Dark Energy Survey Year 1 Results: Cosmological Constraints from Cluster Abundances, Weak Lensing, and Galaxy Correlations.

We present the first joint analysis of cluster abundances and auto or cross-correlations of three cosmic tracer fields: galaxy density, weak gravitational lensing shear, and cluster density split by optical richness. From a joint analysis (4×2pt+N) of cluster abundances, three cluster cross-correlations, and the auto correlations of the galaxy density measured from the first year data of the Dark Energy Survey, we obtain Ω_{m}=0.305_{-0.038}^{+0.055} and σ_{8}=0.783_{-0.054}^{+0.064}. This result is consistent with constraints from the DES-Y1 galaxy clustering and weak lensing two-point correlation functions for the flat νΛCDM model. Consequently, we combine cluster abundances and all two-point correlations from across all three cosmic tracer fields (6×2pt+N) and find improved constraints on cosmological parameters as well as on the cluster observable-mass scaling relation. This analysis is an important advance in both optical cluster cosmology and multiprobe analyses of upcoming wide imaging surveys.

[First data concerning the medical supply of patients with non-alcoholic fatty liver disease in Germany - a survey in university hospital centers of hepatology]. / Erste Daten zur Versorgungssituation von Patienten mit nicht alkoholischer Fettlebererkrankung (NAFLD) in Deutschland - Eine Umfrage an universitären hepatologischen Zentren.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) currently is one oft the most common reasons for chronic liver injury in the western world. In the European and American population the prevalence is up to 30 %. The medical supply of German patients with NAFLD is variable and has not been analyzed to date. METHODS: We sent questionnaires to all university liver centers in Germany (11 questions) concerning the medical supply of patients with NAFLD. Questions included the rate of patients with fatty liver disease in the outpatient clinics, metabolic comorbidities and the kind of assignment. Besides that, individual clinical standards were documented. We compared longitudinal changes between 2008 and 2013. RESULTS: The return rate of questionnaires was 65 % (n = 20). Analysis showed that the portion of NAFLD patients in the university outpatient clinics had increased between 2008 and 2013 with the predominant part of patients being assigned from external practitioners and not from internal departments of the hospital. Only few patients were assigned by diabetologists or endocrinologists, but on the other hand most liver outpatient clinics investigated their NAFLD patients for metabolic disorders. Cooperation between liver outpatient clinics and other medical services was moderate and was rated average, joint conferences were held rarely. Follow-up visits of patients with NAFLD take place regularly in all centers, however based on different criterions. A consistent algorithm concerning risk assessment and invasive workup does not exist. CONCLUSION: The awareness concerning patients with NAFLD seems to have grown in recent years. Nevertheless, the medical supply of these patients is quite heterogenous and consistent standards do not exist. Therefore, a common guidline is urgently required.

Arthroscopic-Assisted Intraosseous Balloon-Assisted Repositioning of a Tibial Plateau Fracture: A Case Report.

This is the first description of an arthroscopic-assisted intraosseous balloon-assisted repositioning and defect filling of a tibial plateau fracture. The bone defect was filled with calcium phosphate cement in a liquid/paste form. The described technique was therefore introduced in order to allow an arthroscopic control of reposition and intra-articular cement escape during defect filling. X-rays showed an exact reposition without cement escape and the clinical outcome was satisfactory.

Two-year clinical experience with the CyPass micro-stent: safety and surgical outcomes of a novel supraciliary micro-stent.

