Family doctors' attitudes toward peer support programs for type 2 diabetes and/or coronary artery disease: an exploratory survey among German practitioners.

BACKGROUND: Type 2 diabetes (T2D) and coronary artery disease (CAD) are chronic illnesses where adherence to a healthy lifestyle is crucial. If organisational and cultural factors are well managed, Peer support programs (PSP) can improve self-management, quality of life, and health outcomes. In preparation for launching a PSP, we surveyed family doctors (FD) about their attitudes toward such a program and about potential barriers, and facilitators. METHODS: In March 2020 we surveyed 896 FDs from five university teaching practice networks in North-Rhine Westphalia, Germany, via an anonymous web-based survey. The questionnaire addressed details of PSPs, including suitable patients and FDs'role. Data were analysed using descriptive and inferential statistics; qualitative material underwent content analysis by two researchers. RESULTS: A total of 165 FDs responded (response rate: 18.4%), 97% were practice owners. Respondents viewed PSPs positively (T2D: 92.0%, CAD 89.9%), especially for patients with poor self-structuring (82.7%), low motivation (76.3%) and few social contacts (67.6%). On average, FDs were able to identify 4.0 ± 3.2 patients as potential group leaders. Major facilitators reported included motivation by peers (92.5%), exercise (79.1%), and social contacts (70.1%). Waning interest over time (73.1%) and poor motivation (70.9%) were considered barriers. The majority of FDs would recommend PSPs to their patients (89.5%). They considered such a program a valuable addition to current care (79.7%). The percentage of FDs' who expected long-term benefits for their workload was relatively low (37.6%). CONCLUSIONS: In an exploratory survey among German FDs on PSPs, respondents viewed PSPs as a valuable add-on for T2D and CAD patients, while not expecting a positive impact on their workload. Communication with FDs on PSPs may need to highlight anticipated implementation outcomes such as benefits of PSPs to the practice.

An Overview of Pathogens Associated with Biotic Stresses in Hemp Crops in Oregon, 2019 to 2020.

Hemp (Cannabis sativa) acreage in Oregon has increased by approximately 240 times in the last 5 years, and a greater number of hemp diseases have been observed. This special report documents pathogens, particularly those causing virus and virus-like diseases, that have been detected from field and greenhouse-grown hemp crops in Oregon, based on plant samples submitted to the Hermiston Agricultural Research and Extension Center Plant Clinic of Oregon State University in 2019 and 2020. Symptoms and signs were used to evaluate disease types and determine diagnostic assays used on each submission. Plants with signs or symptoms of fungal or oomycete infection were cultured to isolate pathogenic organisms and plants with symptoms suspected to be caused by virus infection were assayed for the presence of Beet curly top virus (BCTV), viroids, and phytoplasmas using PCR, or reverse transcription (RT)-PCR. Diseases with fungal or oomycete, and virus causes accounted for 26.5 and 42.9% of submissions, respectively; coinfection of viral and fungal or oomycete pathogens were detected from 6.1% of submissions between 2019 and 2020. BCTV, a curtovirus, and hop latent viroid (HLVd) were the predominant pathogens detected from field and indoor grown hemp. Worland-like strains of BCTV represented 93% of all curtovirus detections. Eighty percent of HLVd detections occurred from plants that originated from indoor growing facilities. Based on BCTV vector, beet leafhopper, prevalence, field-grown hemp in western production regions may be affected by curly top and increasing hemp acreage in the landscape may have potential implications on other crops affected by curtoviruses. Virus and virus-like diseases could be a limiting factor for hemp production in some regions of the United States.

A novel heterozygous variant in ERLIN2 causes autosomal dominant pure hereditary spastic paraplegia.

