Dark Energy Survey Year 1 Results: Cosmological Constraints from Cluster Abundances, Weak Lensing, and Galaxy Correlations.

We present the first joint analysis of cluster abundances and auto or cross-correlations of three cosmic tracer fields: galaxy density, weak gravitational lensing shear, and cluster density split by optical richness. From a joint analysis (4×2pt+N) of cluster abundances, three cluster cross-correlations, and the auto correlations of the galaxy density measured from the first year data of the Dark Energy Survey, we obtain Ω_{m}=0.305_{-0.038}^{+0.055} and σ_{8}=0.783_{-0.054}^{+0.064}. This result is consistent with constraints from the DES-Y1 galaxy clustering and weak lensing two-point correlation functions for the flat νΛCDM model. Consequently, we combine cluster abundances and all two-point correlations from across all three cosmic tracer fields (6×2pt+N) and find improved constraints on cosmological parameters as well as on the cluster observable-mass scaling relation. This analysis is an important advance in both optical cluster cosmology and multiprobe analyses of upcoming wide imaging surveys.

Quiste dermoide latero cervical / Dermoid cyst of the lateral neck

Resumen Introducción: Los quistes dermoides son lesiones de origen ectodérmico poco frecuentes. Solo un 1,6% de ellos, se presenta en el piso de la boca y de éstos, solo un 6% lateralmente en el espacio submandibular. Objetivo: Reporte de caso y revisión de la literatura. Caso clínico: Se presenta un caso de una paciente de 32 años, con un cuadro de 1 año de evolución caracterizado por una lesión de crecimiento lento pero sostenido. Se le realizó la resección de la lesión junto con una submandibulectomía ipsilateral resultando compatible con un quiste dermoide. Discusión: La localización de esta lesión es muy infrecuente. En el estudio histopatológico son lesiones con epitelio pluriestratificado cornificado y anexos cutáneos. El estudio de imágenes orienta a una lesión quística, siendo la resonancia nuclear hoy en día el mejor examen para caracterizar esta lesión. Es una lesión benigna, sin recidivas reportadas cuando la resección ha sido completa.

Introduction: Dermoid cysts are uncommon lesions from ectodermic origin. Only 1.6% arise in the floor of the mouth, and at this site only 6% arise laterally in the submandibular region. Aim: Case report and review of the literature. Clinical Case: 32 years old patient, with a slow growing lesion during 1 year. Complete resection with an ipisilateral submandibulectomy was performed. The pathologic report showed a dermoid cyst. Discussion: The localization of this lesion is very uncommon. In the pathologic report are lesion with pluri stratified cornified epthitelium with skin attachments. Image studies show a cystic lesion being the magnetic resonance the best study to characterize this lesions. Are benign lesions, without recurrence reported when the lesion has been fully excised.

[First data concerning the medical supply of patients with non-alcoholic fatty liver disease in Germany - a survey in university hospital centers of hepatology]. / Erste Daten zur Versorgungssituation von Patienten mit nicht alkoholischer Fettlebererkrankung (NAFLD) in Deutschland - Eine Umfrage an universitären hepatologischen Zentren.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) currently is one oft the most common reasons for chronic liver injury in the western world. In the European and American population the prevalence is up to 30 %. The medical supply of German patients with NAFLD is variable and has not been analyzed to date. METHODS: We sent questionnaires to all university liver centers in Germany (11 questions) concerning the medical supply of patients with NAFLD. Questions included the rate of patients with fatty liver disease in the outpatient clinics, metabolic comorbidities and the kind of assignment. Besides that, individual clinical standards were documented. We compared longitudinal changes between 2008 and 2013. RESULTS: The return rate of questionnaires was 65 % (n = 20). Analysis showed that the portion of NAFLD patients in the university outpatient clinics had increased between 2008 and 2013 with the predominant part of patients being assigned from external practitioners and not from internal departments of the hospital. Only few patients were assigned by diabetologists or endocrinologists, but on the other hand most liver outpatient clinics investigated their NAFLD patients for metabolic disorders. Cooperation between liver outpatient clinics and other medical services was moderate and was rated average, joint conferences were held rarely. Follow-up visits of patients with NAFLD take place regularly in all centers, however based on different criterions. A consistent algorithm concerning risk assessment and invasive workup does not exist. CONCLUSION: The awareness concerning patients with NAFLD seems to have grown in recent years. Nevertheless, the medical supply of these patients is quite heterogenous and consistent standards do not exist. Therefore, a common guidline is urgently required.

