Attitudes of German GP trainees regarding add-on training programs differ if in office or hospital training phase.

BACKGROUND: Many residents are exposed to negative attitudes towards primary care during hospital training. Attractive add-on training programs exist, but it is unclear whether these need to be tailored to the location of training (hospital vs. office). We report differences in learner attitudes from a large German add-on training program. METHODS: Between 2017 and 2020, a regional network offered 31 quarterly seminars to primary care residents. The seminars addressed medical content, practice management and mentoring. We elicited participants' satisfaction, perceived topic relevance, preferences for future seminars, work situation and employer support for participation. A proportionate odds model was used to assess predictors of ratings; results were stratified by training location (hospital vs. office). RESULTS: Most respondents were female (380/575 = 70.0%), aged between 26 and 40 (80.8%), and had on average 3.54 ± 1.64 years of residency training. The majority (83.8%) was working in an office and full-time (63.0%). Overall evaluations were positive (very satisfactory 72.1%). Comparing residents in the hospital phase vs. the office phase, overall seminar ratings of the perceived impact on the motivation for primary care did not differ (p = 0.73 vs. 0.18, respectively). Hospital-based residents were less likely to rate the topics as relevant (39.4% vs. 55.7%, p = 0.02) and had different preferences for future seminar topics (top 3: palliative care, emergencies and chronic care vs. billing, disease management and practice finances for hospital and office phase, respectively). CONCLUSIONS: Keeping primary care residents motivated may require education tailored to training location. Our findings may be of interest to teachers, administrators and policymakers.

Vaginal Er:YAG laser application in the menopausal ewe model: a randomised estrogen and sham-controlled trial.

OBJECTIVE: To describe effects of non-ablative erbium-doped:yttrium-aluminium-garnet (Er:YAG) laser on vaginal atrophy induced by iatrogenic menopause in the ewe. DESIGN: Animal experimental, randomised, sham and estrogen-treatment controlled study with blinding for primary outcome. SETTING: KU Leuven, Belgium. SAMPLE: Twenty-four ewes. METHODS: Menopause was surgically induced, after which the ewes were randomised to three groups receiving vaginal Er:YAG laser application three times, with a 1-month interval; three sham manipulations with a 1-month interval; or estrogen replacement and sham manipulations. At given intervals, ewes were clinically examined and vaginal wall biopsies were taken. Vaginal compliance was determined by passive biomechanical testing from explants taken at autopsy. MAIN OUTCOME MEASURES: Vaginal epithelial thickness (primary), composition of the lamina propria (collagen, elastin, glycogen and vessel content), vaginal compliance, clinical signs. RESULTS: Animals exposed to Er:YAG laser application and sham manipulation, but not to estrogens, displayed a significant and comparable increase in vaginal epithelial thickness between baseline and 7 days after the third application (69% and 67%, respectively, both P < 0.0008). In laser-treated ewes, temporary vaginal discharge and limited thermal injury were observed. Estrogen-substituted ewes displayed a more prominent increase in epithelial thickness (202%; P < 0.0001) and higher vaginal compliance (P < 0.05). None of the interventions induced changes in the lamina propria. CONCLUSIONS: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes. TWEETABLE ABSTRACT: Vaginal Er:YAG laser has comparable effect to sham manipulation in menopausal ewes #LASER #GSM #RCT.

Impact of Body Mass Index and Comorbidities on Outcomes in Upper Extremity Nerve Transfers.

