Ludwig Maximilian University Research Articles

Strukturierte Lehre in der Chirurgie am Beispiel des Humanmedizinstudiums an der Ludwig-Maximilians-Universität München

The medical curriculum (MeCuM) of the Ludwig Maximilian University (LMU) in Munich is a dynamic curriculum aimed to support the learning process of all students with their different learning styles. It is based on interactive, activating teaching methods in order to increase students' interest, and on repetitive evaluation of teaching units to modify the teaching in order to meet students' needs and wishes. In this context the teaching of surgery at our faculty takes place. Besides interdisciplinary lessons where diseases are taught in cooperation with our colleagues from internal medicine, indications for surgery, complications and consequences of surgery for the patients are analysed in PBL tutorials, online cases, bedside teachings and practical teaching on the ward. Surgical skills like suturing are demonstrated in videos, practiced on models or during practical teaching on the ward and they are tested in OSCEs. During the "praktisches Jahr", the students in the last year of their medical studies are supposed to apply their practical skills besides repeating theoretical knowledge in order to pass the final examination. For this purpose they are taught in a revision course called "LMU-StaR" (revision course for the Staatsexamen). In this paper we describe in detail the teaching of surgery at our faculty.

Discordant cardiac xenotransplantation: broadening the horizons

a Transregio Collaborative Research Center 127, Ludwig-Maximilians University, Munich, Germany b Department of Cardiovascular Surgery, Ludwig-Maximilians University, Munich, Germany c Revivicor, Blacksburg, VA, USA d Living Cell Technologies, Auckland, New Zealand e Chair of Livestock Biotechnology, Weihenstephan, Technical University, Munich, Germany f Department of Anaesthesiology and Intensive Medicine, Ludwig-Maximilians University, Munich, Germany

Claudia Trenkwalder: from bench to bedside (and back again)

A few months into her neurology fellowship at the Ludwig-Maximilian University Hospital in her native Munich, Germany, Claudia Trenkwalder was told by a senior colleague to abandon any hopes of a research career in neurology. It was a man's field, he had told her, and she should focus on less demanding tasks. Sat at her desk, 25 years on, as the Clinical Director of the Centre of Parkinsonism and Movement Disorders at the Paracelsus-Elena Klinik in Kassel, Germany, a pioneer in the treatment of restless legs syndrome, and the president of the World Association of Sleep Medicine (WASM), she can afford a wry chuckle at her ex-colleague's misguided advice.

Soluble interleukin-2 receptor alpha in preclinical type 1 diabetes

To the Editor of ‘‘Acta Diabetologica’’. The interleukin-2 receptor alpha (IL-2RA or CD25) plays an essential role in IL-2 signaling and regulation of immune responses [1]. Soluble IL-2RA (sIL-2RA) is produced by proteolytic cleavage of membrane-bound IL-2RA after the induction of cell division and can inhibit IL-2 signaling, but paradoxically enhance T cell proliferation [2]. Serum sIL-2RA concentration is therefore considered a biomarker for T cell activation and can be increased in the context of autoimmune disease, inflammation, or infection [3]. Serum sIL-2RA concentration is also influenced by age and single nucleotide polymorphisms (SNPs) in the IL2RA gene region that are associated with susceptibility for type 1 diabetes and other autoimmune diseases [3, 4]. We here report sIL-2RA concentration in nondiabetic islet autoantibody-positive subjects at risk for type 1 diabetes. We conducted a case–control study using sera from 634 nondiabetic first-degree relatives of patients with type 1 diabetes who participated in prospective cohort studies at our institute [5]. Cases included 317 relatives (158 female) with persistent islet autoantibodies to insulin, GAD, insulinoma-associated antigen-2, and/or zinc transporter 8 [138 with one, 179 with at least two autoantibodies; median age 11.2 years; interquartile range (IQR) 7.3–16.0 years]. Controls were 317 islet autoantibody-negative relatives (169 female) who were matched for age (median age 11.2 years; IQR 7.3–16.0 years). sIL-2RA concentration was measured in a serum sample prior to type 1 diabetes onset or the last available follow-up sample for cases who had not progressed to diabetes, and the respective sample of controls. Sera were stored at -20 C prior to testing. All measurements of sIL-2RA were carried out using the same batch of a commercial ELISA kit (Opt EIA Human IL2sRa [sCD25]; BD Biosciences, San Diego, CA, USA). If DNA was available, IL2RA genotyping was obtained at SNP rs11594656 (n = 413, 247 cases) using the MassARRAY system with iPLEX chemistry (Sequenom, San Diego, CA, USA), and at rs2104286 (n = 383; 233 cases) and rs12722495 (n = 382; 236 cases) using the TaqMan 50 nuclease assay (Applied Biosystems, Warrington, UK). The study was approved by the ethics committees of Bavaria, Germany, and Ludwig-Maximilian University, Munich, Germany. All study participants gave informed consent, and investigations were carried out in accordance with the Declaration of Helsinki. sIL-2RA serum concentrations were minimally increased in islet autoantibody-positive cases (mean ± SD, Communicated by Massimo Porta.