PURPOSE: The aim of this study was to evaluate through 2 postoperative years the clinical outcomes associated with a novel supraciliary micro-stent for the surgical treatment of open-angle glaucoma (OAG) when implanted in conjunction with cataract surgery. PATIENTS AND METHOD: In a multicenter, prospective, consecutive case series, 136 subjects (136 eyes) with OAG and requiring cataract surgery with 24-month postoperative data were included. A combined phacoemulsification procedure, with intraocular lens insertion and CyPass Micro-Stent implantation into the supraciliary space of the study eye, was performed. At baseline, all subjects were on glaucoma medication with either uncontrolled intraocular pressure (IOP; ≥ 21 mmHg, Cohort 1, n=51) or controlled IOP (<21 mmHg, Cohort 2, n=85). Glaucoma medications were stopped postoperatively, but could be restarted if needed, at the investigator's discretion. Device-related adverse events, postoperative IOP, best corrected distance visual acuity (BCDVA), and number of IOP-lowering medications were recorded. RESULTS: The micro-stent was successfully implanted in all eyes. At 24 months, 82 subjects remained in the study. No sight-threatening adverse events occurred. The most common adverse events were transient hypotony (15.4%) and micro-stent obstruction (8.8%), typically due to iris tissue overgrowth. Fifteen subjects (11%) required secondary incisional glaucoma surgery. For Cohort 1 (n=23), mean ± SD IOP was 15.8 ± 3.8 mmHg after 24 months (change, -37% ± 19%). Mean IOP decrease from baseline was statistically significant (p<0.0001) at months 6, 12, and 24. For Cohort 2 (n=59), mean ± SD IOP at 24 months was 16.1 ± 3.2 mmHg (change, 0% ± 28%). Mean decrease from baseline was statistically significant at months 6 (p=0.0188) and 12 (p=0.0356). At 24 months, the mean ± SD number of medications was 1.0 ± 1.1 in Cohort 1 and 1.1 ± 1.1 in Cohort 2. Mean decrease from baseline medication use was statistically significant at months 6 (p<0.001), 12 (p<0.001), and 24 (p=0.0265) in Cohort 1, and at months 6, 12, and 24 (all p<0.0001) in Cohort 2. CONCLUSIONS: CyPass Micro-Stent implantation, in combination with cataract surgery, was associated with minimal complications while substantially lowering IOP and/or use of IOP-lowering medications.

Palmar multidirectional fixed-angle plate fixation in distal radius fractures: do intraarticular fractures have a worse outcome than extraarticular fractures?

INTRODUCTION: The results and complications using a palmar plate system with the possibility of multidirectional fixed-angle screw fixation (Aptus® Radius 2.5 mm by Medartis®) for the treatment of unstable distal radius fractures were evaluated in a single cohort study including 62 patients. PATIENTS: Patients with extra- and intraarticular fractures were evaluated separately. The mean follow-up was 14.7 months. Active wrist motion averaged 60.1° extension, 52.0° flexion, 86.3° pronation, and 84.6° supination. Grip strength averaged 89% of the contralateral wrist. RESULTS: There was no loss of the initial reduction with bony union in all cases. The mean DASH-score was 12.6 points. Postoperative complications included two extensor pollicis longus tendon ruptures, two median nerve compression syndromes, one complex regional pain syndrome, and one postoperative haematoma. In our series the results of the intraarticular fracture group were similar to the extraarticular fracture group. The complication rate, however, was substantially higher in the intraarticular fracture group. CONCLUSION: We conclude that palmar plating with multidirectional fixed-angle screw insertion is an effective and useful treatment option, especially for complex intraarticular distal radius fractures.

Entomological evaluation of malaria vectors at different altitudes in Hai district, northeastern Tanzania.

Entomological monitoring in four villages situated along an altitude transect in the Hai District of Northeastern Tanzania identified Anopheles arabiensis Patton as the principal vector of malaria and detected seasonal changes in vector behavior. Over a 13-mo sampling period, 10,557 mosquitoes were collected with CDC light traps, pyrethrum spray catches, and pit traps of which 5,969 (56.5%) wereAn. arabiensis, 762 (7.2%) wereAnopheles funestus Giles s.l., 3,578 (33.9%) were culicines, and 248 (2.3%) were nonvector anophelines. Vector densities declined rapidly with increasing altitude, demonstrating a 50% decrease in annual human biting rate for every 86-m rise in altitude. Light traps were found to be more efficient than spray catches for the collection of An. arabiensis. This observation was attributed to increased exophily of this species, most notably in the wet season, and is supported by seasonal changes in the human blood index and fed/gravid ratio. These results indicate that spray catches may underestimate the abundance of exophilic vectors such as An. arabiensis and that entomological monitoring may require more than one collection method, especially at low vector densities. The annual entomological inoculation rate (EIR) decreased sharply with increasing altitude, with large variation around the estimate at low vector densities. Increased transmission because of unpredictable short rains at low altitudes and spatial clustering of infective mosquitoes may contribute to elevated EIR estimates.

Treatment of aortocoronary vein graft lesions with membrane-covered stents: A multicenter surveillance trial.