Arthroscopic-Assisted Intraosseous Balloon-Assisted Repositioning of a Tibial Plateau Fracture: A Case Report.

This is the first description of an arthroscopic-assisted intraosseous balloon-assisted repositioning and defect filling of a tibial plateau fracture. The bone defect was filled with calcium phosphate cement in a liquid/paste form. The described technique was therefore introduced in order to allow an arthroscopic control of reposition and intra-articular cement escape during defect filling. X-rays showed an exact reposition without cement escape and the clinical outcome was satisfactory.

[Patient with COPD after allogeneic hematopoietic stem cell transplantation with cough and subfebrile temperature]. / Patient nach allogener hämatopoetischer Stammzelltransplantation mit Husten und subfebrilen Temperaturen bei bekannter COPD.

HISTORY AND ADMISSION FINDINGS: A 53-year-old male presents with progressive cough and subfebrile temperatures with a history of COPD and post one-year allogeneic hematopoietic stem cell transplantation. EXAMINATIONS: No pathogenic agent was identified in virological and microbiological diagnostic testings of sputum. At bronchoscopy a half peanut was retrieved from the right main bronchus. TREATMENT AND COURSE: After recovery of the peanut the patient's symptoms immediately improved. CONCLUSIONS: Even in adults, with high risk of infectious pneumonia a foreign body aspiration should be considered if pulmonary symptoms worsen.

Two-year clinical experience with the CyPass micro-stent: safety and surgical outcomes of a novel supraciliary micro-stent.

PURPOSE: The aim of this study was to evaluate through 2 postoperative years the clinical outcomes associated with a novel supraciliary micro-stent for the surgical treatment of open-angle glaucoma (OAG) when implanted in conjunction with cataract surgery. PATIENTS AND METHOD: In a multicenter, prospective, consecutive case series, 136 subjects (136 eyes) with OAG and requiring cataract surgery with 24-month postoperative data were included. A combined phacoemulsification procedure, with intraocular lens insertion and CyPass Micro-Stent implantation into the supraciliary space of the study eye, was performed. At baseline, all subjects were on glaucoma medication with either uncontrolled intraocular pressure (IOP; ≥ 21 mmHg, Cohort 1, n=51) or controlled IOP (<21 mmHg, Cohort 2, n=85). Glaucoma medications were stopped postoperatively, but could be restarted if needed, at the investigator's discretion. Device-related adverse events, postoperative IOP, best corrected distance visual acuity (BCDVA), and number of IOP-lowering medications were recorded. RESULTS: The micro-stent was successfully implanted in all eyes. At 24 months, 82 subjects remained in the study. No sight-threatening adverse events occurred. The most common adverse events were transient hypotony (15.4%) and micro-stent obstruction (8.8%), typically due to iris tissue overgrowth. Fifteen subjects (11%) required secondary incisional glaucoma surgery. For Cohort 1 (n=23), mean ± SD IOP was 15.8 ± 3.8 mmHg after 24 months (change, -37% ± 19%). Mean IOP decrease from baseline was statistically significant (p<0.0001) at months 6, 12, and 24. For Cohort 2 (n=59), mean ± SD IOP at 24 months was 16.1 ± 3.2 mmHg (change, 0% ± 28%). Mean decrease from baseline was statistically significant at months 6 (p=0.0188) and 12 (p=0.0356). At 24 months, the mean ± SD number of medications was 1.0 ± 1.1 in Cohort 1 and 1.1 ± 1.1 in Cohort 2. Mean decrease from baseline medication use was statistically significant at months 6 (p<0.001), 12 (p<0.001), and 24 (p=0.0265) in Cohort 1, and at months 6, 12, and 24 (all p<0.0001) in Cohort 2. CONCLUSIONS: CyPass Micro-Stent implantation, in combination with cataract surgery, was associated with minimal complications while substantially lowering IOP and/or use of IOP-lowering medications.

[Supraciliary microstent for open-angle glaucoma: clinical results of a prospective multicenter study]. / Supraziliarer Mikrostent bei Offenwinkelglaukom: Klinische Ergebnisse einer prospektiven Multicenterstudie.

