The burden of secrecy in the management of multimorbidity in older people living with HIV aged 70 and over.

The secrecy surrounding HIV continues to be a major concern for older people living with HIV (OPWH) despite their long-term experience of HIV and the presence of other chronic diseases. Our study aims to highlight how the secrecy surrounding HIV can affect the management of the other conditions. The results of this socio-anthropological sub-study of the ANRS EP66 SEPTAVIH study, which assesses frailty in OPWH, are based on in-depth interviews conducted with 20 OPWH with multimorbidities aged 70 years and over and 9 caregivers. Based on a cross-sectional thematic analysis, this study shows that HIV infection differs from other chronic diseases due to the secrecy and stigma associated with HIV. These specific issues associated with HIV complicate the lives of OPWH, depriving them of support from loved ones and forcing them to exclude their general practitioner from their care system. This then causes OPWH with multiple chronic diseases to become socially vulnerable and isolated. Interventions that support the sharing of information on HIV among OPWH and also among caregivers need to be identified as a matter of urgency in order to improve the lives and management of OPWH with multimorbidities.Trial Registration: ClinicalTrials.gov identifier: NCT03958786.

Ketamine-butorphanol-medetomidine for the immobilisation of free-living hyenas (Crocuta crocuta).

Free-ranging spotted hyenas (Crocuta crocuta) are immobilised for a variety of purposes, including wildlife-human conflict mitigation, research, and veterinary treatment. Combinations of tiletamine-zolazepam (Zoletil) and medetomidine are commonly used for immobilisation of hyenas, however, recovery times are long. In this descriptive study, a total of 20 adult or subadult free-ranging hyenas were immobilised near Skukuza in the Kruger National Park using ketamine, butorphanol, and medetomidine. The goal of the study was to evaluate a suitable dose and measure cardiorespiratory effects of this combination. The quality of induction and recovery were scored using an established scoring system from 1 (excellent) to (poor). Twelve of the 20 hyenas were given an induction score of 1 (excellent), five an induction score of 2 (good), and three an induction score of 3 (fair). Of the animals with induction score = 1, the mean drug dose was 1.17 mg/kg ketamine, 0.25 mg/kg butorphanol and 0.03 mg/kg medetomidine, and the mean induction time and time to handling 6:25 minutes and 9:46 minutes respectively. The mean recovery time (from reversal to standing) was 10:16 min, which is shorter than what has been reported for tiletaminezolazepam- based combinations in hyenas. Most hyenas were bradycardic (< 40 beats per minute) and the mean PaO2 69.5 mmHg. Three hyenas, one with induction score = 2, and two with induction scores = 3 spontaneously recovered at 33, 44 and 56 minutes post approach respectively. Regardless of induction time, all hyenas reached a level of surgical anaesthesia while immobilised. Overall, ketamine-butorphanol-medetomidine (KBM) was effective in immobilising hyenas but induction times varied, and animals were bradycardic during immobilisation.

Assessment of the intrasinusidal volume before and after maxillary sinus augmentation using mri - a pilot study of eight patients.

PURPOSE: The purpose of this study was to evaluate the suitability, accuracy, and reliability of a non-invasive 3-Tesla magnetic resonance imaging technique (3 T-MRI) for the visualization of maxillary sinus grafts in comparison to conventional, X-ray-based, established standard imaging techniques. METHODS: A total of eight patients with alveolar bone atrophy who required surgical sinus floor augmentation in the course of dental implantation were included in this pilot study. Alongside pre-operative cone-beam computed tomography (CBCT), 3 T-MRI was performed before and 6 months after sinus floor augmentation. Two investigators measured the maxillary sinus volume preoperatively and after bone augmentation. RESULTS: In all cases, MRI demonstrated accurately the volumes of the maxillary sinus grafts. Following surgery, the bony structures suitable for an implant placement increased at an average of 4.89 cm3, corresponding with the decrease of the intrasinusidal volumes. In general, interexaminer discrepancies were low and without statistical significance. CONCLUSION: In this preliminary study, we could demonstrate the feasibility of MRI bone volume measurement as a radiation-free alternative with comparable accuracy to CT/CBCT before procedures like sinus floor augmentation. Nevertheless, costs and artifacts, also present in MRI, have to be taken into account. Larger studies will be necessary to justify the practicability of MRI bone volume evaluation.

