Combination of cable ties and barbed sutures for fasciotomy closure - two case reports.

While fasciotomy is the only urgent treatment option for compartment syndrome, the resulting open wound leaves room for complications. Closure of the wound can be done by different techniques, including split-thickness skin grafts, negative pressure therapy, an absorbable barbed suture system and a cable ties system. The aim of this paper is to demonstrate how a combined application of these methods can reduce their respective individual disadvantages. Our combined method was tried in two patients, one with an open tibial fracture and the other who underwent ulnar nerve reparation. Both patients started exhibiting signs of compartment syndrome within 3 hrs after surgery. Firstly, absorbable barbed suture systems were positioned with the running intradermal technique. Following this the cable ties were inserted and the limb in question was placed in an elevated position. Complete closure of the patient's wounds was achieved within 2 weeks without complications. This result is a testament to the added benefit of a combination of these methods in comparison with the results they produce individually.

Smooth at one end and rough at the other: influence of object texture on grasping behaviour.

When picking up objects using a pinch grip, there are usually numerous places at which one could place the thumb and index finger. Yet, people seem to consistently place them at or close to the centre of mass (COM), presumably to minimize torque and therefore the required grip force. People also prefer to grasp objects by parallel surfaces and ones with higher friction coefficients (rough surfaces), to prevent the object from slipping when they lift it. Here, we examine the trade-off between friction and COM. Participants were asked to grasp and lift aluminium bars of which one end was polished and therefore smooth and the other was rough. Their finger positions were recorded to determine how they grasped the objects. The bars were oriented horizontally in the frontal plane, with the centre aligned with the participants' body midline. The bars varied in the horizontal offset between the COM and the edge of the rough region. The offset could be 0, 1 or 2 cm. We expected participants to grasp closer to the rough area than the centre of the bar. Completely rough bars and completely smooth bars served as control conditions. The slipperiness of the surface that was grasped affected the height of the grasping points, indicating that participants adjusted their grasping behaviour to the slipperiness of the surface. However, the tendency to grasp closer to the rough area was minimal. This shows that the judged COM largely determines how an object is grasped. Friction has very limited influence.

Characterization of road runoff with regard to seasonal variations, particle size distribution and the correlation of fine particles and pollutants.

Urban runoff is known to transport a significant pollutant load consisting of e.g. heavy metals, salts and hydrocarbons. Interactions between solid and dissolved compounds, proper understanding of particle size distribution, dissolved pollutant fractions and seasonal variations is crucial for the selection and development of appropriate road runoff treatment devices. Road runoff at an arterial road in Augsburg, Germany, has been studied for 3.5 years. A strong seasonal variation was observed, with increased heavy metal concentrations with doubled and tripled median concentrations for heavy metals during the cold season. Correlation analysis showed that de-icing salt is not the only factor responsible for increased pollutant concentrations in winter. During the cold period, the fraction of dissolved metals was lower compared to the warm season. In road dust, the highest metal concentrations were measured for fine particles. Metals in road runoff were found to show a significant correlation to fine particles SS63 (<63 µm). Therefore, it is debatable whether treatment devices only implementing sedimentation processes provide sufficient removal rates.

Torques do not influence proprioceptive localization of the hand.

Because muscle torques counteracting gravity vary systematically during a movement of the arm, it has been suggested that torque differences that occur during a movement provide important information for judging the distance moved away from the body. To test this suggestion, we examined whether external vertical forces applied to the hand (and the torque differences due to these forces) influence proprioception. In a first experiment, the added vertical forces were constant, resulting in a change in torque that was proportional to the gravitational torque, as when holding an object in your hand. This did not affect proprioception. In a second experiment, gradient force fields were used to dramatically change the torque differences. Again, no effect on proprioception was found. Thus, vertical forces caused by hand-held objects do not play an important role in judging the position or movement of the hand.

Anatomical considerations for transanal minimal-invasive surgery: the caudal to cephalic approach.

