Non-invasive method for assessment of inflammation.

This article explores the potential of non-invasive measurement for elevated levels of erythrocyte aggregation in vivo, which have been correlated with a higher risk of inflammatory processes. The study proposes utilizing a dynamic light scattering approach to measure aggregability. The sensor modules, referred to as "mDLS," comprise VCSEL and two photodiodes. Two of these modules are placed on an inflatable transparent cuff, which is then fitted to the subject's finger root, with one sensor module positioned on each side. By temporarily halting blood flow for one minute using over-systolic inflation of the cuff, signals from both sensors are recorded. The study involved three distinct groups of subjects: a control group consisting of 65 individuals, a group of 29 hospitalized COVID-19 patients, and a group of 34 hospitalized patients with inflammatory diseases. Through experimental results, significant differences in signal kinetic behavior were observed between the control group and the two other groups. These differences were attributed to the rate of red blood cell (RBC) aggregation, which is closely associated with inflammation. Overall, the study emphasizes the potential of non-invasive diagnostic tools in evaluating inflammatory processes by analyzing RBC aggregation.

TICI-RANKIN mismatch: Poor clinical outcome despite complete endovascular reperfusion in the ETIS Registry.

INTRODUCTION: Endovascular treatment (EVT) is a well-established technic for acute ischemic stroke, but despite a high recanalization rate of near 80%, at 3 months roughly 50% of patients have a poor functional outcome with a modified Rankin score (mRS) ≥3. The aim of this study was to determine predictive factors of poor functional outcomes in patients with complete recanalization after EVT, defined as modified thrombolysis in cerebral infarction (mTICI) 3. PATIENTS AND METHODS: This retrospective analysis based on the prospective multicenter ETIS registry (endovascular treatment in ischemic stroke) in France included 795 patients from January 2015 and November 2019 with acute ischemic stroke due to anterior circulation occlusion and prestroke mRS 0-1, treated with EVT and who achieved complete recanalization. Univariate and multivariate logistic regression models were used to identify predictive factors of poor functional outcome. RESULTS: 365 patients (46%) showed a poor functional outcome (mRS>2). In backward-stepwise logistic regression analysis, poor functional outcome was independently associated with older age (OR per 10-year increase, 1.51; 95%CI, 1.30 to 1.75), higher admission NIHSS (OR per 1 point increase, 1.28; 95%CI, 1.21 to 1.34), absence of prior intravenous thrombolysis (OR, 0.59; 95%CI, 0.39 to 0.90), and an unfavorable 24-hour NIHSS change (24h-baseline) (OR, 0.82; 95%CI, 0.79 to 0.87). We calculated that patients whose 24h NIHSS decreased by less than 5 points are more at risk of a poor outcome, with a sensitivity and a specificity of 65.0%. CONCLUSION: Despite complete reperfusion after EVT, half of patients had a poor clinical outcome. These patients, who were mainly older with a high initial NIHSS and an unfavorable post-EVT 24h NIHSS change, could represent a target population for early neurorepair and neurorestorative strategies.

Scattering-driven PPG signal model.

This article discusses the origin of PPG signals. Two plausible hypotheses are analyzed: the volumetric hypothesis and a model wherein the PPG is driven by the RBC aggregation process. To verify the model predictions, the PPG signals at the fingertip were measured. External pressure was applied to the fingertip, presumably reducing the blood flow. The results expressed in terms of gamma, used in pulse-oximetry, agree with the aggregation model. In addition, the oscillometric signal and the PPG signal amplitude were simultaneously measured in the fingertip. All of the experimental results favor the proposed aggregation mechanism as responsible the PPG signal.

[Intracerebral hemorrhage as the cause of low-flow priapism : A rare association]. / Intrazerebrale Blutung als Ursache eines Low-flow-Priapismus : Eine seltene Assoziation.