Pilotprojekt einer pädiatrischen Antibiotic-Stewardship-Initiative am Dr. von Haunerschen Kinderspital - neue Wege der pädiatrischen Infektiologie

The steady increase in antimicrobial resistance is of growing concern in healthcare. Antibiotic Stewardship [ABS] Strategies are important tools to control antibiotic use and -prevent antimicrobial resistance. An increasing number of institutions are developing ABS initiatives also in pediatrics. However, few data are available assessing the implementation and efficiency of these pediatric ABS programs.At the Dr. von Hauner Children's Hospital, Ludwig-Maximilian University, a tertiary care pediatric reference center, a pediatric ABS Team has been implemented. Key structural elements were the same as for adult patients, but antimicrobials agents selected for monitoring and appropriate clinical endpoints are different in pediatrics.Key features were: 1. prospective-audit with feedback and formulary restriction and 2. pre-authorization (also referred to as prior approval). The ABS team consisted of one pediatric infectious disease specialist, one clinical fellow in pediatric infectious diseases, and one clinical pharmacist with training in infectious diseases.With the implementation of a pediatric ABS strategy we could significantly influence antimicrobial consumption in our hospital. Cost-savings are estimated to be above 330 000 € per year, and concomitantly the use of broad-spectrum antibiotics and antifungal compounds was significantly reduced.Antibiotic Stewardship [ABS] Strategies may be an effective tool to control antibiotic use in the setting of a large tertiary pediatric teaching hospital. A national guideline for ABS initiatives may help to further improve rational use of antibiotics in the hospital setting.

Footprints of Neutrophil Extracellular Traps as Predictors of Cardiovascular Risk

Cardiovascular events, such as myocardial infarction and stroke, are leading causes of mortality and morbidity in Western societies. Biomarkers could help to predict the risk of a patient and to advance the treatment of people at risk by allowing fine-tuning of the intensity of therapy.1 Although more recent studies have used proteomic, metabolomic, and genetic approaches to identify biomarkers, Borissoff et al2 here investigate the importance of double-stranded DNA, nucleosomes, thrombin-antithrombin complex complexes, and myeloperoxidase (MPO)–DNA complexes in predicting the severity of atherosclerosis and the risk of future cardiovascular events. Their data indicate that these markers were elevated in patients with severe coronary atherosclerosis or calcified coronary arteries. Furthermore, plasma nucleosome levels were found to be associated with an increased risk of coronary stenosis, whereas MPO–DNA complexes predicted the occurrence of major adverse cardiac events. Double-stranded DNA, nucleosomes, and MPO–DNA complexes are all markers of neutrophil extracellular traps (NETs), a mesh …