BACKGROUND: There is a paucity of research investigating the impact of patient comorbidities, such as obesity and smoking, on nerve transfer outcomes. The objective of this retrospective cohort study was to evaluate the impact of body mass index (BMI) and comorbidities on the clinical outcomes of upper extremity nerve transfers. METHODS: A retrospective cohort study was executed. Patients were eligible for inclusion if they had an upper extremity nerve transfer with a minimum of 12-months follow-up. Data was collected regarding demographics, comorbidities, injury etiology, nerve transfer, as well as preoperative and postoperative clinical assessments. The primary outcome measure was strength of the recipient nerve innervated musculature. Statistical analysis used the Mann-Whitney U test, Wilcoxon signed-rank test, and Spearman's rho. RESULTS: Thirty-eight patients undergoing 43 nerve transfers were eligible for inclusion. Patients had a mean age of 48.8 years and a mean BMI of 27.4 kg/m2 (range:19.7-39.0). Injuries involved the brachial plexus (32%) or its terminal branches (68%) with the most common etiologies including trauma (50%) and compression (26%). Anterior interosseous nerve to ulnar motor nerve (35%) was the most common transfer performed. With a mean follow-up of 20.1 months, increased BMI (p = 0.036) and smoking (p = 0.021) were associated with worse postoperative strength. CONCLUSION: This retrospective cohort study demonstrated that increased BMI and smoking may be associated with worse outcomes in upper extremity nerve transfers-review of the literature yields ambiguity in both regards. To facilitate appropriate patient selection and guide expectations regarding prognosis, further experimental and clinical work is warranted.

Branches From the "SEAD": Sustained and Feasible Expansion of the Surgical Exploration and Discovery Program.

PROBLEM: A predicted shortage of surgeons and attrition among surgical residents has highlighted the need to attract well-suited medical students to surgical specialties. Literature suggests that early exposure may increase interest by addressing misconceptions and allowing students more time to make an informed career decision. APPROACH: The Surgical Exploration and Discovery (SEAD) program was created in 2012 with the goal of providing medical students with comprehensive and multifaceted exposure to surgical specialties to develop their knowledge and skills, and in turn positively influence their interest in pursuing a surgical career. The purpose of this innovation report is to describe the challenges, successes, and evolution of the SEAD program. OUTCOMES: Since its inception, SEAD has expanded to include 5 North American institutions and has educated nearly 400 participants in 5 y. Through a replication strategy, SEAD has maintained its basic curriculum, while accommodating the constraints and innovative approaches unique to each institution. Short-term results have demonstrated improved knowledge of curricular objectives, student perception of significant value of the program, and the generation of interest in a career in surgery. CONCLUSIONS: Future directions include the evaluation of long-term impact on pursuing a career in surgery and continuing further expansion using the current replication model, while maintaining a high-quality surgical education program.

Clinical Outcomes of Nerve Transfers in Peroneal Nerve Palsy: A Systematic Review and Meta-Analysis.

BACKGROUND: Given the unsatisfactory outcomes with traditional treatments, there is growing interest in nerve transfers to reestablish ankle dorsiflexion in peroneal nerve palsy. The objective of this work was to perform a systematic review and meta-analysis of the primary literature to assess the effectiveness of nerve transfer surgery in restoring ankle dorsiflexion in patients with peroneal nerve palsy. METHODS: Methodology was registered with PROSPERO, and PRISMA guidelines were followed. MEDLINE, EMBASE, and the Cochrane Library were systematically searched. English studies investigating outcomes of nerve transfers in peroneal nerve palsy were included. Two reviewers completed screening and extraction. Methodological quality was evaluated with Newcastle-Ottawa Scale. RESULTS: Literature search identified 108 unique articles. Following screening, 14 full-text articles were reviewed. Four retrospective case series met inclusion criteria for meta-analysis. Overall, 41 patients underwent nerve transfer for peroneal nerve palsy. The mean age of the patients was 36.1 years, mean time to surgery was 6.3 months, and the mean follow-up period was 19.0 months. Donor nerve was either tibial (n = 36) or superficial peroneal branches/fascicles (n = 5). Recipient nerve was either deep peroneal (n = 24) or tibialis anterior branch (n = 17). Postoperative ankle dorsiflexion strength demonstrated a bimodal distribution with a mean Medical Research Council of 2.1. There were no significant differences in dorsiflexion strength between injury sites (p = 0.491), injury mechanisms (p = 0.125), donor (p = 0.066), or recipient nerves (p = 0.496). There were no significant correlations between dorsiflexion strength and patient age (p = 0.094) or time to surgery (p = 0.493). CONCLUSIONS: There is variability in dorsiflexion strength following nerve transfer in peroneal nerve palsy, whereby there appear to be responders and non-responders. Further studies are needed to better define appropriate patient selection and the role of nerve transfers in the management of peroneal nerve palsy.

