[Fascia iliaca Block with General Anaesthesia vs. Subarachnoid Morphine Block in Total Hip Arthroplasty]. / Blokáda fascia iliaca s celkovou anestezií vs. subarachnoidální blokáda s morfinem u totální náhrady kycelního kloubu.

PURPOSE OF THE STUDY Many physicians believe that loco-regional anaesthesia and analgesia improve the postoperative course of patients indicated for total hip arthroplasty compared to general anaesthesia. However, there are many patients who refuse subarachnoid or epidural anaesthesia, or have contraindications or conditions making the use of such techniques impossible. An alternative option is the combination of general anaesthesia and a peripheral nerve blockade. The aim of this prospective randomized open-label clinical trial was to compare the efficacy and quality of postoperative analgesia between fascia iliaca block combined with general anaesthesia (GA) and subarachnoid anaesthesia with morphine and bupivacaine (SAB). MATERIAL AND METHODS After having obtained the ethics committee approval and the patients consent, a prospective, open-label, randomized trial was conducted in patients referred for total hip arthroplasty (THR). The GA group was administered ultrasound-guided fascia iliaca block with 40 ml of 0.25% bupivacaine solution after the induction of general anaesthesia. In the SAB group, subarachnoid blockade was performed with a mixture of 3 ml of 0.5% bupivacaine with 0.150 mg morphine prepared in the hospital pharmacy. Right after surgery the patients were taken to the ICU for 24 hours, after which they were transferred to a general ward. In addition to vital signs monitoring, pain intensity using a 0-10 numeric rating scale (NRS), first morphine administration at NRS >4, total morphine consumption and potential adverse effects were observed over the period of 72 hours. RESULTS There was no statistical difference between the GA (14 persons) and the SAB (14 persons) group in demographic parameters, time to first morphine administration (10 hrs vs. 19 hrs, p=0.10), number of persons with no need for morphine after surgery (5 vs. 7), tingling sensation (1 vs. 0) or numbness of the limb (0 vs. 1). There was no difference in cardiorespiratory parameters or side effects of therapy. In neither case was there respiratory depression or delayed rehabilitation. No patient developed delirium after surgery, and no patient reported dissatisfaction with pain management. DISCUSSION The fascia iliaca block and subarachnoid anaesthesia using local anaesthetic with opioid addition have been repeatedly published for patients after total hip arthroplasty, but this study is unique by comparing the two methods. The study added a new piece of knowledge to the findings of several recent meta-analyses on the comparable outcomes of general and subarachnoid anaesthesia for hip replacement in the perioperative period. CONCLUSIONS If subarachnoid anaesthesia cannot be used in hip arthroplasty, general anaesthesia with fascia iliaca block provides comparable analgesia and quality of postoperative course. Key words: total hip arthroplasty, general anaesthesia, fascia iliaca block, subarachnoid anaesthesia, postoperative analgesia, postoperative course.

Endoparasites infecting exotic captive amphibian pet and zoo animals (Anura, Caudata) in Germany.