Priapism is a painful erection of the penis lasting for more than 4h and is independent of sexual stimulation. It represents a urological emergency and necessitates rapid treatment. Etiologically, approximately 20% are caused by drugs, 50% are a combination of hematological diseases (e.g. sickle cell anemia), leukemia, injections in the corpora cavernosa, paraneoplastic processes and neurological or infectious causes. Ultimately, 30% have an idiopathic origin. Priapism as a result of traumatic intracerebral hemorrhage has so far rarely been described. This article presents the case of a 48-year-old male patient who presented to the emergency department with a traumatic subarachnoid hemorrhage. During the hospital stay the patient suffered from low-flow priapism, which was initially punctured and ultimately operatively treated.

Impact of Fitness Status on the Optically Measured Hemodynamic Indexes.

The physiological characteristics of skin blood flow can be described in terms of the hemodynamic indices (HI). The HI is derived from the laser speckle characteristics, which are governed by the cutaneous blood flow. A miniaturized dynamic light-scattering sensor was used to measure the speckle pattern from the finger root. Three groups of subjects from 15 to 25 years of age were tested. The first group included subjects who are actively engaged in sport activities; the second group included subjects with low level of physical activity; and the third group included healthy controls with moderate physical activity. The HI parameters were measured prior to and after the performance of a determined physical load. As a marker of cardiovascular fitness (CVF), we used the postload decay rate of HI. We found that the hemodynamic response to the physical load provides a statistically significant correlation with the postload heart rate decay. It was also found that postocclusion increase of the arterial HI is more prominent in the group with higher physical activity. These results indicate that hemodynamic indices can be used as an additional marker for cardiovascular fitness level.

Sample procurement for cultures of infected wounds: a systematic review.

OBJECTIVE: Identifying the responsible pathogen is required in order to select optimum antimicrobial therapy for infected wounds, but the best techniques to use remain the subject of debate. Our aim was to assess the evidence on the value of wound swabs compared with biopsies. METHOD: We conducted a systematic literature review with the terms 'wound infection', 'wound swab', 'wound swab technique', 'wound biopsy', 'wound culture', 'wound swab comparison', 'Levine swab technique', 'microbiological technique', 'specimen handling', 'bacterial load', 'perioperative care', 'swab', and 'culture'. We examined yields in identifying relevant pathogens, summarised salient features of qualifying studies, and defined knowledge gaps and endpoints that future studies should address. RESULTS: Studies have been inconsistent, lacking specificity regarding wound types, clinical features, and sampling methods. We found moderate quality evidence that punch biopsies provide qualitative and quantitative information about the bacterial load and tissue reaction with nearly 100% sensitivity, 90% specificity and 95% accuracy for predicting wound closure. Biopsies are relatively invasive, costly, require skilled operators, and potentially exacerbate infection. Needle aspiration samples a limited portion and may enter uninfected tissue and extend infection. Wound swabs are minimally invasive, easier to perform and widely employed in clinical practice, but techniques vary. In comparative studies, the Levine technique was superior to the Z-swab techniques, and biopsies were more sensitive for antibiotic-resistant wounds than Levine or Levine-like swabs, suggesting that swabs may be useful for initial wound monitoring, but biopsies are preferred when antibiotic resistance is suspected. CONCLUSION: The Levine swab is superior to the Z-swab technique and may be useful for initial wound monitoring, but quantitative biopsies are preferred for evaluation of antibiotic-resistant wounds and to monitor the response to treatment. There is limited evidence on the role of wound swabs for detecting wound colonisation versus infection and the impact of culture-guided therapy on such clinical outcomes as eradication of infection and accelerated healing. Future studies should specify patient populations, wound types, sampling protocols, and outcomes based on culture yield and treatment results, using rigorous statistical methodology.

[Emergencies of the external genital area]. / Notfälle im Bereich des äußeren Genitale.

