[How do internal medicine patients choose their hospital? A cross-sectional study]. / Wie wählen internistische Patienten ihr Krankenhaus? Eine Querschnittstudie.

BACKGROUND: The free choice of hospital by patients is promoted by health policy and is to be supported by the quality reports of hospitals. But how do patients choose a hospital? How many can decide for themselves, where do they inform themselves and what are their decision criteria in the specific situation? This will be answered for inpatients of internal medicine in comparison to those of other specialties. METHODS: The data originate from an observational study. The random sample, stratified by specialties and hospital care levels, was collected in 46 departments of 17 hospitals from 15 cities and municipalities in North Rhine-Westphalia. The weighted sample evaluates 758 patients of internal medicine and 1168 patients of other specialties descriptively and inferentially. RESULTS: Internal medicine patients are older, more often men, without a migration background and chronically ill, and also more often pretreated as inpatients. About half decide on the hospital themselves, with their own knowledge of the hospital through a previous stay being the most important source of information and the important decision criteria being their own previous experience, the hospital call and the recommendation of outpatient treatment providers. The small proportion of patients with more time before admission choose more actively. CONCLUSIONS: In internal medicine, fewer patients can decide on the hospital themselves. These then decide quite predominantly on the basis of their previous experience with the hospital and continue the renewed treatment in the hospital with which they are also familiar. A small proportion of younger, more educated and less hospital-experienced patients inform themselves more actively before elective procedures. Patients' treatment experiences are central to their own and their relatives' choice of hospital via social exchange.

Abnormal thyroid function is common in takotsubo syndrome and depends on two distinct mechanisms: results of a multicentre observational study.

BACKGROUND: Several reports have described Takotsubo syndrome (TTS) secondary to thyrotoxicosis. A complex interaction of central and peripheral catecholamines with thyroid homeostasis has been suggested. In this study, we analysed sequential thyroid hormone profiles during the acute phase of TTS. METHODS: Thyrotropin (TSH), free T4 (FT4) and free T3 (FT3) concentrations were analysed at predefined time points in 32 patients presenting with TTS or acute coronary syndrome (ACS, n = 16 in each group) in a 2-year period in two German university hospitals. Data were compared to age- and sex-matched controls (10 samples, each of 16 subjects), and an unsupervised machine learning (ML) algorithm identified patterns in the hormone signature. Subjects with thyroid disease and patients receiving amiodarone were excluded from follow-up. RESULTS: Among patients with TTS, FT4 concentrations were significantly higher when compared to controls or ACS. Four subjects (25%) suffered from subclinical or overt thyrotoxicosis. Two additional patients developed subclinical or overt thyrotoxicosis during stay in hospital. In four subjects (25%), FT4 concentrations were increased, despite nonsuppressed TSH concentration, representing an elevated set point of thyroid homeostasis. The thyroid hormone profile was normal in only six patients (38%) presenting with TTS. CONCLUSION: Abnormal thyroid function is frequent in patients with TTS. Primary hyperthyroidism and an elevated set point of thyroid homeostasis are common in TTS, suggesting a stress-dependent endocrine response or type 2 thyroid allostasis. Thyroid function may be a worthwhile target in treating or preventing TTS.

[Equine dentistry: Survey on Swiss horse owners]. / Zahnbehandlungen beim Pferd: Umfrage bei Pferdebesitzern in der Schweiz.

INTRODUCTION: The interest in equine dentistry has significantly increased in the last 15 years. On the part of the veterinarians as well as of the horse owners there is a strong attention to the topic. The aim of the questionnaire was to investigate amongst horse owners what their level of information and preferences about dental treatment are and how they are implemented. The questionnaire was translated into the three national languages and included 20 questions about level and sources of information, frequency of treatments and the horse owner's stance over sedation of the animals. With a return rate of 45% (1'466 of 3'250 sent questionnaires) significant conclusions could be drawn. Horse owners showed a strong demand for clarification regarding tooth problems, the causes, consequences and methods of treatment. More than half of the owners considered themselves not well informed. The treating person was in 66.7% a veterinarian with a special education. Horse owners indicated that information circulated most frequently by word of mouth recommendations and they explicitly wished information from professional and reliable sources. The questionnaire provided a clear result about current equine dental treatments. We suggest that they should be performed by veterinarians only with a special education.