DualSort: online spike sorting with a running neural network.

Objective.Spike sorting, i.e. the detection and separation of measured action potentials from different extracellularly recorded neurons, remains one of the bottlenecks in deciphering the brain. In recent years, the application of neural networks (NNs) for spike sorting has garnered significant attention. Most methods focus on specific sub-problems within the conventional spike sorting pipeline, such as spike detection or feature extraction, and attempt to solve them with complex network architectures. This paper presents DualSort, a simple NN that gets combined with downstream post-processing for real-time spike sorting. It shows high efficiency, low complexity, and requires a comparatively small amount of human interaction.Approach.Synthetic and experimentally obtained extracellular single-channel recordings were utilized to train and evaluate the proposed NN. For training, spike waveforms were labeled with respect to their associated neuron and position in the signal, allowing the detection and categorization of spikes in unison. DualSort classifies a single spike multiple times in succession, as it runs over the signal in a step-by-step manner and uses a post-processing algorithm that transmits the network output into spike trains. Main results.With the used datasets, DualSort was able to detect and distinguish different spike waveforms and separate them from background activity. The post-processing algorithm significantly strengthened the overall performance of the model, making the system more robust as a whole. Although DualSort is an end-to-end solution that efficiently transforms filtered signals into spike trains, it competes with contemporary state-of-the-art technologies that exclusively target single sub-problems in the conventional spike sorting pipeline.Significance.This work demonstrates that even under high noise levels, complex NNs are not necessary by any means to achieve high performance in spike detection and sorting. The utilization of data augmentation on a limited quantity of spikes could substantially decrease hand-labeling compared to other studies. Furthermore, the proposed framework can be utilized without human interaction when combined with an unsupervised technique that provides pseudo labels for DualSort. Due to the low complexity of our network, it works efficiently and enables real-time processing on basic hardware. The proposed approach is not limited to spike sorting, as it may also be used to process different signals, such as electroencephalogram (EEG), which needs to be investigated in future research.

Efficacy and safety of three different opioid-based immobilisation combinations in blesbok (Damaliscus pygargus phillipsi).

African wildlife species are increasingly being immobilised with combinations of a low dose of potent opioids combined with medetomidine and azaperone. The physiological effects of these combinations in comparison to conventional potent opioidazaperone combinations have scarcely been evaluated. In this cross-over study conducted on eight captive blesbok, we compared the physiological variables of blesbok immobilised with 2 mg of thiafentanil + 10 mg of azaperone (TA); 0.5 mg thiafentanil + 1.5 mg medetomidine (TM), and 0.5 mg thiafentanil + 1.5. mg medetomidine + 10 mg azaperone (TMA). Thiafentanil's effects were antagonised with naltrexone at 10 mg naltrexone per mg thiafentanil, and the medetomidine effects with atipamezole at 5 mg atipamezole per mg medetomidine. The physiological variables were compared between treatment groups using descriptive statistics and repeated measures ANOVA. The TA combination resulted in the shortest induction and recovery times, higher heart rates, respiratory rates, PaO2, SpO2, and lower MAP and A-a gradients, but with less muscle relaxation. The TM and TMA combinations caused marked bradycardia and hypoxaemia. The hypoxaemia was most severe in animals immobilised with TMA, and four of eight blesbok immobilised had a PaO2 < 35 mmHg at the 10- or 15-minute sampling point. These blesbok were provided supplementary oxygen, which corrected the hypoxaemia. The TA combinations caused the lowest degree of physiological compromise. All three combinations were effective for the immobilisation of blesbok, but as the low-dose thiafentanil and high-dose medetomidine combinations caused marked hypoxaemia, supplementary oxygen is recommended when using these combinations.

Chemical immobilisation of lions: weighing up drug effectiveness versus clinical effects.