BACKGROUND AND PURPOSE: Hereditary spastic paraplegias (HSPs) are clinically and genetically heterogeneous monogenic disorders. To date, nearly 70 genes are known to be causative. The aim of this project was to identify the genetic cause of autosomal dominantly inherited pure HSP in two large, unrelated non-consanguineous families. METHODS: The two families were characterized clinically and selected members underwent whole exome sequencing. Potentially disease-causing variants were confirmed by Sanger sequencing and their functional consequences on protein function were predicted by bioinformatic prediction tools. RESULTS: The patients presented with pure spastic paraplegia with age of onset between 9 and 46 years. In both families, a novel heterozygous missense variant in ERLIN2, c.386G>C; p.Ser129Thr, was the only potentially pathogenic variant identified that segregated with the disease. CONCLUSIONS: Biallelic variants in ERLIN2 are known to cause recessive HSP type SPG18. Here, the first two families with an autosomal dominant, pure form of HSP caused by a novel ERLIN2 heterozygous missense variant are described. These findings expand the mutational and inheritance spectrum of SPG18. ERLIN2 variants should also be considered in the diagnostic evaluation of patients with autosomal dominant HSP.

[What does pain intensity mean from the patient perspective? : A qualitative study on the patient perspective of pain intensity as an outcome parameter in treatment evaluation and on the interpretability of pain intensity measurements]. / Was bedeutet Schmerzintensität aus Sicht der Patienten? : Eine qualitative Studie zur Patientenperspektive auf Schmerzstärke als Konstrukt in der Therapieevaluation und die Interpretierbarkeit der Schmerzstärkemessung.

BACKGROUND: Pain intensity (PI) is a common outcome parameter in effectiveness studies on interdisciplinary multimodal pain therapy (IMPT), despite the fact that IMPT highlights dealing with rather than reducing chronic pain. Moreover, the measurement of pain intensity as a highly subjective experience is problematic. Patient participation is absolutely essential to examine the relevance of PI as a criterion of treatment success as well as to select/develop suitable measurement methods. METHOD: A qualitative multicenter study was conducted using focus groups with 69 patients (18-77 years; 80% female) at four different IMPT centers in Germany to discuss pain intensity as a therapy outcome parameter in IMPT, as well as the interpretability and feasibility of common measurement methods. RESULTS: The discussions emphasized that PI is a relevant, but not the primary, outcome in IMPT for patients. Patients' statements also demonstrate that there are some problems in measuring PI, for instance with regard to pain attacks. CONCLUSIONS: The focus group discussions suggested that, due to the highly subjective nature of PI, as well as (verbal) inaccuracies and a lack of standardization in common instruments, the measurement of pain intensity is a challenging task. These limitations should be taken into account in future studies.

The use of the "preclosure" technique for antegrade aspiration thrombectomy with large catheters in acute limb ischemia.

PURPOSE: This study was designed to assess retrospectively short- and mid-term outcomes of the use of a suture-mediated closure device to close the antegrade access in patients undergoing percutaneous aspiration thrombectomy with large catheters for acute leg ischemia. METHODS: Between November 2005 and February 2010, a suture-mediated active closure system (ProGlide(®) 6F, Abbott) was placed before arterial sheath (mean 9 F, range 6-12 F) introduction in 101 patients (74 men, 73 %, mean age 70.1 ± 12.6 years standard deviation). Data regarding mortality, complications, and factors contributing to vascular complications at the access site was collected for 6 month after the intervention to detect device-related problems. As a coincidence, 77 patients had follow-up visits for a duplex ultrasound. RESULTS: There were a total of 19 vascular complications (19 %) at the puncture site, all of which were of hemorrhagic nature and none of which consisted of vessel occlusion. Two major outcome complications (2 %) occurred. A retroperitoneal hematoma and a serious inguinal bleeding required additive treatment and did not result in permanent sequelae. Nine cases involved death of which eight were not attributable to the closure and one remained unclear. Successful closure was achieved in 95 patients (94 %); additional manual compression was sufficient in the majority of the remaining patients. Numerous factors contributing to vascular complications were encountered. CONCLUSIONS: With acceptable short- and mid-term outcomes, the "preclose" technique can be a reliable option for the closure of a large antegrade femoral access even for patients at a high risk of vascular complications, such as those undergoing aspiration thrombectomy.