INTRODUCTION: Au cours des 15 dernières années, l'intérêt pour la médecine dentaire chez les chevaux a de nouveau beaucoup augmenté. Tant les vétérinaires que les propriétaires de chevaux accordent une grande importance à ce sujet. Le but de la présente enquête était de juger le niveau d'information et des préférences en matière de soins dentaires parmi les propriétaires en Suisse et comment elles se concrétisent. Le questionnaire a été rédigé dans les trois langues nationales et comportait 20 questions relatives au niveau et aux sources d'information des propriétaires ainsi qu'à la fréquence des soins dentaires et à la position des propriétaires face à la sédation de leur animal. Avec un taux de retour de 45% (1'466 sur 3'250 questionnaires envoyés), il a été possible de tirer des conclusions significatives. Les propriétaires de chevaux montrent un net besoin en matière d'explication concernant les problèmes dentaires, leurs causes, leurs conséquences et leurs méthodes de traitement. Plus de la moitié se considèrent comme insuffisamment informés. Chez 66.7%, le traitement est effectué par un vétérinaire spécialisé en soins dentaires. Les propriétaires déclarent que les informations leur sont le plus souvent fournies oralement et souhaitent clairement des informations de sources professionnelles et fiables. L'enquête a fourni des données claires sur les soins dentaires actuels chez le cheval. Il en résulte que nous recommandons que ces soins soient effectués principalement par des vétérinaires spécialisés sur ce domaine.

Effects of macrophage-dependent peroxisome proliferator-activated receptor γ signalling on adhesion formation after abdominal surgery in an experimental model.

BACKGROUND: The pathophysiology of adhesion formation after abdominal and pelvic surgery is still largely unknown. The aim of the study was to investigate the role of macrophage polarization and the effect of peroxisome proliferator-activated receptor (PPAR) γ stimulation on adhesion formation in an animal model. METHODS: Peritoneal adhesion formation was induced by the creation of ischaemic buttons within the peritoneal wall and the formation of a colonic anastomosis in wild-type, interleukin (IL) 10-deficient (IL-10(-/-) ), IL-4-deficient (IL-4(-/-) ) and CD11b-Cre/PPARγ(fl) (/fl) mice. Adhesions were assessed at regular intervals, and cell preparations were isolated from ischaemic buttons and normal peritoneum. These samples were analysed for macrophage differentiation and its markers, and expression of cytokines by quantitative PCR, fluorescence microscopy, arginase activity and pathological examination. Some animals underwent pioglitazone (PPAR-γ agonist) or vehicle treatment to inhibit adhesion formation. Anastomotic healing was evaluated by bursting pressure measurement and collagen gene expression. RESULTS: Macrophage M2 marker expression and arginase activity were raised in buttons without adhesions compared with buttons with adhesions. IL-4(-/-) and IL-10(-/-) mice were not affected, whereas CD11b-Cre/PPARγ(fl) (/fl) mice showed decreased arginase activity and increased adhesion formation. Perioperative pioglitazone treatment increased arginase activity and decreased adhesion formation in wild-type but not CD11b-Cre/PPARγ(fl) (/fl) mice. Pioglitazone had no effect on anastomotic healing. CONCLUSION: Endogenous macrophage-specific PPAR-γ signalling affected arginase activity and macrophage polarization, and counter-regulated peritoneal adhesion manifestation. Pharmacological PPAR-γ agonism induced a shift towards macrophage M2 polarization and ameliorated adhesion formation in a macrophage-dependent manner. Surgical relevance Postoperative adhesion formation is frequently seen after abdominal surgery and occurs in response to peritoneal trauma. The pathogenesis is still unknown but includes an imbalance in fibrinolysis, collagen production and inflammatory mechanisms. Little is known about the role of macrophages during adhesion formation. In an experimental model, macrophage M2 marker expression was associated with reduced peritoneal adhesion formation and involved PPAR-γ-mediated arginase activity. Macrophage-specific PPAR-γ deficiency resulted in reduced arginase activity and aggravated adhesion formation. Pioglitazone, a PPAR-γ agonist, induced M2 polarization and reduced postoperative adhesion formation without compromising anastomotic healing in mice. Pioglitazone ameliorated postoperative adhesion formation without compromising intestinal wound healing. Therefore, perioperative PPAR-γ agonism might be a promising strategy for prevention of adhesion formation after abdominal surgery.

