[Indications, procedure and outcome of prehospital emergency resuscitative thoracotomy-a systematic literature search]. / Indikation, Prozedere und Outcome der präklinischen Notfallthorakotomie ­ eine systematische Literaturrecherche.

BACKGROUND: Prehospital resuscitative thoracotomy (PHRT) is a controversially discussed measure for the acute treatment of traumatic cardiac arrest (TCA) recommended by the current guidelines of the European Resuscitation Council (ERC). The aim of this work is the comprehensive presentation and summary of the available literature with the underlying hypothesis that the available publications show the feasibility and survival following PHRT in patients with TCA with a good neurological outcome. METHOD: A systematic literature search was performed in the databases PubMed, EMBASE, Google Scholar, Springer LINK and Cochrane. The study selection, data extraction and evaluation of bias potential were performed independently by two authors. The outcome of patients with TCA after PHRT was selected as the primary endpoint. RESULTS: A total of 4616 publications were found of which 21 publications with a total of 287 patients could be included in the analyses. For a detailed descriptive analysis, 15 publications with a total of 205 patients were suitable. The TCA of these patients was most commonly caused by pericardial tamponade, thoracic vascular injuries and severe extrathoracic multiple injuries. In 24% of the cases TCA occurred in the presence of the emergency physician. Clamshell thoracotomy (53%) was used preclinically more often than anterolateral thoracotomy (47%). Of the PHRT patients after TCA 12% (25/205) left the hospital alive, 9% (n = 19/205) with good neurological outcome and 1% (n = 3/205) with poor neurological outcome (according to the Glasgow outcome scale, GOS). CONCLUSION: The prognosis of TCA seems to be much better than has long been assumed. Decisive for the success of resuscitation efforts in TCA seems to be the immediate, partly invasive treatment of all reversible causes. The measures for TCA recommended by the ERC resuscitation guidelines, seem to be poorly implemented, especially in the preclinical setting. A controversy regarding the recommendations of the guidelines is the question of whether a PHRT can be successfully implemented and if the comprehensive introduction in Germany seems to be meaningful. Despite the recommendation of the guidelines, this systematic review and meta-analysis underlines the lack of high-quality evidence on PHRT, whereby a survival probability to hospital discharge of 12% was reported, of which 75% had a good neurological outcome. The risk of bias of the results in individual publications as well as in this review is high. Further systematic research in the field of preclinical trauma resuscitation is particularly necessary also for acceptance of the guidelines.

Foodborne hepatitis A outbreak associated with bakery products in northern Germany, 2012.

In October 2012, a hepatitis A (HA) outbreak with 83 laboratory-confirmed cases occurred in Lower Saxony. We defined primary outbreak cases as people with laboratory-confirmed HA and symptom onset between 8 October and 12 November 2012, residing in or visiting the affected districts. Secondary outbreak cases were persons with symptom onset after 12 November 2012 and close contact with primary cases. We identified 77 primary and six secondary cases. We enrolled 50 primary cases and 52 controls matched for age and sex, and found that 82% of cases and 60% of controls had consumed products from a particular bakery (OR=3.09; 95% CI: 1.15­8.68). Cases were more likely to have eaten sweet pastries (OR=5.74; 95% CI: 1.46­22.42). Viral isolates from five selected cases and three positively tested surfaces in the bakery had identical nucleotide sequences. One additional identical isolate derived from a salesperson of the bakery suffering from a chronic disease that required immunosuppressive treatment. Epidemiological and laboratory findings suggested that the salesperson contaminated products while packing and selling. Future risk assessment should determine whether food handlers with chronic diseases under immunosuppressive treatment could be more at risk of contaminating food and might benefit from HAV immunisation.

Genome wide linkage disequilibrium in Chinese asparagus bean (Vigna. unguiculata ssp. sesquipedialis) germplasm: implications for domestication history and genome wide association studies.

