Variantes en la presentación clínica de la enfermedad por arañazo de gato en niños del hospital Garrahan / Variants in the clinical presentation of cat scratch disease in children at Garrahan Hospital

La infección por Bartonella henselae (BH) adopta diversas formas de presentación clínica en pediatría. Según la bibliografía la forma de presentación más frecuente en pacientes inmunocompetentes es la linfadenopatía única asociada a fiebre. En el 85 % de los casos se compromete un solo ganglio siendo los axilares y los epitrocleares los más frecuentemente involucrados. Existen otras formas de presentación menos frecuentes que debemos tener en consideración, para poder realizar un diagnóstico precoz e indicar un tratamiento adecuado si así lo requiere. El diagnóstico requiere de la sospecha clínica del equipo de salud tratante, junto al antecedente epidemiológico, los hallazgos clínicos del examen físico y la realización de serologías que incluyan el dosaje de inmunoglobulina M y G. Los objetivos del presente trabajo fueron reconocer las manifestaciones clínicas típicas y atípicas de la EAG por Bartonella henselae, describir la epidemiología, características clínicas y evolución de esta enfermedad que se presentaron en nuestro hospital. Se estudiaron un total de 187 pacientes. La media de edad fue de 7.6 años (rango 1-14); siendo 53.5% de género masculino. Las formas de presentación más frecuentes en nuestro trabajo fueron la adenitis y la fiebre. La mayoría recibió diversos esquemas de tratamiento antibiótico, secundario al retraso en el diagnóstico. La tasa de hospitalización fue muy baja, remitió con tratamiento ambulatorio con antibióticos o sin ellos (AU)

Bartonella henselae infection has different clinical presentations in pediatrics. According to the literature, the most common form of presentation in immunocompetent patients is single lymphadenopathy associated with fever. In 85 % of the cases a single lymph node is involved, with the axillary and epitrochlear nodes being the most commonly involved. There are other, less frequent, forms of presentation that should be taken into consideration in order to make an early diagnosis and indicate appropriate treatment if required. Diagnosis relies on clinical suspicion by the treating healthcare team, together with the epidemiological history, clinical findings on physical examination, and serology including immunoglobulin M and G dosage. The objectives of this study were to identify both the typical and atypical clinical manifestations of Bartonella henselae cat scratch disease, to describe the epidemiology, clinical characteristics, and outcomes of cases presenting at our hospital. A total of 187 patients were studied. The mean age was 7.6 years (range 1-14); 53.5% were male. The most frequent forms of presentation in our study were adenitis and fever. Most of them received different antibiotic treatment regimens due to delayed diagnosis. The hospitalization rate was very low and the disease typically resolved with outpatient treatment, with or without antibiotics (AU)

Ovarian cancer prevention by opportunistic salpingectomy is a new de facto standard in Germany.

PURPOSE: The most prevalent and aggressive subtype of epithelial ovarian carcinoma (EOC), high-grade serous carcinoma (HGSC), originates in many cases from the fallopian tubes. Because of poor prognosis and lack of effective screening for early detection, opportunistic salpingectomy (OS) for prevention of EOC is being implemented into clinical routine in several countries worldwide. Taking the opportunity of a gynecological surgery in women at average cancer risk, extramural fallopian tubes are completely resected preserving the ovaries with their infundibulopelvic blood supply. Until recently, only 13 of the 130 national partner societies of the International Federation of Obstetrics and Gynecology (FIGO) have published a statement on OS. This study aimed to analyze the acceptance of OS in Germany. METHODS: (1) Survey of German gynecologists in 2015 and 2022 by the Department of Gynecology of the Jena University Hospital in co-operation with the Department of Gynecology at Charité-University Medicine Berlin with support of NOGGO e. V. and AGO e. V. (2) Salpingectomy numbers in Germany for years 2005-2020 as retrieved from the Federal Statistical Office of Germany (Destatis). RESULTS: (1) Survey: Number of participants was 203 in 2015 and 166 in 2022, respectively. Nearly all respondents (2015: 92%, 2022: 98%) have already performed bilateral salpingectomy without oophorectomy in combination with benign hysterectomy with the intention to reduce the risk for malignant (2015: 96%, 2022: 97%) and benign (2015: 47%, 2022: 38%) disorders. Compared to 2015 (56.6%), considerably more survey participants performed OS in > 50% or in all cases in 2022 (89.0%). Recommendation of OS for all women with completed family planning at benign pelvic surgery was approved by 68% in 2015 and 74% in 2022. (2) Case number analysis: In 2020, four times more cases of salpingectomy were reported by German public hospitals compared to 2005 (n = 50,398 vs. n = 12,286). Of all inpatient hysterectomies in German hospitals in 2020, 45% were combined with salpingectomy, and more than 65% in women at the age of 35 to 49 years. CONCLUSION: Mounting scientific plausibility regarding involvement of fallopian tubes in the pathogenesis of EOC led to change of clinical acceptance of OS in many countries including in Germany. Case number data and widespread expert judgment demonstrate that OS has become a routine procedure in Germany and a de facto standard for primary prevention of EOC.

