The diagnosis and management of a vertebral artery loop causing cervical radiculopathy.

BACKGROUND: Cervical radiculopathies are rarely caused by vertebral artery loop formation, which is estimated to be present in less than 3% of patients. It is uncertain what causes the loop formation: some propose an association with spondylotic changes or trauma, whilst others suggest hypertension and atherosclerosis may be responsible. CASE REPORT 1: A 35-year-old male patient presented with signs and symptoms of cervical radiculopathy that was not improved with anterior cervical discectomy and fusion surgery performed 2 years beforehand. Vertebral artery loop was discovered at the level C5/6 on the MRI. Vertebral artery transposition surgery via a lateral approach was performed at the level of the left C5/6 for symptoms of left C6 radiculopathy. Deroofing of the transverse process was performed with post-surgical complete improvement in weakness and pain. CASE REPORT 2: A 48-year-old female patient presented with a 10-year history of left shoulder pain with occasional radiation into her middle three fingers accompanied by intermittent paraesthesia and weakness. Numerous shoulder surgeries, Botox injections and suprascapular nerve blocks had not provided any significant benefit. A vertebral artery loop was identified at the level of C3/4 and C4/5 on the left with cervical MRI. Transposition surgery of these two levels provided some post-surgical improvement in pain. CONCLUSION: Vertebral artery loop formations are a rare but potential cause for cervical radiculopathy. In two cases, the loop formations were not radiographically reported on MRI, thus clinicians should be aware of this as a differential diagnosis in the management of cervical radiculopathy. The presented surgical approach may be useful in managing future cases of vertebral artery loop formation causing cervical radiculopathy resistant to conservative measures.

Involving research participants in a pan-European research initiative: the EPAD participant panel experience.

BACKGROUND: Including participants in patient and public involvement activities is increasingly acknowledged as a key pillar of successful research activity. Such activities can influence recruitment and retention, as well as researcher experience and contribute to decision making in research studies. However, there are few established methodologies of how to set up and manage participant involvement activities. Further, there is little discussion of how to do so when dealing with collaborative projects that run across countries and operate in multiple linguistic and regulatory contexts. METHODS: In this paper we describe the set-up, running and experiences of the EPAD participant panel. The EPAD study was a pan-European cohort study with the aim to understand risks for developing Alzheimer's disease and build a readiness cohort for Phase 2 clinical trials. Due to the longitudinal nature of this study, combined with the enrolment of healthy volunteers and those with mild cognitive impairments, the EPAD team highlighted participant involvement as crucial to the success of this project. The EPAD project employed a nested model, with local panels meeting in England, France, Scotland, Spain and The Netherlands, and feeding into a central study panel. The local panels were governed by terms of reference which were adaptable to local needs. RESULTS: The impact of the panels has been widespread, and varies from feedback on documentation, to supporting with design of media materials and representation of the project at national and international meetings. CONCLUSIONS: The EPAD panels have contributed to the success of the project and the model established is easily transferable to other disease areas investigating healthy or at-risk populations.

[Use of monoclonal antibodies in pathological diagnostics]. / Einsatz monoklonaler Antikörper in der pathologischen Diagnostik.

In pathological diagnostics, monoclonal antibodies (mAb) are mainly used for immunhistochemical analysis. After an initial histological evaluation, a precise panel of antibodies is selected in order to stain the slides by using an indirect immune method. The most frequent issues include localisation of the primary tumor in cases of metastases, determination of undifferentiated tumors, subtyping of lympho-proliferative diseases and soft tissue tumors, as well as the assessment of proliferation via Ki-67. Increasing importance in mAb-based diagnostics is attributed to the analysis of predictive biomarkers such as hormone receptors, mismatch repair proteins (MMR) and programmed death ligand 1 (PD-L1). Their evaluation is performed by using different scores, which the clinical physician needs to be aware of due to their direct therapeutic implications.

Multisensory enhancement of attention depends on whether you are already paying attention.