First Lohmann and K. A. Schat Scientific Award 2012

Even in 2013—more than 40 years after the first vaccine became available—Marek’s disease (MD) is still an important concern in the poultry industry. Outbreaks in commercial poultry flocks still pose a huge danger and an enormous commercial risk. It seems that using MD vaccines created a vicious circle: the more vaccination takes place, the more virulent the current field strains become, resulting in the demand for vaccines with steadily increasing efficacy and thus researchers who are striving to better understand the disease and to develop such improved vaccines. In June 2012 the Ninth International Symposium on Marek’s Disease and Avian Herpesviruses took place at the Freie Universitat Berlin. Some 120 scientists from 22 countries provided for an excellent and highly informative congress. One of the highlights was the presentation of the First Lohmann and K. A. Schat Scientific Award to recognize excellent performance by young researchers in the field of MD virus (MDV) research. This award was initiated 2 years ago by Prof. Karel Schat, who in the 1970s isolated the MDV strain SB-1 that is still used across the globe as a vaccine today. His great wish is to motivate young scientists to orient their research and future career toward MDV. Lohmann Animal Health, a well-known producer of poultry vaccines, is in complete agreement with Prof. Schat’s intentions and has not hesitated to pledge support. The jury, including Dr. Rahaus (Lohmann), Prof. Schat (Cornell University), and Prof. Parcells (University of Delaware), was faced with the hard task of choosing a winner. In the end the first prize was awarded to Julia Schermuly from the Institute for Animal Physiology of the Ludwig-Maximilians University, Munich, for her development of a new method to infect B-cell cultures with MDV to previously unattained percentages, which allows examining molecular events in detail. The second prize went to Annachiara Greco from the Institute of Virology of the Freie Universitat Berlin. Ms. Greco is working on the mode of operation of telomeric repeats in the genome of MDV, which plays a role in tumor development; viruses with modified telomeric repeats reduce tumor formation in chickens. In addition, a travel award was given to Nicole Bance of the Simon Fraser University in Canada who succeeded in inserting genes for fluorescent proteins into the MDV genome, which not only allows the path of the virus through the cell to be visualized but also permits differentiating the state of the virus as lytic or latent. After Prof. Schat bestowed the awards, Dr. Rahaus emphasized in a brief speech the importance to Lohmann Animal Health of supporting the work of young scientists at the start of their careers. Even though we may consider ourselves to be safely set with our existing vaccines, we must not ignore the danger posed by highly virulent field strains and thus must ensure continuity in the development and manufacturing of new and highly efficacious vaccines. Lohmann Animal Health is proud to have set the standard here and has promised to do so again at the next Marek’s disease meeting in East Lansing, MI, in 2014. Winners of the First Lohmann and K. A. Schat Scientific Award 2012. Left to right: Dr. Rahaus, Nicole Bance, Annachiara Greco, and Julia Schermuly. AVIAN DISEASES 57:331, 2013

Kognitiv-psychoedukative Gruppenintervention bei bipolar erkrankten Patienten: Pilotstudie mit Zwei-Jahres-Katamnese

52 patients with bipolar disorder were treated with psychopharmacotherapy and a cognitive psychoeducational group programme that was established at the Department of Psychiatry and Psychotherapy of the Ludwig Maximilian University, Munich, Germany. The programme covers psychoeducation, identifying and coping with depressive and manic symptoms, relapse prevention and establishing a stable life style. 96 % rated the group to be helpful and felt well informed about their illness. There were significant gains in knowledge (F = 25,714, p < 0.001) and improvements in the severity of the illness (CGI; F = 68,255, p < 0.001) post-treatment. With regard to sociodemographic and clinical variables, only the level of work qualification showed a differential treatment response: patients with higher qualifications had a more favourable course of the illness (F = 4,125, p = 0.048). At one and two year follow-up 25 % and, respectively, 30 % of the sample had to be readmitted. A higher number of previous hospitalisations (p = 0.010) and male sex (p = 0.031) turned out to be significant predictors of relapse (R² = 0.358, p = 0.004) at two year follow-up. This disorder-specific group programme represents a key component of treatment offering emotional support for patients and their relatives. Patients are to be involved in the treatment process and need information about the illness, its psychosocial and pharmacological treatment as well as help in learning practical skills to improve their living with the disease. Being integrated and committed to a supporting network may increase their quality of life.