Association mapping of important traits of crop plants relies on first understanding the extent and patterns of linkage disequilibrium (LD) in the particular germplasm being investigated. We characterize here the genetic diversity, population structure and genome wide LD patterns in a set of asparagus bean (Vigna. unguiculata ssp. sesquipedialis) germplasm from China. A diverse collection of 99 asparagus bean and normal cowpea accessions were genotyped with 1127 expressed sequence tag-derived single nucleotide polymorphism markers (SNPs). The proportion of polymorphic SNPs across the collection was relatively low (39%), with an average number of SNPs per locus of 1.33. Bayesian population structure analysis indicated two subdivisions within the collection sampled that generally represented the 'standard vegetable' type (subgroup SV) and the 'non-standard vegetable' type (subgroup NSV), respectively. Level of LD (r(2)) was higher and extent of LD persisted longer in subgroup SV than in subgroup NSV, whereas LD decayed rapidly (0-2 cM) in both subgroups. LD decay distance varied among chromosomes, with the longest (≈ 5 cM) five times longer than the shortest (≈ 1 cM). Partitioning of LD variance into within- and between-subgroup components coupled with comparative LD decay analysis suggested that linkage group 5, 7 and 10 may have undergone the most intensive epistatic selection toward traits favorable for vegetable use. This work provides a first population genetic insight into domestication history of asparagus bean and demonstrates the feasibility of mapping complex traits by genome wide association study in asparagus bean using a currently available cowpea SNPs marker platform.

[The medical habilitation at German universities: a comparison of the regulations over 23 years]. / Die medizinische Habilitation an deutschen Hochschulen: ein Vergleich der Ordnungen über 23 Jahre.

BACKGROUND: Due to the further decrease in the number of habilitations in medicine since 2010, the general requirements for habilitation could have increased during the same period. OBJECTIVE: The requirements for a medical habilitation at German universities in a comparison of 23 years are re-evaluated. MATERIAL AND METHODS: An analysis of habilitation regulations for 12 target parameters and evaluation of these by a scoring system (range 0-34 points). RESULTS: Only the criterion of the requirement for a doctorate has remained the same in the 23-year comparison in the evaluation (1998-2021). All results of the other 11 criteria have changed compared to the previous study from 2010. The rating of habilitation achievements has increased from a total score in 1998 of 15.2 ± 5.1 points (95% confidence interval 13.6-16.9 points) to 25.1 ± 3.6 points in 2021 (95% confidence interval 23.9-26.2 points; p < 0.001). The range of assigned scoring values is again more broadly spread in the 11-year comparison with values from 12 to 31 points. A striking new criterion was that 98% of the assessed habilitation regulations now require a didactic continuing education in, however, significantly different requirements from the faculties. CONCLUSION: The requirements for a medical habilitation continued to significantly increase over the 23-year period with, however, a wider dispersion of scores. The more detailed description can be seen as a direct indication of an improvement in transparency. In contrast, the broader dispersion shows that a uniform assessment standard for Germany has again receded into the distance.

Soft ticks (Acari: Argasidae) in the island nations of Southeast Asia: A review on their distribution, associated hosts and potential pathogens.

Soft ticks (Acari: Argasidae) are the second major family of the blood feeding metastriates and vectors of a number of viral and bacterial pathogens for both humans and animals. Despite the growing effort on tick surveillance and studies worldwide, there is still limited information on the soft tick distribution in the island nations of Southeast Asia, especially species that are medically and veterinarily important. With the aim to provide an overview of the current status of knowledge on soft tick distribution in the island nations of Southeast Asia (Malaysia, Singapore, Brunei, Indonesia, the Philippines and Timor-Leste), this article reviews the species of soft ticks (Acari: Argasidae) and their associated hosts and pathogens, with the addition of a pictorial summary and list of tick species discovered in this region. The most prevalent soft tick genus is Carios, and the host species most associated with findings of soft ticks in this region are bats, particularly of the Pteropodidae and Vespertilionidae families. Furthermore, the only known pathogen originating from soft ticks in the island nations of Southeast Asia was the Keterah virus, which was isolated from Argas pusillus tick in Malaysia.

Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac - Feasibility, workflow data and patient acceptance.