AIM: Nerve-sparing surgery during laparoscopic rectal mobilization is still limited by anatomical constraints such as obesity, the narrowness of the male pelvis, an ultra low rectal cancer or all of these. The transanal approach for total mesorectal excision has overcome the shortcomings of limited access to the rectal 'no-man's land' close to the pelvic floor. The aim of this anatomical study was to define a roadmap of anatomical landmarks for the caudal to cephalic approach so as to standardize nerve-sparing rectal mobilization procedures. METHOD: Macroscopic dissections of the pelvis in a caudal to cephalic direction were performed in eight alcohol-glycerol embalmed cadavers. A roadmap of anatomical landmarks was created at different levels of section to demonstrate the sites of nerve injury. RESULTS: Extrinsic autonomic nerves to the urogenital organs and the internal sphincter muscle are closely adjacent to the lowest portion of the rectum above the pelvic diaphragm. CONCLUSION: This anatomical guide for the pelvic surgeon should facilitate a safe and nerve-sparing dissection of the mesorectal plane with a meticulous overview of the lowest autonomic nerve fibres. New anatomical insights by a 'caudal to cephalic' approach to the 'no-man's land' should help overcome anatomical constraints of a narrow, obese and male pelvis during rectal mobilization procedures.

Ultra-fast selection of grasping points.

To grasp an object one needs to determine suitable positions on its surface for placing the digits and to move the digits to those positions. If the object is displaced during a reach-to-grasp movement, the digit movements are quickly adjusted. Do these fast adjustments only guide the digits to previously chosen positions on the surface of the object, or is the choice of contact points also constantly reconsidered? Subjects grasped a ball or a cube that sometimes rotated briefly when the digits started moving. The digits followed the rotation within 115 ms. When the object was a ball, subjects quickly counteracted the initial following response by reconsidering their choice of grasping points so that the digits ended at different positions on the rotated surface of the ball, and the ball was grasped with the preferred orientation of the hand. When the object was a cube, subjects sometimes counteracted the initial following response to grasp the cube by a different pair of sides. This altered choice of grasping points was evident within ∼160 ms of rotation onset, which is shorter than regular reaction times.

Alignment to natural and imposed mismatches between the senses.

Does the nervous system continuously realign the senses so that objects are seen and felt in the same place? Conflicting answers to this question have been given. Research imposing a sensory mismatch has provided evidence that the nervous system realigns the senses to reduce the mismatch. Other studies have shown that when subjects point with the unseen hand to visual targets, their end points show visual-proprioceptive biases that do not disappear after episodes of visual feedback. These biases are indicative of intersensory mismatches that the nervous system does not align for. Here, we directly compare how the nervous system deals with natural and imposed mismatches. Subjects moved a hand-held cube to virtual cubes appearing at pseudorandom locations in three-dimensional space. We alternated blocks in which subjects moved without visual feedback of the hand with feedback blocks in which we rendered a cube representing the hand-held cube. In feedback blocks, we rotated the visual feedback by 5° relative to the subject's head, creating an imposed mismatch between vision and proprioception on top of any natural mismatches. Realignment occurred quickly but was incomplete. We found more realignment to imposed mismatches than to natural mismatches. We propose that this difference is related to the way in which the visual information changed when subjects entered the experiment: the imposed mismatches were different from the mismatch in daily life, so alignment started from scratch, whereas the natural mismatches were not imposed by the experimenter, so subjects are likely to have entered the experiment partly aligned.

Bartonella infection in urban and rural dogs from the tropics: Brazil, Colombia, Sri Lanka and Vietnam.

Dogs can be infected by a wide range of Bartonella spp., but limited studies have been conducted in tropical urban and rural dog populations. We aimed to determine Bartonella antibody prevalence in 455 domestic dogs from four tropical countries and detect Bartonella DNA in a subset of these dogs. Bartonella antibodies were detected in 38 (8·3%) dogs, including 26 (10·1%) from Colombia, nine (7·6%) from Brazil, three (5·1%) from Sri Lanka and none from Vietnam. DNA extraction was performed for 26 (63%) of the 41 seropositive and 10 seronegative dogs. Four seropositive dogs were PCR positive, including two Colombian dogs, infected with B. rochalimae and B. vinsonii subsp. berkhoffii, and two Sri Lankan dogs harbouring sequences identical to strain HMD described in dogs from Italy and Greece. This is the first detection of Bartonella infection in dogs from Colombia and Sri Lanka and identification of Bartonella strain HMD from Asia.