Alongside exotic reptiles, amphibians, such as toads, frogs, salamanders, and newts, are nowadays considered popular pets worldwide. As reported for other exotic pet animals, amphibians are known to harbor numerous gastrointestinal parasites. Nonetheless, very little data are available on captive amphibian parasitic diseases. In this study, we applied direct saline fecal smears (DSFS) to examine in total 161 stool samples from 41 different amphibian species belonging to the orders Anura and Caudata. In addition, carbolfuchsin-smear (CFS) staining (n = 74 samples) was used to detect amphibian Cryptosporidium oocysts. Also, complete dissections of deceased amphibians (n = 107) were performed to specify parasite infections and to address parasite-associated pathogenicity. Overall, examined amphibian fecal samples contained 12 different parasite taxa. The order Rhabditida with the species Rhabdias spp. and Strongyloides spp. were the most prevalent nematode species (19.3%), followed by flagellated protozoans (8.7%), Amphibiocapillaria spp./Neocapillaria spp. (7.5%), Oswaldocruzia spp. (4.3%), Blastocystis spp. (3.1%), Cosmocerca spp. (3.1%), oxyurids (Pharyngonoidae) (3.1%), spirurids (1.2%), un-sporulated coccidian oocysts (0.6%), Tritrichomonas spp. (0.6%), Karotomorpha spp. (0.6%), and Cryptosporidium spp. (0.6%). One CFS-stained fecal sample (1.4%) was positive for Cryptosporidium oocysts. Within dissected amphibians, 31 (48.4%) of the anurans and 11 (26.2%) of the salamanders were infected with gastrointestinal parasites. One cutaneous Pseudocapillaroides xenopi infection was diagnosed in an adult African clawed frog (Xenopus laevis). Etiologically, 17 (15.9%) of them died due to severe parasitic and/or bacterial infections (e.g., Chryseobacterium indologenes, Citrobacter freudii, Sphingobacterium multivorum, Klebsiella pneumoniae). High prevalence and pathological findings of several clinical amphibian parasitoses call for more detailed investigation on gastrointestinal parasite-derived molecular mechanisms associated with detrimental lesions or even death.

Occurrence of Kalicephalus, Strongyloides, and Rhabdias nematodes as most common gastrointestinal parasites in captive snakes of German households and zoological gardens.

Nowadays, snakes established as domestic exotic pets, harboring numerous (zoonotic) gastrointestinal parasites. In this parasitological survey, we used direct saline fecal smears (DSFS) to examine 586 stool samples from 71 different snake species either kept as pets in households or in zoological gardens in Germany. In addition to DSFS, carbol-fuchsin-fecal smears (n = 296), coproantigen ELISA tests (n = 98), and immunofluorescence assays (IFA; n = 77) for the detection reptile Cryptosporidium infections were conducted. Complete dissections of deceased snakes (n = 63) were also performed in order to gain data on endoparasite species burdens affecting domestic snakes. Overall, examined fecal samples contained 20 different parasite taxa: Ancylostomatid Kalicephalus spp. were the most prevalent nematode species (3.3%), followed by Strongyloides/Rhabdias (2.6%), flagellated protozoan trophozoites (e. g., Proteromonadida, Reteromonadida) (2.3%), Monocercomonas spp. (1.9%), Entamoeba spp. (1.4%), unsporulated coccidian oocysts (1.4%), Kapsulotaenia spp. (0.9%), Capillaria spp. (0.7%), indet. trematodes (0.5%), pentastomids (0.5%), spirurids (0.4%), Eimeria spp. (0.4%), ascarids (0.4%), Blastocystis sp. (0.2%), heterakids (0.2%), cestodes (Proteocephalidae) (0.2%), Plagiorchis spp. (0.2%), Cryptosporidium spp. (0.2%), Caryospora epicratesi (0.2%), and Sarcocystis spp. (0.2%). For Cryptosporidium, four carbol-fuchsin-stained smears (1.4%), 12 (12.2%) coproantigen ELISA-examined samples and 5.2% of examined samples were diagnosed with IFA. Fourteen (22.2%) of dissected snakes showed infections with various pathogenic nematode genera and 8 of them (12.7%) died due to protozoan parasitic infections. High prevalences of intestinal protozoan parasites resulting in severe pathological findings observed in dissected snakes call for more detailed investigations on gastrointestinal parasites.

Neurocognitive, psychosocial, and quality-of-life outcomes in adult survivors of childhood non-Hodgkin lymphoma.