PURPOSE: The suprachoroidal CyPass micro-stent is designed to be implanted into the supraciliary space to facilitate aqueous outflow along the uveoscleral pathway in patients with open-angle glaucoma (OAG). This study assessed the safety of micro-stent implantation in patients undergoing cataract surgery. METHODS: In this multicenter study the CyPass microstent was implanted in patients with OAG undergoing cataract surgery. The implantation was performed using a minimally invasive, conjunctiva-sparing, ab interno intervention. Primary endpoints were safety aspects of the implant, secondary endpoints were the reduction of intraocular pressure (IOP) and topical medication. RESULTS: There were no severe adverse events during or after surgery in any of the patients. In patients with controlled glaucoma (IOP < 21 mmHg) the average IOP remained constant throughout the 24 month follow-up period but mean medication use decreased from 2.0 at baseline to 1.1 postoperative. In patients with IOP of ≥ 21 mmHg the pressure was reduced by 37 % postoperatively and mean medication decreased from 2.2 at baseline to 1.0. CONCLUSIONS: The safety profile of combined cataract surgery and CyPass microstent implantation is acceptable and patients also showed a decrease in IOP and medication use.

[Arterial hypertension: guideline acceptance and implementation in workaday life of internists and general practitioners in Thuringia]. / Arterielle Hypertonie: Leitlinienakzeptanz und -implementierung im Thüringer Praxisalltag von Internisten und Allgemeinmedizinern.

BACKGROUND AND OBJECTIVE: Although evidence-based medical guidelines are widely accepted it is not clear how they are implemented in daily clinical work. The aim of this study was a Thuringia-wide analysis of hypertension diagnosis and treatment in clinical practice of internists and general practitioners, combined with the evaluation of guideline implementation. METHODS: 1884 Thuringian internists and general practitioners were interviewed using a postally delivered, validated questionnaire to assess knowledge and implementation of the hypertension guidelines. RESULTS: 33,4 % of the physicians participated in our survey (433 general practitioners, 197 internists). 98 % of the participants routinely treat hypertension. Internists reported significantly more frequently to treat patients with resistance to antihypertensive therapy. Compared with older physicians and general practitioners, internists were significantly more likely to initiate diagnostic procedures for secondary hypertension according to the guidelines. Long-term measurement of arterial blood pressure in patients with more than three antihypertensive drugs and in cases of suspected endorgan damage or sleep apnea syndrome was more frequently applied by internists. 82,1 % of the participants reported to prescribe nonpharmacological therapies because of their efficacy. ACE-inhibitors (41,6 %) and beta-blockers (34,6 %) were preferred for monotherapy of hypertension without risk factors. ACE-inhibitors (80,1 %), followed by angiotensin receptor antagonists (12,1 %), were primarily selected in hypertensive patients with diabetic nephropathy. In left-ventricular hypertrophy, ACE inhibitors were favoured, too (67%). CONCLUSION: This survey indicates that in clinical practice doctors treat hypertensives according to official guidelines. However, there is a need for further education especially regarding indication of long-term measurement of arterial blood pressure. Continued education related to diagnosis and treatment of arterial hypertension and implementation of guidelines remains a permanent challenge for doctors.

The influence of larval density, food stress, and parasitism on the bionomics of the dengue vector Aedes aegypti (Diptera: Culicidae): implications for integrated vector management.

New larval control strategies for integrated vector management of Aedes aegypti are in high demand, including the use of biological control agents. Exposure of Aedes aegypti to parasites, starvation, and overcrowded conditions during larval development reduces the probability of survival to eclosion, can directly affect fitness parameters such as adult size and fecundity, and can affect the size, provisioning, and viability of eggs produced by females. We compared these parameters after exposing larvae to 1) abundant food at low larval densities, 2) food deprivation and high larval density, and 2) infection with the endoparasite Plagiorchis elegans, an entomopathogenic digenean trematode. Female mosquitoes that eclosed from larval conditions of starvation and overcrowding were smaller and laid fewer and smaller eggs than controls. The proportion of females to complete an oviposition cycle was reduced in the P. elegans-infected treatment group. Parasite load was negatively correlated with wing length and egg size. Infection of Ae. aegypti with P. elegans has sublethal effects and may reduce population-level reproductive output, but one-time low-density P. elegans exposure does not have sufficient effect on Ae. aegypti fitness parameters to be considered a viable biocontrol option.