Epicardial pacemaker implantation and outcome in eight pet ferrets (Mustela putorius furo).

INTRODUCTION/OBJECTIVES: Minimal information exists regarding epicardial pacemaker (EP) implantation in pet ferrets (Mustela putorius furo). The objectives were to describe the indications, surgical technique, and outcome of EP implantation in ferrets for the treatment of advanced atrioventricular block (AVB). ANIMALS, MATERIALS, AND METHODS: Eight client-owned ferrets presenting to five veterinary referral centers. Signalment, physical exam findings, diagnostic tests, anesthesia protocols, surgical implantation techniques, postoperative treatment plans, and EP interrogations were reviewed. Intra- and postoperative, minor and major, and EP-related complications were established. Descriptive statistics were performed to report complication rates. Survival analyses were performed. RESULTS: All ferrets had advanced AVB: 3/8 had high-grade second-degree and 5/8 had third-degree. The primary clinical signs were collapse and weakness. Seven EP were implanted via a transdiaphragmatic approach and one via a left intercostal thoracotomy. Intraoperative complications occurred in 2/8 ferrets, both major. One ferret with severe comorbidities died during general anesthesia. Postoperative pacemaker-related complications were minor: inappropriate sinus beat sensing in 2/8 and occasional muscle fasciculations in 1/8. Two ferrets were alive at the time of manuscript submission, at 10 and 21 months postoperatively. The overall median survival time was 24 months. CONCLUSIONS: Implantation of EP was performed successfully in most ferrets for treatment of advanced AVB and was well tolerated. Ferrets with advanced AVB may experience resolution of clinical signs associated with their cardiac disease following EP implantation. Additional studies are warranted to investigate the effects of epicardial pacing on survival times in this species.

Saxagliptin, a potent, selective inhibitor of DPP-4, does not alter the pharmacokinetics of three oral antidiabetic drugs (metformin, glyburide or pioglitazone) in healthy subjects.

AIM: To evaluate the pharmacokinetic interactions of the potent, selective, dipeptidyl peptidase-4 inhibitor, saxagliptin, in combination with metformin, glyburide or pioglitazone. METHODS: To assess the effect of co-administration of saxagliptin with oral antidiabetic drugs (OADs) on the pharmacokinetics and tolerability of saxagliptin, 5-hydroxy saxagliptin, metformin, glyburide, pioglitazone and hydroxy-pioglitazone, analyses of variance were performed on maximum (peak) plasma drug concentration (C(max)), area under the plasma concentration-time curve from time zero to infinity (AUC(∞)) [saxagliptin + metformin (study 1) and saxagliptin + glyburide (study 2)] and area under the concentration-time curve from time 0 to time t (AUC) [saxagliptin + pioglitazone (study 3)] for each analyte in the respective studies. Studies 1 and 2 were open-label, randomized, three-period, three-treatment, crossover studies, and study 3 was an open-label, non-randomized, sequential study in healthy subjects. RESULTS: Co-administration of saxagliptin with metformin, glyburide or pioglitazone did not result in clinically meaningful alterations in the pharmacokinetics of saxagliptin or its metabolite, 5-hydroxy saxagliptin. Following co-administration of saxagliptin, there were no clinically meaningful alterations in the pharmacokinetics of metformin, glyburide, pioglitazone or hydroxy-pioglitazone. Saxagliptin was generally safe and well tolerated when administered alone or in combination with metformin, glyburide or pioglitazone. CONCLUSIONS: Saxagliptin can be co-administered with metformin, glyburide or pioglitazone without a need for dose adjustment of either saxagliptin or these OADs.