Novel KEL allele associated with loss of Kpb identified in a white blood donor.

The importance of identifying variant alleles among blood donors is significant to the safety of transfusion for recipients. Molecular methods have become more prominent in the routine process of antigen typing donor units. Some variant antigens cannot be detected using only serologic methods. Molecular testing allows the determination of nucleotide sequences that are used to predict a phenotype. Antigens of the Kell blood group system are known for being highly immunogenic and causing adverse reactions upon antibody formation. A female white blood donor who typed Kp(b-) using serologic methods on multiple donations since 2005 was the subject of a typing discrepancy investigation. Routine genotyping using a commercial genotyping kit (HemoID DQS Panel; Agena Bioscience, San Diego, CA) predicted the donor to type Kp(a+b+). Investigation of the discrepancy between these two results identified a rare single nucleotide variant in the KEL gene at nucleotide position c.948G>T that alters amino acid residue 316 from tryptophan (Trp) to cysteine (Cys). After discovery of the novel allele, adsorption and elution studies were performed to see if there was weakened Kpb expression. The elution studies yielded negative results, which indicated that Kpb is not expressed. The KEL transcripts expressed by the donor were determined using cDNA analysis, and the predicted amino acid sequence of the novel allele was modeled to investigate the impact of the amino acid sequence on the structure of the KEL polypeptide. Both SWISS-MODEL and Robetta software were used to evaluate the impact of the p.Trp316Cys on the three-dimensional protein structure. There was no conformational change noted with SWISS-MODEL, whereas the Robetta software showed a significant conformational change compared with the normal Kp(b+) reference sequence. Because the donor is homozygous for variants associated with k and Jsb expression, it was not possible to determine whether the novel allele is associated with loss of Kpb only or loss of all Kell antigens.

Development of anti-Jk3 associated with silenced Kidd antigen expression and a novel single nucleotide variant of the JK gene.

Anti-Jk3 is a rare alloantibody to a high-prevalence antigen primarily seen in individuals of Polynesian descent and is associated with a handful of well-established variants of the SLC14A1 gene. We report a case of the Jknull phenotype, associated with formation of anti-Jk3, in a patient of non-Polynesian descent. This patient, a 51-year-old woman self-described as of Jamaican and Scottish ancestry, presented to our hospital for oncologic care. The patient's blood sample typed as blood group A, D+. All screening and panel reagent red blood cells showed reactivity, ranging from 2 to 4+; autocontrol and direct antiglobulin test were both negative. Antigen phenotyping revealed Jk(a-b-), leading to suspicion for anti-Jk3, which was subsequently confirmed by our immunohematology reference laboratory. Given her reported familial background, testing of the SLC14A1 gene was performed, revealing that the patient was heterozygous for the single nucleotide variant (SNV) at c.838G>A in exon 8 and therefore carries both JK*01 and JK*02 alleles that encode Jka and Jkb, respectively. However, the patient was found to be heterozygous for several additional SNVs: c.28G>A in exon 3; c.191G>A, c.226G>A, and c.303G>A in exon 4; and c.757T>C in exon 7. The patient's Jk(b-) phenotype can be explained by coinheritance of c.838A with c.191G>A, which defines null allele JK*02N.09. Coinheritance of SNVs c.28G>A and c.838G with rare SNV c.757C that is predicted to cause a non-conservative amino acid change (p.S253P) likely accounts for the complete serologic absence of Jka and the ability to form anti-Jk3 in this case. This finding would represent a new JK*01 null allele. This evaluation illustrates the importance of genetic analysis in identifying the factors preventing a high-prevalence antigen from being expressed, particularly when discovered outside of an expected racial or ethnic group.Anti-Jk3 is a rare alloantibody to a high-prevalence antigen primarily seen in individuals of Polynesian descent and is associated with a handful of well-established variants of the SLC14A1 gene. We report a case of the Jknull phenotype, associated with formation of anti-Jk3, in a patient of non-Polynesian descent. This patient, a 51-year-old woman self-described as of Jamaican and Scottish ancestry, presented to our hospital for oncologic care. The patient's blood sample typed as blood group A, D+. All screening and panel reagent red blood cells showed reactivity, ranging from 2 to 4+; autocontrol and direct antiglobulin test were both negative. Antigen phenotyping revealed Jk(a­b­), leading to suspicion for anti-Jk3, which was subsequently confirmed by our immunohematology reference laboratory. Given her reported familial background, testing of the SLC14A1 gene was performed, revealing that the patient was heterozygous for the single nucleotide variant (SNV) at c.838G>A in exon 8 and therefore carries both JK*01 and JK*02 alleles that encode Jka and Jkb, respectively. However, the patient was found to be heterozygous for several additional SNVs: c.28G>A in exon 3; c.191G>A, c.226G>A, and c.303G>A in exon 4; and c.757T>C in exon 7. The patient's Jk(b­) phenotype can be explained by coinheritance of c.838A with c.191G>A, which defines null allele JK*02N.09. Coinheritance of SNVs c.28G>A and c.838G with rare SNV c.757C that is predicted to cause a non-conservative amino acid change (p.S253P) likely accounts for the complete serologic absence of Jka and the ability to form anti-Jk3 in this case. This finding would represent a new JK*01 null allele. This evaluation illustrates the importance of genetic analysis in identifying the factors preventing a high-prevalence antigen from being expressed, particularly when discovered outside of an expected racial or ethnic group.

