Parkinsonian gait in elderly people: Significance of the threshold value of two and more falls per year.

OBJECTIVES: Parkinsonism in the elderly presents a major risk factor for recurrent falls (2 and more falls per year), which is associated with increased morbidity. The main objective was to investigate explanatory variables relating to the risk of being recurrent fallers (RF) in persons with parkinsonian gait. METHODS: Seventy-nine among 172 eligible persons were enrolled in this prospective study, the findings of which were analyzed at 12 months. Motor and non-motor features, as well as follow-up interviews to identify falls, loss of ability to walk, fluctuating cognition, traumatic falls, all-cause hospitalizations and deaths were collated and results compared between non RF (zero and one fall per year) and RF. Bayesian model averaging was used to predict the probability of patients being RF from their medical history as well as from cognitive assessment, gait velocity, vision and posture. RESULTS: N=79, 0.58 men, 50% had Parkinson's disease, 14% other neurodegenerative parkinsonian syndrome, 23% vascular parkinsonism and 13% Lewy body disease, 58% were RF. Median age 81.2 years and median MMSE 25/30. A history of falls and of hallucinations, median odds ratio respectively 9.06 (CI 2.34-38.22), 4.21 (CI 1.04-18.67) were associated with the highest odds ratios along with fluctuating cognition and abnormal posture. Two or more falls a year was a relevant threshold to distinguish a population with a high risk of comorbidity. CONCLUSION: The whole history of falls, hallucinations and fluctuating cognition can be considered predictive of recurrent falls in elderly people with parkinsonian gait and provide a tracking tool for patient management.

Single-cycle, MHz repetition rate THz source with 66 mW of average power.

We demonstrate terahertz (THz) generation using the tilted pulse front method in lithium niobate, driven at an unprecedented high average power of more than 100 W and at a 13.3 MHz repetition rate, provided by a compact amplifier-free mode-locked thin-disk oscillator. The conversion efficiency was optimized with respect to the pump spot size and pump pulse duration, enabling us to generate a maximum THz average power of 66 mW, which is, to the best of our knowledge, the highest reported to date from a laser-driven, few-cycle THz source. Furthermore, we identify beam walk-off as the main obstacle that currently limits the conversion efficiency in this excitation regime (with moderate pulse energies and small spot sizes). Further upscaling to the watt level and beyond is within reach, paving the way for linear and nonlinear high average power THz spectroscopy experiments with an exceptional signal-to-noise ratio at megahertz repetition rates.

MIEO: a micro-invasive endoscopic operation port system for transluminal interventions-an acute and survival porcine study.

BACKGROUND: A reliable and sterile access through the intestinal wall to ease flexible endoscopic transluminal interventions is still appealing but lacks a suitable port system. METHODS: In a granted industry cooperation, we developed the MIEO-Port, a flexible three components overtube system that provides a temporary hermetic sealing of the intestinal wall to allow endoscopic disinfection and manipulation to gain access to the abdominal cavity. The port features an innovative head part which allows for coupling the port to the intestinal wall by vacuum suction and for controlled jetting the isolated intestinal surface with a disinfectant. The device was tested in vivo in 6 pigs for acute and long-term usability. All animal tests were approved by the local ethics committee. RESULTS: In the acute experiment, the port system supported sealed endoscopic mucosa resection and transluminal cholecystectomy. In the survival study on 5 animals, the MIEO-Port proved its reliability after transcolonic peritoneoscopy. In one animal, a port dislocation occurred after extensive retroperitoneal preparation, one animal revealed bacterial contamination at necropsy; however, all animals showed a favourable course over ten days and offered no signs of peritonitis or abscedation during post-mortem examination. DISCUSSION: To the best of our knowledge, the MIEO-Port system is the first device to provide a reliable and sterile flexible access to the peritoneal cavity that can be used throughout the entire gastrointestinal tract regardless of the access route and which combines hermetic sealing with local sterilization. Further studies are warranted.

Antibodies Directed toward Neuraminidase N1 Control Disease in a Mouse Model of Influenza.