Computed tomographic features of apical infection of equine maxillary cheek teeth: a retrospective study of 49 horses.

REASONS FOR PERFORMING STUDY: Computed tomographic (CT) studies evaluating the relevance of individual CT features of apical infection in maxillary cheek teeth are lacking. OBJECTIVES: To study the prevalence and relationship of single CT features in horses with and without clinical evidence of apical infection in maxillary cheek teeth. STUDY DESIGN: Retrospective case-control study. METHODS: Multislice CT scans of the head of 49 horses were evaluated retrospectively. Changes of the infundibulum, pulp, root, lamina dura, periodontal space and alveolar bone in maxillary cheek teeth were recorded. RESULTS: Single CT changes were much more prevalent in the 28 horses with clinical signs. However, infundibular changes and a nondetectable lamina dura were also common in the 21 horses without clinical evidence of apical infection. Computed tomographic abnormalities of the pulp, root, periapical bone and periodontal space and the presence of a tooth fracture were significantly related. Infundibular changes were not associated with other CT signs of apical infection. Although nondetectable lamina dura was the most frequent CT change in all teeth in both studied groups, it was most commonly a solitary feature in otherwise normal teeth. Apical infections, defined as ≥3 CT changes, occurred mainly in the 108/208, 109/209 and 110/210 (Triadan numbers) and were found only in horses with clinical evidence of apical infection, except in one horse without clinical signs that had one affected root. CONCLUSIONS: Combined CT changes of the pulp, root, lamina dura, periapical bone and periodontal space and the presence of a tooth fracture appear to be reliable features to diagnose apical infection in maxillary cheek teeth. As a solitary feature, a nondetectable lamina dura should be interpreted cautiously and may even be considered normal due to its minor thickness and/or too low resolution of the imaging modality.

Internal fixation of a fractured axis in an adult horse.

OBJECTIVE: To report internal fixation of a fractured axis with a dynamic compression plate (DCP). STUDY DESIGN: Case report. ANIMALS: A 7-year-old Warmblood gelding. METHOD: Surgery was performed under anesthesia in sternal recumbency. After fracture reduction the complete transverse fracture in the cranial third of the axis was stabilized with a 7-hole 4.5 mm DCP. Optimal positioning of the plate and the length of the screws were facilitated by fluoroscopy. Recovery from anesthesia was supervised in a pool. RESULTS: The horse had an excellent outcome and returned to its previous activity level. CONCLUSION: Surgical treatment with fracture reduction and plate fixation enables normal bearing of the head and neck and improves neck flexibility soon after surgery.

Molecular mechanisms and therapeutic application of NSAIDs and derived compounds in Alzheimer's disease.

Alzheimer's disease (AD) is the most common form of neurodegenerative dementias worldwide. Amyloid-ß deposition, neurofibrillary tangle formation and Neuroinflammation are the major pathogenetic mechanisms that in concert lead to memory dysfunction and decline of cognition. To date, there is no curative treatment for AD. Epidemiological analysis support the notion that sustained intake of non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk and delay the onset of AD. In contrast, therapeutic studies testing NSAID efficacy in AD patients have not yielded positive results. This suggests that either the investigated drugs have not addressed the mechanism of action required for mediating beneficial effects or that NSAIDs are effective at stages way before clinical onset of symptoms. The NSAIDs concerned are pleiotrophic in nature and interact with more than one pathomechanism. Therefore evidence for more than one neuroprotective action of NSAIDs has been put forward and it seems likely that some of the drugs act at multiple levels through more than one molecular mechanism. Some, even may not only be beneficial, but negative actions may be overruled by protective effects. Within these mechanisms, modulation of γ-secretase activity, the activation of the peroxisome proliferator-activated receptor-γ, binding to prostaglandin receptors or interactions at the blood-brain barrier may account for the observed protection from AD. This article reviews the current knowledge and views on the above mechanisms and critically discusses current obstacles and the potential as future AD therapeutics.