Influence of migrant background on patient preference and expectations in breast and gynecological malignancies (NOGGO-expression V study): results of a prospective multicentre study in 606 patients in Germany.

BACKGROUND: An effective cross-cultural doctor-patient communication is vital for health literacy and patient compliance. Building a good relationship with medical staff is also relevant for the treatment decision-making process for cancer patients. Studies about the role of a specific migrant background regarding patient preferences and expectations are lacking. We therefore conducted a multicentre prospective survey to explore the needs and preferences of patients with a migrant background (PMB) suffering from gynecological malignancies and breast cancer to evaluate the quality of doctor-patient communication and cancer management compared to non-migrants (NM). METHODS: This multicentre survey recruited patients with primary or recurrence of breast, ovarian, peritoneal, or fallopian tube cancer. The patients either filled out a paper form, participated via an online survey, or were interviewed by trained staff. A 58-item questionnaire was primarily developed in German and then translated into three different languages to reach non-German-speaking patients. RESULTS: A total of 606 patients were included in the study: 54.1% (328) were interviewed directly, 9.1% (55) participated via an online survey, and 36.8% (223) used the paper print version. More than one quarter, 27.4% (166) of the participants, had a migrant background. The majority of migrants and NM were highly satisfied with the communication with their doctors. First-generation migrants (FGM) and patients with breast cancer were less often informed about participation in clinical trials (p < 0.05) and 24.5% of them suggested the help of an interpreter to improve the medical consultation. Second and third-generation migrants (SGM and TGM) experienced more fatigue and nausea than expected. CONCLUSIONS: Our results allow the hypothesis that training medical staff in intercultural competence and using disease-related patient information in different languages can improve best supportive care management and quality of life in cancer patients with migrant status.

Rift Valley fever virus detection in susceptible hosts with special emphasis in insects.

Rift Valley fever phlebovirus (RVFV, Phenuiviridae) is an emerging arbovirus that can cause potentially fatal disease in many host species including ruminants and humans. Thus, tools to detect this pathogen within tissue samples from routine diagnostic investigations or for research purposes are of major interest. This study compares the immunohistological usefulness of several mono- and polyclonal antibodies against RVFV epitopes in tissue samples derived from natural hosts of epidemiologic importance (sheep), potentially virus transmitting insect species (Culex quinquefasciatus, Aedes aegypti) as well as scientific infection models (mouse, Drosophila melanogaster, C6/36 cell pellet). While the nucleoprotein was the epitope most prominently detected in mammal and mosquito tissue samples, fruit fly tissues showed expression of glycoproteins only. Antibodies against non-structural proteins exhibited single cell reactions in salivary glands of mosquitoes and the C6/36 cell pellet. However, as single antibodies exhibited a cross reactivity of varying degree in non-infected specimens, a careful interpretation of positive reactions and consideration of adequate controls remains of critical importance. The results suggest that primary antibodies directed against viral nucleoproteins and glycoproteins can facilitate RVFV detection in mammals and insects, respectively, and therefore will allow RVFV detection for diagnostic and research purposes.