Multisensory stimuli are argued to capture attention more effectively than unisensory stimuli due to their ability to elicit a super-additive neuronal response. However, behavioural evidence for enhanced multisensory attentional capture is mixed. Furthermore, the notion of multisensory enhancement of attention conflicts with findings suggesting that multisensory integration may itself be dependent upon top-down attention. The present research resolves this discrepancy by examining how both endogenous attentional settings and the availability of attentional capacity modulate capture by multisensory stimuli. Across a series of four studies, two measures of attentional capture were used which vary in their reliance on endogenous attention: facilitation and distraction. Perceptual load was additionally manipulated to determine whether multisensory stimuli are still able to capture attention when attention is occupied by a demanding primary task. Multisensory stimuli presented as search targets were consistently detected faster than unisensory stimuli regardless of perceptual load, although they are nevertheless subject to load modulation. In contrast, task irrelevant multisensory stimuli did not cause greater distraction than unisensory stimuli, suggesting that the enhanced attentional status of multisensory stimuli may be mediated by the availability of endogenous attention. Implications for multisensory alerts in practical settings such as driving and aviation are discussed, namely that these may be advantageous during demanding tasks, but may be less suitable to signaling unexpected events.

A randomized, controlled, single-blinded, multicenter evaluation of the efficacy and safety of a once weekly two dose otic gel containing florfenicol, terbinafine and betamethasone administered for the treatment of canine otitis externa.

BACKGROUND: Otitis externa is a common problem in small animal practice. Compliance with daily treatment is a major cause of treatment failure. The hypothesis tested is that a novel otic gel applied to the ear canal twice with a one-week interval is as efficacious as a daily otic suspension in the treatment of canine otitis externa. The study included 286 privately owned dogs with otitis externa. In this single blinded randomized study, enrolled dogs received either an otic gel containing 1% florfenicol, 1% terbinafine and 0.1% betamethasone acetate twice with a one-week interval or a suspension containing hydrocortisone aceponate, miconazole and gentamicin daily for 5 days. Ears were cleaned with saline prior to administration of the first dose of medication. Dogs were evaluated at day (D) 0, 7, 28 and 56 with an otitis index score (OTIS-3), otic culture and cytology, pain and pruritus, and overall response to treatment (owner and investigator evaluation). Outcome measures were improvement of the OTIS-3 and number of dogs in clinical remission at each time point. RESULTS: OTIS-3 decreased significantly (p < 0.0001) by 63 and 64% for the otic gel and by 63 and 61% for the suspension on D28 and D56 respectively. There was no significant difference between groups at any time point with regard to clinical success, pain, pruritus, overall assessments or otic cytology and culture. The treatment response was considered excellent or good by approximately three quarters of both the clinicians and Owners. Otitis recurrence at D56 was seen in 11% of both groups. Adverse events attributable to the ear medications were not noted. CONCLUSIONS: Administering an otic gel twice at a one-week interval is an effective, safe and convenient way to treat canine otitis externa.

Community bioirrigation potential (BIPc), an index to quantify the potential for solute exchange at the sediment-water interface.

BIOIRRIGATION: the animal-induced exchange of solutes between pore water and overlying water - is a key process in sediments with profound implications for biogeochemical processes such as nutrient cycling and organic matter regeneration at the sediment water interface. There is an urgent need to understand how a changing environment will affect the irrigation activity of macrofauna and vice versa. A shift in species composition (e.g. from deep burrowing species to smaller, more opportunistic and shallow burrowing species) will have large effects on bioirrigation and thus on ecosystem function (such as benthic pelagic coupling). Considering the difficulties to determine area-covering rates of bioirrigation (e.g. in terms tracer-based fluxes) and the complexity of interactions of multiple species in the community that prohibit a direct measure of bioirrigation attributable to each species, a mechanistically-based approach is needed to predict relative intensities of bioirrigation activity based on the fundamental functional traits. We propose a conceptual framework to develop an index of bioirrigation that takes into account the biological mechanisms of bioirrigation and provides a simplified, yet functionally based approach to quantify the bioirrigation potential of benthic communities. We developed the community bioirrigation potential (BIPc) that provides a biomass- and abundance-weighted scoring system considering functional traits related to pore water and solute exchange. It may be used as a supplement to established methods to assess the function of marine soft sediments related bioirrigation. In analogy to the particle-related community bioturbation potential of Solan et al. (2004), context dependent organismal traits that affect ventilation and bioirrigation (feeding type, morphology of burrows, and burrowing depth) are combined with the data on abundance and biomass of the respective species. These are subsequently summed up to a community bioirrigation potential (BIPc). This review considers ecological traits relevant for bioirrigation and their classification into a bioirrigation index. Furthermore the necessary simplifications in the index (e.g. limiting its applicability to interfacial nutrient fluxes) are discussed. We also provide a working example from the southwestern Baltic Sea to illustrate the practical application of the index and a compilation of key species related to this area containing their classification into the considered bioirrigation traits.

A randomized placebo-controlled trial of the efficacy and safety of a terbinafine, florfenicol and betamethasone topical ear formulation in dogs for the treatment of bacterial and/or fungal otitis externa.