BACKGROUND: Children with non-Hodgkin lymphoma (NHL) undergo treatment with central nervous system-directed therapy, the potentially neurotoxic effects of which have not been reported in NHL survivors. METHODS: NHL survivors (n = 187) participating in the St. Jude Lifetime Cohort who were 10 or more years from their diagnosis and were 18 years old or older underwent neurocognitive, emotional distress (Brief Symptom Inventory 18), and health-related quality of life (HRQOL) assessments (36-Item Short Form Health Survey). Age-adjusted z scores were compared with community controls (n = 181) and normative data. Treatment exposures were abstracted from medical records. Models adjusted for the age, sex, and time from diagnosis were used to calculate the risk of impairment. RESULTS: The mean ages at evaluation were similar for the survivors and the controls (35.7 ± 8.9 vs 35.5 ± 11.0 years; P = .86). Survivors were 25.2 ± 8.8 years from their diagnosis: 43 (23%) received cranial radiation, 70 (37%) received high-dose methotrexate, 40 (21%) received high-dose cytarabine, and 151 (81%) received intrathecal chemotherapy. Survivors' intelligence and attention were within normal limits; however, their memory, executive function, processing speed, and academics were impaired in comparison with both population norms and community controls (P values < .05). Treatment-related exposures were not associated with neurocognitive function; however, neurocognitive impairment was associated with lower educational attainment, unemployment, and occupational status (P values < .03). Slower processing speed and worse self-reported executive function were associated with symptoms of depression (P values ≤ .003) and poorer HRQOL (P values < .05). CONCLUSIONS: Adult survivors of childhood NHL experience impaired neurocognitive function, which is associated with lower social attainment and poor HRQOL. Early-detection and intervention strategies are recommended. Cancer 2017. © 2017 American Cancer Society.

Where cancer genomics should go next: a clinician's perspective.

Large-scale, genomic studies of specific tumors such as The Cancer Genome Atlas have provided a better understanding of the alterations of pathways involved in the development of solid tumors including glioblastoma, breast cancer, ovarian and endometrial cancers, colon cancer and lung squamous cell carcinoma. This tremendous effort of the scientific community has confirmed the view that cancer actually represents a wide variety of diseases originating from different organs. These studies showed that TP53 and PI3KCA are the two most mutated genes in all types of cancers and that 30-70% of all solid tumors harbor potentially 'actionable' mutations that can be exploited for patient stratification or treatment optimization. Translation of this huge oncogenomic data set to clinical application in personalized medicine programs is now the main challenge for the future. The gap between our basic knowledge and clinical application is still wide. Closing the gap will require translational personalized trials, which may initiate a radical change in our routine clinical practice in oncology.

Nasal peak inspiratory flow (NPIF) as a diagnostic tool for differentiating decongestable from structural nasal obstruction.

BACKGROUND: Identifying the cause of nasal obstruction is critical before surgical intervention. Structural nasal obstruction, due to nasal valve stenosis, is unlikely to benefit from simple septoplasty and turbinate reduction. This study assesses changes in nasal peak inspiratory flow (NPIF) as a tool for discriminating decongestable versus structural obstruction. METHODOLOGY: Cross-sectional study of patients undergoing nasal airflow assessment was performed. Rhinomanometry, nasal obstruction visual analogue scores (VAS) and NPIF were performed pre- and post-decongestion. Population groups were defined with decongestable or structural obstruction by relative post-decongestion changes in airways resistance and symptoms. RESULTS: Fifty two patients were assessed, 24 with decongestable, 28 with structural obstruction. Pre- and post-decongestion NPIF were similar between groups. Absolute and percentage NPIF change were larger with decongestable versus structural obstruction. Sensitivity and specificity for predicting decongestable obstruction were 75.0% and 60.7% for NPIF increase >20 L/min; 75.0% and 64.3% for NPIF increase >20%. The respective positive predictive values were 62.1% and 64.3%. CONCLUSION: NPIF increase after decongestion is larger with decongestable than structural nasal obstruction. NPIF alone cannot discriminate the two conditions and does not replace more formal assessment.

Ca(2)Y(2)Cu(5)O(10): the first frustrated quasi-1D ferromagnet close to criticality.

Ca(2)Y(2)Cu(5)O(10) is built up from edge-shared CuO(4) plaquettes forming spin chains. From inelastic neutron scattering data we extract an in-chain nearest-neighbor exchange J(1)≈-170 K and the frustrating next-neighbor J(2)≈32 K interactions, both significantly larger than previous estimates. The ratio α=|J(2)/J(1)|=0.19±0.01 places the system close to the critical point α(c)=0.25 of the J(1)-J(2) chain but in the 1D ferromagnetic regime. We establish that the vicinity to criticality only marginally affects the dispersion and coherence of the spin-wave-like magnetic excitations but instead results in a dramatic T dependence of high-energy Zhang-Rice singlet excitation intensities.