Person-centred, web-based support in pregnancy and early motherhood for women with Type 1 diabetes mellitus: a randomized controlled trial.

AIMS: To report results from and explore use of a multicentre, parallel-group, unblinded, randomized controlled trial testing the effectiveness in terms of well-being and diabetes management of a person-centred, web-based support programme for women with Type 1 diabetes, in pregnancy and postpartum. METHODS: Between 2011 and 2014, 174 pregnant women with Type 1 diabetes were randomly allocated (1:1) to web-based support and standard care (intervention group, n=83), or standard care (control group, n=91). The web-based support consisted of evidence-based information; a self-care diary for monitoring of daily activities; and peer support in a discussion forum. The primary outcomes (mean difference, measured at 6 months after childbirth) were well-being and diabetes management. RESULTS: No differences were found with regard to the primary outcome measure scores for general well-being [1.04 (95% CI -1.28 to 3.37); P=0.68] and self-efficacy of diabetes management [0.08 (95% CI -0.12 to 0.28); P= 0.75], after adjustment for baseline differences in the insulin administration method, nor with regard to the secondary outcome measures. CONCLUSIONS: At 6 months after childbirth, the web-based support plus standard care was not superior to standard care in terms of general well-being or self-efficacy of diabetes management. This might be explained by the low number of participants who had a high activity level. Few simultaneously active participants in the web-based programme and stressors in motherhood and diabetes postpartum were the main barriers to its use. Further intervention studies that offer web-based support are needed, with lessons learned from the present study. (Clinicaltrials.gov identification number: NCT015665824).

Efficacy and safety of bilateral thoracic paravertebral blocks in outpatient breast surgery.

Unilateral thoracic paravertebral blocks (TPVBs) have demonstrated reliable intraoperative analgesia, low postoperative pain scores, and an opioid-sparing effect in breast cancer surgery. However, secondary to the perceived risk of complications, bilateral TPVB have been less well accepted and are less frequently used. The purpose of this study was to evaluate the feasibility of using bilateral TPVBs in outpatient surgery for patients undergoing bilateral mastectomy with immediate implant-based reconstruction. Electronic medical records were retrospectively reviewed for patients receiving bilateral TPVBs for bilateral mastectomy with immediate implant-based reconstruction performed by a single surgeon from September 2012 to September 2015. Records were reviewed for incidence of complications, time to discharge, and incidence of unplanned admission or readmission. Clopper-Pearson method for binomial distribution was used to calculate confidence intervals for proportions. Forty-five patients undergoing bilateral mastectomy with immediate reconstruction received bilateral TPVBs. There were 4 TPVB-related complications, all of which were symptomatic hypotension or bradycardia (9%; 95% CI, 2%-21%). There was no incidence of symptomatic pneumothorax. Mean time to discharge readiness from the postanesthesia care unit (PACU) was 1.9 hours (SD = 1.0). Overall, 91% (n = 29) of the 32 patients scheduled for day surgery were discharged home as planned. Mean time from entry to PACU to home discharge for day surgery patients (n = 32) and planned admissions (n = 13) was 5.9 hours (SD = 4.3) and 16.3 hours (SD = 3.6), respectively. There was no incidence of readmission following discharge. Bilateral TPVBs can safely facilitate day surgery in carefully selected patients undergoing bilateral mastectomy with immediate implant-based reconstruction.

Anomalous Extratemporal Facial Nerve in Oculoauriculovertebral Spectrum.