What are effects of a spaced activation of virtual patients in a pediatric course?

BackgroundVirtual patients (VPs) have a long tradition in the curriculum of the medical faculty at the Ludwig-Maximilians-University (LMU) Munich. However, the pediatric VPs were not well integrated into the curriculum and hardly used by students.MethodsTherefore we created and implemented a self-contained E-learning module based on virtual patients (VPs), which was embedded into the pediatric curriculum.Students taking this course were divided into two groups. For Group A the virtual patients were activated in a timed order (“spaced activation”), whereas Group B could work on all VPs from the beginning.We investigated the performance of these two groups concerning usage pattern including number of sessions and session duration, score on questions integrated into the VP and results of the intermediate exam.ResultsThe integration of the VPs into the pediatric course was successful for both groups. The usage pattern for the spaced activation turned out to be more balanced, however we did not find any significant differences in the results of the intermediate exam, the score on questions included in the VPs nor in the time students spent working on the VPs.ConclusionsOur study showed that the spaced activation led to a more balanced VP usage pattern with a lower peak of sessions at the end of the course. Further studies will have to investigate whether a spaced activation of VPs leads to favorable long-term learning outcomes.

BiotecVisions 2013, February

BiotecVisions 2013, February

Bridging, switching or drug holidays &amp;ndash; how to treat a patient who stops natalizumab?

Natalizumab (NAT) was the first monoclonal antibody to be approved for the treatment of relapsing-remitting multiple sclerosis (RRMS). While pivotal and postmarketing studies have showed considerable and sustained efficacy of NAT in RRMS, the increasing incidence of therapy-associated progressive multifocal leukoencephalopathy (PML), a brain infection caused by the John Cunningham virus (JCV), is a risk associated with long-term therapy. The risk for therapy-associated PML is highest in so-called “triple risk” patients. Therefore, long-term NAT-treated, immunosuppressive-pretreated, and JCV antibody-positive patients often discontinue NAT therapy. However, until now, it is not known which treatment strategy should be followed after NAT cessation. Since disease activity returns to pretreatment levels, or even above, within 4–7 months from the last infusion of NAT, patients who stop NAT are at considerable risk of relapse and worsening of multiple sclerosis (MS)-related disability. Several strategies have been applied to prevent the recurrence of disease activity after discontinuation of NAT. Of these, bridging with intravenous methylprednisolone, and switching to glatiramer acetate or interferon beta (IFN-beta) do not seem to be effective enough. More promising results have been obtained in retrospective studies and case series with fingolimod (FTY), an alternative escalation therapy for RRMS, although some patients have showed a severe disease rebound after starting FTY treatment. The time interval between the discontinuation of NAT and the start of FTY might affect the recurrence of disease activity. Long-term data about the efficacy and safety of FTY treatment after cessation of NAT are urgently needed and should be further investigated. Prospective studies are warranted, to optimize treatment strategies for RRMS patients who discontinue NAT, especially because new therapies will be available in the very near future.

Psychische Belastungen von Medizinstudierenden an den Universitäten München und Witten/Herdecke – ein Vergleich

This study compares the distress levels of medical students in two different academic settings. Data were collected from N= 76 medical students at the Witten/Herdecke University (UW/H) and N = 343 medical students at Ludwig Maximilians University Munich (LMU) with an online questionnaire battery of established questionnaire instruments for assessing distress as well as life and study satisfaction (SWE, ADS-K, PSQ, SF-12, STQL-S). Data analysis revealed significant differences between the students with regard to self efficacy expectation, depression, psychological distress, and satisfaction. Because no differences in coping strategies were found between the two groups of students, with the exception of relaxation techniques, the impact of contextual and structural factors on medical students' well-being is discussed.