BACKGROUND: In addition to epididymitis and testicular torsion, emergencies of the external genital are rare. Rapid diagnosis and therapy are essential so that immediate therapy can be provided, which is important for survival (Fournier gangrene) of the patient or for the preservation of erectile function (priapism and penile fracture). A detailed patient history and clinical examination are generally sufficient for correct diagnosis. RESULTS: Under certain circumstances, it might be useful to perform ultrasound, computed tomography scan or magnetic resonance imaging or retrograde urethrography. A urine analysis is obligatory. In case of penetrating injuries and genital trauma in females, additional imaging should be performed because these are often associated with concomitant injuries of the rectum, vagina, or bladder. Special cases are gunshot wounds, in which caliber and type of weapon play an important role for the degree of damage, and animal or human bites. For animal bites, the risk for rabies infection and in case of a human bite the risk for transmission of HIV and hepatitis should be taken into consideration and post-exposure prophylaxis should possibly be offered.

[Diagnosis and management of priapism]. / Diagnostik und Therapie des Priapismus.

Priapism is defined as an erection for more than 4 h without sexual stimulation. The most common form with nearly 95% is the ischemic or low-flow form, which is very painful. The other 5% are comprised of nonischemic high-flow type usually caused by a blunt perineal trauma and the recurrent or intermittent so-called stuttering priapism. Anamnesis as well as physical and laboratory examination are important during the diagnostic workup. Patients who suffer from sickle cell anemia are predestined to develop priapism. Priapism constitutes a urological emergency because especially the low-flow type has to be treated immediately to prevent a long-lasting fibrosis of the corpus cavernosa and a consecutive erectile dysfunction. The first step is the puncture and aspiration of blood from the corpus cavernosa if necessary combined with the injection of α-agonists. In case detumescence is not achieved, an operative shunt should be placed after an MRI. If there is a complete fibrosis of the corpus cavernosa possibly combined with penis deviation the implantation of a penile prosthesis is an option. The therapy of high-flow priapism is not as urgent as that of low-flow priapism because there is no risk of ischemia. If conservative therapeutic options fail, the superselective embolization of the fistula is the treatment of choice. In recurrent or intermittent priapism, the goal is to avoid new episodes with drug treatment. Because of the low incidence of priapism, it is very difficult to recommend and favor one therapeutic procedure.

[Seminal vesicle cystadenoma as the cause of a retrovesical tumor]. / Zystadenom der Samenblase als Ursache einer retrovesikalen Raumforderung.

Tumors of the seminal vesicle are rare. Malignant tumors are more common than benign tumors. A seminal vesicle cystadenoma is a rarity. We report on a 41-year-old man with the incidental finding of an asymptomatic retrovesical tumor. The tumor, the seminal vesicle, and the abdominal part of the ductus deferens were surgically removed. The operative access is variable and surgical treatment is the method of choice. The patient's prognosis is good and there are no signs of recurrence.

[Variocele in adolescents]. / Die Varikozele des jungen Erwachsenen.

Up to 20% of adolescents have a varicocele. Often a varicocele is an incidental finding during a physical examination. However, adolescents with a varicocele might suffer from pain or they may have noticed a difference in the volume of the testes. The diagnostic investigation of the ejaculate in adolescents is difficult because no age-dependent spermiogram standard values exist. Endocrinological tests are also difficult because of the physiological variability of testosterone and gonadotropins during adolescence. The difference in testes volume normalizes in half of the boys without any therapy during maturation. Most adolescents with a varicocele have a normal semen analysis. The sperm parameters are the most important factor for treatment decision making.If sperm concentration, motility, and morphology are normal, active surveillance with regular control examinations are recommended even if the volume of the testis is divergent. Pathologic sperm parameters should lead to an operative treatment. The microsurgical subinguinal technique is the method of choice due to the low complication and reoperation rates. The sperm concentration, morphology, and motility increase postoperatively as well as the volume of the testis. It is not clear whether the improved sperm parameters lead to improved spontaneous pregnancy rates later in life. Whether scrotal pain decreases after operative therapy is uncertain because of the subjectivity of pain.Until now there are only a few studies with small and very heterogeneous case numbers so that no clear recommendation for the treatment of a varicocele in adolescents can be made. The difficulty in the treatment decision-making is preventing reduced fertility, while avoiding overtreatment.