Facial nerve dysfunction is common in oculoauriculovertebral spectrum (OAVS). However, the course of the nerve has rarely been described. A 23-year-old woman with OAVS underwent excision of microtic ear remnants in preparation for an osseointegrated prosthesis and suffered iatrogenic transection of the facial nerve-the pes anserinus was within the subcutaneous tissue 15 mm posterior and 15 mm cephalad to the external acoustic meatus. The patient underwent primary nerve repair and regained nearly complete preoperative function. When considering reconstruction for OAVS patients, clinicians should have a high index of suspicion for anomalous facial nerve anatomy.

Economic Comparison of Hand-Sutured and Coupler-Assisted Microvascular Anastomoses.

BACKGROUND: Compared with hand-sewn anastomoses, microvascular anastomotic coupling devices (MACDs) provide equivalent flap survival and reduced operative time. To date, an economic analysis of MACDs has not been reported. The objective of this study was to evaluate the economics of a venous anastomosis performed using a coupling device compared with a hand-sewn anastomosis. METHODS: Economics were modeled for a single free tissue transfer (FTT) requiring one venous anastomosis performed with either hand-sewn sutures or with a coupler-assisted anastomosis using the GEM COUPLER. Fixed and variable costs incurred with each anastomotic technique were identified with an activity-based cost analysis. Price lists were retrieved from suppliers to quantify disposable costs and capital expenditures. Two literature reviews were executed to identify microsurgical operating room (OR) costs and operating time reductions with coupler-assisted anastomoses. RESULTS: For each venous anastomosis, the use of the anastomotic coupler increased disposable costs by $284.40 compared with a hand-sutured anastomosis. Total fixed and variable OR costs were $30.82 per minute. Operating time was reduced by a mean of 16.9 minutes with a coupler-assisted anastomosis, decreasing OR costs by $519.29. Total savings of $234.89 were generated for each coupler-assisted anastomosis, recuperating the device's capital expenditure after 13 uses. CONCLUSION: Compared with a hand-sewn venous anastomosis, an MACD produces savings with each case and quickly recoups the device's capital expenditure. Despite its limitations and simplicity, this study provides a practical economic analysis that can help inform purchasing decisions, particularly for smaller volume centers where the economic rationale may be less clear.

Finnish Dentists Find Smoking Cessation Important but Seldom Offer Practical Support for Their Patients.

OBJECTIVES: To investigate Finnish dentists' smoking cessation related attitudes, consultation practices and familiarity with the local treatment guideline on smoking cessation. BASIC RESEARCH DESIGN: An online questionnaire was sent to 1740 dentists, which corresponds to 39% of dentists in Finland. A total of 456 dentists responded (response rate 26%), of whom 435 (95%) were clinicians. The dentists' smoking cessation practices were also compared to ones reported in a previous study in Finnish physicians. RESULTS: Dentists found smoking cessation important and often discussed and recommended quitting to the patients, but concrete withdrawal actions were seldom provided. The local treatment guideline on smoking cessation was actively utilized by 36% of the dentists. Adherence to the guideline was associated with higher rates of smoking cessation activities and success in them. Smoking cessation activity among dentists was significantly lower than in Finnish physicians. In accordance with the literature, among dentists, the most common barriers for smoking cessation were lack of time (44%) and education (42%). CONCLUSION: Although smoking cessation is discussed with patients, dentists are less active in taking concrete actions to support the patient on withdrawal. Adherence to the local treatment guideline was associated with better capabilities in dealing with tobacco withdrawal and a more active role in smoking cessation. The results suggest that more education on the local smoking cessation treatment guideline and cessation intervention is needed in order to overcome the remaining barriers to promoting effective smoking cessation in dental practice.

Pumpless extracorporeal CO(2) removal restores normocapnia and is associated with less regional perfusion in experimental acute lung injury.