There is increasing evidence to suggest that antibodies directed toward influenza A virus (IAV) neuraminidase (NA) are an important correlate of protection against influenza in humans. Moreover, the potential of NA-specific antibodies to provide broader protection than conventional hemagglutinin (HA) antibodies has been recognized. Here, we describe the isolation of two monoclonal antibodies, N1-7D3 and N1-C4, directed toward the N1 NA. N1-7D3 binds to a conserved linear epitope in the membrane-distal, carboxy-terminal part of the NA and reacted with the NA of seasonal H1N1 isolates ranging from 1977 to 2007 and the 2009 H1N1pdm virus, as well as A/Vietnam/1194/04 (H5N1). However, N1-7D3 lacked NA inhibition (NI) activity and the ability to protect BALB/c mice against a lethal challenge with a range of H1N1 viruses. Conversely, N1-C4 bound to a conformational epitope that is conserved between two influenza virus subtypes, 2009 H1N1pdm and H5N1 IAV, and displayed potent in vitro antiviral activity mediating both NI and plaque size reduction. Moreover, N1-C4 could provide heterosubtypic protection in BALB/c mice against a lethal challenge with 2009 H1N1pdm or H5N1 virus. Glutamic acid residue 311 in the NA was found to be critical for the NA binding and antiviral activity of monoclonal antibody N1-C4. Our data provide further evidence for cross-protective epitopes within the N1 subtype and highlight the potential of NA as an important target for vaccine and therapeutic approaches.IMPORTANCE Influenza remains a worldwide burden on public health. As such, the development of novel vaccines and therapeutics against influenza virus is crucial. Human challenge studies have recently highlighted the importance of antibodies directed toward the viral neuraminidase (NA) as an important correlate of reduced influenza-associated disease severity. Furthermore, there is evidence that anti-NA antibodies can provide broader protection than antibodies toward the viral hemagglutinin. Here, we describe the isolation and detailed characterization of two N1 NA-specific monoclonal antibodies. One of these monoclonal antibodies broadly binds N1-type NAs, and the second displays NA inhibition and in vitro and in vivo antiviral activity against 2009 H1N1pdm and H5N1 influenza viruses. These two new anti-NA antibodies contribute to our understanding of the antigenic properties and protective potential of the influenza virus NA antigen.

Milliwatt-class broadband THz source driven by a 112 W, sub-100 fs thin-disk laser.

We demonstrate a high repetition-rate, single-cycle THz source with a maximum average power of 1.35 mW, operating at a center frequency of 2 THz. This result was obtained by optical rectification (OR) in GaP using an amplifier-free, nonlinearly compressed modelocked thin-disk oscillator based on Yb:YAG, delivering 8.4 µJ pulses with 88 fs duration at a repetition rate of 13.4 MHz, resulting in driving pulses for OR with 112 W average power and 80 MW peak power. To the best of our knowledge, our result represents the highest average power so far achieved with OR in GaP. The demonstrated performance is very attractive for improving current linear THz time-domain spectroscopy experiments, which are currently restricted by low signal-to-noise ratio and long measurement times.

[Clinical semiology of anemia in patients over 75 years: a prospective study conducted in France by the SiFMI group]. / Sémiologie clinique de l'anémie chez des patients âgés de plus de 75 ans : une étude prospective menée en France par le groupe SiFMI.

INTRODUCTION: Anemia remains one of the main concerns of the day-today life of Internist since it ranks third among the pathologies seen in Internal Medicine Departments. OBJECTIVE: it seemed appropriate for the SiFMI Group (Common Situations in Internal Medicine of the SNFMI) to carry out a study of anemia evaluating the contribution to the diagnosis of the «classical¼ semiology of the anemic syndrome. This work reports the results from the study of 204 patients aged 75 years and more. METHOD: A prospective, non interventional multicenter study was carried out in Internal and Geriatric Departments in the period September 2015-September 2017. Clinical and biological variables were collected. RESULTS: 204 patients from 10 Internal or Geriatric Departments were included in the period September 2015-September 2017. They were assigned into two groups with and without anemia. According to this study, it seems that the following parameters : asthenia, dyspnea (NYHA stages III and IV), palpitations, chest pain, tachycardia, hypotension as well as confusion, falls, depression and MMSE showed no significant statistical difference between both groups in contrast to pallor, edema, albumin and ECG. CONCLUSION: Clinical diagnosis of anemia in elderly individuals remains a challenge. It is difficult to establish a diagnostic protocol in this population.

