Furtwangen University

Dementia is a neurodegenerative disease that affects more than 45 million patients worldwide. Treatment options for dementia include lecanemab for mild cognitive impairment, acetylcholinesterase inhibitors, which are mainly used for mild to moderate dementia, as well as N-methyl-D-aspartate receptor antagonists for patients with severe dementia or certain antipsychotics. Pharmaceutical approaches are limited by potential side effects. To alleviate symptoms or at least slightly improve cognitive functions, additional herbal medicines (HM) such as Ginkgo biloba and non-pharmacological approaches, e.g., behavioral, exercise, music, and reminiscence therapy, yoga, tai chi, or acupuncture, have been used with heterogeneous results. Helleborus niger, a plant containing multiple bioactive compounds such as ecdysteroids and bufadienolide, is used clinically for its immunomodulatory, anti-inflammatory, analgesic, and antioxidant properties. In a German hospital specializing in geriatric patients, an association between the subcutaneous application of Helleborus niger 12x and changes in dementia was observed. Retrospective study on the effect of subcutaneous application of Helleborus niger 12x for an average of 3 weeks in patients with dementia. Eligible patients were aged ≥ 60 years and treated at the Humboldt Clinic in Bad Steben, Bavaria, Germany, with two different treatment regimens: standard care with conventional medication alone (control group, CG) vs. standard care with conventional medication plus Helleborus niger 12x preparations (Helleborus group, HG). The primary outcome was the between-group difference in pre-post (T0 vs. T1) changes in the Mini-Mental State Examination (MMSE). Secondary outcomes were pre-post changes in the Dementia Detection test (DemTect), the Shulman clock-drawing test (CDT) and the Geriatric Depression Scale (GDS). For the primary outcome, there was a statistically significant difference in MMSE between the groups (p < 0.001; d = 1.5) at T1 with significantly higher values in HG compared to CG. Regarding the secondary outcomes, significantly improved values were seen in HG compared to CG for DemTect, CDT and GDS with medium to high effect sizes. The study gives preliminary evidence that Helleborus niger 12x applied subcutaneously might improve cognitive function in patients with dementia at least during the three-week administration. Further randomized, blinded studies with longer follow-up are needed to confirm preliminary results. Identifier, DRKS00033972.

A pelvic arteriovenous malformation (AVM) is a rare congenital vascular anomaly that may cause relevant clinical symptoms. This systematic review synthesizes current evidence on diagnostic approaches, embolization techniques, and clinical outcomes for pelvic AVMs. A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)-compliant literature search identified 19 studies comprising 49 patients treated with embolization therapy. Venous approaches, including direct puncture of a dominant outflow vein (DOV), were most commonly performed. Coils were the primary embolic agent, frequently combined with adjunctive materials, reflecting substantial technical heterogeneity. Despite this variability, embolization achieved consistently high technical and clinical success rates with low complication rates over a mean follow-up of 21.1months. Embolization therapy of DOV may be considered as first-line therapy for symptomatic pelvic AVMs, although future comparative studies are needed to guide standardized treatment strategies.

Due to the similar size ratios, adult porcine models are suitable for cardiovascular and circulatory physiology studies on extracorporeal circulation. As standard, the connection to the cardiopulmonary bypass (CBP) is established via a sternotomy and cannulation of large vessels. However, problems can arise during methodical implementation, for example, due to a small situs, vessels that are difficult to see, or vascular anomalies with a small aorta. An iatrogenic aortic rupture can lead to the termination of the experiment. Therefore, there is a need for further, safe access via the inguinal vessels. A heart-lung machine with a disposable set (hollow fiber oxygenator with a perfusion capacity of up 3,5 l/min) is used in the in vivo trial. For inguinal cannulation, the femoral artery and vein are dissected in the right groin. A 14-16 French (Fr.). Edwards Heartport cannula and a 22-Fr. SAP femoral cannula is used for cannulation. Cannulation is performed using the Seldinger technique. Inguinal cannulation resulted in significantly fewer aborted experiments in the large animal trials and allowed better relief of the heart during dissection. Inguinal cannulation to establish an extracorporeal circulation in a large animal model trial represents a safe approach. It results in minimal trauma to the aorta and improved visibility in the thorax. In addition, this access enables minimally invasive cardiac surgery. The focus is also on the ethical aspects of animal experiments and the associated experimental success.