In-hospital professional production of patient-specific 3D-printed devices for hand and wrist rehabilitation.

The reported use of 3D printing in hand and wrist rehabilitation has been mostly limited to feasibility studies and case series so far. Some of the reasons are the lack of purpose-built scanning applications, complicated digital design software, and lengthy and error-prone printing processes. We propose a multidisciplinary workflow for in-hospital mass production of patient-specific 3D-printed devices for hand and wrist rehabilitation.

Two small, cysteine-rich and cationic antifungal proteins from Penicillium chrysogenum: A comparative study of PAF and PAFB.

The filamentous fungus Penicillium chrysogenum Q176 secretes the antimicrobial proteins (AMPs) PAF and PAFB, which share a compact disulfide-bond mediated, ß-fold structure rendering them highly stable. These two AMPs effectively inhibit the growth of human pathogenic fungi in micromolar concentrations and exhibit antiviral potential without causing cytotoxic effects on mammalian cells in vitro and in vivo. The antifungal mechanism of action of both AMPs is closely linked to - but not solely dependent on - the lipid composition of the fungal cell membrane and requires a strictly regulated protein uptake into the cell, indicating that PAF and PAFB are not canonical membrane active proteins. Variations in their antifungal spectrum and their killing dynamics point towards a divergent mode of action related to their physicochemical properties and surface charge distribution. In this review, we relate characteristic features of PAF and PAFB to the current knowledge about other AMPs of different sources. In addition, we present original data that have never been published before to substantiate our assumptions and provide evidences that help to explain and understand better the mechanistic function of PAF and PAFB. Finally, we underline the promising potential of PAF and PAFB as future antifungal therapeutics.

Clinical and radiological midterm outcome after treatment of pilonoidal fracture dislocations of the proximal interphalangeal joint with a parabolic dynamic external fixator.

INTRODUCTION: Several methods treating proximal interphalangeal joint (PIP) fracture dislocations have been established providing early joint mobilization. The aim of this study was to evaluate the clinical and radiological outcome of unstable fracture dislocations of the PIP treated with a parabolic dynamic external fixator consisting of two Kirschner (K)-wires. MATERIALS AND METHODS: Twenty-one patients who sustained a pilonoidal fracture of the PIP joint and were treated with a dynamic external fixator were evaluated retrospectively. The active range of motion, pain level, DASH score, Buck Gramcko Score, and the patient's satisfaction and acceptance were assessed. X-ray images were evaluated for bone healing, joint alignment, and signs of osteoarthritis. RESULTS: Mean PIP joint range of motion was 76°. Patients showed very mild discomfort (mean 0.7), high patient satisfaction (mean 1.9), and a moderate acceptance (mean 2.7). The mean DASH score was 11.6 and the Buck Gramcko score 13. All patients showed bone healing. One patient suffered from a recurrent dislocation, and another a subluxation of the PIP joint while wearing the fixator. Both joints could be corrected by modifying the fixator under image intensifier. Twenty patients (95%) showed a concentric and stable aligned joint. Three patients showed an osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 according to the Kellgran-Lawrence Score. CONCLUSION: The use of a parabolic dynamic external fixator constructed from two K-wires restores joint alignment and stability in unstable pilonoidal PIP joint disclocation fractures. It allows immediate PIP joint mobilization to avoid adhesions. Modifications of the radius of the parabolic construct within cases of postoperative malalignment, without anesthesia, can restore joint axis and malalignment. This fixator is a cost-effective alternative, showing a good clinical outcome.

Light-induced sexually active rams prevent the seasonal inhibition of luteinizing-hormone in ovariectomized estradiol-implanted ewes.