INTRODUCTION: Stereotactic body radiotherapy (SBRT) is an established ablative treatment for liver tumors with excellent local control rates. Magnetic resonance imaging guided radiotherapy (MRgRT) provides superior soft tissue contrast and may therefore facilitate a marker-less liver SBRT workflow. The goal of the present study was to investigate feasibility, workflow parameters, toxicity and patient acceptance of MRgSBRT on a 1.5 T MR-Linac. METHODS: Ten consecutive patients with liver metastases treated on a 1.5 T MR-Linac were included in this prospective trial. Tumor delineation was performed on four-dimensional computed tomography scans and both exhale triggered and free-breathing T2 MRI scans from the MR-Linac. An internal target volume based approach was applied. Organ at risk constraints were based on the UKSABR guidelines (Version 6.1). Patient acceptance regarding device specific aspects was assessed and toxicity was scored according to the common toxicity criteria of adverse events, version 5. RESULTS: Nine of ten tumors were clearly visible on the 1.5 T MR-Linac. No patient had fiducial markers placed for treatment. All patients were treated with three or five fractions. Median dose to 98% of the gross tumor volume was 38.5 Gy. The median time from "patient identity check" until "beam-off" was 31 min. Median beam on time was 9.6 min. Online MRgRT was well accepted in general and no treatment had to be interrupted on patient request. No event of symptomatic radiation induced liver disease was observed after a median follow-up of ten month (range 3-17 months). CONCLUSION: Our early experience suggests that online 1.5 T MRgSBRT of liver metastases represents a promising new non-invasive marker-free treatment modality based on high image quality, clinically reasonable in-room times and high patient acceptance. Further studies are necessary to assess clinical outcome, to validate advanced motion management and to explore the benefit of online response adaptive liver SBRT.

[Acceptance of case-based, interactive e-learning in veterinary medicine on the example of the CASUS system]. / Akzeptanz von fallbasiertem, interaktivem eLearning in der Tiermedizin am Beispiel des CASUS-Systems.

OBJECTIVE: New teaching methods such as e-learning, are increasingly used to support common methods such as lectures, seminars and practical training in universities providing education in veterinary medicine. In the current study, the acceptance of e-learning in the example of the CASUS system by veterinarians as well as students of veterinary medicine of all German-speaking universities was analyzed. Material und methods: For this purpose an online evaluation questionnaire was developed. Members of the target groups were informed by e-mail and references in professional journals, as well as through veterinarian exchange platforms on the internet. Additionally, 224 students' final anatomy marks were compared and correlated to the utilization of CASUS to gain an important insight for the development of new teaching practices in the teaching of veterinary medicine. RESULTS: In total 1581 questionnaires were evaluated. A good acceptance regarding new teaching practices was found, although the classical textbook is still the most important instrument for imparting knowledge. The degree of utilization of e-learning strongly depends on its integration into the teaching content. CASUS is regarded as an efficient teaching method, with over 90% of the respondents indicating a strong desire to expand the number of case studies. Due to the present low degree of integration into the teaching content, no significant correlation could be found between the utilization of anatomy case studies and the final anatomy mark. However, based on their subjective perception, the students reported a high level of success in their study results with the likely effect of supporting increasing self-assurance in the situation of examinations. CONCLUSION: With the help of e-learning, educational objectives can be achieved that are not attainable by traditional teaching methods, e.g. the review of individual improvements by using the integrated feedback-function of e-learning programs. However, e-learning is not able to completely replace current teaching practices and hence should be considered as an additional element in future teaching models.

Distribution and Prevalence of Parasitic Nematodes of Cowpea (Vigna unguiculata) in Burkina Faso.

A comprehensive survey of the plant parasitic nematodes associated with cowpea (Vigna unguiculata) production fields was carried out in the three primary agro-climatic zones of Burkina Faso in West Africa. Across the three zones, a total of 109 samples were collected from the farms of 32 villages to provide a representative coverage of the cowpea production areas. Samples of rhizosphere soil and samples of roots from actively growing cowpea plants were collected during mid- to late-season. Twelve plant-parasitic nematode genera were identified, of which six appeared to have significant parasitic potential on cowpea based on their frequency and abundance. These included Helicotylenchus, Meloidogyne, Pratylenchus, Scutellonema, Telotylenchus, and Tylenchorhynchus. Criconemella and Rotylenchulus also had significant levels of abundance and frequency, respectively. Of the primary genera, Meloidogyne, Pratylenchus, and Scutellonema contained species which are known or suspected to cause losses of cowpea yield in other parts of the world. According to the prevalence and distribution of these genera in Burkina Faso, their potential for damage to cowpea increased from the dry Sahelian semi-desert zone in the north (annual rainfall < 600 mm/year), through the north-central Soudanian zone (annual rainfall of 600-800 mm/year), to the wet Soudanian zone (annual rainfall ≥ 1000 mm) in the more humid south-western region of the country. This distribution trend was particularly apparent for the endoparasitic nematode Meloidogyne and the migratory endoparasite Pratylenchus.