BACKGROUND: Stent implantation in lesions of degenerated aortocoronary vein grafts is associated with a high risk of periprocedural thrombus embolization and in-stent restenosis. METHODS AND RESULTS: In a multicenter study, we followed up 109 consecutive patients (mean age 66+/-8 years, 12% female) who received polytetrafluoroethylene (PTFE) membrane-covered stents for 125 de novo stenoses in vein grafts 11+/-5 years after bypass surgery. Stent deployment was successful in all but 1 patient; 1 patient suffered from subacute stent thrombosis. Six-month cardiac mortality was 7% (8 patients), 3 patients (3%) underwent repeat bypass surgery, and 9 patients (8%) required target-lesion PTCA. Repeat angiography revealed vessel occlusions in 9% and in-stent restenosis in 8% of patients by the end of follow-up. CONCLUSIONS: Membrane-covered stents appear to be a safe and efficient treatment strategy associated with a low incidence of restenosis and target-vessel revascularization. Compared with previous studies, the investigated device is not associated with an increase in mortality or late vessel occlusions.

Possible roles of HIV-1 nucleocapsid protein in the specificity of proviral DNA synthesis and in its variability.

Retroviral nucleocapsid (NC) protein is an integral part of the virion nucleocapsid where it coats the dimeric RNA genome. Due to its nucleic acid binding and annealing activities, NC protein directs the annealing of the tRNA primer to the primer binding site and greatly facilitates minus strand DNA elongation and transfer while protecting the nucleic acids against nuclease degradation. To understand the role of NCp7 in viral DNA synthesis, we examined the influence of NCp7 on self-primed versus primer-specific reverse transcription. The results show that HIV-1 NCp7 can extensively inhibit self-primed reverse transcription of viral and cellular RNAs while promoting primer-specific synthesis of proviral DNA. The role of NCp7 vis-a-vis the presence of mutations in the viral DNA during minus strand elongation was examined. NCp7 maximized the annealing between a cDNA(-) primer containing one to five consecutive errors and an RNA representing the 3' end of the genome. The ability of reverse transcriptase (RT) in the presence of NCp7 to subsequently extend the mutated primers depended upon the position of the mismatch within the primer:template complex. When the mutations were at the polymerisation site, primer extension by RT in the presence of NCp7 was very high, about 40% for one mismatch and 3% for five consecutive mismatches. Mutations within the DNA primer or at its 5' end had little effect on the extension of viral DNA by RT. Taken together these results indicate that NCp7 plays major roles in proviral DNA synthesis within the virion core due to its ability to promote prime-specific proviral DNA synthesis while concurrently inhibiting non-specific reverse transcription of viral and cellular RNAs. Moreover, the observation that NCp7 enhances the incorporation of mutations during minus strand DNA elongation favours the notion that NCp7 is a factor contributing to the high mutation rate of HIV-1.

Examination of the failure properties of the anterior cruciate ligament during the estrous cycle.

The purpose of this study was to determine whether the mechanical properties of the rat anterior cruciate ligament (ACL) vary when tested in vitro at different stages of the estrous cycle. Sixty female rats were allocated to four groups according to their stage of the estrous cycle: diestrus (n=16), proestrus (n=17), estrus (n=13) and metestrus (n=14). Right hindlimbs were harvested for mechanical testing and left hindlimbs were harvested for immunohistochemical staining to confirm the presence of the estrogen receptor. Results from the first relaxation test showed a significant difference between the estrus and proestrus stage, which was not observed in a second subsequent relaxation test. Likewise, no significant differences were found when comparing failure load and stiffness between the different stages of the estrous cycle. These results suggest that normal physiological fluctuations in estrogen during the estrous cycle did not alter the failure properties of the rat ACL.

Quiste dermoide latero cervical / Dermoid cyst of the lateral neck

Resumen Introducción: Los quistes dermoides son lesiones de origen ectodérmico poco frecuentes. Solo un 1,6% de ellos, se presenta en el piso de la boca y de éstos, solo un 6% lateralmente en el espacio submandibular. Objetivo: Reporte de caso y revisión de la literatura. Caso clínico: Se presenta un caso de una paciente de 32 años, con un cuadro de 1 año de evolución caracterizado por una lesión de crecimiento lento pero sostenido. Se le realizó la resección de la lesión junto con una submandibulectomía ipsilateral resultando compatible con un quiste dermoide. Discusión: La localización de esta lesión es muy infrecuente. En el estudio histopatológico son lesiones con epitelio pluriestratificado cornificado y anexos cutáneos. El estudio de imágenes orienta a una lesión quística, siendo la resonancia nuclear hoy en día el mejor examen para caracterizar esta lesión. Es una lesión benigna, sin recidivas reportadas cuando la resección ha sido completa.