BACKGROUND: Lung protective ventilation may lead to hypoventilation with subsequent hypercapnic acidosis (HA). If HA cannot be tolerated or occurs despite increasing respiratory rate or buffering, extracorporeal CO2-removal using a percutaneous extracorporeal lung assist (pECLA) is an option. We hypothesised that compensation of HA using pECLA impairs regional perfusion. To test this hypothesis we determined organ blood flows in a lung-injury model with combined hypercapnic and metabolic acidosis. METHODS: After induction of lung injury using hydrochloric acid (HCl) aspiration and metabolic acidosis by intravenous HCl infusion in nine pigs, an arterial-venous pECLA device was inserted. In randomised order, four treatments were tested: pECLA shunt (1) with and (2) without HA, and clamped pECLA shunt (3) with and (4) without HA. Regional blood flows were measured with the coloured microsphere technique. RESULTS: HA resulted in higher perfusion in adrenal glands, spleen and parts of splanchnic area (P < 0.05) compared with normocapnia. During CO2-removal with pECLA, regional perfusion decreased to levels comparable with those without pECLA and normocapnia. Cardiac output (CO) increased during HA without a pECLA shunt and was highest during HA with a pECLA shunt compared with normocapnia. During CO2-removal with pECLA, this variable decreased but stayed higher than during normocapnia with clamped pECLA shunt (P < 0.05). CONCLUSION: In our lung-injury model, HA was associated with increased systemic and regional blood flow in several organs. pECLA provides effective CO2 removal, requiring a higher CO for perfusion of the pECLA device without improvement of regional organ perfusion.

Alternative Nerve Coaptations: End-To-Side and Beyond.

Modern end-to-side (ETS) nerve transfers have undergone several permutations since the early 1990's. Preclinical data have revealed important mechanisms and patterns of donor axon outgrowth into the recipient nerves and target reinnervation. The versatility of ETS nerve transfers can also potentially address several processes that limit functional recovery after nerve injury by babysitting motor end-plates and/or supporting the regenerative environment within the denervated nerve. Further clinical and basic science work is required to clarify the ideal clinical indications, contraindications, and mechanisms of action for these techniques in order to maximize their potential as reconstructive options.

Outcomes of Nerve Transfers in Peroneal Nerve Palsy.

Background: The objective of this work is to: (i) evaluate the postoperative outcomes after lower extremity nerve transfer (LENT) in patients with peroneal nerve palsy, and (ii) evaluate the patient and surgical factors that best predict successful restoration of ankle dorsiflexion following nerve transfer. Methods: A retrospective cohort of prospectively collected data included all patients who underwent LENT (2010-2018). Two independent reviewers performed data collection. Primary outcome measures were: (i) clinically with British Medical Research Council (MRC) strength assessments, and (ii) electrodiagnostically with nascent motor unit potentials. Statistical analysis was performed using descriptive and nonparametric statistics. Results: Nine patients (56% male, mean age 38.3, range 18-57 years) underwent LENT surgery a mean of 4.3 months following injury (range 2.2-6.4 months). Mean follow-up was 15.6 months (range 9.1-28.2 months). Postoperatively, ankle dorsiflexion (P = .015) and ankle eversion (P = .041) increased significantly. After surgery, 44% achieved MRC 4, 33% obtained MRC 1 motor recovery, and 22% sustained MRC 0. A shorter time to surgery was associated with significantly better outcomes (P = .049). Conclusions: It appears that there is a bimodal distribution between responders and nonresponders to LENT for foot drop. Further research is required to elucidate patient and surgical factors that prognosticate success.