Selection of an effective drug combination to immobilise African lions (Panthera leo) requires balancing immobilisation effectiveness with potential side effects. We compared the immobilisation effectiveness and changes to physiological variables induced by three drug combinations used for free-ranging African lions. The lions (12 animals per drug combination) were immobilised with tiletamine-zolazepam-medetomidine (TZM), ketamine-medetomidine (KM) or ketamine-butorphanol-medetomidine (KBM). Induction, immobilisation, and recovery were timed, evaluated using a scoring system, and physiological variables were monitored. The drugs used for immobilisation were antagonised with atipamezole and naltrexone. The quality of induction was rated as excellent for all drug combinations and induction times (mean ± SD) did not differ between the groups (10.54 ± 2.67 min for TZM, 10.49 ± 2.63 min for KM, and 11.11 ± 2.91 min for KBM). Immobilisation depth was similar over the immobilisation period in the TZM and KBM groups, and initially light, progressing to deeper in lions administered KM. Heart rate, respiratory rate and peripheral arterial haemoglobin saturation with oxygen were within the expected range for healthy, awake lions in all groups. All lions were severely hypertensive and hyperthermic throughout the immobilisation. Following antagonism of immobilising drugs, lions immobilised with KM and KBM recovered to walking sooner than those immobilised with TZM, at 15.29 ± 10.68 min, 10.88 ± 4.29 min and 29.73 ± 14.46 min, respectively. Only one lion in the KBM group exhibited ataxia during recovery compared to five and four lions in the TZM and KM groups, respectively. All three drug combinations provided smooth inductions and effective immobilisations but resulted in hypertension. KBM had an advantage of allowing for shorter, less ataxic recoveries.

Enhanced recovery after surgery (ERAS®) society guidelines for gynecologic oncology: Addressing implementation challenges - 2023 update.

BACKGROUND: Despite evidence supporting its use, many Enhanced Recovery After Surgery (ERAS) recommendations remain poorly adhered to and barriers to ERAS implementation persist. In this second updated ERAS® Society guideline, a consensus for optimal perioperative care in gynecologic oncology surgery is presented, with a specific emphasis on implementation challenges. METHODS: Based on the gaps identified by clinician stakeholder groups, nine implementation challenge topics were prioritized for review. A database search of publications using Embase and PubMed was performed (2018-2023). Studies on each topic were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded by an international panel according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS: All recommendations on ERAS implementation challenge topics are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS: The updated evidence base and recommendations for stakeholder derived ERAS implementation challenges in gynecologic oncology are presented by the ERAS® Society in this consensus review.

Towards an automated data cleaning with deep learning in CRESST.

The CRESST experiment employs cryogenic calorimeters for the sensitive measurement of nuclear recoils induced by dark matter particles. The recorded signals need to undergo a careful cleaning process to avoid wrongly reconstructed recoil energies caused by pile-up and read-out artefacts. We frame this process as a time series classification task and propose to automate it with neural networks. With a data set of over one million labeled records from 68 detectors, recorded between 2013 and 2019 by CRESST, we test the capability of four commonly used neural network architectures to learn the data cleaning task. Our best performing model achieves a balanced accuracy of 0.932 on our test set. We show on an exemplary detector that about half of the wrongly predicted events are in fact wrongly labeled events, and a large share of the remaining ones have a context-dependent ground truth. We furthermore evaluate the recall and selectivity of our classifiers with simulated data. The results confirm that the trained classifiers are well suited for the data cleaning task.

Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

The effects of feeding and transport length on the welfare of white rhinoceroses (Ceratotherium simum simum) during long-distance translocations: a preliminary study.

Translocation is a valuable conservation tool, but poses significant risks for the transported rhinoceroses. Interventions reducing these risks are required to ensure positive welfare during transportation. The aim of this study was to evaluate the effect of journey duration and feeding during the transport of white rhinoceroses (Ceratotherium simum simum). A total of 32 animals were transported by road during two events, five days apart. Fifteen rhinoceroses in the first transport event (37.0 ± 2.4 hr duration) were not fed, while 17 rhinoceroses in the second event (32.2 ± 1.5 hr duration) were offered lucerne. Blood samples were collected at capture and after transport for the evaluation of changes in serum clinical chemistry analytes. The Wilcoxon rank-sum test was used to compare differences between the groups. In all rhinoceroses, transport resulted in changes in serum electrolyte, metabolite and enzyme concentrations, indicating a loss in total body water, nutritional shifts, stress and fatigue. Fed rhinoceroses, transported over a shorter time, displayed greater changes in osmolality (p < 0.006), serum sodium and chloride concentrations (p = 0.005 and = 0.001, respectively) indicating a greater degree of total body water loss than non-fed rhinoceroses. Feeding and a shorter transport duration reduced, but did not prevent, nutritional challenges. A greater increase in the muscle enzymes CK and AST (p = 0.027 and = 0.001, respectively), indicated greater fatigue in non-fed rhinoceroses transported over a longer time. Further work to distinguish the effects of feeding and journey duration is required to better understand the role feeding may play in mitigating welfare challenges during rhinoceros translocation.

