordinance (DüMV). Approximately 30% of the bottom ashes directly complied with the heavy metal limits of the Fertilizer Ordinance. The limits were exceeded for chromium(VI) (62%), cadmium (12%) and lead (4%). If chromium(VI) could be reduced by suitable treatment, 85% of the bottom ashes would comply with the required limit values. Cyclone ashes were high in cadmium, lead, and zinc. The analysis of the main nutrients showed high values for potassium and calcium in bottom ashes, but also relevant amounts of phosphorus, making them suitable as fertilizers if pollutant limits are met. Quality assurance systems should be applied at biomass heating plants to improve ash quality if wood ashes are used as fertilizers in agriculture.