Relative finger position influences whether you can localize tactile stimuli.

To investigate whether the relative positions of the fingers influence tactile localization, participants were asked to localize tactile stimuli applied to their fingertips. We measured the location and rate of errors for three finger configurations: fingers stretched out and together so that they are touching each other, fingers stretched out and spread apart maximally and fingers stretched out with the two hands on top of each other so that the fingers are interwoven. When the fingers contact each other, it is likely that the error rate to the adjacent fingers will be higher than when the fingers are spread apart. In particular, we reasoned that localization would probably improve when the fingers are spread. We aimed at assessing whether such adjacency was measured in external coordinates (taking proprioception into account) or on the body (in skin coordinates). The results confirmed that the error rate was lower when the fingers were spread. However, there was no decrease in error rate to neighbouring fingertips in the fingers spread condition in comparison with the fingers together condition. In an additional experiment, we showed that the lower error rate when the fingers were spread was not related to the continuous tactile input from the neighbouring fingers when the fingers were together. The current results suggest that information from proprioception is taken into account in perceiving the location of a stimulus on one of the fingertips.

Identification of a predominant genotype of Mycobacterium tuberculosis in Brazilian indigenous population.

After nearly a century of vaccination and six decades of drug therapy, tuberculosis (TB) kills more people annually than any other infectious disease. Substantial challenges to disease eradication remain among vulnerable and underserved populations. The Guarani-Kaiowá people are an indigenous population in Paraguay and the Brazilian state of Mato Grosso do Sul. This community, marginalized in Brazilian society, experiences severe poverty. Like other South American indigenous populations, their TB prevalence is high, but the disease has remained largely unstudied in their communities. Herein, Mycobacterium tuberculosis isolates from local clinics were whole genome sequenced, and a population genetic framework was generated. Phylogenetics show M. tuberculosis isolates in the Guarani-Kaiowá people cluster away from selected reference strains, suggesting divergence. Most cluster in a single group, further characterized as M. tuberculosis sublineage 4.3.3. Closer analysis of SNPs showed numerous variants across the genome, including in drug resistance-associated genes, and with many unique changes fixed in each group. We report that local M. tuberculosis strains have acquired unique polymorphisms in the Guarani-Kaiowá people, and drug resistance characterization is urgently needed to inform public health to ensure proper care and avoid further evolution and spread of drug-resistant TB.

When North and South don't mix: genetic connectivity of a recently endangered oceanic cycad, Cycas micronesica, in Guam using EST-microsatellites.

Subject to environmental changes and recurrent isolation in the last ca. 250 Ma, cycads are often described as relicts of a previously common lineage, with populations characterized by low genetic variation and restricted gene flow. We found that on the island of Guam, the endemic Cycas micronesica has most of the genetic variation of 14 EST-microsatellites distributed within each of 18 genetic populations, from 24 original sampling sites. There were high levels of genetic variation in terms of total number of alleles and private alleles, and moderate levels of inbreeding. Restricted but ongoing gene flow among populations within Guam reveals a genetic mosaic, probably more typical of cycads than previously assumed. Contiguous cycad populations in the north of Guam had higher self-recruitment rates compared to fragmented populations in the south, with no substantial connection between them except for one population. Guam's genetic mosaic may be explained by the influence of forest continuity, seed size, edaphic differences, and human transport of cycads. Also important are the extent of synchrony among flushes of reproductive female seed-bearing sporophylls and restricted pollen movement by an obligate mutualist and generalist insects. An NADH EST-locus under positive selection may reflect pressure from edaphic differences across Guam. This and three other loci are ideal candidates for ecological genomic studies. Given this species' vulnerability due to the recent introduction of the cycad aulacaspis scale, we also identify priority populations for ex situ conservation, and provide a genetic baseline for understanding the effects of invasive species on cycads in the Western Pacific, and islands in general.

Laparoscopic fundoplication and new aspects of neural anatomy at the oesophagogastric junction.