Novel combination of orientation measurements and transmission microscopy for experimental determination of grain boundary miller indices in silicon and other semiconductors.

The determination of grain boundary planes in multicrystalline material has only been restricted to transmission electron microscope investigations (Jang et al., 1992; Elgat et al., 1985) or to metallograpical investigations of the grain boundary (Randle et al., 1993). The first method is expensive, and both are complex and time consuming in grain boundary preparation. This paper proposes the determination of grain boundary planes in semiconductor wafer by a combined application of Electron Back Scatter Diffraction and Infrared Transmission Microscopy. In particular, the new method is demonstrated with directional solidificated multicrystalline silicon.

[Postoperative therapy for pain in children].

Treatment of acute pain is one of the most important tasks of perioperative pediatric anesthesia. Pain-relieving drugs are usually administered on the basis of the concept of balanced analgesia, which involves a combination of analgesics with either synergic or additive effects. The concept of balanced analgesia is successful under many circumstances, but continuous efforts are needed to improve management in dificult cases. The key problem is to decide if a child has pain. Establishing a high standard at an institution requires a regular evaluation and documentation of pain scores. Non-opioid analgesics are frequently administered just in the induction of anesthesia due to their long-term effects, and then combined with opioids or regional anesthetic techniques. The present review focuses on non-opioid analgesics that can be intravenously injected for the perioperative treatment of acute pain.

[Secretin-enhanced magnetic resonance cholangiopancreaticography: value for the diagnosis of chronic pancreatitis]. / Sekretinstimulierte Magnetresonanzcholangiopankreaticografie (MRCP): Wertigkeit in der Diagnostik der chronischen Pankreatitis.

Endoscopic retrograde cholangiopancreaticography (ERCP) is the morphologic gold standard for the diagnosis of chronic pancreatitis. Magnetic Resonance Imaging (MRI) enables the visualization of not only the pancreatic duct but also the surrounding parenchyma using T2- and T1-weighted sequences before and after the application of a contrast agent. Moreover, it allows the depiction of ductal segments distal to a stenosis or occlusion. However, conventional Magnetic Resonance Cholangiopancreaticography (MRCP) was not able to achieve accuracy similar to that of ERCP. Despite many technological innovations, such as fast breath-hold acquisitions or respiratory-gated 3D sequences, this drawback could not be overcome. In recent years, secretin-enhanced MRCP has been used for the diagnosis of chronic pancreatitis. A recent study showed that secretin not only improves the visibility of the pancreatic duct and its side branches but it also enhances the diagnostic accuracy of MRCP. The sensitivity, specificity, and positive and negative predictive values were improved by the application of secretin. Moreover, the agreement between independent observers increased after the use of secretin. In addition, quantitative post-processing tools have been developed that enable the measurement of the exocrine pancreatic output non-invasively using secretin-enhanced MRCP. These tools facilitate applications, such as functional follow-up after pancreaticogastrostomy and pancreaticogastric anastomoses, evaluation of the functional status of the graft after pancreas transplantation and follow-up of pancreatic drainage procedures and duct disruption.

Otarine Herpesvirus-1, not papillomavirus, is associated with endemic tumours in California sea lions (Zalophus californianus).