On our own behalf: a new editorial board and focus of EAPCN

EAPCN looks back to a long history since its foundation in 1868. During its development from an originally German to today’s English format, it continuously has been under guidance of outstanding editors—Alois Alzheimer is just one to name in the prominent list. In the last two decades, it was Hans-Jurgen Moller who decisively shaped the journal’s scope. Originally stemming from a northern town in Germany, directly after obtaining his degree in medicine, Hans-Jurgen Moller headed southwards: After specializing in psychiatry and postgraduate training at the Max-PlanckInstitute of Psychiatry in Munich, he was assigned as professor at the psychiatric department of the Munich Technical University. In 1988, he was appointed as chairman of the Department of Psychiatry and Psychotherapy at the University of Bonn. In 1993, 1 year before his return to the same position in Munich at the Ludwig-MaximiliansUniversity (LMU), the former work space of famous psychiatrists like E. Kraepelin or A. Alzheimer, Hans-Jurgen Moller resumed the managing editorship of EAPCN and ever since has substantially shaped its bias. As author or co-author of more than 1,300 publications, he always strongly focused on the methodology of clinical research in psychiatry, biological psychiatry of schizophrenia and depression, clinical psychopharmacology and psychogeriatrics. Hans-Jurgen Moller furthermore has been member of the executive committees of several national and international psychiatric societies, among them the past presidentship of the European Psychiatric Association (EPA), as chairman of the Section on Pharmacopsychiatry of the World Psychiatric Association (WPA) plus presidency of the Collegium Internationale Neuro-Psychopharmacologicum (CINP). He is honorary president of the World Federation of Societies of Biological Psychiatry (WFSBP), which he chaired from 1997 to 2001, and headed—last not least—the German Society for Biological Psychiatry (DGBP) from 1995 until 1999, for which EAPCN since 1997 is the official publication platform. His work was honoured by various academic prizes and honorary titles. Concordant with his primary interest in clinical research, EAPCN owes Hans-Jurgen Moller, the publication of outstanding and excellent clinical studies. In the light of his retirement, he now chose Peter Falkai as follower, who in July 2012 also overtook his position as chairman of the department at the LMU in Munich. But no worries: Moller will stay on the ball and be in charge of keeping his critical editorial eye on special issues and invited reviews of EAPCN. Peter Falkai, longstanding member of EAPCN’s editorial board and account managing editor since May 2011, as new chief editor of EAPCN (starting in October 2012) intends to strengthen the journal’s focus towards neurobiological topics without intentions to distract authors from furthermore submitting thorough clinical studies of high quality. Congruent with his personal continuous interest, with this bias, Peter Falkai plans following the direction of the DGBP towards neurobiological substrates and their neurobiological origins as well as causal treatment options. This core area has been visible throughout his entire academic career. Before overtaking the aforementioned position as chairman of the Department of Psychiatry and Psychotherapy at the University of Munich, he held the same position at the Universities of Saarland (2002–2006) and P. Falkai (&) A. Schmitt Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nusbaumstr. 7, 80336 Munich, Germany e-mail: Peter.Falkai@med.uni-muenchen.de

Erratum: Re: “Diagnostic efficacy of backscattering intensity measurements in optical coherence tomography of cervical intraepithelial dysplasia”

Julia Gallwas, MD,1 U. Mortensen, PhD,2 Rebecca Gaschler,1 H. Stepp, PhD,3 Nina Ditsch, MD,1 K. Friese, MD,1 C. Dannecker, MD1 1Department of Obstetrics and Gynecology, Ludwig-Maximilians University, Munich, Germany 2Department of Psychology, Westfa¨︁lische Wilhelms-University, Muenster, Germany 3Laser Forschungs Labor – Life Science Centre, Ludwig-Maximilians University, Munich, Germany In this Basic Science article, “Diagnostic Efficacy of Backscattering Intensity Measurements in Optical Coherence Tomography of Cervical Intraepithelial Dysplasia,” there is an error in the author listing. Inadvertently, one of the authors, Nina Ditsch, at the Department of Gynecology and Obstetrics, University of Munich, has not been listed as a co-author in the published article. The authors regret this mistake and would like to emphasize that Miss Ditsch contributed to this work to a great extent. This erratum is published to correct the error.