A comparison of immobilisation quality and cardiorespiratory effects of etorphine-azaperone versus etorphine-midazolam combinations in blesbok.

ABSTRACT: The study compared immobilisation of blesbok (Damaliscus pygargus phillipsi) with etorphine and azaperone vs etorphine and midazolam. Twelve female blesbok, weighing 59.4 ± 2.8 kg, were used. Each animal randomly received Treatment 1 (T1) (etorphine, 0.07 ± 0.003 mg/kg + azaperone, 0.36 ± 0.02 mg/kg) and Treatment 2 (T2) (etorphine, 0.07 ± 0.003 mg/kg + midazolam, 0.20 ± 0.01 mg/kg) with a one-week washout period between treatments. Induction times were recorded followed by physiological monitoring for 45 minutes of immobilisation. Immobilisation was reversed with naltrexone (20 mg per mg etorphine). Recovery times were also recorded. Induction, immobilisation and recovery were scored with subjective measures. Inductions and recoveries did not differ between combinations, but the quality of immobilisation was significantly better with T1. Rectal temperature and blood pressure were significantly lower during T1. Both treatments resulted in severe hypoxaemia and impaired gas exchange, although overall hypoxaemia was more pronounced for T1. Animals treated with T2, however, exhibited a deterioration in respiration as the monitoring period progressed, possibly as a result of impaired ventilatory muscle function due to the effects of midazolam. Both combinations are suitable for adequate immobilisation of blesbok and should be selected based on the specific capture situation. Supplementation with oxygen is highly recommended.

Factors associated with hospital admission and adverse outcome for COVID-19: Role of social factors and medical care.

BACKGROUND: Beyond sex, age, and various comorbidities, geographical origin and socioeconomic deprivation are associated with Coronavirus Disease (COVID-19) morbidity and mortality in the general population. We aimed to assess factors associated with severe forms of COVID-19 after a hospital emergency department visit, focusing on socioeconomic factors. METHODS: Patients with laboratory-confirmed COVID-19 attending the emergency department of Béclère Hospital (France) in March-April 2020 were included. Postal addresses were used to obtain two geographical deprivation indices at the neighborhood level. Factors associated with hospitalization and factors associated with adverse outcomes, i.e. mechanical ventilation or death, were studied using logistic and Cox analyses, respectively. RESULTS: Among 399 included patients, 321 were hospitalized. Neither geographical origin nor socioeconomic deprivation was associated with any of the outcomes. Being male, older, overweight or obese, diabetic, or having a neuropsychiatric disorder were independent risk factors for hospitalization. Among 296 patients hospitalized at Béclère Hospital, 91 experienced an adverse outcome. Older age, being overweight or obese, desaturation and extent of chest CT scan lesions>25% at admission (aHR: 2.2 [95% CI: 1.3-3.5]) and higher peak CRP levels and acute kidney failure (aHR: 2.0 [1.2-3.3]) during follow-up were independently associated with adverse outcomes, whereas treatment with hydrocortisone reduced the risk of mechanical ventilation or death by half (aHR: 0.5 [0.3-0.8]). CONCLUSION: No association between geographical origin or socioeconomic deprivation and the occurrence of a severe form of COVID-19 was observed in our population after arrival to the emergency department. Empirical corticosteroid use with hydrocortisone had a strong protective impact.

More Retrieval Attempts are Associated with Poorer Functional Outcome After Unsuccessful Thrombectomy.