Plagiorchis elegans (Trematoda) induces immune response in an incompatible snail host Biomphalaria glabrata (Pulmonata: Planorbidae).

Plagiorchis elegans has been shown to decrease the fecundity and survivorship of the incompatible snail host Biomphalaria glabrata. Furthermore, a prior infection with P. elegans was shown to render the snails resistant to the compatible parasite Schistosoma mansoni. Here, we test the hypothesis that infection with P. elegans stimulates the immune system of B. glabrata. Our findings indicate that infection by P. elegans significantly increased the number of free hemocytes in the hemolymph of B. glabrata by an average of ~60%. Furthermore, this immuno-stimulated state lasted from the first day post-infection (PI) to some time between 7 and 21 days PI. This is one of the few reported examples of a parasite stimulating the immune response of an incompatible host.

Initial Pseudomonas aeruginosa infection in patients with cystic fibrosis: characteristics of eradicated and persistent isolates.

Despite intensive eradication therapy, some CF patients with early Pseudomonas aeruginosa infection rapidly develop a chronic infection. To elucidate factors associated with this persistence, bacterial characteristics of early P. aeruginosa isolates were analysed that were either eradicated rapidly or persisted despite multiple antimicrobial treatments. Eighty-six early infection episodes were studied. First P. aeruginosa isolates from patients with eradication (36) or persistent infection (16) were included; isolates from patients with intermittent infection (34) were omitted from the study. Virulence assays, antimicrobial resistance, cytotoxicity and mutation frequencies were analysed in vitro. P. aeruginosa was genotyped by SNP-array. Transcriptomic profiles of two eradicated and two persistent strains were compared. Nineteen per cent of patients developed persistent infection; 42% achieved eradication. Secretion of virulence factors and mutation frequencies were highly variable among both eradicated and persistent isolates and were not different between the groups. Cytotoxicity was present in 57% of eradicated vs. 100% of persistent isolates (p <0.01). None of the isolates were resistant to antibiotics. The isolates were genotypically highly diverse. Multivariate analysis showed that in vitro determined bacterial characteristics could not predict persistence after first P. aeruginosa infection. Preliminary transcriptomic data showed increased expression of some genes related to a metabolic pathway. The early onset of chronic infection was not associated with (in vitro determined) bacterial characteristics only. Although the persistent isolates were more often cytotoxic, for the individual patient it was not possible to predict the risk of persistence based on bacterial characteristics. Unknown factors such as host-pathogen and pathogen-pathogen interactions should be further explored.

Argatroban for elective percutaneous coronary intervention: the ARG-E04 multi-center study.

UNLABELLED: The synthetic arginine-derived direct thrombin inhibitor argatroban is an attractive anticoagulant for percutaneous coronary intervention (PCI), because of its rapid onset and offset, and its hepatic elimination. Argatroban was approved for PCI in patients with heparin-induced thrombocytopenia (HIT). However, there are limited data about argatroban in non-HIT patients. The objective of this open-label, multiple-dose, controlled study was to examine the safety and efficacy of argatroban in patients undergoing elective PCI. METHODS AND RESULTS: Of 140 patients randomized to three argatroban dose groups (ARG250, ARG300, and ARG350 with 250, 300, or 350 µg/kg bolus, followed by 15, 20, or 25 µg/kg/min infusion) and one unfractionated heparin (UFH) group (70-100 IU/kg bolus), 138 patients were analyzed. Argatroban dose-dependently prolonged activated clotting time (ACT) with more patients reaching the minimum target ACT after the initial bolus injection (ARG250: 86.1%, ARG300: 89.5%, and ARG350: 96.8%) compared to 45.5% in UFH (p<0.001). The patient proportion who did not require additional bolus injections to start PCI was significantly higher in argatroban than in UFH (p ≤ 0.002). Consequently, the time to start of PCI was shortened in argatroban groups. Composite incidences of death, myocardial infarction, and urgent revascularization until day 30 were not significantly different between the groups (ARG250: 2.8%, ARG300: 0.0%, ARG350: 3.2% vs. UFH: 3.0%). Major bleeding was observed only in UFH (3.0%), while minor bleeding occurred in ARG350 (3.2%) and UFH (6.1%, n.s.). CONCLUSION: Argatroban dose-dependently increases coagulation parameters and, compared to UFH, demonstrates a superior predictable anticoagulant effect in patients undergoing elective PCI.