How tough is tuff in the event of fire?

Research Article| April 01, 2012 How tough is tuff in the event of fire? M.J. Heap; M.J. Heap 1Laboratoire de Géophysique Expérimentale, Institut de Physique de Globe de Strasbourg (UMR 7516 Centre National de la Recherche Scientifique, Université de Strasbourg/Ecole et Observatoire des Sciences de la Terre), 5 rue René Descartes, 67084 Strasbourg cedex, France Search for other works by this author on: GSW Google Scholar Y. Lavallée; Y. Lavallée 2Earth and Environment, LMU (Ludwig Maximilian University) University of Munich, Theresienstrasse 41/III, 80333 Munich, Germany Search for other works by this author on: GSW Google Scholar A. Laumann; A. Laumann 2Earth and Environment, LMU (Ludwig Maximilian University) University of Munich, Theresienstrasse 41/III, 80333 Munich, Germany Search for other works by this author on: GSW Google Scholar K.-U. Hess; K.-U. Hess 2Earth and Environment, LMU (Ludwig Maximilian University) University of Munich, Theresienstrasse 41/III, 80333 Munich, Germany Search for other works by this author on: GSW Google Scholar P.G. Meredith; P.G. Meredith 3Rock & Ice Physics Laboratory, Department of Earth Sciences, University College London, Gower Street, London WC1E 6BT, UK Search for other works by this author on: GSW Google Scholar D.B. Dingwell D.B. Dingwell 2Earth and Environment, LMU (Ludwig Maximilian University) University of Munich, Theresienstrasse 41/III, 80333 Munich, Germany Search for other works by this author on: GSW Google Scholar Author and Article Information M.J. Heap 1Laboratoire de Géophysique Expérimentale, Institut de Physique de Globe de Strasbourg (UMR 7516 Centre National de la Recherche Scientifique, Université de Strasbourg/Ecole et Observatoire des Sciences de la Terre), 5 rue René Descartes, 67084 Strasbourg cedex, France Y. Lavallée 2Earth and Environment, LMU (Ludwig Maximilian University) University of Munich, Theresienstrasse 41/III, 80333 Munich, Germany A. Laumann 2Earth and Environment, LMU (Ludwig Maximilian University) University of Munich, Theresienstrasse 41/III, 80333 Munich, Germany K.-U. Hess 2Earth and Environment, LMU (Ludwig Maximilian University) University of Munich, Theresienstrasse 41/III, 80333 Munich, Germany P.G. Meredith 3Rock & Ice Physics Laboratory, Department of Earth Sciences, University College London, Gower Street, London WC1E 6BT, UK D.B. Dingwell 2Earth and Environment, LMU (Ludwig Maximilian University) University of Munich, Theresienstrasse 41/III, 80333 Munich, Germany Publisher: Geological Society of America Received: 19 Oct 2011 Accepted: 03 Nov 2011 First Online: 09 Mar 2017 Online ISSN: 1943-2682 Print ISSN: 0091-7613 © 2012 Geological Society of America Geology (2012) 40 (4): 311–314. https://doi.org/10.1130/G32940.1 Article history Received: 19 Oct 2011 Accepted: 03 Nov 2011 First Online: 09 Mar 2017 Cite View This Citation Add to Citation Manager Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Search Site Citation M.J. Heap, Y. Lavallée, A. Laumann, K.-U. Hess, P.G. Meredith, D.B. Dingwell; How tough is tuff in the event of fire?. Geology 2012;; 40 (4): 311–314. doi: https://doi.org/10.1130/G32940.1 Download citation file: Ris (Zotero) Refmanager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentBy SocietyGeology Search Advanced Search Abstract Tuff has been extensively used as a building material in volcanically and tectonically active areas over many centuries, despite its inherent low strength. A common and unfortunate secondary hazard accompanying both major volcanic eruptions and tectonic earthquakes is the initiation of catastrophic fires. Here we report new experimental results on the influence of high temperatures on the strength of three tuffs that are commonly used for building in the Neapolitan region of Italy. Our results show that a reduction in strength was only observed for one tuff; the other two were unaffected by high temperatures. The cause of this strength discrepancy was found to be a product of the initial mineralogical composition, or more specifically, the presence of thermally unstable zeolites within the initial rock matrix. The implications of these data are that, in the event of fire, only the stability of buildings or structures built from tuff containing thermally unstable zeolites will be reduced. Unfortunately, this includes the most widespread dimension stone in Neapolitan architecture. We recommend that this knowledge should be considered during fire hazard mitigation in the Neapolitan area and that other tuffs used in construction worldwide should be tested in a similar way to assess their fire resistance. You do not have access to this content, please speak to your institutional administrator if you feel you should have access.