Introduction: Dermoid cysts are uncommon lesions from ectodermic origin. Only 1.6% arise in the floor of the mouth, and at this site only 6% arise laterally in the submandibular region. Aim: Case report and review of the literature. Clinical Case: 32 years old patient, with a slow growing lesion during 1 year. Complete resection with an ipisilateral submandibulectomy was performed. The pathologic report showed a dermoid cyst. Discussion: The localization of this lesion is very uncommon. In the pathologic report are lesion with pluri stratified cornified epthitelium with skin attachments. Image studies show a cystic lesion being the magnetic resonance the best study to characterize this lesions. Are benign lesions, without recurrence reported when the lesion has been fully excised.

Anterior operculum syndrome.

The anterior operculum syndrome (AOS) is a well-defined clinical entity that has received little attention in the English literature. We report the clinical and CT findings in 3 cases of AOS; 2 were caused by bilateral cerebral infarctions secondary to bilateral internal carotid occlusion and 1 by the residual effects of viral encephalitis. Although there was variability in the range of deficits found in our cases, each of these patients presented with characteristic facio-pharyngo-glosso-masticatory diplegia with a dramatic automatic-voluntary movement dissociation. This syndrome deserves attention for its characteristic anatomic and prognostic implications.

ACE I/D gene polymorphism: presence of the ACE D allele increases the risk of coronary artery disease in younger individuals.

BACKGROUND: Presence of the D allele or homozygosity for the deletion (D) allele of the ACE insertion/deletion (I/D) polymorphism has been discussed as potent risk factor for coronary artery disease (CAD) and myocardial infarction (MI). METHODS AND RESULTS: In 2267 male Caucasians the relation of the ACE I/D gene polymorphism to CAD and MI were investigated. An association of the D allele to CAD was detected in younger subjects (e.g. < 61.7 years, mean value), but not in older patients (e.g. > or = 61.7 years). Additional exclusion of individuals with other cardiovascular risk factors (e.g. high BMI) produced an even stronger association of the D allele to CAD. In contrast, a relation of this polymorphism to non-fatal MI was only observed in older subjects; additional limitation to individuals without cardiovascular risk factors (e.g. BMI and/or diabetes) yielded a further enhancement of this association to MI. In younger subjects (e.g. < 61.7 years) the gene polymorphism was not related to non-fatal MI even after exclusion of additional risk factors. CONCLUSIONS: The present large case-control study strengthens the assumption of an association of the ACE D allele with the risk of ischemic heart disease.

Association of the platelet glycoprotein IIIa PlA1/A2 gene polymorphism to coronary artery disease but not to nonfatal myocardial infarction in low risk patients.

BACKGROUND: The platelet membrane glycoprotein IIb/IIIa functions as a receptor for fibrinogen and von Willebrand factor during platelet aggregation. In a small case-control study, evidence has been presented that the PlA2 allele of the platelet glycoprotein GPIIIa PlA/A2 gene polymorphism might be an independent risk factor for acute myocardial infarction (MI). METHODS AND RESULTS: We explored the association of the PlA1A2 to the severity of coronary artery disease (CAD), as assessed angiographically in 2252 male individuals, and to myocardial infarction (MI). The severity of coronary heart disease (CHD) was also estimated by calculating a CHD score according to Gensini. The PlA genotype was determined by allele specific restriction digestion. Relation of the PlA2 allele to CAD: In the total population, the frequency of the PlA2 allele was not associated to the presence or to the extent of CAD. Also the CHD scores of PlA1/PlA2 genotypes were essentially the same. However, after exclusion of individuals with high BMI (> or =26.9 kg/m2) and/or low apoAI (< 1.43 g/l) PlA2PlA2 carriers had clearly higher CHD scores than PlA1PlA1 genotypes: PlA1PlA2 heterozygotes had intermediate values (p <0.05). After division of the study population into one group of individuals without any angiographic signs of CAD (CHD score = 0) and into another group of patients with severe CAD (CHD score (> or = 120), a strong association of the PlA2 allele with severe CAD was also found in the same low risk groups: e.g. exclusion of persons with high BMI and low apoAI resulted in an Odds ratio of 5.37 (1.46-19.7) (p <0.02). Relation of the PlA2 allele to MI: No association was found between PlA1/PlA2 genotypes and risk of MI neither in the total population nor in low risk subgroups. CONCLUSIONS: Whereas no difference in the distribution of allele and genotype frequencies between controls and survivors of MI could be detected, the PlA2 allele is associated with CHD in low risk patients.