BACKGROUND: In fundoplication, mobilization of the distal oesophagus and proximal stomach is essential to obtain a sufficient tension-free intra-abdominal oesophageal length for creation of an efficient antireflux barrier. Most surgical literature and anatomical illustrations do not describe nerve branches running from the diaphragm to the stomach. After observing small nerve branches at laparoscopic fundoplication, penetrating the left crus of the diaphragm lateral to the hiatus and apparently running into the stomach, an anatomical cadaver study was undertaken to identify the origin and target organ of these nerves. METHODS: Fifty-three human cadavers (23 men, 30 women; age range 35-103 years) were dissected with special attention to the nerves that penetrate the left crus of the diaphragm. The entire course of these nerves was documented with standardized drawings and photos. RESULTS: Small nerve branches penetrating the diaphragm lateral to the left crus of the hiatus were found in 17 (32 per cent) of the 53 cadavers. In 14 of these 17 cadavers, one or two splanchnic nerve branches were identified, and in ten of the 17 the nerve branches were found to be phrenic nerves. In seven of these 17 cadavers, two different nerve branches were found and assigned to both splanchnic and phrenic nerves. CONCLUSION: Nerves penetrating the left crus with splanchnic origin or phrenic origin have been identified. Their function remains unclear and their relationship to postfundoplication symptoms remains to be determined.

ANTECEDENTES: A la hora de realizar una fundoplicatura, la movilización del esófago distal y del estómago proximal es esencial para obtener una longitud de esófago intraabdominal suficiente y sin tensión para crear una barrera antirreflujo eficiente. La mayoría de la literatura quirúrgica y de las ilustraciones anatómicas no describen unas ramas nerviosas que discurren desde el diafragma al estómago. Tras observar pequeñas ramas nerviosas durante la realización de una fundoplicatura laparoscópica que penetran la crura izquierda del diafragma lateral al hiato y que aparentemente discurren hacia el estómago, se llevó a cabo un estudio anatómico en cadáver para identificar el origen y el órgano diana de estos nervios. MÉTODOS: Se diseccionaron 53 cadáveres humanos (23 varones, 30 mujeres, rango de edad: 35-103 años) con especial atención hacia los nervios que penetran la crura izquierda del diafragma. Se documentó el recorrido completo de estos nervios con fotos y dibujos de una forma estandarizada. RESULTADOS: En 17 (32%) de 53 cadáveres se hallaron pequeñas ramas nerviosas que penetraban el diafragma lateral a la crura izquierda del hiato. En 14 cadáveres (de los 17) se identificaron una o dos ramas nerviosas esplácnicas, y en 10 de los 17 cadáveres las ramas nerviosas que se hallaron resultaron ser nervios frénicos. En 7 de estos 17 cadáveres, se hallaron dos ramas nerviosas diferentes y se asignaron a ambos nervios, esplácnicos y frénicos. CONCLUSIÓN: Se han identificado los nervios que penetran la crura izquierda con un origen esplácnico y frénico. Sus funciones están por aclarar, así como su relación con los síntomas que aparecen tras la fundoplicatura.

Different cue weights at the same place.

The visual system uses multiple cues to estimate properties of interest. Since the errors in the estimates from different cues for the same property are generally different, a weighted average of the cues provides a better overall estimate. The most precise estimate is found when each cue's weight is proportional to its reliability. We here show that the weights given to cues for surface slant can differ between two transparent surfaces that are at the same location at the same time. Thus the weights must be assigned separately for each structure, rather than for each location.

[Relict microorganisms of cryolithozone as possible objects of gerontology].

Permafrost is widely distributed in the Northern Hemisphere, and its age reaches hundreds of thousands and millions of years. Permafrost contains alive microorganisms which are not frozen due to relatively high temperature of the environment (-2...-8 degrees C), but the microorganisms are immobilized and therefore aged probably similar to the age of permafrost. Longevity of the relict microbial cells is related obviously to their mechanism of protection against heat, radiation, free radicals and other damaging agents. A strain of Bacillus sp. was isolated from permafrost aged of about 3 million years, 16S rDNA sequence was identified and preliminary testing of bacterial culture on Drosophila melanogaster and mice was made. Immune stimulation and improvement of physical condition were observed, and that, together with the age of the microbial cells, presents the relict microorganisms as objects of gerontology.