Ephedrine accelerates psychomotor recovery from anesthesia in macaque monkeys.

BACKGROUND: Ephedrine is used in treatment of hypotension during anesthesia. We investigated its effects on the psychomotor recovery and its potential adverse reactions on cardiorespiratory functions in rhesus monkeys. METHODS: The monkeys received 50 µg/kg medetomidine, 2.0 mg/kg S-ketamine with 150 IU hyaluronidase i.m. Pulse rate, blood pressure and saturation of haemoglobin were monitored for 20 minutes. Thereafter, 1 mg/kg of ephedrine or a placebo was administered i.m. and behavioural changes, pulse rate, blood pressure and saturation of haemoglobin were monitored every 5 minutes. RESULTS: Ephedrine shortened recovery from anaesthesia from 80.4 ± 25.8 to 14.83 ± 13.70 minutes. Ephedrine also increased oxygen saturation of haemoglobin and systolic blood pressure and caused significant decrease in pulse rate 5 minutes after its administration. CONCLUSIONS: Ephedrine can be successfully used to accelerate psychomotor recovery after the use of common anesthetic protocols combining dissociative anesthetic agent and alpha 2-adrenoceptor agonist in primates.

Can changes in skin impedance be used to monitor sedation after midazolam and during recovery from anesthesia?

It has been suggested that sympathetic activity, measured as changes in electrical skin impedance (SI), can be used to assess the adequacy of general anesthesia. Our prospective study investigated if measurements of skin impedance can determine levels of sedation induced by midazolam. Twenty-seven patients scheduled for arthroscopy requiring general anesthesia were served as their own control. These were blinded to the order of injections by telling them that they will be randomly administered a placebo (saline) orsedative agent. A DM 3900 multimeter was used for SI measurements. The degree of sedation was measured using the modified Observer's Assessment of Alertness and Sedation (mOAAS) scale. Resting SI values were noted, and all participants were then administered the placebo followed 5 min later by midazolam 2 mg i.v. Five min after that, patients were administered standard general anesthesia with propofol, oxygen, nitrous oxide 60 %, and isoflurane 1 MAC via a laryngeal mask, and sufentanil 5 - 10 µg. SI significantly increased after administration of midazolam and induction of anesthesia. There were no significant differences between pre-administration (baseline) and placebo and end of surgery and end of anesthesia with closed eyes. There were highly significant differences (p<0.001) between pre-administration vs. midazolam, placebo vs. midazolam, pre-administration vs. induction of anesthesia. We found slight correlation between mOAAS and SI. There were no significant changes between the end of surgery and the end of anesthesia with closed eyes, but SI significantly decreased (p<0.01) after eyes opened.

Late outcomes in survivors of childhood acute myeloid leukemia: a report from the St. Jude Lifetime Cohort Study.

Cumulative burden of chronic health conditions and neurocognitive and physical function were examined among survivors of childhood acute myeloid leukemia (AML) treated with hematopoietic cell transplant (HCT; n = 66) or conventional therapy (CT; n = 67). Survivors and controls underwent a comprehensive clinical assessment, and health conditions were graded using a modified version of the Common Terminology Criteria for Adverse Events. By age 40 years, HCT and CT survivors had an average 17.4 (95% confidence interval [CI] 14.6-20.1) and 9.3 (7.7-11.1) grade 1-4 conditions versus 3.8 (3.3-4.2) in community controls. Compared to controls, HCT survivors had a higher prevalence of hypertriglyceridemia (45.5% vs. 18.3%), hypercholesterolemia (47.0% vs. 30.9%), hypothyroidism (27.3% vs. 4.0%), and primary hypogonadism (p < 0.001). CT survivors had a higher prevalence of cardiomyopathy (11.9% vs. 2.7%) and hypertension (53.7% vs. 44.3%). Neurocognitive impairment was elevated across all domains compared to controls but did not differ by treatment modality. Compared to controls, a higher proportion of HCT survivors had impairments in strength and endurance; whereas flexibility and mobility impairments were noted among CT survivors. Despite successful advances in childhood AML therapy, many therapeutic exposures remain unchanged. These findings support ongoing investigations of novel therapies and strategies to ameliorate the risk of late morbidities.