INTRODUCTION: L'anémie reste une des préoccupations majeures du quotidien de l'Interniste, puisque classée troisième parmi les pathologies prises en charge dans les services de Médecine Interne. Objectif : Il a semblé? opportun au Groupe SiFMI (Situations Fréquentes en Médecine Interne de la Société Nationale Française de Médecine Interne - SNFMI) de s'attacher à l'étude des anémies au travers de l'apport au diagnostic de la sémiologie «classique¼ du syndrome anémique. Méthode : Etude prospective, non interventionnelle, multicentrique, menée de septembre 2015 à septembre 2017, dans des services de Médecine Interne et de Gériatrie. Des données cliniques et biologiques ont été recueillies. Résultats : 204 patients ont été inclus par 10 services de Médecine Interne et de Gériatrie de septembre 2015 à septembre 2017. Ils ont été répartis en deux groupes, avec et sans anémie. Dans ce travail, il apparaît que les différents paramètres suivants : asthénie, dyspnée de stades III et IV de la NYHA, palpitations, douleur thoracique, tachycardie, hypotension, mais également confusion, chute, dépression et MMSE, sont sans différence notable sur le plan statistique entre les deux groupes, à l'exception de la pâleur cutanéomuqueuse, des œdèmes des membres inférieurs, du taux d'albuminémie et de l'ECG. CONCLUSION: Le diagnostic clinique de l'anémie au sein d'une population de sujets âgés s'avère être un vrai défi. Il reste difficile d'établir une démarche diagnostique standardisée au sein de cette population.

Addressing the needs of terminally-ill patients in Bosnia-Herzegovina: patients' perceptions and expectations.

BACKGROUND: Many terminally ill patients in Bosnia-Herzegovina (BiH) fail to receive needed medical attention and social support. In 2016 a primary healthcare centreer (PHCC) in Doboj (BiH) requested the methodological and technical support of a local partner (Fondacija fami) and the Geneva University Hospitals to address the needs of terminally ill patients living at home. In order to design acceptable, affordable and sustainable solutions, we involved patients and their families in exploring needs, barriers and available resources. METHODS: We conducted interviews with 62 purposely selected patients using a semi-structured interview guide designed to elicit patients' experiences, needs and expectations. Both qualitative and quantitative analyses were conducted, using an inductive thematic approach. RESULTS: While patients were aware that their illnesses were incurable, they were poorly informed about medical and social support resources available to them. Family members appeared to be patients' main source of support, and often suffered from exhaustion and financial strain. Patients expressed feelings of helplessness and lack of control over their health. They wanted more support from health professionals for pain and other symptom management, as well as for anxiety and depression. Patients who were bedridden or with reduced mobility expressed strong feelings of loneliness, social exclusion, and stigma from community members and - occasionally - from health workers. CONCLUSIONS: Our findings suggest a wide gap between patients' end-of-life care needs and existing services. In order to address the medical, psychological and social needs of terminally ill patients, a multi-pronged approach is called for, including not only better symptom management through training of health professionals and improved access to medication and equipment, but also a coordinated inter-professional, inter-institutional and multi-stakeholder effort aimed at offering comprehensive medical, psycho-social, educational and spiritual support.

Liver Transplantation After Ex Vivo Normothermic Machine Preservation: A Phase 1 (First-in-Man) Clinical Trial.

The number of donor organs suitable for liver transplantation is restricted by cold preservation and ischemia-reperfusion injury. We present the first patients transplanted using a normothermic machine perfusion (NMP) device that transports and stores an organ in a fully functioning state at 37°C. In this Phase 1 trial, organs were retrieved using standard techniques, attached to the perfusion device at the donor hospital, and transported to the implanting center in a functioning state. NMP livers were matched 1:2 to cold-stored livers. Twenty patients underwent liver transplantation after NMP. Median NMP time was 9.3 (3.5-18.5) h versus median cold ischaemia time of 8.9 (4.2-11.4) h. Thirty-day graft survival was similar (100% NMP vs. 97.5% control, p = 1.00). Median peak aspartate aminotransferase in the first 7 days was significantly lower in the NMP group (417 IU [84-4681]) versus (902 IU [218-8786], p = 0.03). This first report of liver transplantation using NMP-preserved livers demonstrates the safety and feasibility of using this technology from retrieval to transplantation, including transportation. NMP may be valuable in increasing the number of donor livers and improving the function of transplantable organs.