Palmar multidirectional fixed-angle plate fixation in distal radius fractures: do intraarticular fractures have a worse outcome than extraarticular fractures?

INTRODUCTION: The results and complications using a palmar plate system with the possibility of multidirectional fixed-angle screw fixation (Aptus® Radius 2.5 mm by Medartis®) for the treatment of unstable distal radius fractures were evaluated in a single cohort study including 62 patients. PATIENTS: Patients with extra- and intraarticular fractures were evaluated separately. The mean follow-up was 14.7 months. Active wrist motion averaged 60.1° extension, 52.0° flexion, 86.3° pronation, and 84.6° supination. Grip strength averaged 89% of the contralateral wrist. RESULTS: There was no loss of the initial reduction with bony union in all cases. The mean DASH-score was 12.6 points. Postoperative complications included two extensor pollicis longus tendon ruptures, two median nerve compression syndromes, one complex regional pain syndrome, and one postoperative haematoma. In our series the results of the intraarticular fracture group were similar to the extraarticular fracture group. The complication rate, however, was substantially higher in the intraarticular fracture group. CONCLUSION: We conclude that palmar plating with multidirectional fixed-angle screw insertion is an effective and useful treatment option, especially for complex intraarticular distal radius fractures.

Caso clínico: síndrome poliglandular autoinmune tipo II, forma de presentación en un paciente adulto / Clinical case: autoimmune polyglandular syndrome type II, presentation in adult patient

Autoimmune Polyglandular Syndrome (APS) type II or Schmidt`s Syndrome is diagnosed when a patient has adrenocortical deficiency with type 1 diabetes mellitus, chronic lymphocyticthyroiditis, or Graves’ disease. The disease commonly manifests in the third or fourth decade. We present the case of a 45 yo male patient who manifested simultaneously at the moment of diagnosis, clinical and laboratory features of hypothyroidism, pernicious anemia and Addison disease. We discuss etiologic, clinical and biochemical aspects in type II APS.

Partograma en mujeres multíparas con manejo médico del trabajo de parto / Graphic analyses of labor in multiparous womens with medical management

Antecedentes. La evaluación gráfica del parto fue descrito originalmente por Friedman, sin embargo, una descripción de la evolución del trabajo de parto con un manejo médico contemporáneo no ha sido completamente evaluado. Objetivo: Analizar el efecto de un manejo médico estandarizado del trabajo de parto, que incluye anestesia regional, rotura artificial de membranas y conducción ocitócica, sobre la fase activa del trabajo de parto en multíparas. Método. Análisis retrospectivo de 130 multíparas en trabajo de parto espontáneo, que ingresaron con 3 a 4 cm de dilatación. Resultados. Se observó una duración de la fase activa del trabajo de parto de aproximadamente 3,5 horas, con una progresión promedio de 1,5 cm/ h, produciéndose la mayor progresión entre los 7 y 9 cm de dilatación con 1,9 cm/h. La segunda fase del trabajo de parto presento una duración promedio de 28 minutos. Conclusiones. Nuestros resultados muestran que el manejo médico estandarizado del trabajo de parto no reduce los tiempos de la fase activa ni de la segunda fase en multíparas. Creemos que es necesario implementar estudios randomizados para determinar la influencia de este tipo manejo del trabajo de parto en la incidencia de cesáreas.

Espectro clínico de la preeclampsia: estudio comparativo de sus diversos grados de severidad / Clinical spectrum of preeclampsia: comparative study of different grades of severity