Contexte: Les objectifs de cette étude étaient les suivants : (i) évaluer les résultats postopératoires après un transfert de nerf dans le membre inférieur (LENT; lower extremity nerve transfer) chez des patients ayant une paralysie du nerf péronier et (ii) évaluer les facteurs propres au patient et à la chirurgie qui permettent de prédire le mieux possible le succès d'une restauration de la dorsiflexion de la cheville après le transfert nerveux. Méthodes: Une cohorte rétrospective de données collectées de façon prospective a inclus tous les patients ayant bénéficié d'un LENT de 2010 à 2018. Deux réviseurs indépendants ont réalisé la collecte des données. Les critères de jugement principaux étaient les suivants : (i) cliniques avec des évaluations de la force selon l'échelle MRC et (ii) électrodiagnostiques avec potentiels d'unités motrices naissantes. Une analyse statistique a été réalisée au moyen de statistiques descriptives et non paramétriques. Résultats: Neuf patients (hommes : 56%, âge moyen : 38,3 ans, extrêmes : 18 à 57 ans) ont subi une LENT, en moyenne 4,3 mois après une blessure (extrêmes : 2,2 à 6,4 mois). Le suivi moyen a été de 15,6 mois (extrêmes : 9,1 à 28,2 mois). En postopératoire, la dorsiflexion de la cheville (P = 015) et l'éversion de la cheville (P = 041) ont augmenté de façon significative. Après l'intervention chirurgicale, 44% des patients ont atteint un score de 4 sur l'échelle MRC, 33% ont obtenu une récupération motrice cotée à 1 et 22% ont conservé une cote MRC de 0. Un délai plus court avant la chirurgie a été associé à des résultats significativement meilleurs (P = .049). Conclusions: Il semble y avoir une répartition bimodale entre les répondeurs et les nonrépondeurs à la chirurgie de LENT pour la chute du pied. Des recherches supplémentaires sont nécessaires pour renseigner les facteurs pronostiques de succès liés au patient et à l'intervention chirurgicale.

Long-range quantitative PCR for determining inactivation of adenovirus 2 by ultraviolet light.

AIMS: An extra-long-range quantitative PCR (LR-qPCR) method was developed for estimating genome damage to adenovirus 2 caused by UV irradiation. The objective was to use LR-qPCR as a rapid method to determine adenovirus UV inactivation. METHODS: The LR-qPCR consisted of two steps: a long-range PCR (up to 10 kb fragment) and a real-time, quantitative (q) PCR for quantifying the products of the first PCR. We evaluated LR-qPCR with adenovirus irradiated with medium-pressure (MP, polychromatic emission) and low-pressure (LP, 254 nm) mercury vapour lamps and compared results with cell culture infectivity. RESULTS: Using LR-qPCR, a fragment of 6 kb estimated DNA damage in a linear relationship to doses between 0 and 20 mJ cm(-2) , and a 1-kb fragment related linearly to doses between 20 and 100 mJ cm(-2) . The LR-qPCR results for the 6-kb fragment were similar to infectivity assays results for adenovirus exposed to MP UV. For adenovirus irradiated with LP lamps, LR-qPCR results for the shorter fragment size (1 kb) were similar to reduction in viral infectivity. No difference was observed between 10 and 6 kb LR-qPCR results. CONCLUSION: The LR-qPCR can be used as a tool for estimating DNA damage caused by UV in adenovirus. The LR-qPCR results were related to reduction in viral infectivity. SIGNIFICANCE AND IMPACT OF THE STUDY: The use of LR-qPCR to determine DNA damage and estimate inactivation of adenovirus 2 from UV disinfection allows for same-day results compared with >7 days required for cell culture. This accelerates adenovirus inactivation results for the water industry where adenovirus is used as a representative virus for crediting UV systems. This PCR approach provides a framework that can be used for other viral viability assays using the inhibition of amplification of viral nucleic acid after pretreatments, such as propidium monoazide, and for cellular biology studies of DNA damage.

Constructed wetlands combined with UV disinfection systems for removal of enteric pathogens and wastewater contaminants.