Experience with a naphthylmedetomidine-ketamine-hyaluronidase combination in inducing immobilization in anthropoid apes.

BACKGROUND: The aim of the study was to compare the effect of naphthylmedetomidine to medetomidine on the behavior of orangutans and chimpanzees. METHODS: The immobilization was performed as part of a medical examination in five chimpanzees and three orangutans. Following pre-medication with midazolam (0.70-1.20 mg/kg p.o.), naphthylmedetomidine (50-70 microg/kg), or medetomidine (20-30 microg/kg) was given with ketamine (3 mg/kg) and hyaluronidase (150 M.U.) into musculus deltoideus. RESULTS: We observed the distinct anti-aggressive effect of naphthylmedetomidine. The immobilization with naphthylmedetomidine was shallower and the influence on cardiac frequency less substantial compared to medetomidine. The overall sedative effect of naphthylmedetomidine lasted for less time, and its effect was incompletely antagonized with atipamezole in comparison to medetomidine. CONCLUSIONS: Naphthylmedetomidine could replace medetomidine for inducing immobilization and sedation. A combination of naphthylmedetomidine-ketamine is suitable for relocating animals to other cages or for painless medical examinations.

[A combination of dexmedetomidine with ketamine and opioids results in significant inhibition of hemodynamic changes associated with laparoscopic cholecystectomy and in prolongation of postoperative analgesia]. / Kombinace dexmedetomidinu s ketaminem a opioidy významne potlacuje hemodynamické zmeny zpusobené laparoskopickou cholecystektomií a prodluzuje trváiní pooperacní analgezie.

THE AIM OF THE STUDY: Recently, alpha2 sympathoadrenergic drugs are used in premedication to improve the perioperative course. The aim of our study was to compare a premedication with a new alpha2 sympathoadrenergic drug and standard premedication. METHODS: After ethic committee approval and written patient consent, in a randomised, double-blinded study, combination of dexmedetomidine 1.0 microg x kg(-1) + ketamine 0.5 mg x kg(-1) + fentanyl 1.0 microg x kg(-1) + atropine 0.5 mg (group FNT), dexmedetomidine 1.0 microg x kg(-1) + ketamine 0.5 mg x kg(-1) + alfentanil 5.0 microg x kg(-1) + atropine 0.5 mg (group ALFNT), or pethidine 1.0 mg x kg(-1) + atropine 0.5 mg (group Dolsin) was administered to a deltoid muscle 15 min. before anaesthesia (GA) in patients elicited for laparoscopic cholecystectomy (LCHE). GA was performed in a standard way, ECG, NIBP, respiration rate, SpO2, onset of effect, Observers Assessment of Alertness Sedation Score (OAASS) before GA, circulatory reaction to intubation and capnoperitoneum, fentanyl consumption during GA, time to the first request for post-operative analgesia and postoperative nausea and vomiting were measured. The data were processed by Kruskal-Wallis and Fisher tests. P-value < 0.05 was considered significant. RESULTS: There were 16 patients in FNT and Dolsin and 15 patients in ALFNT with no differences in demography except for younger age in ALFNT. The main differences were in hypertension during capnoperitoneum: 0/16 FNT and 1/15 ALFNT vs. 11/16 Dolsin, both p < 0.001, per-operative fentanyl consumption: FNT 31.5 microg vs. Dolsin 165.0 microg, p < 0.001 and ALFNT 50.0 microg, p < 0.05 (ALFNT vs. Dolsin, p < 0.01) and request to the first analgesic post surgery: FNT 1.3 h. vs. Dolsin 0.45 h., p < 0.05 vs. ALFNT 0.8 h., p < 0.01. There were no differences in side effects except for bradycardia in ALFNT (p < 0.05). CONCLUSIONS: Dexmedetomidine-ketamine-fentanyl-atropine combination is superior to pethidine-atropine combination in suppressing of adverse hemodynamic effects of capnoperitoneum, decreased need for analgesia during GA and prolonged postoperative analgesia.