Simulation evaluation of Salmonella monitoring in finishing pigs in Lower Saxony, Germany.

Results of serological monitoring for Salmonella in finishing pigs are used to classify herds and target control measures at herds with high prevalence. The outcome of monitoring is determined by three factors: (a) the cut-off value for the optical density percentage (OD%) to declare a sample positive, (b) the classification scheme to allocate farms to different Salmonella prevalence classes, and (c) the annual number of samples per herd to calculate its Salmonella prevalence. Our goal was to analyse the impact of these three factors on (i) the accuracy of Salmonella monitoring in finishing pigs and (ii) the total number of tests required. We constructed a stochastic simulation model in Excel and @Risk to evaluate 12 monitoring scenarios based on: (a) four cut-off values for the OD% (10, 20, 30, and 40) and (b) three herd classification schemes. Furthermore, eight different sampling schemes were evaluated. The main outputs of the model are (a) the accuracy of monitoring which is reflected by the percentage of herds that retain classification when re-sampled at the same moment in time and (b) the total number of tests. To illustrate the model, we used input data from Salmonella monitoring in Lower Saxony, Germany. Model calculations demonstrated that - with the tests in use - monitoring scenarios based on cut-off OD% 10 are most accurate with 80-90% of herds retaining classification. Monitoring scenarios based on cut-off OD% 20 or 30 are, however, comparable to those based on cut-off OD% 40 with 50-70% of herds retaining classification. Besides, we predicted that herd classifications based on three classes (low-, moderate-, and high-prevalence) give more accurate results than when a zero-prevalence class is included. The total number of tests depends heavily on the sampling scheme and - if sampling is based on Salmonella prevalence class - the distribution of herds over the different classes. We predicted that the current German sampling scheme that is based on herd size requires more tests than those sampling schemes based on herd classification. Of these, the sampling scheme in which most samples are taken from high-prevalence herds is most accurate and might be a good incentive to reduce Salmonella prevalence at herd level if farmers had to pay for the tests themselves.

Intraoperative optical coherence tomography: past, present, and future.

To provide an overview of the current state of intraoperative optical coherence tomography (OCT). Literature review of studies pertaining to intraoperative OCT examining both the technology aspects of the imaging platform and the current evidence for patient care. Over the last several years, there have been significant advances in integrative technology for intraoperative OCT. This has resulted in the development of multiple microscope-integrated systems and a rapidly expanding field of image-guided surgical care. Multiple studies have demonstrated the potential role for intraoperative OCT in facilitating surgeon understanding of the surgical environment, tissue configuration, and overall changes to anatomy. In fact, the PIONEER and DISCOVER studies, both demonstrated a potential significant percentage of cases that intraoperative OCT alters surgical decision-making in both anterior and posterior segment surgery. Current areas of exploration and development include OCT-compatible instrumentation, automated tracking, intraoperative OCT software platforms, and surgeon feedback/visualization platforms. Intraoperative OCT is an emerging technology that holds promise for enhancing the surgical care of both anterior segment and posterior segment conditions. Hurdles remain for adoption and widespread utilization, including cost, optimized feedback platforms, and more definitive value for individualized surgical care with image guidance.

Visual-evoked potentials: assessment of retrobulbar and peribulbar anesthesia.

PURPOSE: To assess the effects of retrobulbar and peribulbar anesthesia on nerve function as detected by visual-evoked potentials (VEPs). SETTING: University hospital in southern Brazil. METHODS: In a prospective study, 7 patients had peribulbar anesthesia and 9 had retrobulbar anesthesia for extracapsular cataract extraction. Visual-evoked potentials with pattern reversal and flash stimulation were performed at least 1 month before and 1 month after surgery. Study participants did not have ocular pathology other than cataract. The Lens Classification System III was used to grade the opacities before surgery. RESULTS: No significant difference was found between preoperative and postoperative evaluations in VEP flash and pattern-reversal amplitude and latency in either group (P >.05). Postoperative amplitude and latency was not significantly different between the peribulbar and retrobulbar groups. Two cases in the peribulbar group had altered wave morphology without clinical manifestation postoperatively. All patients had a final best spectacle-corrected visual acuity of 20/20. CONCLUSION: Block anesthetic procedures were safely used in cataract surgery, with no clinical sequelae to the optic nerve.