[An accessory spleen as a very rare entity causing a spermatic cord tumor]. / Nebenmilzen als seltene Ursache einer Raumforderung am Samenstrang.

An accessory spleen in the region of the spermatic cord is a very rare entity so that preoperative screening with splenic scintigraphy is not indicated. Sonographically there will always be the suspicion of a malignant tumor so operative exploration of the testes is the therapy of choice. However, it should always been borne in mind that such rare entities can occur in the region of the spermatic cord and if there is any doubt about the identity of the mass an intraoperative rapid section should be performed because in the case of an accessory spleen ablation of the testes is not necessary.

[Primary and secondary prevention of erectile dysfunction]. / Primäre und sekundäre Prävention der erektilen Dysfunktion.

Erectile dysfunction has an incidence of up to 75% in men aged 80, thus making primary prevention really important. Aetiologically multiple reasons are responsible for erectile dysfunction; therefore, recommendations for primary prevention contain different parts. The first one is to maintain a healthy arterial system and prevent atherosclerosis. Besides that diabetes, neurogenic disturbances or mental distress should be avoided. Physical activity, balanced nutrition, nonsmoking, unsaturated fatty acids and moderate alcohol consumption are preventive. Regular erections cause oxygenation of the cavernous body and prevent fibrosis which could lead to an insufficient occlusion of the cavernous veins. If the patient already suffers from coronary heart disease or diabetes, blood pressure, pulse, blood lipids and blood sugar should be as normal as possible. Erectile dysfunction might be the primary symptom of coronary heart disease; therefore, consideration should be given to a cardiac examination in the diagnostic setting.

[Testosterone substitution therapy in prostate cancer]. / Testosteronsubstitutionstherapie beim Prostatakarzinom.

After the fourth decade of life the total testosterone level in men decreases continually. If clinical symptoms, such as decreased libido or erectile dysfunction are combined with a decreased serum testosterone level this is known as late onset hypogonadism (LOH) or partial androgen deficiency in the aging male (PADAM). In such cases testosterone substitution therapy is indicated. One important question is how to treat patients suffering from LOH but also have prostate cancer which was treated curatively in the past? Only relatively little data are available with small numbers of patients which show that testosterone substitution therapy is possible without an increased risk of a relapse in cases of cured prostate cancer. If the patient was cured it does not matter if radical prostatectomy or radiation therapy was used. It is mandatory that patients are well-informed about substitution therapy and that regular surveillance and controls are carried out during the therapy. For patients who still have prostate cancer which has not yet been treated or not yet cured decisions on whether the benefit of the testosterone replacement is greater than the potential risk of a progress of the disease have to be made on an individual case-specific basis.

A noninvasive method of examination of the hemostasis system.

We propose a noninvasive method of in vivo examination the hemostasis system based on speckle pattern analysis of coherent light scattering from the skin. We compared the results of measuring basic blood coagulation parameters by conventional invasive and noninvasive methods. A strict correlation was found between the results of measurement of soluble fibrin monomer complexes, international normalized ratio (INR), prothrombin index, and protein C content. The noninvasive method of examination of the hemostatic system enable rough evaluation of the intensity of the intravascular coagulation and correction of the dose of indirect anticoagulants maintaining desired values of INR or prothrombin index.

[Testosterone replacement therapy for prostate cancer]. / Testosteronsubstitutionstherapie beim Prostatakarzinom.

During the male 40s total testosterone levels decrease continuously. If clinical symptoms like decreasing libido, erectile dysfunction, osteoporosis, altered distribution of body fat, reduction in physical strength, or alterations in psychological mood are combined with a decreased serum testosterone level late-onset hypogonadism (LOH) is obvious. Before the substitution of testosterone is initiated, it is essential to exclude prostate cancer because the progress of prostate cancer depends on androgens. The question is now how to treat patients who suffer from androgen deficiency but have cured prostate cancer in their history? Concerning this there are only a few studies with a small number of patients which show that testosterone substitution therapy is possible without an increased risk for recurrence of prostate cancer. As long as the patient was cured it does not matter if he underwent a radical prostatectomy or brachytherapy. Absolutely necessary is that the patient is well informed about the therapy and regularly controlled during the therapy.