Health benefits of multicomponent training programmes in seniors: a systematic review.

BACKGROUND: The ageing process is intrinsically associated with decline in physical endurance, muscle strength and gait ability and balance, which all contribute to functional disability. Regular physical training, and more particularly multicomponent training (MCT), has demonstrated many health benefits. OBJECTIVE: To evaluate the evidence of the health benefits of MCT including endurance training, muscle strengthening, balance exercises, and/or stretching (i.e. flexibility training) and/or coordination training in adults aged 65 years or over. METHODS: A comprehensive, systematic database search for manuscripts was performed in CINAHL Plus, Embase, Medline, PubMed Central, ScienceDirect, Scopus, Sport Discus and Web of Science using key words. For potential inclusion, two reviewers independently assessed all intervention studies published in English language from 1 January 2000 to 30 April 2015. RESULTS: Of 2525 articles initially identified, 27 studies were finally included in this systematic review. They were all divided into five categories according to their main outcome measurements (cardio-respiratory fitness, metabolic outcomes, functional and cognitive functions and quality of life, QoL). These studies reported that MCT has a significant beneficial effect on cardio-respiratory fitness and on metabolic outcomes. Substantial improvement in functional and cognitive performance was also measured and a slighter but positive effect on QoL. CONCLUSION: Overall, this review demonstrates a positive effect of MCT with functional benefits and positive health outcomes for seniors. Based on this evidence, clinicians should encourage all adults aged 65 or over to engage in MCT programmes to favour healthy ageing and keeping older members of our society autonomous and independent.

[Inappropriate prescription and administration of medications in 10 nursing homes in Alsace, France]. / Prescriptions et administrations inappropriées de médicaments dans dix établissements alsaciens d'hébergement pour personnes âgées dépendantes--France.

BACKGROUND: Medication care is a complicated process in nursing homes. The aim of the study was to offer an overview of inappropriate medication prescription and administration practices in nursing homes in Alsace in order to propose improvement actions to remedy the weaknesses identified. METHODS: This study was conducted prospectively in 10 nursing homes under contract with community pharmacies in Alsace. The practices of prescription were examined to determine the prevalence of potentially inappropriate medications, inappropriate and contraindicated medication associations. Crushing and opening practices were also assessed, daily treatment costs were calculated. RESULTS: Two hundred and eighty-four residents were included (age: 87.1 ± 5.6 years). The average number of drugs per resident was 8.1 ± 4.0 (daily treatment cost: 4.19 ± 5.21 €). On average, 1.5 drugs ± 1.4 per prescription were considered as potentially inappropriate (daily treatment cost: 0.49 ± 0.76 €). The contraindication associations concerned 8 % of prescriptions and involved potentially inappropriate drugs in 60 % of cases. Inappropriate associations mainly concerned nervous system drugs. Thirty-three residents were taking more than 2 psychotropic drugs; 23 had more than one benzodiazepine. Regarding drug administration, practices differed from one nursing home to another. Crushing was performed in 8 nursing homes. It concerned 20 residents (7 %) and 69 drugs. In 50 %, the crushing decision was made by nurses without physician or pharmacist supervision. Fifty-seven percent of crushed drugs had a formulation which did not allow crushing (n=39 drugs). The analysis of those items led to the proposal of improvement actions. CONCLUSION: This study pointed out inappropriate medication practices. Tracking tools for inappropriate clinical practices could be operated by physicians, pharmacists and nursing teams through coordinated multidisciplinary approaches.

Health benefits of endurance training alone or combined with diet for obese patients over 60: a review.