Congenital intramedullary tumor with neonatal manifestations.

The authors report on a 45-day-old boy with a congenital intramedullary tumor with clinical manifestations since birth. Neurologic examination disclosed severe bilateral lower-limb hypotonia and diplegia, with exacerbated deep tendon reflexes and clonus associated with severe pain at manipulation. Further evaluation of this patient included screening for infections, computed tomographic scan, myelography, and somatosensory evoked potentials. The definite diagnosis was a solid holocord astrocytoma. This report discusses a rare disorder in the neonatal period and makes other medical practitioners aware of this diagnosis. Previously published literature is also reviewed.

The occurrence of Poland and Poland-Moebius syndromes in the same family: further evidence of their genetic component.

The combination of Moebius and Poland anomalies is rarely described in the literature. Some authors believe that this association is an independent syndrome, while others propose that Poland, Moebius and Poland-Moebius are a spectrum of the same condition. Here we report a family where a child has Poland-Moebius syndrome and an aunt is affected with Poland anomaly. This probably represents the second report of possible autosomal dominant transmission of Poland-Moebius syndrome. The presence of contralateral triphalangeal thumb in the proband and in other members of the family can be explained by chance alone or, alternatively, by a pleiotropic expression of this gene.

Effect of acid decontamination of beef subprimal cuts on the microbiological and sensory characteristics of steaks.

Beef strip loins were decontaminated by spraying with solutions of various food grade acids (1.0% lactic acid, 1.0% acetic acid and an acid mixture containing 1.0% lactic acid, 2.0% acetic acid, 0.25% citric acid and 0.1% ascorbic acid) followed by vacuum packaging and storing at 4 ± 1°C. Initially and at days 3 and 6 of display in polyvinyl chloride (PVC) film, aerobic plate counts (APCs) of steaks fabricated from the acid treated loins that were stored for 0, 14, 28, 42, 56, 70 and 84 days were not significantly different (P > 0.05) from the APCs of steaks fabricated from control loins.

Green tobacco sickness: occupational nicotine poisoning in tobacco workers.

In this study the authors describe the investigation of a 1992 outbreak of green tobacco sickness, a form of nicotine poisoning from dermal exposure, among 47 tobacco workers in a five-county region of central and south-central Kentucky. Cases were identified through medical record searches at participating hospitals, as well as from reports submitted to the Occupational Health Nurses in Agricultural Communities program. A case-control study was undertaken to assess risk factors for green tobacco sickness. In a 20-min telephone interview, 40 cases and 83 controls responded to questions contained in a questionnaire. In 1992, 47 persons (3 were under age 16 y) in the study region sought medical treatment for green tobacco sickness. Twelve persons were hospitalized and 2 required intensive-care treatment. The crude incidence in 1992 was 10.0/1,000 tobacco workers. In 1993, 66 cases (7 were under age 16 y) of green tobacco sickness were identified in the study region (i.e., annual incidence of 14.0/1,000). A case-control study demonstrated that ill workers were younger, and were more likely to have worked in wet conditions, compared with workers who were not ill. Green tobacco sickness is a common problem among tobacco workers that may be prevented by avoiding work in wet tobacco or by use of protective clothing. Children younger than 16 y of age represented 9% of the green tobacco sickness cases in 1992 and 1993. Current occupational safety and health laws do not address protection of tobacco workers with respect to green tobacco sickness.

Effects of ethanol on human visual evoked potentials.

Studies of the effect of ethanol on human visual evoked potentials are rare and usually involve chronic alcoholic patients. The effect of acute ethanol ingestion has seldom been investigated. We have studied the effect of acute alcoholic poisoning on pattern-reversal visual evoked potentials (PR-VEP) and flash light visual evoked potentials (F-VEP) in 20 normal volunteers. We observed different effects with ethanol: statistically significant prolonged latencies of F-VEP after ingestion, and no significant differences in the latencies of the PR-VEP components. We hypothesize a selective ethanol effect on the afferent transmission of rods, mainly dependent on GABA and glutamatergic neurotransmission, influencing F-VEP latencies, and no effect on cone afferent transmission, as alcohol doesn't influence PR-VEP latencies.