The effect of the continuous presence of sexually active Rasa Aragonesa rams on the plasma luteinizing-hormone (LH) concentrations of ewes was studied from November to May. Light-treated rams were rendered sexually active (SA rams) by exposure to 2 months of artificially long days (16 h light/8 h dark) in one of two groups from either 1 November (SAR1, n = 3) or 1 December (SAR2, n = 3). Rams (n = 6) in a Control group were kept under the natural photoperiod. Thirty ewes were ovariectomized in September and implanted with a subcutaneous implant (l = 15 mm) that contained estradiol-17ß. One group of ewes (SAR; n = 10) was housed with control rams from 1 October to 15 February before being housed with SAR1 rams from 16 February to 31 March, and with SAR2 rams from 1 April to 31 May. A second group of ewes (C; n = 10) remained with control rams throughout the experiment, and a third group was kept isolated from rams throughout the experiment (ISO; n = 10). Blood samples were collected weekly from November to May, and plasma LH concentrations were measured. In the breeding season (November-February), plasma LH concentrations of ewes did not differ significantly between groups (SAR: 2.00 ±â€¯0.34; C: 1.88 ±â€¯0.16; ISO: 1.67 ±â€¯0.51 ng/ml). From March to May (seasonal anestrus), however, LH plasma concentrations decreased in the C and ISO groups (1.30 ±â€¯0.20 and 0.48 ±â€¯0.04 ng/ml, respectively), but remained at the same level as in the breeding season in the SAR group (2.30 ±â€¯0.17 ng/ml; P < 0.001). Significant differences (P < 0.01) between groups were observed from March onwards: LH concentrations were highest in SAR ewes (P < 0.001) and lowest in the ISO ewes. In conclusion, the continuous presence of sexually active rams prevented the seasonal decrease in plasma LH concentrations, probably by preventing the seasonal negative feedback of estradiol on LH secretion.

A GCIG international survey: clinical practice patterns of sentinel lymph node biopsies in cervical cancer.

PURPOSE: To evaluate the practice patterns among centers and physicians worldwide regarding sentinel lymph node biopsies (SLNB) in cervical cancer (CC) patients. METHOD: A validated 35-item questionnaire regarding SLNB in CC supported by the Gynecologic Cancer Intergroup (GCIG), and sponsored by the North-Eastern German Society of Gynaecologic-Oncology (NOGGO) was sent to all major gynecological cancer societies across the globe for further distribution from October 2015 and continued for a period of 7 months. RESULTS: One hundred and sixty-one institutions from around the world participated. One hundred and six (66%) of the participants were from university centers and 111 (69%) were gynecologic oncologists. One hundred and fifty-two (97%) performed lymphadenectomy (LNE) and 147 (94%) did so systematically; 97 (60%) used SLNB, due to lower morbidity (73%), reliability (55%) and time-saving (27%). In cases of positive SLNB (pN+), 39% of respondents stopped the operation and sent the patient for chemoradiation (CRT), 45% completed pelvic and paraaortic LNE, whereas 26% went on to perform a radical hysterectomy (RH) and systematic pelvic and paraaortic LNE. In case of negative SLNB (pN0), 39% of institutions still performed a systematic pelvic and paraaortic LNE. CONCLUSION: In this survey worldwide, SLNB adoption is an encouraging 60%, yet ample differences exist regarding strategy, and to a lower extent the techniques used. Lack of experience is the most common reason SLNB is not performed. Efforts to increase surgical education on SLNB technique and multicenter prospective trials providing evidence-based guidelines are warranted.

Patients' perspectives towards malignant ascites: results of a prospective observational trial regarding expectations, characteristics and quality of life-a study of the North-Eastern-German Society of Gynecological Oncology.

PURPOSE: Malignant ascites (MA) is a frequent and common symptom in (gyneco-) oncological patients. The present trial evaluated and assessed patients' characteristics, clinical features and the possible influence of MA on QoL measurements. METHODS: A prospective observational trial was conducted from Oct 2013 until Nov 2016. Therefore an interdisciplinary questionnaire was developed. Overall 250 patients with histological confirmed MA were included with different cancer entities (gynecological, gastrointestinal). The correlation of MA caused symptoms and QoL measurements was assessed using Kendall's tau b. Multivariable logistic regression models were applied to analyze the risks of symptoms or severe limitation in daily activities. RESULTS: 125 questionnaires could be analyzed. The majority of patients with MA had diagnosis of ovarian cancer (68.8%) and were under current cancer treatment (57.6%), mostly chemotherapy. Over 50% reported abdominal tension as major symptom, around 56% of the patients had MA when cancer was firstly diagnosed. Regression analysis showed that patients with MA above 2l were significantly more likely to be harmed in everyday activities. However, the age, gender, type of malignancy and the current treatment (chemotherapy vs. no chemotherapy) had no significant influence. CONCLUSION: MA has a significantly impact on QoL measurements in cancer patients and might influence everyday activities including basic needs like eating, walking and body care. There is a high need for more information and education of patients with MA.