[Can the sacral spongiosa bleeding cause fatal complications of unstable pelvic fracture?]. / Muze být krvácení ze spongiózy sakra fatální komplikací nestabilní zlomeniny pánve?

The authors present the case of 36 years old woman, who suffered from unstable fracture of pelvis after she fell from the 5th floor. The spongiosa bleeding from both massae laterales sacri caused significant blood circuit destabilisation not only immediately after the injury but also in hours following the external fixation of pelvis. Due to persistent blood losses it was necessary to apply 38 RBC units, 48 FFP units, 1500 IU of antithrombin III, 1000 mg of fibrinogen and 6 platelet units within first 12 hospitalisation hours. With respect to ongoing bleeding and lack of accessible blood products it was decided to stop intensive hemotherapy and rationalize the treatment. The rationalization led to the hypotension (systolic blood pressure was 40-60 mm Hg), which along with gradual increase of body temperature caused unexpectable patient stabilisation. The systolic blood pressure was stabilized on 80 mm Hg and heart rate about 100/min. After 4 hours another 3 RBC units and 4 FFP units brought from the nearest reachable hospital were applied. The following blood pressure measurement was 120/80 and heart rate about 90/min. In the course of following 2 days it was possible to stop the catecholamine treatment. The authors are of opinion, that uncovered spongiosa caused by expresive dislocation of fragments may lead to massive bleeding that is difficult to stop by accessible means. The bleeding may be an essential risk for patients life and neither targeted intensive postoperative care can settle the matter.

Non-traditional administration of remifentanil in an experimental setting.

Remifentanil is ultrashort-acting opioid with a unique pharmacokinetic profile. It is used exclusively intravenously. While considering its rapid onset of action and other pharmacokinetic properties, we decided to assess its effects following administration via non-traditional routes. Rabbits (n=10 per each group) were randomized into six groups: remifentanil 1 microg/kg and 3 microg/kg IM, 5.0 and 10.0 microg/kg conjunctivally, and 10 microg/kg and 25.0 microg/kg intranasally. Sedating effects were assessed via a loss of the righting reflex. Secondary, mean arterial blood pressure, arterial oxygen saturation of hemoglobin, and pulse rate was monitored in all rabbits. Non-traditional routes of administration were shown to provide a rapid onset of action as well as fast recovery. Importantly, the administration of remifentanil did not result in any deterioration of cardiovascular functions.

Captive Agamid lizards in Germany: Prevalence, pathogenicity and therapy of gastrointestinal protozoan and helminth infections.

Reptiles are becoming popular pets in many parts of the world. They are also known to harbor numerous gastrointestinal parasites. We used faecal smears to examine 748 stool samples from 14 different agamid lizard species. In addition, we used coproantigen ELISA tests (11 samples) and immunofluorescence assays (IFA) (19 samples) to detect reptile Cryptosporidium infections. In 28 cases, veterinarians requested therapy to treat oxyurid- and/or Isospora amphiboluri-infections and resent fecal samples after proposed therapy and anti-parasitic treatments had been applied. We also performed complete dissections of 24 deceased agamas in order to specify protozoan and helminth parasite infections. Overall, the examined fecal samples contained 6 different taxa. Oxyurids (Pharyngodonidae) were the most prevalent nematodes (41.2%), followed by I. amphiboluri (17.0%), Entamoeba spp. (0.8%), Choleoeimeria spp. (0.5%), Trichomonas spp. (0.3%), Cryptosporidium spp. (0.3%) and Strongyloides-like nematodes (0.1%). I. amphiboluri infections were significantly more prevalent (Chi-square test: χ2 = 21,5, df = 1, P < 0.001) in juvenile agamid lizards (31.9%) than in adults (14.2%). One of 11 (9.1%) coproantigen ELISA-examined samples was positive for Cryptosporidium. In 10.5% of the samples we found oocysts of Cryptosporidium. Thirteen (54.2%) of necropsied agamid lizards were infected with endoparasites and it is likely that three (12.5%) of them died due to severe parasitic infections. 74.0% of the samples that were submitted after therapy had been applied were negative. The high prevalences and pathological findings of several clinical parasitoses observed in these exotic reptiles calls for more detailed investigations on agamid gastrointestinal parasite fauna.