PURPOSE: In mechanical thrombectomy, it has been hypothesized that multiple retrieval attempts might the improve reperfusion rate but not the clinical outcome. In order to assess a potential harmful effect of a mechanical thrombectomy on patient outcome, the number of retrieval attempts was analyzed. Only patients with a thrombolysis in cerebral infarction (TICI) score of 0 were reviewed to exclude the impact of eventual successful reperfusion on the mechanical hazardousness of repeated retrievals. METHODS: In this study 6635 patients who underwent endovascular thrombectomy (EVT) for acute large vessel occlusion (LVO) from the prospectively administered multicenter German Stroke Registry were screened. Insufficient reperfusion was defined as no reperfusion (TICI score of 0), whereas a primary outcome was defined as functional independence (modified Rankin scale [mRS] 0-2 at day 90). Propensity score matching and multivariable logistic regressions were then performed to adjust for confounders. RESULTS: A total of 377 patients (7.8%) had a final TICI score of 0 and were included in the study. After propensity score matching functional independence was found to be significantly more frequent in patients who underwent ≤ 2 retrieval attempts (14%), compared to patients with > 2 retrieval attempts (3.9%, OR 0.29, 95% CI 0.07-0.73, p = 0.009). After adjusting for age, sex, admission NIHSS score, and location of occlusion, more than two retrieval attempts remained significantly associated with lower odds of functional independence at 90 days (OR 0.2, 95% CI 0.07-0.52, p = 0.002). CONCLUSION: In patients with failure of reperfusion, more than two retrieval attempts were associated with a worse clinical outcome, therefore indicating a possible harmful effect of multiple retrieval attempts.

Outcomes of enhanced recovery after surgery (ERAS) in gynecologic oncology - A systematic review and meta-analysis.

OBJECTIVE: To assess the benefit of Enhanced Recovery After Surgery (ERAS) on length of stay (LOS), postoperative complications, 30-day readmission, and cost in gynecologic oncology. METHODS: A systematic literature search was performed in MEDLINE, EMBASE, Cochrane Register of Controlled Trials, and Web of Science for all peer-reviewed cohort studies and controlled trials on ERAS involving gynecologic oncology patients. Abstracts, commentaries, non-controlled studies, and studies without specific data on gynecologic oncology patients were excluded. Meta-analysis was performed on the primary endpoint of LOS. Subgroup analyses were performed based on risk of bias of the studies included, number of ERAS elements, and ERAS compliance. Secondary endpoints were readmission rate, complications, and cost. RESULTS: A total of 31 studies (6703 patients) were included: 5 randomized controlled trials, and 26 cohort studies. Meta-analysis of 27 studies (6345 patients) demonstrated a decrease in LOS of 1.6 days (95% confidence interval, CI 1.2-2.1) with ERAS implementation. Meta-analysis of 21 studies (4974 patients) demonstrated a 32% reduction in complications (OR 0.68, 95% CI 0.55-0.83) and a 20% reduction in readmission (OR 0.80, 95% CI 0.64-0.99) for ERAS patients. There was no difference in 30-day postoperative mortality (OR 0.61, 95% CI 0.23-1.6) for ERAS patients compared to controls. No difference in the odds of complications or reduction in LOS was observed based on number of included ERAS elements or reported compliance with ERAS interventions. The mean cost savings for ERAS patients was $2129 USD (95% CI $712 - $3544). CONCLUSIONS: ERAS protocols decrease LOS, complications, and cost without increasing rates of readmission or mortality in gynecologic oncology surgery. This evidence supports implementation of ERAS as standard of care in gynecologic oncology.

Incomplete or failed thrombectomy in acute stroke patients with Alberta Stroke Program Early Computed Tomography Score 0-5 - how harmful is trying?

BACKGROUND AND PURPOSE: It is currently unknown whether mechanical thrombectomy (MT) for ischaemic stroke patients with low initial Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is clinically beneficial or even harmful. The purpose of this study was to investigate whether failed or incomplete MT in acute large vessel occlusion stroke with an initial ASPECTS ≤ 5 is associated with worse clinical outcome compared to patients not undergoing MT. METHODS: This observational cohort study included a consecutive sample of patients with anterior circulation stroke and initial ASPECTS ≤ 5 admitted between March 2015 and August 2019. Failed recanalization was defined as Thrombolysis in Cerebral Infarction (TICI) score 0-2a, and incomplete recanalization as TICI 2b. Clinical outcome was assessed using the modified Rankin Scale (mRS) at 90 days defining very poor clinical outcome as mRS > 4. RESULTS: One hundred and seventy patients were included. Ninety-nine patients underwent MT and 71 patients received best medical treatment only. Clinical outcome after failed or incomplete MT (TICI 0-2b) was significantly better compared to patients with medical treatment only (median mRS 5, interquartile range 4-6 vs 5-6, P = 0.03). In multivariable logistic regression analysis, failed or incomplete MT (TICI 0-2b) showed a significantly reduced likelihood for very poor outcome (odds ratio 0.39, 95% confidence interval 0.19-0.83, P = 0.01). Failed MT (TICI 0-2a) was not associated with a worse outcome compared to best medical treatment. CONCLUSIONS: Patients with failed or incomplete recanalization results (TICI 0-2b) showed a reduced likelihood for very poor outcome compared with those who did not receive MT. Evidence from randomized trials is needed to confirm that even failed or incomplete MT is not harmful in these patients.