Distinct adrenergic system changes and neuroinflammation in response to induced locus ceruleus degeneration in APP/PS1 transgenic mice.

Degeneration of locus ceruleus (LC) neurons and subsequent reduction of norepinephrine (NE) in LC projection areas represent an early pathological indicator of Alzheimer's disease (AD). In order to study the effects of NE depletion on cortical and hippocampal adrenergic system changes, LC degeneration was induced in 3-month-old APP/PS1 mice by the neurotoxin N-(2-chloroethyl)-N-ethyl-bromo-benzylamine (dsp4). Dsp4 induced a widespread loss of norepinephrine transporter binding in multiple brain structures already at 4.5 months. This was accompanied by changes of α-1-, α-2-, and ß-1-adreneroceptor binding sites as well as altered adrenoceptor mRNA expression. In parallel, we observed increased micro- and astrogliosis in cortical and hippocampal structures in dsp4-treated groups. In addition, the expression of the pro-inflammatory cytokines CCL2 and IL-1ß were induced in both, dsp4-treated and APP/PS1-transgenic mice, whereas IL-1α was only up-regulated in dsp4-treated APP/PS1 mice. Concerning amyloid ß (Aß) deposition, we observed an elevation of Aß1-42 levels in aged dsp4-treated APP/PS1 mice. These data support the hypothesis that LC degeneration leads to dysregulation of adrenergic receptors and exacerbation of Aß-induced neuroinflammation, both of which are exploitable for early disease marker development.

Treatment of type 2 and 4 olecranon fractures with locking compression plate osteosynthesis in horses: a prospective study (2002-2008).

This prospective study describes a series of 18 olecranon fractures in 16 horses that were treated with locking compression plates (LCP). Twelve of the 18 fractures were simple (type 2), whereas six were comminuted (type 4). Six fractures were open and 12 were closed. Each horse underwent LCP osteosynthesis consisting of open reduction and application of one or two LCP. Complete fracture healing was achieved in 13 horses. Three horses had to be euthanatized: two because of severe infection and one because of a comminuted radial fracture 11 days after fixation of the olecranon fracture. Complications encountered after discharge of the horses from the Equine Hospital at the Vetsuisse Faculty (University of Zurich) included implant infection (n=2) and lameness (n=3), which were successfully treated with implant removal. Despite being easier to use, LCP osteosynthesis resulted in a clinical outcome similar to DCP osteosynthesis.

Bilateral iatrogenic [corrected] maxillary fractures after dental treatment in two aged horses.

This clinical report describes two horses with bilateral maxillary fractures following dental treatment. The fractures occurred during dental treatment by a veterinarian, and both had rostral, transverse, and complete bilateral maxillary fractures with instability and minimal displacement. The fractures were repaired using bilateral intraoral wiring with the patients under general anesthesia. The postoperative period was without complications and the fractures healed as expected. Maxillary fractures during or after routine dental treatment are rare, but can occur, especially in older horses. Appropriate sedation and, if necessary, regional nerve blocks might reduce the risk of iatrogenic fractures of the maxilla. General anesthesia must be considered for tooth extraction in horses that are difficult to restrain.

Results and complications of a novel technique for primary castration with an inguinal approach in horses.

REASONS FOR PERFORMING STUDY: Complications associated with equine castration can have medical and financial consequences. This retrospective study investigated a novel method of castration via an inguinal approach in mature stallions and compared the incidence of complications with other methods. HYPOTHESIS: Castration via an inguinal approach has a low complication rate at the site of surgery compared with other castration techniques. METHODS: Mature stallions (n = 238) were castrated under general anaesthesia in dorsal recumbency using an inguinal approach. The vaginal process was incised, the spermatic cord ligated twice and the testis removed. After suturing, the vaginal process and one or 2 layers of fascia, the subcutis and cutis were closed in a simple continuous pattern. RESULTS: Five of 238 (2.1%) horses had post operative haemorrhage and a haematoma in the scrotal region, which required additional treatment. All horses made a full recovery. Five of 238 (2.1%) of the horses had a post operative respiratory infection, which resolved with antibiotic therapy. Sixteen of 238 (8.8%) had transient signs of colic shortly after surgery. CONCLUSION: This technique of castration with an inguinal approach had a low incidence of complications at the site of surgery compared with other methods. An inguinal approach and leaving the vaginal tunic in situ may cause less soft tissue trauma than a scrotal approach.