Subsequent Breast Cancer in Female Childhood Cancer Survivors in the St Jude Lifetime Cohort Study (SJLIFE).

PURPOSE: Anthracycline-associated risk for subsequent breast cancer in childhood cancer survivors is hypothesized to be mediated by TP53 mutation-related gene-environment interactions. We characterized treatment/genetic risks and the impact of screening for breast cancer in the St Jude Lifetime Cohort. PATIENTS AND METHODS: Female participants underwent risk-based assessments, prior health event validation, chest radiation dosimetry, and whole genome sequencing. Breast biopsy reports were reviewed. A subgroup (n = 139) underwent both breast magnetic resonance imaging and mammography. Multivariable regression was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS: Among 1,467 women, 56 developed 68 breast cancers at a median age 38.6 (range, 24.5 to 53.0) years. Cumulative incidences at age 35 years were 1% (no chest radiation) and 8% (≥ 10 Gy of chest radiation). In adjusted models, breast cancer was associated with 20 Gy or more of chest radiation versus none (HR, 7.6; 95% CI, 2.9 to 20.4), anthracycline exposure versus none (1 to 249 mg/m2: HR, 2.6; 95% CI, 1.1 to 6.2; ≥ 250 mg/m2: HR, 13.4, 95% CI, 5.5 to 32.5), and having a breast cancer predisposition gene mutation (HR, 23.0; 95% CI, 7.3 to 72.2). Anthracyclines 250 mg/m2 or greater remained significantly associated with increased risk of breast cancer in models excluding survivors with cancer predisposition gene mutations, chest radiation 10 Gy or greater, or both. Sensitivity/specificity were 53.8%/96.3% for mammography, 69.2%/91.4% for magnetic resonance imaging, and 85.8%/99.7% for dual imaging. Breast cancers detected by imaging and/or prophylactic mastectomy compared with physical findings were more likely to be in situ carcinomas, smaller, without lymph node involvement, and treated without chemotherapy. CONCLUSION: Higher doses of anthracyclines are associated with increased risk of breast cancer independent of mutations in known cancer predisposition genes. Surveillance imaging identifies breast cancers less likely to require chemotherapy than those detected by physical findings.

Occurrence of health-compromising protozoan and helminth infections in tortoises kept as pet animals in Germany.

