Incidence and clinical features of endometriosis in 2484 consecutive female patients undergoing appendectomy for suspected appendicitis-a retrospective analysis.

INTRODUCTION: Endometriosis is a common condition affecting 5 to 10% of women of childbearing age. The true incidence of endometriosis of the appendix is currently unknown. Since symptoms often overlap with those of acute appendicitis, endometriosis of the appendix presents a diagnostic challenge in the emergency department. This large retrospective study investigates the incidence and perioperative clinical, radiologic, and laboratory findings, as well as possible differences between patients with and without endometriosis. METHODS: Data from consecutive patients who underwent appendectomy for suspected appendicitis without a history of endometriosis were analyzed. Perioperative clinical, laboratory, perioperative, and histopathologic findings were compared between women with and without endometriosis. RESULTS: Between January 2008 and June 2023, 2484 consecutive patients without a history of endometriosis underwent urgent appendectomy for suspected appendicitis. Endometriosis was detected on histopathologic examination in 17 (0.7%) patients. Signs of appendicitis were found less frequently on ultrasound in the endometriosis group compared to the non-endometriosis group (23.4% vs. 61.5%; p = 0.002; OR = 0.193; 95% CI 0.063-0.593). There were no differences in physical examination findings, duration of symptoms, degree of inflammation, surgical outcomes, or complication rates. CONCLUSION: The incidence of endometriosis of the appendix in patients undergoing appendectomy for suspected appendicitis was higher than suggested by data from autopsy series and populations with biopsy-proven endometriosis. Patients with endometriosis of the appendix were less likely to have a positive ultrasound finding, but perioperative and histopathologic findings and severity of inflammation did not differ from patients without endometriosis, presenting diagnostic challenges for clinicians.

A behavioural and ERP investigation of the wearable camera photo review in autobiographical memory.

Wearable camera photo review has successfully been used to enhance memory, yet very little is known about the underlying mechanisms. Here, the sequential presentation of wearable camera photos - a key feature of wearable camera photo review - is examined using behavioural and EEG measures. Twelve female participants were taken on a walking tour, stopping at a series of predefined targets, while wearing a camera that captured photographs automatically. A sequence of four photos leading to these targets was selected (∼ 200 trials) and together with control photos, these were used in a recognition task one week later. Participants' recognition performance improved with the sequence of photos (measured in hit rates, correct rejections, & sensitivity), revealing for the first time, a positive effect of sequence of photos in wearable camera photo review. This has important implications for understanding the sequential and cumulative effects of cues on episodic remembering. An old-new ERP effect was also observed over visual regions for hits vs. correct rejections, highlighting the importance of visual processing not only for perception but also for the location of activated memory representations.

Immune cell dynamics deconvoluted by single-cell RNA sequencing in normothermic machine perfusion of the liver.

Normothermic machine perfusion (NMP) has emerged as an innovative organ preservation technique. Developing an understanding for the donor organ immune cell composition and its dynamic changes during NMP is essential. We aimed for a comprehensive characterization of immune cell (sub)populations, cell trafficking and cytokine release during liver NMP. Single-cell transcriptome profiling of human donor livers prior to, during NMP and after transplantation shows an abundance of CXC chemokine receptor 1+/2+ (CXCR1+/CXCR2+) neutrophils, which significantly decreased during NMP. This is paralleled by a large efflux of passenger leukocytes with neutrophil predominance in the perfusate. During NMP, neutrophils shift from a pro-inflammatory state towards an aged/chronically activated/exhausted phenotype, while anti-inflammatory/tolerogenic monocytes/macrophages are increased. We herein describe the dynamics of the immune cell repertoire, phenotypic immune cell shifts and a dominance of neutrophils during liver NMP, which potentially contribute to the inflammatory response. Our findings may serve as resource to initiate future immune-interventional studies.

Correlation between Histopathology and Signal Loss on Spin-Echo T2-Weighted MR Images of the Inner Ear: Distinguishing Artifacts from Anatomy.

BACKGROUND AND PURPOSE: MR imaging of the inner ear on heavily T2-weighted sequences frequently has areas of signal loss in the vestibule. The aim of the present study was to correlate the anatomic structures of the vestibule with areas of low signal intensity. MATERIALS AND METHODS: We reviewed T2-weighted spin-echo MR imaging studies of the internal auditory canal from 27 cases and cataloged signal intensity variations in the vestibulum of inner ears. Using a histologic preparation of a fully mounted human ear, we prepared 3D reconstructions showing the regions of sensory epithelia (semicircular canal cristae, utricular, and saccular maculae). Regions of low signal intensity were reconstructed in 3D, categorized by appearance, and compared with the 3D histologic preparation. RESULTS: The region corresponding to the lateral semicircular canal crista showed signal loss in most studies (94%). In the utricle, a focus of signal loss occurred in the anterior-cranial portion of the utricle and corresponded to the location of the utricular macula and associated nerve on histopathologic specimens (63% of studies). Additional areas of low signal were observed in the vestibule, corresponding to the fluid-filled endolymphatic space and not to a solid anatomic structure. CONCLUSIONS: Small foci of signal loss within the inner ear vestibule on T2-weighted spin-echo images correlate with anatomic structures, including the lateral semicircular canal crista and the utricular macula. More posterior intensity variations in the endolymphatic space are likely artifacts, potentially representing fluid flow within the endolymph caused by magneto-hydrodynamic Lorentz forces.