Interaction of hemocytes and prophenoloxidase system of fifth instar nymphs of Acheta domesticus with bacteria.

The hemocytes to which bacteria adhere were defined and the contribution of the prophenoloxidase system of fifth instar nymphs of Acheta domesticus to adhesion were examined. The physicochemical parameters affecting hemocyte and phenoloxidase activity were determined. Both plasmatocytes and granular cells responded to bacteria, the latter cells entrapping the microorganisms on filopodial extensions. The optimum pH for hemocyte adhesion to glass slides was 6.5, the granular cells being the most sensitive hemocyte type. Although hydrophobic resin beads and positively-charged beads favoured hemocyte attachment, these parameters did not contribute to differential bacterial adhesion to hemocytes. Activation of phenoloxidase was neither enhanced nor inhibited by 0.1 and 1 mg/ml of laminarin or zymosan nor by dead Bacillus subtilis. However, live B. subtilis activated the enzyme and dead Xenorhabdus nematophilus inhibited enzyme activation. Serine protease components of the prophenoloxidase system had opsonic properties for B. subtilis but not for X. nematophilus. Phenoloxidase activity was enhanced by Ca(2+) and Mg(2+) and inhibited by SO(2-)(4).

A longitudinal study of the psychosocial impact of stroke on primary support persons.

We investigated longitudinally the effects of a stroke on the social support systems and well-being of the patient's primary support person, both acutely and as the condition stabilized. Individuals who had suffered a first stroke and a primary support person participated in two waves of data collection, carried out in 6-month intervals beginning 7 weeks after the stroke. Our data show that the prevalence of depressive symptoms is from 2 1/2 to 3 1/2 times higher than rates found among representative samples of middle-aged and elderly populations. Mean level of depression did not change over time, although level of optimism declined significantly. Multiple regression analyses showed that levels of depression and perceived burden in support persons are highly related to aspects of the stroke such as its severity, and that demographic variables such as age and income play a relatively minor role in attenuating these relations in the acute adjustment phase. However, from 7 to 9 months after the stroke, well-established demographic variables such as health, income, and age were significant predictors of depression. Individuals who were older and who had good health and higher incomes were least depressed.

Oviposition attraction and repellency of Aedes aegypti (Diptera: Culicidae) to waters from conspecific larvae subjected to crowding, confinement, starvation, or infection.

As the biomass of Aedes aegypti (L.) larvae increased in relation to the volume of rearing waters, oviposition attraction of these waters to conspecific, gravid females first rose to a peak and then declined. Further increases in biomass rendered waters strongly repellent. Comparable responses were elicited by a decrease in the volume of rearing waters or an increase in the relative size or number of mosquito larvae. Low volumes of water reduced oviposition attraction and increased repellency, whereas larger volumes increased attraction. Excessively large volumes diluted attraction to neutrality. Constraints imposed by the physical dimensions of the larval environment which interfered with the normal postural movements and behaviors of the larvae also induced repellency, independent of rearing volume. Titration of repellent waters revealed that infection with the digenean Plagiorchis elegans (Rudolphi) generated the most powerful repellent effect, whereas crowding or starvation induced significantly weaker responses. At no time did dilution of repellent waters restore attractive properties. Repellents, even at minute concentrations, overrode attractants. The density-dependent action of oviposition attractants and repellents may help to maintain larval populations near optimal levels through their influence on recruitment. Oviposition repellency induced by sublethal infections with P. elegans may maintain population levels below the carrying capacity of the environment. Persistence of oviposition attraction and repellency varied inversely with temperature. The magnitude of the repellent effect induced by larvae appears to be a good indicator of their probability of survival and may be of selective significance. Repellency may deflect ovipositing females away from sites close to human habitation and may lead to new, and perhaps more effective, method, to control mosquitoes and the diseases they transmit.

Serum composition of Aedes aegypti (Diptera: Culicidae) larvae and the production of an oviposition repellent are influenced by infection with the entomopathogenic digenean Plagiorchis elegans (Trematoda: Plagiorchiidae), starvation, and crowding.