The purpose of this study was to determine if Otarine Herpesvirus-1 (OtHV-1) is associated with the presence of urogenital carcinomas in California sea lions. Polymerase chain reaction (PCR) analysis with primers specific for OtHV-1 was used to compare the prevalence of OtHV-1 infection in 15 sea lions affected by urogenital carcinoma with that of age-matched and juvenile tumour-free animals, and animals with tumours of non-urogenital origin. The herpesvirus was more prevalent (100%) and more widespread in the 15 animals with urogenital carcinoma than in 25 control animals, and was most often found in the urogenital tissue (vagina and prostate) and in the draining lymph nodes. Moreover, OtHV-1 DNA was not found in any juvenile animal, or in the neoplastic tissues of animals with non-urogenital tumours. Papillomavirus-specific PCR analysis of urogenital carcinoma tissues detected papillomavirus sequences in only one carcinomatous tissue. Further studies are needed to determine if OtHV-1 contributes to oncogenesis in the California sea lion; these data show, however, that OtHV-1 is associated with urogenital carcinomas, is preferentially present in urogenital tissues, and may be sexually transmitted. Papillomaviruses, which are known to contribute to urogenital tumours in other species, did not appear to be associated with the sea lion carcinomas.

[Fractures of the cervical vertebrae: diagnosis with multi-slice spiral CT]. / Halswirbelsäulenfrakturen: Diagnostik mit der Mehrschicht-Spiral-CT.

PURPOSE: It is the aim of this study to investigate the efficiency of multislice helical CT for the diagnosis of cervical spine fractures. The advantages of this technique are demonstrated by case reports. MATERIAL AND METHODS: The entire cervical spine or selected vertebral bodies of 66 patients with cervical spine fractures known from preceding plain films were scanned with a multislice helical CT. The CT-scans were obtained with a slice thickness of 1.25 mm and with two different pitches (0.75 or 1.5) and table speeds (3.75 or 7.5 mm/rot.). Additionally, sagittal and coronal reformations were performed. RESULTS: The mean scan-time for the cervical spine was 13 seconds. High quality sagittal and coronal reformations were obtained from axial images within a few minutes. Fractures of the dens (n = 17) and of the vertebral body of C3-C7 (n = 12) occurred predominantly. CONCLUSION: Multislice helical CT is an effective tool to diagnose fractures of the cervical spine rapidly and exactly.

[Diagnosis of lung embolism and underlying venous thrombosis in multi-slice spiral CT]. / Diagnostik der Lungenembolie und zugrundeliegender Venenthrombosen in der Mehrzeilen-Spiral-CT.

AIM: To determine the value of multi-slice CT for the diagnosis of acute pulmonary embolism and an underlying venous thrombosis. METHODS: 70 patients with clinically suspected acute pulmonary embolism were examined. Using multi-slice CT a combined examination of the pulmonary arteries and the veins of the lower limb, pelvis and abdomen was performed. Only one single bolus of 150 ml iopromid 300 was injected into a cubital vein with a flow of 4 ml/s. First, the pulmonary arteries were scanned with a slice thickness of 2.5 mm and a pitch of 1.5. On arrival of the contrast medium at the popliteal veins, indicated by bolus trakking, the veins of the lower limbs up to the end of the inferior vena cava were imaged using a slice thickness of 3.75 mm and a pitch of 1.5. The results could be compared with a ventilation-perfusion scan in 48 cases, with a Doppler ultrasound examination in 46 cases, and with a venography in 10 cases. Furthermore, the image quality of all arterial and venous regions was subjectively assessed. RESULTS: In all patients who underwent multi-slice CT the pulmonary arteries as well as the veins of the lower half of the body could be recorded completely. Regarding the pulmonary arteries the image quality showed excellent results for the central and segmental arteries. The region up to the 3rd division in subsegmental branches could be sufficiently judged. More peripherally, a diagnostic assessment was not possible. The image quality of the veins was excellent in all sections, except the calf, where a reliable diagnosis could not be made. The comparison with the other techniques confirmed the superiority of multi-slice CT concerning the central and segmental pulmonary arteries and the veins from the popliteal vein to the inferior vena cava. In contrast, peripheral pulmonary emboli can be detected more certainly in ventilation/perfusion scans. The veins of the calf can be evaluated more reliably with venography. CONCLUSION: Multi-slice CT proved to be an outstanding tool in the diagnosis of acute pulmonary embolism. The clinically suspected disease and a causing venous thrombosis can be detected in a fast and reliable way. At present, multi-slice CT is not suitable for the recognition of peripheral emboli. However, expected technical developments hold promise for future improvements.