The Occupational Health Nurses in Agricultural Communities program: identifying and preventing agriculturally related illnesses and injuries.

1. The Occupational Health Nurses in Agricultural Communities (OHNAC) program is a national surveillance program to identify and prevent agriculturally related illnesses and injuries. Locally based nurses work closely with health departments, hospitals, physicians, and other providers to identify and report sentinel health events. 2. Through OHNAC, sentinel health events are assessed and evaluated to identify occupational risk factors that may be applicable to the larger community of agricultural workers. This information is then disseminated nationally, locally, and to the individual workers. 3. The surveillance and investigation information is used to develop programs to prevent agricultural illnesses and injuries. The use of case based surveillance and subsequent data driven interventions has broad applicability for occupational health nurses in other industrial sectors.

Health and safety hazards associated with farming.

1. Farming is a dangerous occupation with many potential physical, chemical, and biological hazards. Hazards include noise, machinery, motor vehicles, electricity, temperature extremes, pressurized hydraulic fluids, grain storage facilities, hand and power tools, repetitive motion, vibration, chemicals, dusts, gases, and infectious agents. 2. Psychosocial factors related to agriculture include stress, economic considerations, poor access to health care, and injuries to minors who begin working at a young age. 3. Many who farm also work at other jobs. Farm related illnesses and injuries can be costly to non-farm employers in terms of lost work time, medical insurance, and life insurance. 4. Occupational health nurses can promote agricultural occupational health through companies that employ farmers and through community organizations, thereby contributing to a better understanding of farm related hazards and developing strategies for reducing these hazards.

[Epidemiologic studies of the detection of viral infection agents in calf losses in the Weser-Ems region]. / Epidemiologische Untersuchungen über Nachweise von viralen Infektionserregern bei Kälberverlusten im Weser-Ems-Gebiet.

In 961 calves up to an age of 6 months which were sent to the animal health center in Oldenburg between March 1987 and March 1990 for necropsy the results of determination of different viruses were calculated: BVD-, rota-, corona-, parainfluenza-3- (PI-3)-, bovine herpes-1 (BHV-1)- and bovine respiratory syncytial virus (BRSV). In 122 and 104 randomly collected health calves of 22 farms antibodies against BRSV and bovine adeno virus-types 5, 7 and 8 were determined. 50.1% of the necropsied calves were one and two weeks old. In this group in 40.2% rotavirus and in 19.0% coronavirus could be isolated. All over the calves the frequencies of isolated viruses were 13.3% for BVDV, 4.6% for BRSV, 3.2% for BHV-1, and 2.1% for PI-3. The percentages of positive findings for rota- and coronavirus increased up to 7 days after birth, and thereafter both decreased. The frequencies of BVDV and BRSV were higher in older groups. The frequency of PI-3 was low and remained constantly. Infections with rota-, corona- and with both viruses were accompanied by BVDV in 11.3, 5.3 and 14.3%, respectively. Against bovine adenoviruses and BRSV in the first 8 weeks and after 14 weeks of life in more than 70% of the calves antibodies were detected.

[Selenium content in blood of cattle in the Weser-Ems region and effects of Se fertilization of pasture grounds on Se levels in growth and in blood dairy cattle with extreme selenium deficiency]. / Selengehalte im Blut von Rindern im Weser-Ems-Gebiet sowie Effekt einer Se-Düngung der Weide-flächen auf den Se-Gehalt im Aufwuchs und im Blut von Weiderindern auf einem extremen Selenmangel-Standort.

The evaluation of 1.974 selenium levels in samples of bovine blood mainly from the Weser-Ems region showed a high rate of selenium deficiency in calves, young cattle and heifers ante partum. More than 50% of cows showed Se deficiency, too. After fertilizing of pasture grounds exhibiting extreme selenium deficiency with 35 g of selenium per hectare, the authors found significantly positive effects on plant selenium levels and in blood of grazing young cattle. At the same time, the selenium contents in blood of the control animals decreased extremely as the result from being cut off from the selenium supply in the young stock shed during winter time.