Objetivo: Comparar los resultados maternos y perinatales en embarazadas que cursaron con preeclampsia (PE) en sus diversas presentaciones en el período 2001 -2005. Material y Método: Estudio retrospectivo de 7.205 partos asistidos en la maternidad del Hospital Clínico de la Universidad de Chile. 204 mujeres presentaron PE/eclampsia, dividiéndose en 3 grupos: PE modera, severa y síndrome de HELLP. Se analizaron las variables clínicas y de laboratorio de la embarazada y del recién nacido. Se compararon estos resultados en los 3 grupos de estudio. Para variables continuas de distribución normal se empleó el análisis de varianza (ANOVA). Para variables categóricas se empleó la tabla de contingencia de Chi2 o la prueba exacta de Fisher. Resultados: 80 mujeres presentaron PE moderada (39,2 por ciento), 114 PE severa (55,8 por ciento) y 10 HELLP (4,9 por ciento). Se observaron diferencias significativas en la vía de parto, edad gestacional, peso del recién nacido, percentil, morbi-mortalidad neonatal, complicaciones maternas médico-quirúrgicas en los grupos de PE severa y HELLP comparados con las PE moderadas. La PE severa tuvo una mayor proteinuria que los otros dos grupos. Así mismo, se observaron también diferencias significativas en el grupo de síndrome de HELLP en los niveles de enzimas hepáticas, LDH y recuento plaquetario en comparación con el grupo de las PE moderadas y severas. Conclusión: La PE es una entidad clínica que puede presentarse en diversos grados de severidad, por lo que su correcta clasificación de acuerdo a criterios clínicos y de laboratorio, es clave para el tratamiento y pronóstico de las pacientes.

Prevalencia de procedimientos invasivos en una población chilena usuaria de métodos de cribado y diagnóstico prenatal / Prevalence of invasive procedures in a chilean population users of screening and prenatal diagnosis methods

Objetivo: Evaluar la prevalencia del uso de procedimientos invasivos prenatales en una población chilena con cribado y diagnóstico de alteraciones morfológicas y/o cromosómicas. Método: Estudio descriptivo en 17.906 embarazadas entre junio de 2000 y octubre de 2006, a las cuales se les realizó cribado ecográfico de aneuploidia y malformaciones congénitas durante el primer y segundo trimestre. Las pacientes fueron informadas y aconsejadas acerca de las implicancias de dichos procedimientos. Los procedimientos efectuados fueron la biopsia de vellosidades coriales (BVC), amniocentesis (AMCT) y cordocentesis. Se calculó la prevalencia y las indicaciones de dichos procedimientos. Resultados:Se realizaron 81 procedimientos invasivos (0,45 por ciento). Las BVC representaron un 43,3 por ciento, las AMCT el 37,0 por ciento y las cordocentesis un 19,7 por ciento. Las principales motivaciones para realizarse un estudio invasivo fueron malformaciones congénitas (48,1 por ciento) y aumento del riesgo de aneuploidia (40,7 por ciento). Los cariotipos alterados fueron 43,2 por ciento del total de los procedimientos, encontrándose 29 por ciento de trisomías 21, 46 por ciento de trisomías 18 y 13 y 20 por ciento de síndrome de Turner. Conclusión: La prevalencia de procedimientos invasivos fue 10 veces inferior a la descrita en países donde el aborto es legal, y aproximadamente la mitad de ellos resultaron alterados. En nuestra población utilizando una asesoría adecuada, la principal motivación para realizarse un procedimiento invasivo fue el mejor manejo obstétrico del embarazo y, secundariamente, la posibilidad de contar con una mejor información sobre la salud del hijo no nacido.

Objective: The purpose of this study was to evaluate the prevalence and indications of invasive procedures in a population without termination of pregnancy. Method: This descriptive study was performed in pregnant women who had either assessment of risk for chromosomal abnormalities during the first and second trimester of pregnancy or detection of soft markers or structural defects at any gestational age from June 2000 to October 2006. The patients were counseled with regards their estimated risk, and were informed about invasive diagnostic tests. The invasive testing offered were chorion villous sampling (CVS), amniocentesis (AMCT) and fetal blood sampling (FBS). The prevalence of invasive testing was calculated and its causes analyzed according to the type of screening test. Results: Ultrasound was carried out in 17,906 pregnant women, being 70 percent performed either during the first or second trimester of pregnancy. Eighty one invasive procedures were performed (0.45 percent). CVS accounted for 43.3 percent, AMCT for 37.0 percent and FBS for 19.7 percent. The main motivation for opting for invasive testing was fetal abnormalities (48.1 percent) and increased risk of chromosomal anormalities (40.7 percent). Abnormal fetal kaiyotypes were 43.2 percent, being 29 percent Down's syndrome, 46 percent Edwards and Pateau's syndromes, and 20 percent Turner syndrome. Conclusion:Jhe low frequency of invasive procedures observed in this population might be an expression of our social, cultural and legal characteristics, but it is also a demonstration of pragmatic and ethically rational decisions about invasive testing for chromosomal abnormalities.

Entomological evaluation of malaria vectors at different altitudes in Hai district, northeastern Tanzania.