Facile preparation of Hexahydropyrrolo

Chlorolactames 2a-f reacted with sodium azide to give the cyclopropylketimines 3a-f (75-89%), and acid hydrolysis of 3c,d yielded the cyclopropylketones 6c,d (61-67%). Compounds 3a-f and 6c, d were transformed by heating (170-240 degrees C, sublimation) to the air-sensitive dihydropyrroles 4a-f (51-71%) and dihydrofurans 7c, d (85-91%). Oxidation of the dihydro derivatives 4a-f and 7c,d with DDQ led to novel types of pyrrolo[3,2-e][1,4]diazepinedione derivatives 5a-f (75-84%) and furo[1H][3,2-e][1,4]diazepinediones 8c, d (91-93%).

[Multislice CT angiography: optimization of scan parameters in a vascular phantom]. / Mehrschicht Spiral-CT-Angiographie: Optimierung der Untersuchungsparameter an einem Gefässphantom.

PURPOSE: The aim of this study is to determine the optimal scan parameters for the evaluation of experimental vascular stenoses with a multislice-helical CT. MATERIAL AND METHODS: A vascular phantom consisting of four tubes with an inner diameter of 8 mm and with experimental stenoses of 50%, 75% and 90% was scanned in different tube orientations using a multislice-CT scanner (LightSpeed QX/i, GE, Milwaukee, USA). Examinations were performed with increasing collimations (1.25-5 mm), tube currents (100-300 mA) and two different table speeds (0.75 HQ mode and 1.5 HS mode). RESULTS: The most exact measurements were obtained in tubes angulated parallel to the scan direction with a collimation of 2.5 mm in the HQ mode (7.5 mm/rot.). An almost equivalent accuracy was obtained in the HS mode (15 mm/rot.) with a collimation of 2.5 mm when higher tube currents (300 mA) were employed. The degree of stenoses was overestimated when the tube was angulated perpendicular to the z-axis. CONCLUSION: Multislice-CT provides a good detection rate of vascular stenoses especially at 0 degree and also at 45 degrees angulation in the HQ mode. The use of the HS mode with higher tube currents allows scanning of longer distances with almost identical accuracy.

Changes in AV node conduction curves following slow pathway modification.

Dual AV node physiology often persists after successful slow pathway (SP) ablation, and the mechanism of tachycardia elimination is unresolved. Therefore, AV node conduction curves were analyzed following successful ablation (4 +/- 1 energy applications) in 85 consecutive patients (58 women, age 50 +/- 2 years) with typical AVNRT. Twenty-seven patients (32%) had complete elimination (group 1) whereas 58 (68%) patients had persistence (group 2) of dual AV node physiology. A significant increase in the AV node Wenckebach cycle length (WB-CL) was observed in both groups (310 +/- 9 to 351 +/- 15 ms in group 1, and 325 +/- 8 to 369 +/- 9 ms in group 2, P < 0.05). A decrease in the fast pathway (FP) ERP (339 +/- 15 to 279 +/- 12 ms) and an increase in the maximum FP AH interval (141 +/- 5 to 171 +/- 7) were observed only in group 1 (P < 0.05). In group 2, no change in the SP ERP (267 +/- 7 to 280 +/- 10 ms) was observed, and the change in the maximum SP-AH following ablation showed a significant inverse relation to the maximum SP-AH at baseline in group 2. In conclusion, (1) an increase in the WB-CL is observed independent of the persistence or elimination of dual physiology after successful ablation; (2) when dual physiology is eliminated, significant changes in the FP ERP and the maximum FP-AH occur; (3) when dual physiology persists, FP physiology and the SP ERP remain unchanged, and a significant inverse relation between the change in the maximum SP-AH following ablation and the maximum baseline SP-AH is observed.