[Incidence of retinal vein occlusion during the football World Cup in 2014 : A database analysis]. / Inzidenz von Zentralvenen- und Venenastverschlüssen während der Fußballweltmeisterschaft 2014 : Eine Datenbankanalyse.

BACKGROUND: The association between cardiovascular events, such as acute coronary syndrome and emotional triggers, such as football world cups is well-known. Significant differences could sometimes be identified depending on the country of origin and design of the study. From an ophthalmological perspective the correlation between pre-existing cardiovascular diseases and retinal angiopathy is well-known. This study investigated whether the incidence of retinal vein occlusion (RVO) at a German university eye clinic increased during and 4 weeks after the 2014 football World Cup. METHODS: From the electronic files of almost 290,000 patients contained in the Smart Eye database, those with RVO during and 4 weeks after the 2014 football World Cup (from 12 June to 13 August 2014) and during the same time period in 2013 could be identified. Demographic data, visual acuity, intraocular pressure (IOP) and laboratory parameters were extracted and compared, when available. RESULTS: From 10 male (average age 68 years) and 8 female (average age 62 years) a total of 9 central RVO (CRVO), 8 branch RVO (BRVO) and 1 hemi-CRVO were identified in 2013 with a visual acuity ranging from 0.05 to 0.9 (average 0.39) and an IOP from 12 mmHg to 25 mmHg (average 16 mmHg). In 2014 a total of 26 patients (11 male average age 67 years and 15 female average age 76 years) were identified, an increase of 69 % (15 CRVO, 6 BRVO and 5 hemi-CRVO). The visual acuity ranged from 0.05 to 1.0 (average 0.63) and the IOP from 8 mmHg to 24 mmHg (average 15 mmHg). CONCLUSION: Due to the high comparability of the patient collectives an increase of RVO during and 4 weeks after the 2014 football World Cup could be identified, compared to the same period in 2013. It can be assumed that emotional strain caused by a World Cup is a risk factor. Data from other centers have to be assessed in order to be able to make a more general statement.

Planar photonic crystals infiltrated with liquid crystals: optical characterization of molecule orientation.

Nematic liquid crystals are infiltrated into InP-based planar photonic crystals. Optical measurements as a function of temperature and polarization are used to study the average director field configuration in the nanometer-size holes: a planar equilibrium state is found.

Planes of sharp pelvic dissection for primary, locally advanced, or recurrent rectal cancer.

In the design of operations for rectal cancers, the focus is often on circumventing the local extent of disease and leaving the pelvis free of cancer. The local extent of disease may range from minimal intramural invasion to the direct extension of a primary tumor to pelvic sidewall structures, e.g., the internal iliac vessels. In the absence of distant spread, understanding the planes of pelvic anatomy may allow the knowledgeable surgeon to cure patients who would otherwise be declared unresectable. We present the four planes (and one rare situation) available for sharp dissection which allow for the resection of all but a few cases of locally advanced disease.

Current status of total mesorectal excision and autonomic nerve preservation in rectal cancer.

Two decades have passed since the late 1970s, which witnessed the introduction of total mesorectal excision (TME)-based operations for rectal cancers on both sides of the Atlantic. Since the introduction of TME, clinical experience has been reported widely in the form of single- and multisurgeon reports from wide geographic regions with multiple participants, and from specialty services with narrow focus and high levels of expertise. All of these published results conclude that in comparison with conventionally practiced blunt surgery for rectal cancer, TME-based (i.e., anatomically correct, sharply performed) operations are associated with significantly lower rates of pelvic (local) recurrences, a significantly higher rate of survival, and significantly lower long-term morbidity. The latter is accomplished through dramatically higher rates of sphincter preservation, and the preservation of both sexual and urinary functions. Overall, there is a remarkable similarity in the clinical results that have been reported from diverse centers. TME now forms the basis of large randomized clinical trials in which the role of adjuvant therapy is being reexamined. The current status of TME is reviewed, and the authors' clinical results of a consecutive series of 544 TME-based operations performed through 1998 are updated.

Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model.