BACKGROUND: The prevalence of obesity is rapidly increasing in older patients and it is ubiquitous in many developed countries. Obesity is related to various negative health outcomes, making it a major public health target for intervention. PURPOSE: The aim of this study was to explore and summarise the literature that addresses endurance training alone or combined with nutrition interventions to combat obesity in obese patients over age 60. METHODS: We searched online electronic databases up to September 2014 for original observational and intervention studies published between 1995 and 2014 on the relationship between endurance training alone or combined with a diet in obese patients over 60 regarding health outcomes. RESULTS: Twenty-six studies examined interventions aimed specifically at promoting endurance training alone or combined with diet for older obese patients over 60. These studies demonstrated a positive effect of this intervention on the primary prevention of cardiovascular disease, and a significant beneficial effect on the lipid profile. Improvement of body composition and insulin sensitivity, and a reduction in blood pressure were also well established. CONCLUSIONS: Overall, this review demonstrates a positive effect of endurance training alone or combined with diet on health outcomes and metabolic benefits in older adults. Clinicians can now use this evidence to formulate actions to encourage the older obese to profit from the health benefits of endurance training and diet. This will not only help reduce the dramatic increase in the number of older obese but also help prevent sarcopenic obesity, which is a complex challenge for healthcare professionals.

Impact of introduction of mid-trimester scan on pregnancy outcome of open spina bifida in The Netherlands.

OBJECTIVE: To examine the impact of introduction of the mid-trimester scan on pregnancy outcome in cases of open spina bifida in two regions of The Netherlands. METHODS: This was a retrospective cohort study of 190 cases of open spina bifida diagnosed pre- or postnatally, with an estimated date of delivery between 2003 and 2011. RESULTS: With implementation of the mid-trimester scan the percentage of cases of open spina bifida detected before the 24(th) week of pregnancy increased from 43% to 88%. The rise in prenatal detection rate was associated with a significant increase in the number of terminated pregnancies and a decrease in the rate of perinatal loss; the percentage of children born alive did not change significantly. In the subgroup that underwent a scan between 18 and 24 weeks of pregnancy, cranial signs were present in 94.4% of cases. CONCLUSION: Introduction of the mid-trimester scan has led to an increase in early identification of pregnancies complicated by open spina bifida. Pregnancies previously destined to end in perinatal loss are now terminated whilst pregnancies with a relatively good prognosis are frequently continued; the number of children with open spina bifida who are born alive has not changed significantly. Our study confirms that prenatal diagnosis is usually triggered by visualization of a lemon-shaped skull or a banana-shaped cerebellum.

Revealing the quantum nature of the voltage-induced conductance changes in oxygen engineered yttrium oxide-based RRAM devices.

In this work, the quasi-analog to discrete transition occurring in the current-voltage characteristic of oxygen engineered yttrium oxide-based resistive random-access memory (RRAM) devices is investigated in detail. In particular, the focus of our research is not on the absolute conductance values of this characteristic but on the magnitude of its conductance changes occurring during the reset process of the device. It is found that the detected changes correspond to conductance values predominantly of the order of the quantum unit of conductance G0 = 2e2/h, where e is the electron charge and h the Planck constant. This feature is observed even at conductance levels far above G0, i.e. where electron transport is seemingly diffusive. It is also observed that such behavior is reproducible across devices comprising yttrium oxide layers with different oxygen concentrations and measured under different voltage sweep rates. While the oxygen deficiency affects the total number of quantized conductance states, the magnitude of the changes in conductance, close to 1 G0, is invariant to the oxygen content of the functional layer.

Effects of the interaction range on structural phases of flexible polymers.

We systematically investigate how the range of interaction between non-bonded monomers influences the formation of structural phases of elastic, flexible polymers. Massively parallel replica-exchange simulations of a generic, coarse-grained model, performed partly on graphics processing units and in multiple-gaussian modified ensembles, pave the way for the construction of the structural phase diagram, parametrized by interaction range and temperature. Conformational transitions between gas-like, liquid, and diverse solid (pseudo) phases are identified by microcanonical statistical inflection-point analysis. We find evidence for finite-size effects that cause the crossover of "collapse" and "freezing" transitions for very short interaction ranges.