[Surgical treatment of canker involving all hoofs in a warmblood gelding]. / Die chirurgische Behandlung von Strahlkrebs an allen vier Gliedmassen bei einem Warmblutwallach.

The following case report describes the treatment of canker in a 14 years old warmblood gelding. The horse showed the typical appearance with caseous surface and early detachment of the superficial horn layers. The histological results show a severe degradation in the germinal layer of the epidermis of the frog. Surgical therapy under general anaesthesia was performed. On all limbs a tourniquet was applied and all abnormal tissue in the region of the frog and also the subdermal tissue underneath were removed. Postoperatively the horse was treated with hoof bandages for 2 weeks. Treatment plates were than applied on all hoofs. During the following weeks the wounds were topically treated with Giessner Mischung 2 an astringent, desinfectant powder. The powder contains jodophorm, zincoxyde, tanninic acid, metronidazole. After 5 months the frog showed a complete cover with strong horn material and without any signs of recrudescence.

Locking compression plate osteosynthesis of complicated mandibular fractures in six horses.

Complicated mandibular fractures were recognised in one foal, one pony and four horses. The foal was two months old while the adult animals ranged in age from 12 to 24 years. Three horses had a unilateral horizontal ramus fracture. Two fractures were open and one was closed. Comminution was present in one of these patients while the other two horses had marked displacement of the fragments. Two suffered from comminuted fractures of the horizontal and vertical ramus of the mandible. One of these patients had open and infected fractures. One foal had a bilateral horizontal ramus fracture with marked periosteal 'new bone' formation and malalignement which required corrective osteotomy. Each horse underwent locking compression plate (LCP) osteosynthesis consisting of open fracture reduction and application of one to three 4.5/5.0 mm LCP at the ventral, lateral or caudal aspect of the mandible under fluoroscopic control. Two 3.5 mm LCP were used in the foal. Plate fixation was supported by application of a cerclage wire construct between the incisor and premolar teeth in most patients. Complete fracture healing, with an excellent functional and cosmetic outcome, was achieved in all of the patients. Complications encountered included seroma formation, screw and wire breakage, as well as implant and apical tooth root infections. The LCP was removed after fracture healing had occurred in four patients.

Abeta induces cell death by direct interaction with its cognate extracellular domain on APP (APP 597-624).

Amyloid beta-peptide (Abeta) is postulated to play a central role in the pathogenesis of Alzheimer's disease. We recently proposed a pathway of Abeta-induced toxicity that is APP dependent and involves the facilitation of APP complex formation by Abeta. The APP-dependent component requires cleavage of APP at position 664 in the cytoplasmic domain, presumably by caspases or caspase-like proteases, with release of a potentially cytotoxic C31 peptide. In this study we show that Abeta interacted directly and specifically with membrane-bound APP to facilitate APP homo-oligomerization. Using chimeric APP molecules, this interaction was shown to take place between Abeta and its homologous sequence on APP. Consistent with this finding, we demonstrated that Abeta also facilitated the oligomerization of beta-secretase cleaved APP C-terminal fragment (C99). We found that the YENPTY domain in the APP cytoplasmic tail and contained within C31 is critical for this cell death pathway. Deletion or alanine- scanning mutagenesis through this domain significantly attenuated cell death apparently without affecting either APP dimerization or cleavage at position 664. This indicated that sequences within C31 are required after its release from APP. As the YENPTY domain has been shown to interact with a number of cytosolic adaptor molecules, it is possible that the interaction of APP, especially dimeric forms of APP, with these molecules contribute to cell death.