A prospective three-year follow-up study on the clinical significance of anti-neuronal antibodies in acute psychiatric disorders.

The clinical significance of anti-neuronal antibodies for psychiatric disorders is controversial. We investigated if a positive anti-neuronal antibody status at admission to acute psychiatric inpatient care was associated with a more severe neuropsychiatric phenotype and more frequent abnormalities during clinical work-up three years later. Patients admitted to acute psychiatric inpatient care who tested positive for N-methyl-D-aspartate receptor (NMDAR), contactin-associated protein 2 (CASPR2) and/or glutamic acid decarboxylase 65 (GAD65) antibodies (n = 24) were age - and sex matched with antibody-negative patients (1:2) from the same cohort (n = 48). All patients were invited to follow-up including psychometric testing (e.g. Symptom Checklist-90-Revised), serum and cerebrospinal fluid (CSF) sampling, EEG and 3 T brain MRI. Twelve antibody-positive (ab+) and 26 antibody-negative (ab-) patients consented to follow-up. Ab+ patients had more severe symptoms of depression (p = 0.03), psychoticism (p = 0.04) and agitation (p = 0.001) compared to ab- patients. There were no differences in CSF analysis (n = 6 ab+/12 ab-), EEG (n = 7 ab+/19 ab-) or brain MRI (n = 7 ab+/17 ab-) between the groups. In conclusion, anti-neuronal ab+ status during index admission was associated with more severe symptoms of depression, psychoticism and agitation at three-year follow-up. This supports the hypothesis that anti-neuronal antibodies may be of clinical significance in a subgroup of psychiatric patients.

The use of proprioception and tactile information in haptic search.

To investigate how tactile and proprioceptive information are used in haptic object discrimination we conducted a haptic search task in which participants had to search for either a cylinder, a bar or a rotated cube within a grid of aligned cubes. Tactile information from one finger is enough to detect a cylinder amongst the cubes. For detecting a bar or a rotated cube amongst cubes touch alone is not enough. For the rotated cube this is evident because its shape is identical to that of the non-targets, so proprioception must provide information about the orientation of the fingers and hand when touching it. For the bar one either needs proprioceptive information about the distance and direction of a single finger's movements along the surfaces, or proprioceptive information from several fingers when they touch it simultaneously. When using only one finger, search times for the bar were much longer than those for the other two targets. When the whole hand or both hands were used the search times were similar for all shapes. Most errors were made when searching for the rotated cube, probably due to systematic posture-related biases in judging orientation on the basis of proprioception. The results suggest that tactile and proprioceptive information are readily combined for shape discrimination.

Haptic search is more efficient when the stimulus can be interpreted as consisting of fewer items.

In a typical haptic search task, separate items are presented to individual fingertips. The time to find a specific item generally increases with the number of items, but is it the number of items or the number of fingers that determines search time? To find out, we conducted haptic search experiments in which horizontal lines made of swell paper were presented to either two, four or six of the participants' fingertips. The task for the participant was to lift the finger under which they did not feel (part of) a line. In one of the conditions separate non-aligned lines were presented to the fingertips so that the number of items increased with the number of fingers used. In two other conditions the participants had to find an interruption in a single straight line under one of the fingertips. These conditions differed in the size of the gap. If only the number of items in the tactile display were important, search times would increase with the number of fingers in the first condition, but not depend on the number of fingers used in the other two conditions. In all conditions we found that the search time increased with the number of fingers used. However, this increase was smaller in the single line condition in which the gap was large enough for one finger to not make any contact with the line. Thus, the number of fingers involved determines the haptic search time, but search is more efficient when the stimulus can be interpreted as consisting of fewer items.