Water shortage is an ongoing cardinal issue in the Middle East region. Wastewater reuse offers some remediation, but to-date many rural communities in the Palestinian Authority (PA) and in Jordan are not connected to centralized wastewater treatment plants (WWTPs), many of them are disposing of their wastewater using infiltration septic tanks. This highlights the need for a small, local, low cost WWTP that can directly benefit local communities, producing effluents suitable for unrestricted irrigation. Constructed wetlands (CWs) could offer a solution as they are relatively easy and cheap to construct and maintain, and effective in removal of many pollutants. Nevertheless, pathogen removal in CWs is often not adequate, calling for additional disinfection. Here we describe the use of low-cost, consumer level, UV based disinfection systems coupled to CWs for wastewater treatment in three CWs: in Israel, Jordan and in the PA. Once mature, our adapted CWs reduced chemical oxygen demand (COD) load, and, given proper use of the UV systems, inactivated indicator bacteria (faecal and E. coli) to levels suitable for irrigation, even when UV transmission (UVT) levels were low (∼40%). Our results demonstrate the promise in this combined treatment technique for cheap and simple wastewater treatment suitable for the Middle East region.

An actinometric method to characterize performance of reflecting UVC reactors used for water treatment.

The applicability of chemical actinometry to characterize the fluence in UV reactors with reflections, non-parallel light, and variable water transmittance is limited due to the unknown effective path length or hydraulic shortcuts within the reactor. In this study, the effects of reflection and transmittance on actinometry were examined and a new, optimized and easy method for determining fluence was developed. KI/KIO3 and uridine actinometry experiments were carried out under controlled conditions using a collimated beam apparatus and a completely mixed batch reactor with or without diffuse reflection and compared to biodosimetry results. Whereas optically opaque actinometers such as KI/KIO3 are not directly capable of predicting the fluence of reflecting reactors, the results of uridine actinometry are influenced by reflection and transmission. To precisely predict the fluence rate in UV reactors with uridine, knowledge about the effective optical path length of the light is needed. Here, an existing method to mathematically calculate the optical path length was adopted and optimized for uridine actinometry. Results for average fluence were validated by biodosimetry using MS2 phages under different degrees of reflection and transmission. It could be shown that by modifying the bottom of the reactor with diffusely reflecting polytetrafluoroethylene foil, the fluence rate was increased by a factor of approximately 2.6 and the path length by factor of 2.4. When only half of the bottom was covered with reflective foil, fluence rate increased by a factor of 1.8 and path length by 1.8. Although this new approach cannot replace biodosimetry, to predict the fluence distribution received by microorganisms, it can provide means to characterize more complex reactor designs, validate results of advanced reactor modeling, and quantify fluence for non-parallel irradiation and reflective light, especially for the application of high fluence (e.g., advanced oxidation processes), where biodosimetry may be too sensitive. Further, comparing the fluence obtained with actinometry to the results of biodosimetry might qualitatively indicate hydraulic short cuts or unideal fluence distributions for flow-through reactors.

Elevated Body Mass Index Negatively Impacts Recovery of Shoulder Abduction Strength in Triceps Motor Branch to Axillary Nerve Transfers.

BACKGROUND: The purpose of this work was to evaluate the clinical outcomes of triceps motor branch to axillary nerve transfers and to identify prognostic factors which may influence these outcomes. METHODS: A retrospective cohort included all patients who underwent a triceps motor branch to axillary nerve transfer (2010-2019) with at least 12 months of follow-up. The primary outcome measure was shoulder abduction strength assessed with British Medical Research Council (MRC) grade. RESULTS: Ten patients were included with a mean follow-up of 19.1 (SD 5.9) months. Compared with preoperative MRC shoulder abduction strength (0.2 SD 0.4), patients significantly improved postoperatively (2.8 SD 1.6; P = .005). Increased body mass index (BMI) was significantly associated with worse postoperative MRC (P = .014). CONCLUSION: Triceps motor branch to axillary nerve transfer is a beneficial procedure for restoring shoulder function in patients presenting with either isolated axillary nerve or brachial plexus pathology. Patients with elevated BMI may not have as robust strength recovery and should be counseled carefully regarding prognosis.