BACKGROUND: Treatment of infected otitis externa (OE) relies on the topical application of specific formulations that most often contain an antibiotic, an antifungal and a glucocorticoid. This study is to report the results of a randomized, placebo-controlled field trial evaluating the efficacy and safety of OSURNIA™ (Elanco Animal Health, a division of Eli Lilly and Company, Greenfield, IN), a novel topical ear medication containing florfenicol, terbinafine and betamethasone acetate in an adaptable gel. The study includes 284 dogs with bacterial and/or fungal OE who were randomly assigned to receive two doses of Osurnia or its vehicle, one week apart. Dogs were evaluated at various time points through Day 45, and a total clinical score (TCS) was calculated based on pain, erythema, exudate, swelling, odor and ulceration. The primary outcome measure was the rate of treatment success (RTS), defined as a TCS of 0, 1 or 2 on Day 45. Before and after treatment, a "clap test" was performed to subjectively assess hearing, and blood and urine were collected for routine clinical pathology. RESULTS: The RTS was significantly higher in ears treated with Osurnia (64.78%) than with placebo (43.42%). There was no significant interaction between efficacy and duration of history, recurrence of otitis or body weight. Adverse events were similar between groups. All dogs treated with Osurnia maintained their hearing, and there were no relevant clinical pathology changes. CONCLUSIONS: The application of two doses of Osurnia, one week apart, is effective and safe to treat microbial otitis externa in dogs.

Dynamics in the Plastic Crystalline Phases of Cyclohexanol and Cyclooctanol Studied by Quasielastic Neutron Scattering.

Plastic crystals are a promising candidate for solid state ionic conductors. In this work, quasielastic neutron scattering is employed to investigate the center of mass diffusive motions in two types of plastic crystalline cyclic alcohols: cyclohexanol and cyclooctanol. Two separate motions are observed which are attributed to long-range translational diffusion (α-process) and cage rattling (fast ß-process). Residence times and diffusion coefficients are calculated for both processes, along with the confinement distances for the cage rattling. In addition, a binary mixture of these two materials is measured to understand how the dynamics change when a second type of molecule is added to the matrix. It is observed that, upon the addition of the larger cyclooctanol molecules into the cyclohexanol solution, the cage size decreases, which causes a decrease in the observed diffusion rates for both the α- and fast ß-processes.

Zoonotic Transfer of Clostridium difficile Harboring Antimicrobial Resistance between Farm Animals and Humans.

The emergence of Clostridium difficile as a significant human diarrheal pathogen is associated with the production of highly transmissible spores and the acquisition of antimicrobial resistance genes (ARGs) and virulence factors. Unlike the hospital-associated C. difficile RT027 lineage, the community-associated C. difficile RT078 lineage is isolated from both humans and farm animals; however, the geographical population structure and transmission networks remain unknown. Here, we applied whole-genome phylogenetic analysis of 248 C. difficile RT078 strains from 22 countries. Our results demonstrate limited geographical clustering for C. difficile RT078 and extensive coclustering of human and animal strains, thereby revealing a highly linked intercontinental transmission network between humans and animals. Comparative whole-genome analysis reveals indistinguishable accessory genomes between human and animal strains and a variety of antimicrobial resistance genes in the pangenome of C. difficile RT078. Thus, bidirectional spread of C. difficile RT078 between farm animals and humans may represent an unappreciated route disseminating antimicrobial resistance genes between humans and animals. These results highlight the importance of the "One Health" concept to monitor infectious disease emergence and the dissemination of antimicrobial resistance genes.

Observation and Structure Determination of an Oxide Quasicrystal Approximant.

We report on the first observation of an approximant structure to the recently discovered two-dimensional oxide quasicrystal. Using scanning tunneling microscopy, low-energy electron diffraction, and surface x-ray diffraction in combination with ab initio calculations, the atomic structure and the bonding scheme are determined. The oxide approximant follows a 3^{2}.4.3.4 Archimedean tiling. Ti atoms reside at the corners of each tiling element and are threefold coordinated to oxygen atoms. Ba atoms separate the TiO_{3} clusters, leading to a fundamental edge length of the tiling 6.7 Å.

Aflibercept in diabetic macular edema: evaluating efficacy as a primary and secondary therapeutic option.