In previous studies we reported that an acute elevation in intra-abdominal pressure (IAP) is responsible for the elevation in intracranial pressure (ICP) and mean blood pressure (MBP). Thus far, the reasons for the increased ICP during an acute elevation in IAP and the combined effects of increased IAP and ICP on hemodynamics have not been reported. Five large animals (swine) were studied. Each animal served as its own control. A subarachnoid screw was placed for ICP monitoring. The jugular vein, femoral vein, and femoral artery were cannulated. ICP, MBP, central venous pressure above (CVPA) and below (CVPB) the diaphragm, and PaC02 were monitored after a pneumoperitoneum with C02 was established at 5, 15, and 30 mm Hg of IAP. Cavography was performed to evaluate the morphology of the inferior vena cava at different increments of IAP. Measurements were obtained in reverse Trendelenburg (group 1), supine (group 2), and Trendelenburg (group 3) positions. Multiple regression analysis was used to examine the effects of IAP and positioning in separate models with different blood pressures as dependent variables. Increased IAP significantly increased CVPA, CVPB, ICP, and MBP. There were no changes in cerebral perfusion pressure. The change in position (from group 1 to group 3) significantly increased CVPA and decreased the CVPB. Cavograms performed on animals in the supine position with increased IAP showed a narrowing of the IVC at the level of the diaphragm. Increases in IAP will increase ICP and MBP without altering the cerebral perfusion pressure. A mechanical effect mediated by compression of the inferior vena cava at the level of the diaphragm with increased central venous pressure and decreased drainage from the lumbar plexus and central nervous system is responsible for this effect.

Effects of hyperventilation and hypoventilation on PaCO2 and intracranial pressure during acute elevations of intraabdominal pressure with CO2 pneumoperitoneum: large animal observations.

BACKGROUND: The side effects of acute elevations in intraabdominal pressure (IAP) are related to a multifactorial etiology. Previous studies have reported that acute elevations in IAP produce an immediate increase in intracranial pressure (ICP). This study was designed to analyze the reasons for increased ICP during acute elevations of IAP and to determine the combined effects of IAP and changes in ventilation indices on ICP and hemodynamic indices. STUDY DESIGN: Five pigs were studied. A subarachnoid screw was placed for ICP monitoring. The jugular vein, femoral vein, and femoral artery were cannulated. Mean arterial pressure (MAP), central venous pressure (CVP), ICP, and arterial pressure of carbon dioxide (PaCO2) were monitored before and after carbon dioxide pneumoperitoneum was established at 0, 10, and 20 mmHg of IAP Effects of hyperventilation and hypoventilation were recorded and compared with baseline ventilation. Cavography was performed to evaluate the morphology of the inferior vena cava (IVC) at different levels of IAP. Multiple regression and Student's t-test were used to examine the effects of IAP and ventilation on dependent variables. RESULTS: The IVC showed a progressive narrowing at the level of the diaphragm as IAP was increased. There was a simultaneous increase in CVP, MAP, and ICP. The mean changes in ICP with hypoventilation were significantly larger than with hyperventilation. CONCLUSIONS: Acutely increased IAP displaces the diaphragm cranially, narrowing the IVC and increasing intrathoracic pressure. This increases CVP and increases ICP by venous stasis and increased pressure in the sagittal sinus with decreased resorption of cerebrospinal fluid. Hemodynamic changes are directly related to the rise in ICP. Hypoventilation and hypercarbia significantly increase ICP when compared with hyperventilation and hypocarbia. Hyperventilation does not significantly decrease ICP during acute elevations of IAP.

Merging medical groups.

One of the trends of the past 10 years that has marked the way physicians practice medicine is growth in the size and complexity of group practice. The reasons for these changes (better patient coverage, within-the-group referral, a larger financial base, a collegial environment, shared overhead, professional management, and packaged negotiation) are clear and are certainly valid. This trend shows few signs of slowing and may be accelerating. Indeed, most of the proposals for national health care reform seem likely to put larger groups at a competitive advantage. We have developed a highly effective procedure that helps improve the efficiency and the success of the merger process.

Information retrieved from a database and the augmentation of personal knowledge.