[Do hoof cracks represent a superficial hoof-problem?]. / Sind die Hornspalten ein oberflächliches Hufproblem?

Fifty-four horses with hoof cracks were referred to the Equine Hospital of the University of Zurich, for treatment. The horses were admitted because of lameness or other symptoms caused by the cracks. Deep or complicated quarter cracks were the most common type of cracks diagnosed. Poor conformation and abnormal hoof shape were the most important causes of hoof crack development, whereas injury to the coronary band was a less frequently encountered cause. Effective treatment of this problem includes corrective shoeing, removing horn from the weight-bearing surface as well as from the crack with a Dremel tool and immobilization of the borders of the crack. However, even with such a therapy, the recurrence rate of hoof cracks was with 20% very high.

[The art of horseshoeing--between empiricism and science]. / Die Kunst des Hufbeschlags--zwischen Empirie und Wissenschaft.

To correctly shoe a horse requires the farriers to have a good working knowledge of postural anomalies and movement patterns, as well as of the different concepts of horseshoeing and to be able to apply the appropriate technique to every individual horse they shoe. The correct technique for specific problem cases is frequently a subject of debate amongst specialists and many theories would benefit from objective gait analyses. The case study presented examines the influence of different shoeing conditions on selected gait analysis parameters. The measurements were conducted on a Warmblood mare: (A) shod with long toes, (B) properly trimmed without shoes, (C) conventionally shod with rolled toes and finally (D) shod using the 4-point technique. Data on force-, time- and distance parameters were recorded using an instrumented treadmill. First contact and breakover of the hooves were documented using high-speed videography. A long toe resulted in a prolongation of the breakover time and, therefore, in a prolongation of the second half of the stance phase. Additionally, the prolonged stance duration associated with an unaltered force impulse, led to decreased force peaks. It was possible to objectively record differences between the trimmed, unshod foot, the shod long-toe and the shod rolled toe configurations. The differences between the rolled toe and the 4 point shoe however, were minimal. Gait analysis is a technique well suited for objective evaluation of different shoeing techniques under standardised conditions.

Evaluation of a standardised radiographic technique of the equine hoof.

Radiography of the equine hoof is often used to obtain a diagnosis. Quantitative interpretation, especially for research purposes requires high quality and accuracy of radiographs. The purpose of this study was to describe and evaluate a radiographic technique for the lateromedial (LM) and the dorsopalmar (DP) view of the equine hoof. Ten radiographs for each view from one cadaver limb and from both front feet in a standing horse were taken in order to assess repeatability of the radiographic technique. The method requires easy to use adjustable and portable equipment and strictly defined external radio opaque markers on the hoof capsule. The digitalised radiographs were processed and analysed with the software package Metron PX, measuring 13 parameters in the LM view and 10 parameters in the DP view, respectively. Results show that with few exceptions measurements of these parameters revealed a coefficient of variation that was smaller than 0.05. It was concluded that this easy to use standardised radiographic technique ensures excellent accuracy and repeatability for both the LM and DP view. Hence, this method provides an adequate tool for quantitative assessment of the equine hoof, inter- and intraindividually.

Self-diffusion of (31)Si and (71)Ge in relaxed Si(0.20)Ge(0.80) layers.

Self-diffusion of implanted (31)Si and (71)Ge in relaxed Si(0.20)Ge(0.80) layers has been studied in the temperature range 730-950 degrees C by means of a modified radiotracer technique. The temperature dependences of the diffusion coefficients were found to be Arrhenius-type with activation enthalpies of 3.6 eV and 3.5 eV and preexponential factors of 7.5 x 10(-3) m(2) s(-1) and 8.1 x 10(-3) m(2) s(-1) for (31)Si and (71)Ge , respectively. These results suggest that, as in Ge, in Si(0.20)Ge(0.80) both (31)Si and (71)Ge diffuse via a vacancy mechanism. Since in Si(0.20)Ge(0.80) (71)Ge diffuses only slightly faster than (31)Si , in self-diffusion studies on Si-Ge (71)Ge radioisotopes may be used as substitutes for the "uncomfortably" short-lived (31)Si radiotracer atoms.