[Confirmation of Tick-borne encephalitis virus in an European hedgehog (Erinaceus europaeus)]. / Frühsommer-Meningoenzephalitis-Virus Nachweis beim Europäischen Igel (Erinaceus europaeus).

INTRODUCTION: European hedgehogs (Erinaceus europaeus) have a high exposure to various ticks, which could transmit pathogens with direct health significance for the host and may have zoonotic potential. Tick-borne meningoencephalitis (FSME) is an important tick-borne disease in Switzerland, caused by the tick-borne encephalitis virus. About its occurrence in the European hedgehog population is little known. The present study examined various organs, blood and ticks of 65 European hedgehogs to obtain data of FSME virus presence in this species in Switzerland. Real-time RT-PCR from the lungs, liver, spleen and kidney of 56 hedgehogs and of 114 infesting ticks (Ixodes hexagonus or Ixodes ricinus) were used for the detection of viral RNA. In addition, 19 blood samples were tested for antibodies against FSME by ELISA. FSME virus antibodies were detected for the first time in the serum of a European hedgehog. Lung and spleen tissue samples of the same animal tested also weak virus positive on RT-PCR. Clinically, the hedgehog showed neurological symptoms, although these symptoms could have originated from an other diseases. No viral RNA was detected in any of the ticks. This study could not confirm if the meningoencephalitis in the hedgehog was triggered by the FSME viral infection. Nevertheless, the simultaneous detection of antibodies and virus RNA in the same animal makes the European hedgehog a competent host of the tick-borne encephalitis virus and leads to the assumption that this species can act as a reservoir.

INTRODUCTION: En raison du nombre élevé de tiques présents chez les hérissons d'Europe (Erinaceus europaeus), ces animaux sont fortement exposés aux différents pathogènes qu'ils transmettent, pathogènes qui, en plus de l'importance directe pour la santé de l'hôte, peuvent aussi avoir un potentiel en termes de zoonose. La méningo-encéphalite à tique est, en Suisse, une maladie importante transmise par les tiques. Elle est causée par le virus de la méningo-encéphalite verno-estivale. Son occurrence chez les hérissons d'Europe est jusqu'à maintenant peu connue. Au travers de l'étude des organes, du sang et des tiques provenant de 65 hérissons européens, il devrait pour la première fois être possible de se prononcer sur la présence du virus chez cette espèce en Suisse. La détection de l'ARN viral a été effectuée au moyen d'une RT-PCR en temps réel sur les poumons, le foie, la rate et les reins de 56 hérissons ainsi que sur un total de 114 tiques dont ils étaient porteurs, appartenant aux espèces Ixodes hexagonus ou Ixodes ricinus. En outre, 19 échantillons de sang ont été testés par ELISA pour des anticorps contre le virus. Dans la présente étude, des anticorps contre le virus de l'encéphalite à tiques dans le sérum d'un hérisson européen ont pu être détectés pour la première fois. Les échantillons de poumon et de rate du même animal ont également montré une faible présence virale. Le même hérisson a présenté des symptômes neurologiques, mais ceux-ci pouvaient également être associés à d'autres maladies. On n'a démontré la présence d'ARN viral chez aucune tique. La possibilité d'une encéphalite causée par l'infection virale chez les hérissons ne peut pas être confirmée ou exclues avec cette étude. La détection simultanée des anticorps et de l'ARN viral chez le même animal fait du hérisson européen non seulement un hôte compétent du virus de l'encéphalite verno-estivale mais donne également également à penser que cette espèce pourrait servir de réservoir.

[Forefoot relief with shoe inserts : Effects of different construction strategies]. / Vorfußentlastung durch Schuheinlagen : Effekte unterschiedlicher Konstruktionsprinzipien.

BACKGROUND: Shoe inserts and shoe modifications are used to reduce plantar peak pressure. The effects of different shoe inserts and shoe construction strategies for relief of the forefoot have not yet been sufficiently evaluated. PURPOSE: The aim of this study was to analyze the effects of shoe inserts and shoe construction strategies (e.g. metatarsal pad, forefoot cushioning and control) and shoe modifications (e.g. flexible or stiff) on the peak plantar pressure in the forefoot region. MATERIAL AND METHODS: In this study 15 healthy subjects were recruited. Plantar pressure distribution was measured using an in-shoe system during walking (3.5km∙h-1) on a treadmill and the average plantar peak pressure (kPa) in the forefoot was calculated. The statistics for testing the hypothesis were carried out using 2­factorial ANOVA with repeat measurements (factors: shoe, insert; α = 0.05). RESULTS: The metatarsal pad and forefoot cushioning led to a reduction of peak pressure, which was statistically significant compared to the control condition (p = 0.009). No differences were observed between both shoe inserts (p > 0.05). A comparison between stiff and flexible shoes revealed a statistically significant pressure reduction in favor of stiff shoes (p = 0.0001). The metatarsal pad led to a peak pressure increase in the midfoot of 12% and by 21% compared to control and forefoot cushioning, respectively. DISCUSSION: A peak pressure reduction in the forefoot can be achieved with a metatarsal pad or with cushioning; however, the metatarsal pad resulted in a subsequent increase in midfoot pressure. Moreover, shoe construction is crucial because a stiff shoe contributes to a better peak pressure reduction compared to a flexible shoe. Prospective clinical studies should be carried out to prove whether this results in beneficial effects for patients with metatarsalgia.