Progesterone doses of 5, 3 or 1 mg do not prevent short ovulatory cycles in goats exposed to photo-stimulated bucks.

The aim of this study was to determine whether lower doses than 25 mg of progesterone reduce the frequency of short ovulatory cycles in seasonal anestrous goats exposed to sexually active bucks. Females from the control group were given an im dose of 2 mL olive oil (n = 9). Females from the experimental groups were given an im dose of 1 mg (n = 15), 3 mg (n = 16), 5 mg (n = 15) or 25 mg (n = 16) of progesterone diluted in 2 mL olive oil, 48 h prior exposition to bucks (n = 1 per group). Males were daily switched among groups, and they remained with goats during 21 days. The proportion of goats that ovulated was high (≥87%), and was not different among groups (P > 0.05). In contrast, the proportion of goats that displayed short ovulatory cycles differed among groups (P < 0.05). Indeed, the proportion of goats displaying short ovulatory cycles was lower in those treated with 25 mg (12%) than in those from the control (78%), 1 mg (85%), 3 mg (50%), or 5 mg (71%) groups (P < 0.05), but there were no differences among these last four groups (P > 0.05). Finally, the percentage of kidding females (≥40%) and the number of kids born per female (≥1.4) did not differ among groups (P > 0.05). In conclusion, an im dose of 25 mg of progesterone was more effective than 5, 3 or 1 mg to avoid the short ovulatory cycles in seasonal anestrous goats exposed to the male effect.

Photochromic peptidic NPY Y4 receptor ligands.

The neuropeptide Y (NPY) Y4 receptor is a G protein coupled receptor, which is targeted by pancreatic polypeptide, a homologue of NPY. Selective Y4R agonists were suggested as potential therapeutics for the treatment of obesity. Highly potent dimeric peptidic Y4R agonists, constituting two pentapeptide moieties connected through an aliphatic linker, represent an interesting class of Y4R ligands. Based on this compound class, photoresponsive Y4R ligands, containing an azobenzene, azopyrazole, diethienylethene or a fulgimide chromophore were prepared to explore structural requirements of such Y4R agonists on Y4R binding. The synthesized Y4R ligands, containing a non-aliphatic rigid photochromic linker, switch reversibly in aqueous buffer and exhibited high Y4R affinity throughout. This demonstrated that the replacement of the highly flexible aliphatic linker by a considerably less flexible photochromic linker was well tolerated with respect to Y4R binding. Differences in Y4R affinity and activity between the individual photoisomers (varying in spatial orientation and flexibility) were marginal suggesting that the linking element in the dimeric ligands is less critical for the adaptation of high-affinity binding modes at the receptor.

The reproductive response to the male effect of 7- or 10-month-old female goats is improved when photostimulated males are used.

The exposure of adult, female, Mediterranean goats during anoestrus to males with induced sexual activity via photostimulation, induces a very high percentage of ovulations. The present work examines the ability of photostimulated bucks to improve the male effect-induced reproductive response of young does over that induced by non-stimulated bucks. A 2×2 factorial experiment was designed, consisting of doe age and buck photoperiod treatments. During seasonal anoestrus, 41 does aged 7 (n=19) or 10 (n=22) months were subjected to the male effect on 10 April; half of each group was exposed to males rendered sexually active by prior exposure to 3 months of long days (16 h of light/day) from 31 October (PHOTO bucks), and half to males maintained under the natural photoperiod (CONTROL bucks). Oestrous activity was recorded daily by direct visual observation of the marks left by male-worn marking harnesses over the 32 days following the bringing of the sexes together (introduction). Doe body weight and body condition were determined weekly. Ovulation was detected by measuring plasma progesterone concentrations twice per week over the 3 weeks after introduction. The ovulation rate was assessed by transrectal ultrasonography. Fecundity, fertility, prolificacy and productivity were also determined. The interaction doe age × buck photoperiod treatment had no effect on any outcome. The percentage of females showing ovulation or oestrus was higher in the does exposed to PHOTO bucks (85% v. 43% for those exposed to CONTROL bucks) they also showed higher fertility (75% v. 43%) and productivity (1.05±0.17 v. 0.57±0.16 kids born per doe serviced) (all P values at least P<0.05). The 10-month-old group showed higher percentage of females showing ovulation, oestrus, fertility and productivity than the 7-month-old does after the male effect (females showing ovulation: 82% v. 42%; showing oestrus: 73% v. 42%; fertility: 73% v. 42% and productivity: 1.09±0.17 v. 0.47±0.14 goat kids born per doe serviced; respectively, all P values at least P<0.05). The present results show that the use of photostimulated males improves the reproductive performance of 7- and 10-month-old does, and may contribute towards increasing their productivity and lifetime reproductive performance.