The liver-resident immune cell repertoire - A boon or a bane during machine perfusion?

The liver has been proposed as an important "immune organ" of the body, as it is critically involved in a variety of specific and unique immune tasks. It contains a huge resident immune cell repertoire, which determines the balance between tolerance and inflammation in the hepatic microenvironment. Liver-resident immune cells, populating the sinusoids and the space of Disse, include professional antigen-presenting cells, myeloid cells, as well as innate and adaptive lymphoid cell populations. Machine perfusion (MP) has emerged as an innovative technology to preserve organs ex vivo while testing for organ quality and function prior to transplantation. As for the liver, hypothermic and normothermic MP techniques have successfully been implemented in clinically routine, especially for the use of marginal donor livers. Although there is evidence that ischemia reperfusion injury-associated inflammation is reduced in machine-perfused livers, little is known whether MP impacts the quantity, activation state and function of the hepatic immune-cell repertoire, and how this affects the inflammatory milieu during MP. At this point, it remains even speculative if liver-resident immune cells primarily exert a pro-inflammatory and hence destructive effect on machine-perfused organs, or in part may be essential to induce liver regeneration and counteract liver damage. This review discusses the role of hepatic immune cell subtypes during inflammatory conditions and ischemia reperfusion injury in the context of liver transplantation. We further highlight the possible impact of MP on the modification of the immune cell repertoire and its potential for future applications and immune modulation of the liver.

When and how do patients with cardiac amyloidosis die?

BACKGROUND: Cardiac amyloidosis (CA) is an underappreciated cause of morbidity and mortality. Light-chain (AL) and transthyretin (ATTR) amyloidosis have different disease trajectories. No data are available on subtype-specific modes of death (MOD) in patients with CA. METHODS AND RESULTS: We retrospectively investigated 66 with AL and 48 with wild-type ATTR amyloidosis (ATTRwt) from 2000 to 2018. ATTRwt differed from AL by age (74.6 ± 5.4 years vs. 63 ± 10.8 years), posterior wall thickness (16.8 ± 3.3 mm vs. 14.3 ± 2.2 mm), left ventricular mass index (180.7 ± 63.2 g/m2 vs. 133.5 ± 42.2 g/m2), and the proportions of male gender (91.7% vs. 59.1%), atrial enlargement (92% vs. 68.2%) and atrial fibrillation (50% vs. 12.1%). In AL NYHA Functional Class and proteinuria (72.7% vs. 39.6%) were greater; mean arterial pressure (84.4 ± 13.5 mmHg vs. 90.0 ± 11.3 mmHg) was lower. Unadjusted 5-year mortality rate was 65% in AL-CA vs. 44% in the ATTRwt group. Individuals with AL-CA were 2.28 times ([95%CI 1.27-4.10]; p = 0.006) more likely to die than were individuals with ATTRwt-CA. Information on MOD was available in 56 (94.9%) of 59 deceased patients. MOD was cardiovascular in 40 (66.8%) and non-cardiovascular in 16 (27.1%) patients. Cardiovascular [28 (68.3%) vs. 13 (80%)] death events were distributed equally between AL and ATTRwt (p = 0.51). CONCLUSION: Our data indicate no differences in MOD between patients with AL and ATTRwt cardiac amyloidosis despite significant differences in clinical presentation and disease progression. Cardiovascular events account for more than two-thirds of fatal casualties in both groups.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research.

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research.

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

Effect of lingual gauze swab placement on pulse oximeter readings in anaesthetised dogs and cats.

This study aimed to evaluate the effect of lingual gauze swab placement on pulse oximeter readings in anaesthetised dogs and cats. Following anaesthetic induction, the following pulse oximeter probe configurations were performed: no gauze swab (control), placement of a gauze swab between the tongue and the probe, placement of different thicknesses of gauze swab, placement of red cotton fabric, placement of a sheet of white paper and placement of the probe and gauze swab on different locations on the tongue. Oxygen saturation (SpO2) and peripheral perfusion index (PI) were recorded. Placement of a gauze swab between the pulse oximeter probe and the tongue in anaesthetised dogs and cats resulted in significantly higher SpO2 values compared with the control group. In dogs, PI values were significantly higher than the control in all groups except the quarter thickness swab group. In cats, PI was significantly higher in the double thickness swab and white paper groups compared with the control. Cats had significantly higher SpO2 and lower PI values than dogs. The authors propose that increased contact pressure is responsible for significantly higher SpO2 and PI readings with the use of a lingual gauze swab resulting from changes in transmural pressure and arterial compliance.

Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA.

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

Estimation of reference intervals from a SENIEUR protocol compatible aged population for immunogerontological studies.

Because many laboratory values change with age, the study of healthy aging as well as diagnosis of disease in geriatric patients requires specific age-corrected reference intervals. We have established such reference intervals for a healthy population aged 65-74 years by selection of a sample group applying the clinical criteria of the SENIEUR protocol and we have compared them with those of a young control group (20-33 years) fulfilling the same criteria. Significant or minor elevations were seen, e.g. for plasma concentrations of fasting glucose, urea, total and LDL-cholesterol, triglycerides, gamma-glutamyl-transferase, alkaline phosphatase, erythrocyte sedimentation rate and serum neopterin levels. These reference intervals can be used for selecting a SENIEUR compatible population aged between 65 and 74 years. Additionally, plasma lipid parameters (cholesterol, triglycerides) are proposed to be included in the SENIEUR protocol.

Brief report: melatonin facilitates sleep in individuals with mental retardation and insomnia.

Mentally retarded people typically exhibit poor sleep efficiency and reduced nocturnal plasma melatonin levels. The daytime administration of oral melatonin to those people, in doses that raise their plasma melatonin levels to the nocturnal range, can accelerate sleep onset. We examined the ability of similar, physiological doses to restore nighttime melatonin levels and sleep efficiency in mentally retarded subjects with sleep deficits. In a double-blind, placebo-controlled study, mentally retarded subjects (n = 20) received, in randomized order, a placebo and two melatonin doses (0.1, and 3.0 mg) orally 30 minutes before bedtime for a week. Treatments were separated by 1-week washout periods. Sleep data were obtained by polysomnography on the last three nights of each treatment period. The physiologic melatonin dose (0.3 mg) restored sleep efficiency (p < 0.0001), acting principally in the midthird of the night; it also elevated plasma melatonin levels (p < 0.0008) to normal. The lowest dose (0.1 mg) also improved sleep.

[123I] beta-CIT binding and SPET compared with clinical diagnosis in parkinsonism.

The largest group of neurodegenerative disorders are extrapyramidal diseases, especially parkinsonism. The development of the cocaine derivative [123I] beta-CIT and single photon emission tomography (SPET) may help in the diagnosis of these patients. The aim of this study was to demonstrate the diagnostic value of this method and its relationship with clinical data. Ninety-eight individuals were investigated: 11 healthy volunteers, 58 patients with idiopathic Parkinson's disease (IPD) and 29 patients with symptomatic parkinsonism (SPD). All patients with parkinsonism were staged according to the clinical classification of Hoehn and Yahr. [123I] beta-CIT was injected intravenously and a triple-headed camera was used to obtain images 20 h later. The images were evaluated visually and semi-quantitatively to obtain comparable values (ratio: specific to non-displaceable binding). The ratios differed significantly between controls and IPD patients. A significant correlation also existed between the ratios and clinical stages. In 11 hemiparkinsonian patients, a significantly diminished ratio was demonstrated not only contralateral to the affected side, but also in the clinically silent striatum. A clinical threshold at a reduction of 34% [123I] beta-CIT binding was calculated in this group. The ratios of all SPD patients in our study did not differ significantly from those of the healthy volunteers. According to the clinical degree of symptoms, the more severe subgroup showed a diminished mean ratio of 22% and therefore could not be clearly differentiated from mild IPD. In contrast, ratios were significantly different when comparing groups of the same clinical severity. We conclude that this method is not only a powerful diagnostic tool in IPD patients, but it is also possible to differentiate between IPD and SPD patients, if clinical aspects are also included.

[How is tinnitus influenced by cochlear implantation?] / Wie wird der Tinnitus durch eine Kochlearimplantation beeinflusst?

INTRODUCTION: Tinnitus is one of the most common symptoms in patients with profound sensorineural hearing loss (SNHL). Cochlear implantation (CI), which has become a standard method to rehabilitate profound SNHL, has been also observed to effect tinnitus in many cases. In the Salzburg Cochlear Implant Center,more than 230 profoundly deaf patients, mainly children,have been provided with CI between 1992 and 2000. PATIENTS AND METHOD: In a retrospective study, 39 adult patients were assessed by questionnaire for the frequency of tinnitus, subjective loudness sensitivity, and tinnitusspecific impairment before and after the CI. RESULTS: Before implantation 26 patients had tinnitus, while 24 patients had the same symptoms after the CI. In 13 patients (50%) tinnitus remained unaffected by the operation. Intensity of tinnitus decreased in seven patients (26.7%), and in four patients (15.4%) it completely disappeared after the implantation.However, intensity increased in two patients (7.7%), and in another two patients, who had not experienced tinnitus before, it began first after the implantation. No correlation has been found between the daily using time of CI and the tinnitus impairment.Also no effect of tinnitus was seen on postoperative hearing assessed by Freiburg numbers, monosyllables, and Innsbruck sentence test scores. CONCLUSION: CI significantly reduces the subjectively perceived impairment, although the reduction in the subjectively perceived loudness of the tinnitus is not significant.