Clinical Outcomes of Upper Extremity Nerve Transfers in Neuralgic Amyotrophy.

SUMMARY: Neuralgic amyotrophy (NA) is a disease affecting peripheral nerves. Treatment has historically been conservative, as the natural course of the disease was thought to be self-limiting. Recent work has demonstrated that as many as two-thirds of people with NA have persistent pain, fatigue, or weakness. At the authors' center, supercharged end-to-side (SETS) nerve transfers are commonly performed in patients with NA to optimize motor recovery while allowing for native axonal regrowth. The authors describe the technique and clinical outcomes of patients with NA affecting the anterior interosseous nerve (AIN) who were treated with SETS nerve transfer from extensor carpi radialis brevis to AIN. Ten patients (90% male; mean age, 51.3 ± 9.7 years) underwent extensor carpi radialis brevis-to-AIN transfer at a mean period of 6.4 ± 1.4 months after onset of symptoms. Mean postoperative follow-up duration was 14.8 ± 3.2 months. Before surgery, all patients demonstrated clinically significant weakness in the flexor pollicis longus (FPL), flexor digitorum profundus muscle to the index finger (FDP2), or both. FPL strength improved from a median Medical Research Council (MRC) grade of 1.5 to 4 ( P = 0.011) and FDP2 strength improved from a median MRC grade of 1 to 5 ( P = 0.016). A postoperative MRC grade of 4 or greater was achieved in nine of 10 (90%) FPL and 10 of 10 (100%) FDP muscles. This is the first report of SETS nerve transfer for the treatment of NA. The outcomes of this work suggest that SETS nerve transfers may be an option to optimize motor outcomes in patients with NA. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Inactivation of murine norovirus, feline calicivirus and echovirus 12 as surrogates for human norovirus (NoV) and coliphage (F+) MS2 by ultraviolet light (254 nm) and the effect of cell association on UV inactivation.

AIMS: To determine inactivation profiles of three human norovirus (NoV) surrogate viruses and coliphage MS2 by ultraviolet (UV) irradiation and the protective effect of cell association on UV inactivation. METHODS AND RESULTS: The inactivation rate for cell-free virus or intracellular echovirus 12 was determined by exposure to 254-nm UV light at fluence up to 100 mJ cm(-2) . The infectivity of murine norovirus (MNV), feline calicivirus (FCV) and echovirus 12 was determined by cell culture infectivity in susceptible host cell lines, and MS2 infectivity was plaque assayed on Escherichia coli host cells. The UV fluencies to achieve 4-log(10) inactivation were 25, 29, 30 and 70 (mJ cm(-2) ) for cell-free FCV, MNV, echovirus 12 and MS2, respectively. However, a UV fluence of 85 mJ cm(-2) was needed to inactivate intracellular echovirus 12 by 4 log(10) . CONCLUSIONS: Murine norovirus and echoviruses 12 are more conservative surrogates than FCV to predict the UV inactivation response of human NoV. Intracellular echovirus 12 was 2·8-fold more resistant to UV irradiation than cell-free one. SIGNIFICANCE AND IMPACT OF THE STUDY: Variation in UV susceptibilities among NoV surrogate viruses and a likely protective effect of cell association on virus susceptibility to UV irradiation should be considered for effective control of human NoV in water.

[Transient splenial lesion in influenza A H1N1 2009 infection]. / Transiente Spleniumläsion bei Influenza-A-H1N1-09-Infektion.

Severe neurologic complications have been rarely reported during novel pandemic influenza A(H1N1) virus infections. We describe the case of an 10-year-old boy with new onset seizures and proven influenza A(H1N1) 2009 infection showing a reversible hyperintense lesion in the splenium of the corpus callosum on T2-weighted and FLAIR magnetic resonance images without contrast enhancement. Transient splenial lesions have been described in the context of virus encephalopathy and do not require specific treatment.