Eritemas figurados / Erythema Figuratum

La denominación de eritemas figurados comprende una serie de afecciones que se caracterizan por eritema, con o sin descamación, que adoptan formas anulares, de arcos de círculo o policíclicas, y que se extienden de forma centrífuga. La mayoría de estos cuadros son reacciones a factores desconocidos–inmunitarios, infecciosos, tumorales u otros– tienen un curso crónico, evolucionan por brotes y son recidivantes. A veces desaparecen si se erradica la causa, pero en general no hay tratamientos específicos. Pueden aparecer en cualquier momento de la vida; algunos son más frecuentes en los adultos y otros sólo en la infancia (AU)

The term erythema figuratum is used to refer to erythematous lesions—with or without desquamation—that spread centrifugally in annular, arcuate, or polycyclic forms. Most of these conditions are reactions to unknown factors (immune, infectious, tumoral, and other processes), follow a chronic course with exacerbations and remissions, and are recurrent. They may disappear if the underlying cause is eradicated, but in general there are no specific treatments. They may appear at any time in life; some are more common in adults whereas others only present during childhood (AU)

Biomechanical comparison of techniques to reduce the bulk of lacerated flexor tendon ends within digital sheaths of the porcine forelimb.

PURPOSE: Zone II flexor tendon repairs may create a bulging effect with increased bulk and resistance to tendon gliding. A biomechanical time 0 study was performed to assess 2 methods of tendon antibulking for work of flexion and strength characteristics. METHODS: We placed 24 fresh-frozen porcine forelimb tendons in a custom jig. Deep flexor tendon was sectioned just distal to the intact A1 and A2 pulleys. Specimens were divided into 3 groups before repair: group 1, nonmodified tendon; group 2, 30 degrees bilateral notch excised from both tendon ends; and group 3, triangular longitudinal central wedge excised from both tendon ends. All repairs used a 4-strand modified Kessler core suture and running circumferential epitendinous suture. Work of flexion, 2-mm gap formation, and ultimate load to failure were tested. RESULTS: Both antibulking techniques (groups 2 and 3) had significantly less work of flexion than group 1 (36.3 and 34.9 J vs 142.9 J, p < .001). There was no significant change in work of flexion between groups 2 and 3 (p > .05). There was no significant difference in terms of 2-mm gap formation among the 3 groups (p > .05). Groups 1 and 3 exhibited a significantly higher load to failure compared with group 2 (p < .05). CONCLUSIONS: The antibulking repair techniques used in this study decrease the work of flexion with no significant change in force to 2-mm gap formation. Group 2, however, did have significantly lower load to failure. These techniques might be beneficial in zone II flexor tendon injury, in which the tight annular pulley system restricts tendon gliding. However, this is a time 0 study and the potential adverse effects of increase tendon manipulation and trauma were not analyzed, which might increase adhesions and scar during the healing phase of tendon repair.

[Testicular sperm extraction and intracytoplasmic sperm injection : Are there useful predictors of pregnancy and take home baby rate?]. / Testikuläre Spermienextraktion und intrazytoplasmatische Spermieninjektion : Gibt es brauchbare Prädiktoren zur Schwangerschafts- und Baby-take-home-Rate?

Among married couples in Germany, 3-9% suffer from infertility. Due to the tremendous changes in reproductive medicine, several successful approaches including ICSI after operative sperm retrieval are available.The age of the woman has a positive predictive value for the ICSI outcome, but for the male partner no predictive value for any parameter before TESE and ICSI has been demonstrated. Therefore we investigated whether there is a parameter before TESE that will elucidate the question of success of assisted reproduction after successful sperm retrieval.The outcome of 108 married couples that were treated consecutively for infertility with one or more TESE were investigated to determine whether the man's age, FSH concentration or testicular volume has a significant influence on the success of this therapy. None of the parameters had a positive predictive value about the outcome that could enhance the counselling of these couples before operative sperm retrieval.