Features in families and family relationships.

Standardized assessment of family features is not used routinely, although these factors may play an important role in the course of children's psychological disorders. The present study investigated the association among relationships within the families of 115 healthy children (M=8.2 yr., SD=2.13; 70 boys, 45 girls). 115 mothers and fathers were asked to complete a standardized questionnaire assessing the family features (Familienklima-Testsystem by Schneewind, et al.) and another asking for their estimation of emotional relationships of the members of the family (Subjektives Familianbild-Test System by Mattejat). Analysis showed that the parents' ratings indicated significantly more empathic fathers as well as significantly more autonomous mothers in well-organized, conflict-free families. Our results indicate an association between families' organization and measured scores for fathers' empathy and mothers' autonomy. Sufficient intrafamilial communication is associated with roles of the parents within the family. Psychotherapeutic interventions might focus on the families' organization.

Family coherence and ADHD.

A lack of perseverance, poor attention, and poorly modulated behaviour are important criteria of Attention Deficit Hyperactivity Disorder (ADHD). Instructions often must be repeated, sometimes even by different family members, before a child with ADHD attends and complies. The hyperkinetic child might cause less disruption in families with high coherence. Families of 15 boys (aged 6 to 12 years) diagnosed with ADHD using the Mannheim Parent's Interview and the teacher's form of the Conners scale were compared with a matched healthy control group of 15 boys. Parents completed a form assessing the family's cooperation and childrearing practices. Intrafamilial coherence seems to have little positive association with the family's characteristics, especially for boys with Attention Deficit Hyperactivity Disorder. Low coherence among family members may reduce ADHD symptoms and may have protective effects on children with ADHD.

[Computer-assisted analysis of pressure distribution on cattle claws]. / Computergestützte Analyse von Druckverteilungsmessungen an Rinderklauen.

A newly developed measuring device was applied to quantify in 5 first and 5 second lactation cows of the breed German Black and White the pressure distribution underneath the claws of one front limb. The pressure distribution of cows was recorded five times in intervals of four weeks. At each measuring date each had to undergo three tests. Procedures for image processing were applied in analysis of pressure distributions. The average pressure per sqcm was about 19 N, the maximum pressure measured was 59 N per sqcm in first lactating cows and 56 N per sqcm in second lactation cows. Factors were developed which characterize the patterns of pressure distributions. Especially the "gradient factor" seems to be well suited to recognize inhomogeneous pressure distributions.

Functional recovery after ischemic stroke--a matter of age: data from the Austrian Stroke Unit Registry.

OBJECTIVE: To analyze the association between patient age and good functional outcome after ischemic stroke with special focus on young patients who were numerically underrepresented in previous evaluations. METHODS: Of 43,163 ischemic stroke patients prospectively enrolled in the Austrian Stroke Unit Registry, 6,084 (14.1%) were ≤55 years old. Functional outcome was available in a representative subsample of 14,256 patients free of prestroke disability, 2,223 of whom were 55 years or younger. Herein we analyzed the effects of age on good functional outcome 3 months after stroke (modified Rankin Scale score ≤2). RESULTS: Good outcome was achieved in 88.2% (unadjusted probability) of young stroke patients (≤55 years). In multivariable analysis, age emerged as a significant predictor of outcome independent of stroke severity, etiology, performance of thrombolysis, sex, risk factors, and stroke complications. When the age stratum 56-65 years was used as a reference, odds ratios (95% confidence interval [95% CI]) of good outcome were 3.4 (1.9-6.4), 2.2 (1.6-3.2), and 1.5 (1.2-1.9) for patients aged 18-35, 36-45, and 46-55 years and 0.70 (0.60-0.81), 0.32 (0.28-0.37), and 0.18 (0.14-0.22) for those aged 66-75, 76-85, and >85 years (p < 0.001). In absolute terms, the regression-adjusted probability of good outcome was highest in the age group 18-35 years and gradually declined by 3.1%-4.2% per decade until age 75 with a steep drop thereafter. Findings applied equally to sexes and patients with and without IV thrombolysis or diabetes. CONCLUSIONS: Age emerged as a highly significant inverse predictor of good functional outcome after ischemic stroke independent of stroke severity, characteristics, and complications with the age-outcome association exhibiting a nonlinear scale and extending to young stroke patients.