Entomological monitoring in four villages situated along an altitude transect in the Hai District of Northeastern Tanzania identified Anopheles arabiensis Patton as the principal vector of malaria and detected seasonal changes in vector behavior. Over a 13-mo sampling period, 10,557 mosquitoes were collected with CDC light traps, pyrethrum spray catches, and pit traps of which 5,969 (56.5%) wereAn. arabiensis, 762 (7.2%) wereAnopheles funestus Giles s.l., 3,578 (33.9%) were culicines, and 248 (2.3%) were nonvector anophelines. Vector densities declined rapidly with increasing altitude, demonstrating a 50% decrease in annual human biting rate for every 86-m rise in altitude. Light traps were found to be more efficient than spray catches for the collection of An. arabiensis. This observation was attributed to increased exophily of this species, most notably in the wet season, and is supported by seasonal changes in the human blood index and fed/gravid ratio. These results indicate that spray catches may underestimate the abundance of exophilic vectors such as An. arabiensis and that entomological monitoring may require more than one collection method, especially at low vector densities. The annual entomological inoculation rate (EIR) decreased sharply with increasing altitude, with large variation around the estimate at low vector densities. Increased transmission because of unpredictable short rains at low altitudes and spatial clustering of infective mosquitoes may contribute to elevated EIR estimates.

Release pattern of N-terminal pro B-type natriuretic peptide (NT-proBNP) in acute coronary syndromes.

BACKGROUND: Recently it has been found that BNP and NT-proBNP provide independent prognostic information in patients with acute coronary syndromes (ACS). However, little data are available on the time course of NT-proBNP levels in relation to onset of symptoms. METHODS AND RESULTS: We included 765 patients (236 females, aged 64 +/- 11 years) with an ACS (STEMI 42%, NSTEMI 41%, UAP 17%), who were referred for coronary angiography. NT-proBNP was assessed on admission and the next day. NT-proBNP values were related to the time duration from onset of symptoms until blood drawing with lowest values within 3 h and highest values 24-36 h after onset of symptoms (147 (64-436) pg/ml and 1099 (293-3795) pg/ml, respectively, p < 0.001). Highest values for NT-proBNP on admission were found in patients with NSTEMI compared to patients with STEMI and UAP (912 (310-2258) pg/ml) vs 262 (85-1282) pg/ml) vs 182 (74- 410) pg/ml; p < 0.001), but no difference was present between STEMI and NSTEMI the day after admission (1325 (532-2974) pg/ ml vs 1169 (555-3413) pg/ml; p = 0.676). In contrast NT-proBNP values remained unchanged in UAP (182 (74-410) pg/ml) vs 171 (53-474) pg/ml). CONCLUSION: The time interval from onset of symptoms to first blood collection is an important determinant for NT-proBNP values on admission in patients with an ACS and needs to be considered in clinical practice.

Treatment of in-stent restenosis with sirolimus-eluting-stents -- a six month clinical and angiographic follow-up.

Treatment of in-stent restenosis (ISR) remains a therapeutic challenge since many pharmacological and mechanical approaches have shown disappointing results except for brachytherapy. Drug-eluting stents (DES) have been reported to effectively reduce ISR in de novo lesions. We studied 55 consecutive patients with ISR in native coronary arteries and 7 with ISR in saphenous vein grafts (SVG) with elective indication for percutaneous coronary intervention (PCI), who underwent successful implantation with DES. No in-hospital postprocedural major adverse cardiac events were observed. All but one patient (n=61) underwent an angiographic follow-up at 183+/-30 days. Grade of stenosis was assessed by quantitative coronary angiography (QCA) at index procedure and at control angiography. Restenosis (>50%) occurred in 5 patients (8.2%). Target vessel revascularization was performed in an additional 4 patients. Minimal intimal hyperplasia was observed in all segments covered by DES (late loss 0.08+/-0.37 mm, loss index 0.11+/-0.47). One patient suffered from subacute stent thrombosis due to discontinuation of clopidogrel medication. At six month follow-up two patients had died. Death was not related to a restenosis in the treated segment. Conclusion Our experiences with DES treatment of ISR lesions show good angiographic and clinical results at index procedure and at the 6 month follow-up with low sub acute thrombosis rate as compared with existing treatment modalities. Restenosis rate seems to be at least as low as reported for brachytherapy.