Ambient temperature influences tolerance to plant secondary compounds in a mammalian herbivore.

Growing evidence suggests that plant secondary compounds (PSCs) ingested by mammals become more toxic at elevated ambient temperatures, a phenomenon known as temperature-dependent toxicity. We investigated temperature-dependent toxicity in the desert woodrat (Neotoma lepida), a herbivorous rodent that naturally encounters PSCs in creosote bush (Larrea tridentata), which is a major component of its diet. First, we determined the maximum dose of creosote resin ingested by woodrats at warm (28-29°C) or cool (21-22°C) temperatures. Second, we controlled the daily dose of creosote resin ingested at warm, cool and room (25°C) temperatures, and measured persistence in feeding trials. At the warm temperature, woodrats ingested significantly less creosote resin; their maximum dose was two-thirds that of animals at the cool temperature. Moreover, woodrats at warm and room temperatures could not persist on the same dose of creosote resin as woodrats at the cool temperature. Our findings demonstrate that warmer temperatures reduce PSC intake and tolerance in herbivorous rodents, highlighting the potentially adverse consequences of temperature-dependent toxicity. These results will advance the field of herbivore ecology and may hone predictions of mammalian responses to climate change.

Gender-specific predictors of early mortality after coronary artery bypass graft surgery.

BACKGROUND: Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained. OBJECTIVES: To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors. METHODS: A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005-2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality. RESULTS: Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70-4.96, P < 0.001). Women were older than men (+4.7 years, P < 0.001), had lower self-assessed preoperative physical functioning (-16 points on a scale from 0 to 100, P < 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %, P = 0.01), respiratory insufficiency (9.4 vs. 5.3 %, P = 0.006) and resuscitation (5.2 vs. 1.8 %, P = 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77-2.41, P = 0.29). CONCLUSIONS: Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.

Diagnostic, prognostic, and cost assessment of coronary artery disease in women.

Women with obstructive coronary disease appear to be more challenging diagnostically and suffer a more adverse prognosis than men. More than one half of women with symptoms of ischemic heart disease have no obstructive coronary artery disease at coronary angiography, yet these women frequently have persistent symptom-related disability and consume large amounts of healthcare resources. Prior evidence has been limited regarding effective diagnostic strategies for the assessment of symptomatic women. The current report synthesizes existing evidence on diagnostic testing in women, including research from the ongoing National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation (WISE) study. In addition to recent published evidence (drawn from much larger cohorts of women) that stress echocardiography and nuclear imaging are similar in their ability to risk-stratify women, the WISE study is exploring new pathophysiological mechanisms of microvascular dysfunction in women. An unfolding body of evidence suggests that as tests become more diagnostically and prognostically accurate, the process will become more cost efficient. The results from a growing number of large observational series and National Institutes of Health-sponsored studies are expected to be the foundation for cost-effective diagnostic and prognostic strategies for the approximately 5 million women who undergo evaluation for coronary disease annually.

Gender-related differences in clinical management after exercise nuclear testing.

OBJECTIVES: This study sought to determine the rate of referral to cardiac catheterization in men and women early after nuclear testing as a function of the magnitude of myocardial ischemia by radionuclide perfusion imaging. BACKGROUND: Although many previous studies have suggested that gender-related differences are present in the clinical management of coronary artery disease, the presence of such a difference with respect to referral to catheterization after noninvasive testing is disputed. METHODS: We examined 3,211 consecutive patients (1,074 women, 2,137 men) who underwent exercise dual-isotope single-photon emission computed tomography and had follow-up evaluation performed at least 1 year after nuclear testing (mean [+/- SD] follow-up 19 +/- 5 months) for "hard" events (cardiac death and myocardial infarction) and referral to cardiac catheterization or revascularization within 60 days of nuclear testing. Multiple logistic regression analysis was performed to determine the best predictors of referral to catheterization as well as to examine whether gender itself added further information to this model. RESULTS: Although men were referred to catheterization more frequently than women (10.6% vs 7.1%, p < 0.001) early after exercise nuclear testing, there were no differences in the rate of referral to catheterization or revascularization after stratification by the amount of abnormally perfused myocardium detected by the nuclear scan. Both men and women with normal scan results were infrequently referred to subsequent catheterization. In the setting of severe ischemia, women were referred to catheterization more frequently than men. This higher rate appears to be clinically appropriate because women with severely abnormal scan results had a significantly higher event rate than men (17.5% vs. 6.3%, p < 0.0001). This greater risk in women than in men appeared to be underappreciated because the increased rate of hard events in women with severely abnormal scan results was out of proportion to the smaller increase in their rate of referral to cardiac catheterization. Although gender added information to the multivariate model most predictive of referral to catheterization models when nuclear variables were not included, when nuclear variables were considered, the addition of gender added no further significant information. This finding suggests that adjusting for differences in perfusion scan abnormalities by the use of nuclear testing eliminated the apparent gender-related referral bias. CONCLUSIONS: After controlling for differences in perfusion scan abnormalities, no gender-related referral bias to catheterization was present. In the setting of severe ischemia, women had a greater rate referral to catheterization than men. As a function of risk, both men and women were appropriately referred to catheterization at a low rate when the scan result was normal. However, because women with severe perfusion abnormalities had a greater rate of cardiac death and myocardial infarction then men, women in this high risk subgroup were underreferred to catheterization relative to men. This finding points to the need to better identify women at high cardiac risk.