Subjecting Aedes aegypti (L.) larvae to conditions that induced the production of oviposition repellency also reduced their wet and dry weights and the concentration of total serum carbohydrates, amino acids, and proteins. Thus, infection with metacercariae of the entomopathogenic digenean Plagiorchis elegans (Rudolphi), starvation for 7 d, or crowding for 2 d reduced larval dry weights by as much as 32, 20, and 23%, respectively, and wet weights by 20, 14, and 11%, respectively. Total serum carbohydrates declined by as much as 36, 21, and 29% for infected, starved, and crowded larvae, respectively, amino acids by 39, 48, and 44%, and protein concentrations by 72, 63, and 62%, respectively. Repellency dilution titers were correlated inversely with movement of the mouth parts and gut. Incubation of infected, starved, and crowded larvae in 0.01 g/liter glucose greatly reduced the level of repellency of their waters, whereas adding glucose to repellent waters had only minor effects. Results indicate that the induction of repellency is associated strongly with nutritional depletion effects.

Oviposition responses of Aedes aegypti and Ae. atropalpus (Diptera: Culicidae) females to waters from conspecific and heterospecific normal larvae and from larvae infected with Plagiorchis elegans (Trematoda: Plagiorchiidae).

Ovipositing Aedes aegypti (L.) females were attracted to waters in which uninfected Aedes atropalpus (Coquillett) larvae had been reared, but were repelled by waters from larvae of either species infected with the entomopathogenic digenean Plagiorchis elegans (Rudolphi). In contrast, Ae. atropalpus females were attracted to or repelled by waters from conspecific uninfected and infected larvae, respectively, but did not respond to corresponding waters from Ae. aegypti larvae. The sensitivity of ovipositing females of both species to repellents and attractants is discussed in terms of possible selective pressures exerted by unstable breeding environments.

Effects of Plagiorchis elegans (Trematoda: Plagiorchiidae) infection on the carbohydrate metabolism of fourth instar Aedes aegypti (Diptera: Culicidae).

Infection of fourth-instar Aedes aegypti (L.) with the entomopathogenic digenean Plagiorchis elegans (Rudolphi) alters the carbohydrate metabolism of the insect. Within 24 h of cercarial penetration, total body extracts of infected fourth instars exhibited decreased trehalase activity, increased trehalose-6-phosphatase activity, and a concomitant accumulation of trehalose when compared with uninfected larvae. The amounts of glucose, glycogen and lipids, and the activity of glycogen phosphorylase a were similar in extracts of infected and control larvae. The predominant fatty acids, in both control and infected larvae, were C 18:0, C 18:1, and C 18:3. There were no significant differences in the types or proportions of fatty acids found in control and infected larvae. Parasitic infection is discussed in terms of impaired trehalose metabolism.

Transcranial Doppler sonography as a supplement in the detection of cerebral circulatory arrest.

The effects of compromised cerebral hemodynamics on intracranial blood flow velocity patterns (BFV) were studied by noninvasive transcranial Doppler sonography (TCD). Pulsatility index (PI) as an estimation of peripheral cerebral vascular resistance was additionally analyzed. TCD patterns were determined in 19 mechanically ventilated brain dead patients (group A) and 8 resuscitated or severely head injured patients (group B) with intermittent elevated intracranial pressure (ICP). Group A and B TCD data were compared to control measurements obtained in 20 healthy volunteers (group C). Normal TCD recordings (group C) were characterized by anterograde Doppler wave-forms with a predominantly high diastolic flow pattern and PI values of <1. In brain dead patients (group A), flow velocity profiles were significantly decreased. The flow curve consisted of low systolic anterograde spikes, while early diastolic flow components of low amplitudes revealed retrograde phases with a late diastolic zero flow. In some cases, total diastolic circulatory arrest was obtained. PI in brain dead patients was increased by a factor of 10 and was infinite in situations of zero net flow. The low systolic spikes and retrograde diastolic flow may be explained by the effects of reduced intracranial compliance due to increased intracranial pressure (ICP). The detection of bidirectional signals, indicating anterograde and retrograde movements of the blood column or low systolic spikes without diastolic signals, seems to be specific for the condition of brain death. Insonation of the basilar artery should be performed in order to exclude preserved perfusion of infratentorial brain regions during supratentorial circulatory arrest and vice versa. In group B patients, episodes of increased ICP predominantly affected the diastolic flow velocity component. In these patients, resistive Doppler signals with normal or reduced systolic peaks and decreased diastolic flow velocities were expressed as increases in PI. Noninvasive transcranial Doppler sonography appears to confirm cerebral circulatory arrest. Additionally, TCD may be of value for the early detection of impaired cerebral hemodynamics due to changes in intracranial compliance.