BACKGROUND: Exotic reptiles such as tortoises, have become increasingly common domestic pets worldwide and are known to host different gastrointestinal parasites. Some of these parasites bear zoonotic potential. In the present survey, we parasitologically examined tortoise faecal samples (n = 1005) from 19 different species held as pets in private German households and German zoological gardens. METHODS: Saline faecal smears were used to generate prevalence data for potentially health-compromising gastrointestinal parasites. In addition, we performed complete parasitological dissections of dead tortoises (n = 49) to estimate endoparasite burdens precisely. RESULTS: Analysed tortoise faecal samples contained a broad spectrum of endoparasites. We detected ten taxa of endoparasites; oxyurid nematodes (e.g. Tachygonetria spp.) were the most prevalent parasites in faecal samples (43.18%), followed by ascarids (Angusticaecum spp.) (0.01%), Hexamita spp. (0.007%), Balantidium spp. (0.007%), trichomonads (0.004%), Strongyloides spp. (0.003%), Entamoeba spp. (0.005%), Hartmanella spp. (0.001%), Blastocystis spp. (0.002%), heterakids (0.001%) and Trimitus spp. (0.001%). Additionally, we investigated dead tortoise individuals (n = 49; of 10 different species) for aetiological diagnosis and estimation of endoparasite burden. Of these individuals, 38 (77.6%) were infected with parasites and 14 (28.6%) of them died most probably due to severe parasitic infection. Oxyurid infections correlated positively with calcium deficiency and metabolic bone disease (MBD) as well as nephrosis/nephritis, mainly occurring in juvenile tortoises (< 5 years of age). CONCLUSIONS: The saline faecal smear technique proved to be efficient in detecting different metazoan and protozoan parasite stages in tortoise faeces. The prevalence of oxyurid infections was particularly high. In combination with pathological findings in clinical oxyuridosis obtained from necropsied animals, our findings call for further, detailed investigations on pathogenesis and immunology of oxyurids in pet reptiles. Coprological analyses for parasite detection should be mandatory before tortoises are transferred to a new owner, animal group, or public and private enclosures such as zoos. We advocate for regular health screenings in pet tortoises and, if parasitic infections are diagnosed, adequate medication or alternative hygiene management should be considered to improve and maintain individual and population health.

Temperature dependence of blood surface tension.

Whole blood surface tension of 15 healthy subjects recorded by the ring method was investigated in the temperature range from 20 to 40 degrees C. The surface tension omega as a function of temperature t ( degrees C) is described by an equation of linear regression as omega(t) = (-0.473 t + 70.105) x 10(-3) N/m. Blood serum surface tension in the range from 20 to 40 degrees C is described by linear regression equation omega(t) = (-0.368 t + 66.072) x 10(-3) N/m and linear regression function of blood sediment surface tension is omega(t) = (-0.423 t + 67.223) x10(-3) N/m.

A randomized comparison of different methods of analgesia in abortion using manual vacuum aspiration.

OBJECTIVE: To estimate the effectiveness of different methods of analgesia among women treated with manual vacuum aspiration for spontaneous abortion. MATERIALS AND METHODS: The 113 patients diagnosed with incomplete abortion and considered candidates for manual vacuum aspiration were randomly assigned to 3 groups of analgesic administration: diclofenac plus paracervical block; meperidine plus diclofenac; and meperidine alone. Pain levels were evaluated using the Wong Scale of Pain. RESULTS: The mean pain scores for the three groups were: diclofenac and paracervical block 5.4; meperidine plus diclofenac 5.0; meperidine 5.7 (P=0.57). Analysis of pain using the levels mild (0-3), moderate (4-6), and severe (7-10) showed no statistical significance among the 3 groups of analgesics. Adverse effects were more common in the groups using analgesia containing meperidine. CONCLUSIONS: There was no significant difference between the analgesics used among the 3 groups. Most of the patients, regardless of the analgesic used, reported moderate pain.

[Knowledge level of cardiopulmonary resuscitation in secondary school students of non-medical specialisation in the Czech Republic]. / Uroveni znalostí studentu stredních nezdravotnických skol o neodkladné resuscitaci v Ceské republice.

BACKGROUND: Knowledge of cardiopulmonary resuscitation (CPR) is essential part of the first aid skill. Constant attention is given to education in CPR mainly among adolescents. The aim of our epidemiological study was to asses the actual level of theoretical knowledge in CPR. METHODS AND RESULTS: We have developed a simple questionnaire including 17 items with 4 possible answers, just one correct. The questionnaire was distributed to students of middle schools excluding those with medical specialisation. Total 796 students from 26 classrooms participated, 784 (98.5%) of questionnaires could be used for evaluation. Excluding the knowledge in the purpose of resuscitation mask and telephone number of Emergency service, the number of correct answers was below 30%, even in items, which did not change for many years (position of the victim's body during resuscitation, frequency of artificial ventilation). CONCLUSIONS: Our results demonstrate that in spite of the effort to increase the level of knowledge in CPR in laymen, the actual level of knowledge is low and more frequent repetition of courses should be considered. In the future, we shall evaluate the effectiveness of new educational film.