The recent results of Protocol T have illustrated the efficacy of aflibercept in the treatment of diabetic macular edema. It also demonstrated that in patients with poor vision (<6/12), aflibercept offers anatomical and visual advantages over ranibizumab and bevacizumab in the first 12 months of treament. At 2 years, the difference between the three drugs decreased with patients with a better baseline VA (69-78) showing a statistically insignificant advantage for ranibizumab compared with aflibercept.These results were achieved using a pro-re nata (PRN) protocol, which was not previously studied in large phase 3 trials, VIVID and VISTA, that chose to compare the 2.0 mg dose in a monthly and bimonthly regimen. In this review article, we analyzed earlier studies such as DAVINCI and VIVID and VISTA to determine which treatment strategy offers the best results; monthly, bimonthly, or PRN. We also studied the different doses for aflibercept used in DAVINCI to determine which is more effective the 0.5 mg dose or the 2.0 mg dose. In addition, we analyzed the recent data from protocol T with regards to visual and anatomic outcomes to try to determine whether these results concur with previous studies. Finally, we discuss the role of aflibercept as a potential alternative to any diabetic macular edema regimen regardless what the primary drug used is.

[CAMIC Recommendations for Surgical Laparoscopy in Non-Obstetric Indications during Pregnancy]. / CAMIC-Empfehlungen zur chirurgischen Laparoskopie aus nicht geburtshilflicher Indikation während der Schwangerschaft.

In the operative surgical primary care, the laparoscopic surgical technique has firmly established itself in recent years. Meanwhile, in the normal population over 90 % of all cholecystectomies and over 80 % of all appendectomies are performed in a minimally invasive manner. The proven benefits of the laparoscopic surgical technique, compared with conventional open surgery, are a comparatively rapid early postoperative recovery with early resumption of the general physical and occupational activity. As these benefits are equally applicable for necessary interventions during pregnancy, in recent years laparoscopy has become the preferred treatment for non-obstetric indications in the gravid patient. Overall, it can be assumed that such interventions have to be performed in approximately 2 % of all pregnant patients. Numerous studies have proven here that the use of laparoscopic techniques, in particular for the expectant mother, is safe and not associated with an increased risk. On the other hand, the current pregnancy makes necessary an adapted approach to the solution of surgical problems to ensure the protection of the unborn child. On the basis of currently available data situation, recommendations are formulated which can be used as a decision-making support for a variety of clinical situations.

Presentations with alcohol-related serious injury to a major Sydney trauma hospital after 2014 changes to liquor laws.

OBJECTIVE: To determine any impact associated with changes to liquor licensing regulations on emergency department attendances for alcohol-related serious injuries in an inner-city entertainment precinct. DESIGN, SETTING AND PARTICIPANTS: A blinded retrospective analysis of data from the Emergency Department Information System (EDIS) of the major trauma and teaching hospital (St Vincent's Hospital, Darlinghurst) in the Sydney CBD Entertainment Precinct. Data for trauma cases classified as Australasian triage categories 1 (immediately life-threatening) and 2 (imminently life-threatening, important time-critical treatment, very severe pain) in the 12 months before (24 February 2013 - 23 February 2014; period 1) and the 12 months after (24 February 2014 - 23 February 2015; period 2) the 2014 changes to liquor licensing regulations applied to the precinct. MAIN OUTCOME MEASURES: Critically or seriously injured emergency presentations that were identified as related to alcohol use. RESULTS: In the 2-year study period, there were 13 110 triage category 1 and 2 presentations to the St Vincent's Hospital emergency department: 6467 during period 1 and 6643 during period 2. Of these, 1564 (4.3%) were patients who presented with alcohol-related serious injuries: 318 (4.9%) during period 1 and 246 (3.7%) during period 2 (P < 0.05). The proportion of alcohol-related serious injury presentations (triage categories 1 and 2) was much higher (9.1% of presentations) during the high alcohol time (HAT; 6 pm Friday to 6 am Sunday) than during the rest of the week (3.1%). After the introduction of the regulatory changes, there was a significant decrease in the number of seriously injured patients during HAT, from 140 presentations (10.4% of presentations) before the change to 106 (7.8%) after their introduction, a relative reduction of 24.8% (P < 0.05). There was a small increase in the number of patients presenting with alcohol-related injuries between 9 pm and midnight. CONCLUSIONS: There was a significant reduction in the number of alcohol-related serious injury and trauma presentations to the emergency department in the 12 months after the introduction of the new liquor regulations. This change was seen throughout the week, but was especially marked at weekends.