External Validation of a Risk Model to Predict Recurrence-Free Survival After Radical Cystectomy in Patients With Pathological Tumor Stage T3N0 Urothelial Carcinoma of the Bladder

Patients with stage pT3N0 urothelial bladder cancer vary in outcome after radical cystectomy. To improve prognosis estimation a model was recently developed that defines 3 risk groups for recurrence-free survival based on pT substaging, lymphovascular invasion and positive surgical margin. We present what is to our knowledge the first external validation of this risk model. Analogous to the risk model derivation cohort our study group comprised 472 patients with stage pT3, pN0, cM0 disease without perioperative chemotherapy and with a median followup of 42 months (IQR 20-75). The primary end point was recurrence-free survival. The effect of variables was determined by univariate and multivariate Cox regression analysis, and predictive accuracy was determined by ROC analysis. Stage pT3aN0 and pT3bN0 cases showed significantly different recurrence-free survival after 5 years (51% vs 29%, p<0.001). In the multivariate Cox model pT3 substage (HR 1.86, p<0.001), lymphovascular invasion (HR 1.48, p=0.002), positive surgical margins (HR 1.90, p=0.030) and patient age with a dichotomy at 70 years (HR 1.51, p=0.001) had an independent effect on recurrence-free survival. In the low (221 patients or 47%), intermediate (184 or 39%) and high (67 or 14%) risk groups the 5-year recurrence-free survival rate was 55%, 45% and 13%, respectively (p<0.001). The concordance index of the risk model to predict recurrence-free survival was 0.64 (95% CI 0.59-0.69). This user friendly risk model can be recommended to estimate prognosis in patients with stage pT3N0 after radical cystectomy. Patients at high risk showed clearly compromised recurrence-free survival and should be included in adjuvant therapy studies.

Pro Pent: A project for the study of the Pentateuch in South Africa

This article focused on Pro Pent (or the Project for the Study of the Pentateuch) which was established in August 2000 after professor Eckart Otto from the Ludwig Maximilian University (LMU) of Munich visited the University of Pretoria (UP). Pro Pent is a joint project of UP and the LMU and since 2001 annual seminars drive the initiative. These seminars are held in Pretoria and sometimes in Munich. Pro Pent is now an established international study group on the Pentateuch. In order to understand Pro Pent in the South African context, the article briefly discussed the work of previous South African Pentateuch scholars like John William Colenso, Johannes du Plessis and Ferdinand Deist. Their contributions were firstly assessed before Pro Pent’s contribution to the study of the Pentateuch was discussed and its relevancy for the South African context assessed, and highlight Pro Pent’s intention to be relevant.

Clinical evaluation of therapeutic success in rabbits with suspected encephalitozoonosis

Between 2000 and 2008, 95 rabbits with suspected encephalitozoonosis and neurological symptoms were treated at the Clinic of Small Animal Medicine, Ludwig Maximilian University Munich. Standard treatment consisted of oxytetracycline (from 2000 to 2003; n=50) or fenbendazole and oxytetracycline (from 2004 to 2008; n=45), and the rabbits were randomly assigned to treatment groups with or without dexamethasone. Each therapeutic regime was given for 10days, with fluids, B vitamins and nutritional support added as needed. Therapeutic success was evaluated by assessing the survival rate on day 10, the neurological score of the surviving rabbits and Kaplan–Meier curves for long-term survival past 10days. Inclusion of fenbendazole in the treatment protocol was associated with increased survival rates on day 10 (p=0.043), better neurological scores (p=0.008), and improved long-term survival (p=0.025) based on the results of univariate analyses. Treatment with dexamethasone showed no effect on neurological score or on short- or long-term survival. The study did not provide any evidence that dexamethasone is an effective component of the treatment scheme.