Effect of a short-term intermittent exercise-training programme on the pulse wave velocity and arterial pressure: a prospective study among 71 healthy older subjects.

AIMS OF THE STUDY: Stiffening of large arteries has been associated with increased cardiovascular outcomes among older subjects. Endurance exercises might attenuate artery stiffness, but little is known about the effects of intermittent training programme. We evaluate the effect of a short Intermittent Work Exercise Training Program (IWEP) on arterial stiffness estimated by the measure of the pulse wave velocity (PWV). METHODS AND SUBJECTS: Seventy-one healthy volunteers (mean age: 64.6 years) free of symptomatic cardiac and pulmonary disease performed a 9-week IWEP that consisted of a 30-min cycling twice a week over a 9-week period. Each session involved six 5-min bouts of exercise, each of the latter separated into 4-min cycling at the first ventilatory threshold alternated with 1-min cycling at 90% of the pretraining maximal tolerated power. Before and after the IWEP, the following measurements were made: carotid-radial PWV and carotid-femoral PWV with a tonometer and systolic and diastolic blood pressure. RESULTS: Training resulted in a non-significant decrease of the carotid-radial PWV, a significant decrease of the carotid-femoral PWV from 10.2 to 9.6 m/s (p < 0.001) (that was no longer significant after adjustment for mean arterial pressure) and a significant decrease in both systolic and diastolic blood pressure, respectively, from 129.6 ± 14.9 mmHg to 120.1 ± 14.1 mmHg (p < 0.001) and from 77.2 ± 8.8 mmHg to 71.4 ± 10.1 mmHg (p < 0.001). CONCLUSION: The present results support the idea that a short-term intermittent aerobic exercise programme may be an effective lifestyle intervention for reducing rapidly blood pressure and probably central arterial stiffness among older healthy subjects.

[Outcome 4 years after isolated single-bundle posterior cruciate ligament reconstruction]. / Vierjahresergebnisse nach Isolierter Hinterer Kreuzbandrekonstruktion in Einbündeltechnik.

BACKGROUND: The purpose of this study was to evaluate the clinical and radiological results after isolated reconstruction of the posterior cruciate ligament (PCL) using semitendinosus (ST) and gracilis (GT) tendon grafts with the arthroscopic single-bundle technique. MATERIALS AND METHODS: Following PCL reconstruction using the single-bundle technique performed between 2002 and 2005, 14 patients (2 women, 12 men) prospectively underwent a standardized follow-up examination after an average postoperative time of 4 years. All patients included in this study had isolated insufficiency of the PCL and symptomatic instability. The exclusion criteria were the presence of a complex knee joint instability and the implementation of additional stabilizing measures or another method of PCL reconstructive surgery. The mean follow-up time was 47.2 ± 8.7 months. Preoperative and postoperative stress radiographs were taken using the Telos stress instrument in order to evaluate the posterior translation. Knee joint function and degree of activity were recorded using the Tegner activity score, the subjective IKDC score and the overall IKDC score. RESULTS: The posterior tibial translation of 10.1 ± 1.7 mm had an overall average improvement to a postoperative value of 4.6 ± 2.3 mm (p < 0.001). The patients showed a significant improvement in the Tegner activity score from an average 2.7 ± 0.8 points to 5.7 ± 1.3 points (p < 0.001). Evaluation of the subjective IKDC showed a significant improvement from a preoperative score of 41.32 ± 11.23 points to a postoperative score of 65.08 ± 13.51 points (p < 0.001). In total, 10 patients (71.5%) exhibited a normal or nearly normal outcome. According to the objective IKDC score, 4 patients (28.5%) were categorized as moderate. CONCLUSION: The above mentioned reconstruction technique can achieve a stable knee function in patients with isolated PCL insufficiency. The isolated single-bundle PCL reconstruction offers a medium-term improvement regarding the activity level and stability of the knee joint.

Surgical reporting for laparoscopic cholecystectomy based on phase annotation by a convolutional neural network (CNN) and the phenomenon of phase flickering: a proof of concept.