[Inguinal Hernia Repair According to Desarda - Implementation of a Mesh-Free Method in a German University Hospital]. / Operation der Leistenhernie nach Desarda - Implementierung einer netzfreien Reparationsmethode an einer deutschen Universitätsklinik.

Inguinal hernia repair shows a clear tendency towards mesh-based as well as laparoscopic approaches. This is widely reflected in data-based statistics and guidelines. In contrast we have initiated and hereby illustrate the surgical method according to Desarda using autologous fascia to repair inguinal hernia.

The impact of amphetamine-type stimulants on emergency services.

PURPOSE OF REVIEW: Amphetamine-type stimulants now rank second worldwide in the table of most widely used recreational drugs. Many countries report increased availability and increased purity of the drugs.Surprisingly, while many authors in the last decade have described clinical issues and demographic patterns associated with amphetamine use, there is little published research quantifying the specifics of the impact of 'ICE' use on health resources.It is, therefore, timely to review the available literature on the impact of this group of drugs on emergency medical systems. RECENT FINDINGS: Recent research has focused on the increase in production and availability of metamphetamines. Clinical findings at acute presentation and long-term sequelae have been studied and in particular, the impact of the drugs on mental health and development of long-term neurological problems. Work has also been done unsuccessfully to develop therapeutic agents for the acute management of patients who present under the influence of amphetamines. SUMMARY: It is clear that the use of metamphetamine-type substances places an increasing burden on acute health services. There is a need for preventive and harm-minimization strategies.

Polymer adsorption on reconstructed Au(001): a statistical description of P3HT by scanning tunneling microscopy and coarse-grained Monte Carlo simulations.

We report on a combined theoretical and experimental characterization of isolated Poly(3-hexylthiophene) (P3HT) chains weakly adsorbed on a reconstructed Au(001) surface. The local chain conformations of in situ deposited P3HT molecules were investigated by means of scanning tunneling microscopy. For comparison, Monte Carlo simulations of the system were performed up to a maximum chain length of 60 monomer units. The dependence of the end-to-end distance and the radius of gyration on the polymer chain length shows a good agreement between experiment and Monte Carlo simulations using simple updates for short chains.

[Loss of domain-a surgeon's challenge. Surgical approach to an enormous scrotal hernia]. / Das "verlorene Heimatrecht" - eine chirurgische Herausforderung : Operative Versorgung einer monströsen Skrotalhernie.

We report on the one-stage procedure surgical approach to an enormous scrotal hernia bearing the whole small bowel and part of the large bowel as a loss of domain situation. Using a mesh-based component separation abdominal wall technique according to Ramirez we managed to retrieve the hernia content into the abdominal cavity allowing reduction of the resulting intra-abdominal pressure. We present our surgical approach in detail and report on the postoperative process based on focused intensive care surveillance and specific surgical complication management leading to hospital discharge of the patient on postoperative day 57.

Prediction of glioma recurrence using dynamic ¹8F-fluoroethyltyrosine PET.

BACKGROUND AND PURPOSE: Inter- and intratumor heterogeneity and the variable course of disease in patients with glioma motivate the investigation of new prognostic factors to optimize individual treatment. Here we explore the usefulness of standard static and more sophisticated dynamic (18)F-fluoroethyltyrosine-PET imaging for the assessment of patient prognosis. MATERIALS AND METHODS: Thirty-four consecutive patients with untreated, first-diagnosed, histologically proved glioma were included in this retrospective study. All patients underwent dynamic PET scans before surgery (± standard treatment) and were followed up clinically and by MR imaging. Static and dynamic tumor-to-background ratio, TTP, and slope-to-peak were obtained and correlated with progression-free survival. RESULTS: Twenty of 34 patients experienced progression, with a median progression-free survival of 28.0 ± 11.1 months. Dynamic TTP was highly prognostic for recurrent disease, showing a strong correlation with progression-free survival (hazard ratio, 6.050; 95% CI, 2.11-17.37; P < .001). Most interesting, this correlation also proved significant in the subgroup of low-grade glioma (hazard ratio, 5.347; 95% CI, 1.05-27.20; P = .044), but not when using established static imaging parameters, such as maximum tumor-to-background ratio and mean tumor-to-background ratio. In the high-grade glioma subgroup, both dynamic and static parameters correlated with progression-free survival. The best results were achieved by defining ROIs around "hot spots" in earlier timeframes, underlining the concept of intratumor heterogeneity. CONCLUSIONS: (18)F-fluoroethyltyrosine-PET can predict recurrence in patients with glioma, with dynamic analysis showing advantages over static imaging, especially in the low-grade subgroup.