Extensive management conditions do not modify the frequency of short ovulatory cycles in progesterone-treated does exposed to sexually active males.

Most goats exposed to males in confined conditions have short ovulatory cycles. The frequency of these cycles can be reduced with a progesterone treatment prior to the introduction of males. The objective of this study was to determine whether extensive management conditions modify the frequency of short ovulatory cycles in progesterone-treated does exposed to photostimulated males. One group of does remained in extensive management conditions and grazed daily from 10:00 to 18:00 h; two other groups were confined separately in shaded pens, and fed alfalfa hay. In March, females from the grazing group (n = 45; grazing-P4 group) and those from one confined group (n = 45; confined-P4 group) were treated with 25 mg of progesterone by intra-muscular injections 48 h before joining with photostimulated males (n = 3 per group). The other confined group did not receive the progesterone treatment and was exposed to two photostimulated males (n = 25; confined-control group). Does were exposed to males for 45 consecutive days. Determination of whether ovulations occurre were made by quantifying plasma progesterone concentrations after introduction of males. The proportion of does that had ovulations at least once was not different between groups (≥98%; P > 0.05). The proportion of does that had short ovulatory cycles differed between groups (P < 0.001), and this proportion was greater in the confined-control group (76%) than in confined-P4 (27%) and grazing-P4 groups (25%; P < 0.001). It is concluded that extensive management conditions do not modify the frequency of short ovulatory cycles in progesterone-treated does exposed to the photostimulated males.

Effect of probiotic lozenges containing Lactobacillus reuteri on oral wound healing: a pilot study.

It has been suggested that beneficial bacteria may stimulate wound healing. The aim was to investigate the effect of topical applications of probiotic lactobacilli on the healing of standardised oral wounds. This pilot study employed a randomised, placebo-controlled, double-blind cross-over design. Standardised biopsies were punched in the oral mucosa of 10 healthy volunteers, with and without exposure to two strains of Lactobacilli reuteri administrated as lozenges and topical oil. The healing was scored clinically after 2, 5 and 8 days. The amount of exudate was quantified through filter papers and the levels of selected cytokines and chemokines were determined with multiplex immunoassays. Saliva samples were collected before the biopsy and after healing for determination of oxytocin with ELISA. Subjectively perceived pain and discomfort was reported through a daily logbook. There was a clear tendency of improved healing in test group at the 2-and 5-day check-ups but the difference compared with the placebo intervention was not statistically significant (P=0.08). Higher but non-significant expressions of the tumour necrosis factor (TNF) superfamily ligand members 13 (APRIL) and 13B (BAFF), as well as the chemokine interleukin 8 (IL-8), were displayed in wound exudates from the probiotic group as compared with placebo, particularly after 5 and 8 days. The salivary levels of oxytocin were significantly lower (P<0.05) in the placebo group at the 8-day follow-up. The mean number of days with pain and/or discomfort after the biopsies was similar in both groups. No side-effects were reported. The findings of this pilot study justify a larger clinical trial to elucidate the possible role of probiotic supplements on oral wound healing.

[Wide awake hand surgery based on application examples]. / Wide-awake-Technik in der Handchirurgie anhand von Anwendungsbeispielen.