A single oral dose of fluralaner (Bravecto®) in dogs rapidly kills 100% of blood-fed Phlebotomus perniciosus, a main visceral leishmaniasis vector, for at least 1 month after treatment.

Dogs are the reservoir host of zoonotic visceral leishmaniasis (VL) caused by Leishmania infantum (Kinetoplastida: Trypanosomatidae). Both subclinically-infected and sick animals can be infectious to competent phlebotomine vectors. The degree and duration of insecticidal efficacy of an oral dose of fluralaner (Bravecto®; Merck Animal Health) was determined in dogs exposed to bites of Phlebotomus perniciosus (Diptera: Psychodidae), a main Mediterranean vector of VL. Twelve dogs allocated to two groups of six animals each were included in a parallel-group designed, negative-controlled, randomized, blinded, single-centre efficacy study. Group 2 was treated with fluralaner on day 0, and sand-fly exposure of both groups was performed on days 1, 28 and 84. Viability of blood-fed females was assessed up to 96 h after exposure and efficacy was measured as the survival rate of specimens fed on Group 2 versus those fed on Group 1. A mortality of 100% was recorded at 24 h in females fed on Group 2 at both days 1 and 28. Significant insecticidal efficacy was still observed on day 84, with > 50% mortality recorded by 48 h post blood meal in Group 2. Fluralaner treatment of dogs represents a promising and affordable method for reducing the pool of infected vectors in endemic settings of zoonotic VL.

[Diagnostic Imaging of Acute Ischemic Stroke]. / Bildgebung beim akuten ischämischen Schlaganfall.

PURPOSE OF IMAGING: Imaging plays a major role in the diagnosiss, treatment indication, and prognosis of acute ischemic stroke. RECENT STUDY RESULTS: Recent studies have proved the safety and effectiveness of thrombolysis and endovascular thrombectomy based on the individual combination of imaging and patients clinical information even beyond the classical time-windows. In these cases, magnetic resonance imaging and perfusion-imaging can provide additional and important information. STANDARD DIAGNOSTICS: Nevertheless, computed tomography with and without contrast media still represents the most available and fastest method to diagnose stroke.

Anatomical and functional outcomes of ILM interposition in surgery for large macular holes: A retrospective study.

INTRODUCTION: While surgery for small macular holes (<400µm) is well-described, the results are not as clear-cut for larger holes (>400µm). Our purpose is to demonstrate the difference in terms of closure and final visual acuity between 3 techniques: the classical technique, the FLAP technique and internal limiting membrane (ILM) transfer. METHODS: This retrospective non-randomized study included consecutive patients with a macular hole greater than 400µm. Myopic eyes (>26.5mm or >6.50D) and eyes with other retinal comorbidities were excluded. All patients underwent pars plana vitrectomy in combination with one of the 3 techniques. RESULTS: We included 84 eyes of 77 patients between 2005 and 2018; 57 in the classic group (A), 13 in the FLAP group (B) and 14 in the ILM transfer group (C). The closure rate at 3 months was 70.18 % in group A, 100 % in group B and 92.86 % in group C. The closure rate was significantly higher in group B and C compared to group A. There was no significant improvement between pre- and post-operative best corrected visual acuity in any group. The gain in BCVA was 2.90 lines (±2.98) in group A, 3.40 lines (±2.40) in group B, and 1.07 lines (±1.04) in group C. The gain was significantly lower in group C compared to group A and B. CONCLUSION: ILM interposition appears to offer a true anatomical advantage for closing large holes, but the functional recovery does not appear to be better or worse.