Abstract Ultra-high molecular weight polyethylene (UHMWPE) is widely used in biomedical applications due to its excellent wear resistance, low friction, and high impact strength than other polymers. However, its challenging machinability especially under dry machining stemming from poor thermal conductivity, viscoelasticity, and susceptibility to burr formation necessitates advanced process control to ensure high surface quality and productivity. This study proposes a data-driven, multi-objective optimization framework for UHMWPE high speed slot milling, aimed at minimizing surface roughness and burr height while maintaining high material removal rates (MRR). The methodology integrates principal component analysis (PCA) for constructing a unified surface roughness index (SRI) from twelve measured topographic parameters, gaussian process regression (GPR) for surrogate modeling of process responses, non-dominated sorting genetic algorithm II (NSGA-II) for pareto-based optimization, and the technique for order preference by similarity to ideal solution (TOPSIS) for decision support. Milling experiments were conducted under three cooling strategies including dry, super critical CO 2 (scCO₂), and scCO₂+ bio MQL, with four cutting speeds and four feed per tooth levels. Results demonstrate that the PCA-based dimensionality reduction captured over 87% of the surface texture variance, enabling efficient and interpretable optimization. Pareto front analysis revealed that scCO₂+MQL dominated the low-SRI and low-burr region. Under this condition, the process achieved superior surface quality with minimum SRI of − 2.57 and a burr height as low as 0.03 mm, while sustaining high MRR. TOPSIS identified the optimal condition (f z = 0.086 mm/tooth, v c = 970 m/min), which was experimentally validated with a prediction error below 20%.

IntroductionWe conducted an exploratory pilot feasibility study to assess the safety and feasibility of cardiopulmonary exercise testing (CPET) in patients with mild generalized myasthenia gravis (gMG), aiming to determine whether test termination results from systemic exertion or MG-specific neuromuscular fatigability and to evaluate short-term effects on fatigue.MethodsNine patients with mild gMG (median age of 58 years, IQR 46.0–66.5) were included in this exploratory feasibility study and underwent a single maximal incremental CPET on a cycle ergometer with breath-by-breath gas exchange analysis and blood lactate measurements. Predefined exertion criteria (EC) included respiratory exchange rate (RER; ≥1.1), ventilatory equivalent for O2 (EQO2; ≥30), attainment of age-related maximum heart rate (ARMHR), peak blood lactate concentration (>6 mmol·L−1), and Borg Scale for Rated Perceived Exertion (RPE; ≥17). Repetitive nerve stimulation (RNS) was performed before and after CPET to assess neuromuscular fatigability. Fatigue was assessed using the Chalder Fatigue Scale (CFS) at baseline and 4 weeks after CPET.ResultsCPET was completed by all participants without adverse events. All reported symptoms resolved within 30 min after exercise termination, and no participant required medical intervention. All participants completed the maximal incremental CPET according to the predefined protocol. Among the predefined EC, 44% of participants achieved an RER ≥1.1, 78% an EQO2 ≥30, 44% an ARMHR, 67% reached a peak blood lactate concentration >6 mmol·L−1-, and 67% an RPE ≥17. A decremental response in RNS was observed in 78% both before and after CPET. No relevant changes in CFS scores were detected over 4 weeks.DiscussionCPET appears safe and feasible in mild gMG, with exercise termination primarily driven by systemic exertion rather than MG-specific neuromuscular fatigue. CPET may complement clinical evaluation by supporting individualized training recommendations and the identification of cardiopulmonary limitations.