OBJECTIVE: Anesthesiologic method with low bleeding level, risk level, and complication rate for surgical procedures on the hand without a tourniquet on an unsedated patient with the possibility for functional testing during surgery. INDICATIONS: Surgical procedures of the hand can be carried out using the wide awake technique depending on the patient's suitability and preference considering individual risk factors. CONTRAINDICATIONS: Absolute contraindications are allergies to the local anesthetic or its components. Relative contraindications are severe hepatic or renal insufficiency, infections in the injection area, acute circulatory disorders, or higher cardiac function impairment. INJECTION TECHNIQUE: Infiltration of a lidocaine/epinephrine mixture with 8.4% sodium bicarbonate in a ratio of 10:1.5 at least 30 min prior to surgery. Perpendicular puncture of the skin and slow injection. Continue injection until reaching a pale skin area of at least 1 cm around the entire operating area. If the needle tip always remains in a cushion of local anesthetic, a "hole-in-one" anesthesia can be achieved (only the first needle puncture is felt). POSTOPERATIVE MANAGEMENT: Elevated care and awareness for numb body parts by the patient because of impaired sensation. Follow-up treatment according to the surgeon's specifications. Postoperative use of painkillers. RESULTS: Of 38 patients, 32 felt that the procedure was not stressful, 6 rated it as a bit stressful. Pain perception on a visual analog scale (0 = no pain, 10 = severe pain) scored an average of 1.6 during infiltration, 0.5 during the operation, 3.5 during the reduction of the anesthesia, and 2.9 on the following day. All patients would undergo surgery again using the wide awake technique.

Expression III: patients' expectations and preferences regarding physician-patient relationship and clinical management-results of the international NOGGO/ENGOT-ov4-GCIG study in 1830 ovarian cancer patients from European countries.

Backround: The primary aim of this study was to investigate information needs and treatment preferences of patients with ovarian cancer, focusing especially on physician-patient relationship and treatment. Patients and methods: A questionnaire was developed based on the experiences of the national German survey 'Expression II', and was provided to patients with ovarian cancer either at initial diagnosis or with recurrent disease via Internet (online-version) or as print-out-version. Results: From December 2009 to October 2012, a total of 1830 patients with ovarian cancer from eight European countries (Austria, Belgium, France, Germany, Italy, Poland, Romania, Spain) participated, 902 (49.3%) after initial diagnosis and 731 (39.9%) with recurrent ovarian cancer. The median age was 58 years (range 17-89). Nearly all patients (96.2%) had experienced upfront surgery followed by first-line chemotherapy (91.8%). The majority of patients were satisfied with the completeness and comprehensibility of the explanation about the diagnosis and treatment options. The three most important aspects, identified by patients to improve the treatment for ovarian cancer included: 'the therapy should not induce alopecia' (42%), 'there must be more done to counter fatigue' (34.5%) and 'the therapy should be more effective' (29.7%). Out of 659 (36%) patients, who were offered participation in a clinical trial, 476 (26%) were included. Conclusion: This study underlines the high need of patients with ovarian cancer for all details concerning treatment options irrespective of their cultural background, the stage of disease and the patient's age. Increased information requirements regarding potential side effects and treatment alternatives were recorded. Besides the need for more effective therapy, alopecia and fatigue are the most important side effects of concern to patients.

Effect of tablets containing probiotic candidate strains on gingival inflammation and composition of the salivary microbiome: a randomised controlled trial.

The aim of the study was to investigate clinical and microbial effects of probiotic candidate strains in patients with moderate gingivitis. The null hypothesis was that the clinical measurements with treatment would not differ from placebo. 47 adult patients were enrolled in a randomised placebo-controlled trial with a 4-week intervention of tablets containing a mix of Lactobacillus rhamnosus PB01, DSM 14869 and Lactobacillus curvatus EB10, DSM 32307 or placebo. Clinical examinations and samplings were done at baseline and after 2, 4 and 6 weeks. The clinical endpoints were general bleeding on probing (BOP), general plaque index (PI) and flow of gingival crevicular fluid (GCF). In addition, the concentration of selected cytokines (interleukin (IL)-1ß, IL-6, IL-8, IL-10, tumour necrosis factor alpha (TNF-α)) in GCF was determined with multiplex immunoassays. The profiles of the salivary microbiome were analysed with Next Generation Sequencing (NGS) and qPCR. In contrast to the placebo group, there was a significant reduction in BOP and amount of GCF (P<0.05) after 4 weeks in the probiotic test group when compared with baseline. The general PI was less affected although there was a tendency of decreased plaque levels in the probiotic group (P=0.05-0.09). The cytokines were unaffected by the intervention as well as the salivary microbiome. The Shannon index showed no significant differences between the groups or alterations over time. The occurrence of both probiotic strains increased in saliva of the test subjects during the intervention but returned to baseline levels within 2 weeks. Although a marked improvement in gingival health was recorded in the probiotic group, the null hypothesis could not be rejected.