OBJECTIVE: To assess the degree to which information retrieved from a biomedical database can augment personal knowledge in addressing novel problems, and how the ability to retrieve information evolves over time. DESIGN: This longitudinal study comprised three assessments of two cohorts of medical students. The first assessment occurred just before student course experience in bacteriology, the second occurred just after the course, and the third occurred five months later. At each assessment, the students were initially given a set of bacteriology problems to solve using their personal knowledge only. Each student was then reassigned a sample of problems he or she had answered incorrectly, to work again with assistance from a database containing information about bacteria and bacteriologic concepts. The initial pass through the problems generated a "personal knowledge" score; the second pass generated a "database-assisted" score for each student at each assessment. RESULTS: Over two cohorts, students' personal knowledge scores were very low (approximately 12%) at the first assessment. They rose substantially at the second assessment (approximately 48%) but decreased six months later (approximately 25%). By contrast, database-assisted scores rose linearly: from approximately 44% at the first assessment to approximately 57% at the second assessment, to approximately 75% at the third assessment. CONCLUSION: The persistent increase in database-assisted scores, even when personal knowledge had attenuated, was the most remarkable finding of this study. While some of the increase may be attributed to artifacts of the design, the pattern seems to result from the retained ability to recognize problem-relevant information in a database even when it cannot be recalled.

Studies on the mechanisms by which transforming growth factor-beta (TGF-beta) protects against allergic encephalomyelitis. Antagonism between TGF-beta and tumor necrosis factor.

Experimental allergic encephalomyelitis (EAE) is an autoimmune disease in which peripheral lymphoid cells are activated by immunization with myelin proteins and become effector cells that traverse the central nervous system (CNS) capillaries and initiate inflammatory demyelinating lesions. The administration of transforming growth factor-beta (TGF-beta) has been shown previously to decrease the incidence and severity of EAE. In our studies we have determined: 1) the effects of TGF-beta injected at different intervals after the EAE-inducing immunization; 2) the effect of TGF-beta on the development of sensitized T cells, as assayed by the proliferative responses of T cells from lymph nodes and peripheral blood; 3) the extent of lymphoid cell infiltration in CNS of TGF-beta-treated and control mice; and 4) the role of endogenous TGF-beta and TNF in determining the severity of both acute and relapsing EAE. The onset of acute-EAE in SJL mice, induced by immunization with spinal cord homogenate in CFA and pertussigen, is on days 10 to 15. Although daily i.p. injections of 0.2 to 2 micrograms TGF-beta 1 or TGF-beta 2 on days 5 to 9 after immunization are highly protective, injections on days 1 to 5 or 9 to 13 are not. Moreover, anti-TGF-beta accelerates and aggrevates EAE when given on days 5 and 9, but not on day 12. Anti-TNF, injected on days 5 and 9, provides a comparable degree of protection as does TGF-beta. Similarly, in relapsing EAE, anti-TGF-beta increases, whereas anti-TNF decreases the incidence and severity of relapses. TGF-beta treatment on days 5 to 9 does not influence the appearance of sensitized cells in peripheral blood and lymph nodes, but does prevent the accumulation of T cells in brain and spinal cord, as assayed on days 15 to 20. It is concluded that the protective effect of TGF-beta is exerted at the level of the target organ, CNS and/or its vascular endothelium, rather than through a direct effect on lymphoid cells, and that there is a small window of 4 days in which TGF-beta exerts its protective effect.

Database access and problem solving in the basic sciences.

This study examined the potential contribution that access to a database of biomedical information may offer in support of problem-solving exercises when personal knowledge is inadequate. Thirty-six medical students were assessed over four occasions and three domains in the basic sciences: bacteriology, pharmacology, and toxicology. Each assessment consisted of a two-pass protocol in which students were first assessed for their personal knowledge of a domain with a short-answer problem set. Then, for a sample of problems they had missed, they were asked to use a database, INQUIRER, to respond to questions which they had been unable to address with their personal knowledge. Results indicate that for a domain in which the database is well-integrated in course activities, useful retrieval of information which augmented personal knowledge increased over three assessment occasions, even continuing to increase several months after course exposure and experience with the database. For all domains, even at assessments prior to course exposure, students were able to moderately extend their ability to solve problems through access to the INQUIRER database.