IMPORTANCEEndurance exercise is effective in improving peak oxygen consumption (peak V ˙O2 ) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects. OBJECTIVE To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak V ˙O2 in patients with HFpEF.

Current state-of-the-art diagnostic measures of Alzheimer's disease (AD) are invasive (cerebrospinal fluid analysis), expensive (neuroimaging) and time-consuming (neuropsychological assessment) and thus have limited accessibility as frontline screening and diagnostic tools for AD. Thus, there is an increasing need for additional noninvasive and/or cost-effective tools, allowing identification of subjects in the preclinical or early clinical stages of AD who could be suitable for further cognitive evaluation and dementia diagnostics. Implementation of such tests may facilitate early and potentially more effective therapeutic and preventative strategies for AD. Before applying them in clinical practice, these tools should be examined in ongoing large clinical trials. This review will summarize and highlight the most promising screening tools including neuropsychometric, clinical, blood, and neurophysiological tests.

To reduce potential mis-registration from differences in the breathing pattern between two complementary PET and CT data sets, patients are generally allowed to breathe quietly during a dual-modality scan using a combined PET/CT tomograph. Frequently, however, local mis-registration between the CT and the PET is observed. We have evaluated the appearance, magnitude, and frequency of respiration-induced artefacts in CT images of dual-modality PET/CT studies of 62 patients. Combined PET/CT scans during normal respiration were acquired in 43 subjects using single- or dual-slice CT. Nineteen patients were scanned with a special breathing protocol (limited breath-hold technique) on a single-slice PET/CT tomograph. All subjects were injected with approximately 370 MBq of FDG, and PET/CT scanning commenced 1 h post injection. The CT images were reconstructed and, after appropriate scaling, used for on-line attenuation correction of the PET emission data. We found that respiration artefacts can occur in the majority of cases if no respiration protocol is used. When applying the limited breath-hold technique, the frequency of severe artefacts in the area of the diaphragm was reduced by half, and the spatial extent of respiration-induced artefacts was reduced by at least 40% compared with the acquisition protocols without any breathing instructions. In conclusion, special breathing protocols are effective and should be used for CT scans as part of combined imaging protocols using a dual-modality PET/CT tomograph. The results of this study can also be applied to multi-slice CT to potentially reduce further breathing artefacts in PET/CT imaging and to improve overall image quality.

Background and Purpose-Intracerebral hemorrhage (ICH) is the most serious and potentially fatal complication of oral anticoagulant therapy (OAT). Still, there are no universally accepted treatment regimens for patients with OAT-ICH, and randomized controlled trials do not exist. The aim of the present study was to compare the acute treatment strategies of OAT-associated ICH using vitamin K (VAK), fresh frozen plasma (FFP), and prothrombin complex concentrates (PCCs) with regard to hematoma growth and outcome. Methods-In this retrospective study, a total of 55 treated patients were analyzed. Three groups were compared by reviewing the clinical, laboratory, and neuroradiological parameters: (1) patients who received PCCs alone or in combination with FFP or VAK (nϭ31), (2) patients treated with FFP alone or in combination with VAK (nϭ18), and (3) patients who received VAK as a monotherapy (nϭ6). The end points of early hematoma growth and outcome after 12 months were analyzed including multivariate analysis. Results-Hematoma growth within 24 hours occurred in 27% of patients. Incidence and extent of hematoma growth were significantly lower in patients receiving PCCs (19%/44%) compared with FFP (33%/54%) and VAK (50%/59%). However, this effect was no longer seen between PCC-and FFP-treated patients if international normalized ratio (INR) was completely reversed within 2 hours after admission. The overall outcome was poor (modified Rankin scale 4 to 6 in 77%). Predictors for hematoma growth were an increased INR after 2 hours, whereas administration of PCCs was significantly protective in multivariate analyses. Predictors for a poor outcome were age, baseline hematoma volume, and occurrence of hematoma growth. Conclusions-Overall, PCC was associated with a reduced incidence and extent of hematoma growth compared with FFP and VAK. This effect seems to be related to a more rapid INR reversal. Randomized controlled trials are needed to identify the most effective acute treatment regimen for lasting INR reversal because increased levels of INR were predisposing for hematoma enlargement.

The presence of vital carcinoma and mature teratoma is common (55%) in residual masses in patients with NSGCT, and CT and STM cannot reliably predict absence of disease. In contrast to prior studies, this prospective trial, which is the only with histologic confirmation in all patients, demonstrated that FDG-PET is unable to give a clear additional clinical benefit to the standard diagnostic procedures, CT and STM, in the prediction of tumor viability in residual masses.

SUMMARYMissense mutations in SCN2A, encoding the brain sodium channel Na V 1.2, have been described in benign familial neonatal-infantile seizures (BFNIS), a self-limiting disorder, whereas several SCN2A de novo nonsense mutations have been found in patients with more severe phenotypes including epileptic encephalopathy. We report a family with BFNIS originating from Madagascar. Onset extended from 3 to 9 months of age. Interictal EEGs were normal. In two patients, ictal electroencephalography (EEG) studies showed partial seizure patterns with secondary generalization in one. Seizures remitted before 18 months of age, with or without medication. Intellectual development was normal. A novel missense mutation of SCN2A, c.4766A>G/p.Tyr1589Cys, was found in a highly conserved region of Na V 1.2 (D4/S2-S3). Functional studies using heterologous expression in tsA201 cells and whole-cell patch clamping revealed a depolarizing shift of steady-state inactivation, increased persistent Na + current, a slowing of fast inactivation and an acceleration of its recovery, thus a gain-of-function. Using an action potential waveform in a voltage-clamp experiment we indicated an increased inward Na + current at subthreshold voltages, which can explain a neuronal hyperexcitability. Our results suggest that this mutation induces neuronal hyperexcitability, resulting in infantile epilepsy with favorable outcome.