PURPOSE: Surgical documentation is an important yet time-consuming necessity in clinical routine. Beside its core function to transmit information about a surgery to other medical professionals, the surgical report has gained even more significance in terms of information extraction for scientific, administrative and judicial application. A possible basis for computer aided reporting is phase detection by convolutional neural networks (CNN). In this article we propose a workflow to generate operative notes based on the output of the TeCNO CNN. METHODS: Video recordings of 15 cholecystectomies were used for inference. The annotation of TeCNO was compared to that of an expert surgeon (HE) and the algorithm based annotation of a scientist (HA). The CNN output then was used to identify aberrance from standard course as basis for the final report. Moreover, we assessed the phenomenon of 'phase flickering' as clusters of incorrectly labeled frames and evaluated its usability. RESULTS: The accordance of the HE and CNN was 79.7% and that of HA and CNN 87.0%. 'Phase flickering' indicated an aberrant course with AUCs of 0.91 and 0.89 in ROC analysis regarding number and extend of concerned frames. Finally, we created operative notes based on a standard text, deviation alerts, and manual completion by the surgeon. CONCLUSION: Computer-aided documentation is a noteworthy use case for phase recognition in standardized surgery. The analysis of phase flickering in a CNN's annotation has the potential of retrieving more information about the course of a particular procedure to complement an automated report.

Virus-specific cytotoxic T-lymphocyte responses select for amino-acid variation in simian immunodeficiency virus Env and Nef.

Cytotoxic T-lymphocyte (CTL) responses to human immunodeficiency virus arise early after infection, but ultimately fail to prevent progression to AIDS. Human immunodeficiency virus may evade the CTL response by accumulating amino-acid replacements within CTL epitopes. We studied 10 CTL epitopes during the course of simian immunodeficiency virus disease progression in three related macaques. All 10 of these CTL epitopes accumulated amino-acid replacements and showed evidence of positive selection by the time the macaques died. Many of the amino-acid replacements in these epitopes reduced or eliminated major histocompatibility complex class I binding and/or CTL recognition. These findings strongly support the CTL 'escape' hypothesis.

Cranial neuroendoscopy: novel applications and next frontiers.

Neuroendoscopy is an ever-evolving frontier in neurosurgery and its use has spanned decades with safe and efficacious treatment in a variety of cranial procedures. There are areas of technology that are broadening the cranial use of the endoscope. Here we discuss the foundations of cranial neuroendoscopy in the areas of cerebrospinal fluid diversion and tumor biopsy and discuss the recent advancements in the areas of craniosynostosis, endonasal surgery, ventriculo-cisternal approaches, brain parenchymal surgery and skull base surgery. We highlight the ongoing evolution of neuroendoscopic technology and consider the potential future applications that will help to revolutionize the current standards in endoscopy and its use inn neurosurgical practice.

[Does osteoporosis lead to reduction the primary stability of cementless hip cups?]. / Führt Osteoporose zu einer Reduktion der Primärstabilität zementfreier Hüftpfannen?

BACKGROUND: Cementless hip cups require adequate primary stability in order to achieve osseointegration. Depending on implant design, a different biomechanical behavior in osteoporotic bone and in bone with normal bone mineral density might be expected. MATERIAL AND METHODS: The micromovement between bone and implant was determined in macerated human hip acetabula with reduced and with normal bone density for two different cementless screwed cups and two different cementless press-fit cups. The bone mineral density was assessed by means of Q-CT and 20 implantations were performed for each acetabulum with reduced and with normal bone density. RESULTS: Screwed cups showed significantly less micromovement than press-fit cups. The average micromovement of all cups, with the exception of the Monoblock cup, remained below the value of 100 µ, the upper limit for successful osseointegration. Values of over 200 µ were measured only for the Monoblock cup and only in some of the tests. There was no significant difference between the micro-movement in acetabula with reduced bone mineral density and with normal bone. CONCLUSION: Impaired osseointegration in osteoporotic bone because of increased micromovement is not to be expected in the investigated cementless hip cups as no relevant differences in micromovement were found between normal and osteoporotic bone stock. On the basis of the good clinical results with the Monoblock cup, the upper limit of 100 µ of micromotion for osseointegation in macerated bone is probably set too low.