Editorial

The Journal of Anatomy has a long history and proud reputation of publishing the best papers in the field of anatomy, stretching from its first edition in 1867 to the present time. The continued success of the Journal has been fostered by a dedicated series of Editors and it is now our turn to take the helm. Indeed, it is a great honour and privilege for us to take over as the Editors in Chief of Journal of Anatomy. Firstly, we would like to thank our immediate predecessor, Professor Gillian Morriss-Kay for the fantastic work that she has done for the Journal over the last 10 years. Gillian has been instrumental in revitalising the Journal and ensuring that it is still relevant to current anatomical research, which of course embraces a much broader range of scientific approaches now than it did in the past. We are also very grateful for the continuing support of the members of the Editorial Board, our referees and authors, who have all played important roles in ensuring the vibrancy of the Journal. With the end of Gillian’s tenure, the editorial process is being reconfigured. Rather than having a single Editor in Chief working with a group of receiving editors, we will now have four Editors in Chief, each of whom will be responsible for papers in their areas of expertise, as well as working together across the spectrum of anatomical sciences. In alphabetical order, the new Editors in Chief are: Julia Clarke, University of Texas, Austin, – a paleontologist; Tom Gillingwater, University of Edinburgh – a neuroscientist; Anthony Graham, King’s College London – a developmental biologist: Stefan Milz, Ludwig-Maximilians University Munich – a musculoskeletal scientist. Moving forward, we will continue to ensure that the Journal receives a broad range of submissions. As always, the main focus of the Journal will be on the understanding of anatomy through an analysis of structure, function, development and evolution. More specifically, we particularly welcome submissions spanning the following areas: Cell biology and tissue architecture Comparative functional morphology Developmental biology Evolutionary developmental biology Evolutionary morphology Functional human anatomy Integrative vertebrate paleontology Methodological innovations in anatomical research Musculoskeletal system Neuroanatomy and neurodegeneration Significant advances in anatomical education In addition to our standard research articles and reviews, we are introducing a new series of articles –‘Insights’– which will be commissioned by the Editors. These will be succinct up-to-date analyses of key areas of interest to the anatomy community, that will serve as primers for understanding unfamiliar territories and which we hope will also be very useful for teaching purposes. We will continue to work to provide a fair and rapid review process that results in the speedy publication of important scientific advances. Our anticipated time from acceptance to publication is 2–3 months. Full details of the submission procedure can be found on the Journal website. We believe that these are exciting times for anatomical research and for the Journal, and we aim to play a major role in promoting and helping to shape modern anatomical research. We hope you will support us in these efforts by considering Journal of Anatomy as your journal of choice for publishing your work. We look forward to receiving your manuscripts.

Hemianopia and visual loss due to progressive multifocal leukoencephalopathy in natalizumab-treated multiple sclerosis

This case describes typical ophthalmic findings as a key feature for diagnosis of progressive multifocal leukoencephalopathy (PML) and its possible differential diagnosis. A 58-year-old female patient with relapsing-remitting multiple sclerosis on immunotherapy with natalizumab developed visual disturbance, reading problems, and visual field defects due to PML. PML is a reactivation of latent infection with the John Cunningham virus, which is a type of polyomavirus acquired in childhood or adolescence and is quite common in the general population. PML so far has been mostly associated with other immunodeficiency disorders, such as acquired immunodeficiency syndrome, but is also gaining importance in association with the increasing use and duration of treatment with natalizumab in patients suffering from multiple sclerosis. Natalizumab is a highly specific α4-integrin antagonist approved for treatment of patients with active relapsing-remitting multiple sclerosis.