Giardia in a selected population of dogs and cats in Germany - diagnostics, coinfections and assemblages.

Infections with the zoonotic endoparasite Giardia duodenalis are widely spread among dogs and cats worldwide. Since the question whether the infection might be transmitted from domestic animals to their owners is still an important topic, a reliable detection of patent Giardia infections and the determination of the associated Giardia assemblages is of major concern. The objectives of the present study were to determine the prevalence of Giardia infections in dogs and cats living in Germany using different diagnostic tests and to identify the Giardia assemblages of infected animals. Furthermore, a possible correlation of coinfections with other endoparasites was analysed. All samples were investigated by enzyme-linked immunosorbent assay (ELISA), merthiolate-iodine-formalin concentration technique (MIFC) and zinc chloride flotation. ELISA-positive samples were additionally screened with a direct immunofluorescence assay (IFA). Faecal DNA was extracted from all Giardia cyst-positive samples and used for multilocus sequence typing with nested PCRs targeting the following gene loci: SSU rRNA (SSU), glutamate dehydrogenase (gdh) and triosephosphate isomerase (tpi). Samples from dogs and cats tested positive for Giardia coproantigen (ELISA) in 30.6% and 17.9%, respectively. The MIFC technique revealed Giardia cysts in 33.9% of canine and in 34.6% of feline ELISA-positive samples, while using IFA, cysts were present in 90.4% of canine and in 76.9% of feline ELISA-positive samples. Coinfections with other endoparasites besides Giardia were found in both dogs and cats, yet a statistically significant correlation could solely be drawn for the canine samples. The success rate of the different PCR protocols varied between 23.1% (tpi) and 91.3% (SSU) for dogs and between 25.0% (gdh) and 90.0% (SSU) for cats. Dog-specific Giardia assemblages C and D were detected in 42 and 55 canine isolates, respectively. The cat-specific Giardia assemblage F was detected in 14 feline isolates. Two canine and two feline samples harboured the zoonotic assemblage A. According to the results of the study, Giardia is a common endoparasite in dogs and cats from Germany. The exclusive application of MIFC is insufficient for a reliable identification of patent Giardia infections since the IFA revealed a higher sensitivity for the detection of Giardia cysts in feline and canine faecal samples. Even though the majority of investigated animals harboured the species-specific Giardia assemblages C, D and F, a zoonotic potential arising from assemblage A could not be excluded.

[Outpatient care in emergency departments and primary care services : A descriptive analysis of secondary data in a rural hospital]. / Ambulante Versorgung in ZNA und Bereitschaftsdienstpraxis : Eine deskriptive Sekundärdatenanalyse in einer ländlichen Klinik.

BACKGROUND: The use of emergency departments in German hospitals has been increasing in recent years. Emergency care provided by primary care services ("Bereitschaftsdienstpraxis") or a hospital emergency departments (EDs) is the subject of current discussions. AIMS: The purpose of this study was to determine the reasons that outpatients with lower treatment urgency consult the ED. Further, the effects of the cooperation between primary care services and the ED will be examined. METHODS: The study was an exploratory secondary data analysis of data from the hospital information system and a quality management survey of a basic and standard care clinic in a rural area. All patients classified as 4 and 5 according to the emergency severity index (ESI), both four weeks before and after the primary care services and ED visit, were included in the study. RESULTS: During the two survey periods, a total of 1565 outpatient cases were treated, of which 962 cases (61%) were triaged ESI 4 or 5. Of these patients, 324 were surveyed (34%). Overall, 276 cases (85%) visited the ED without contacting a physician beforehand, 161 of the cases (50%) reported an emergency as the reason. In 126 cases (39%) the symptoms lasted more than one day. One-third of all outpatient admissions (537 cases, 34%) visited the ED during the opening hours of the general practitioner. DISCUSSION: More than 80% of the surviving cases visited the ED without physician contact beforehand. The most common reason for attending the ED was, "It is an emergency." The targeted control of the patients by integrating the primary care service into the ED does not lead to an increased number of cases in the primary care service, but to a subjective relief of the ED staff.

Competition of single and double rescattering in the strong-field photoemission from dielectric nanospheres.

Nanostructures exposed to ultrashort waveform-controlled laser pulses enable the generation of enhanced and highly localized near fields with adjustable local electric field evolution. Here, we study dielectric SiO2 nanospheres (d = 100-700 nm) under strong carrier-envelope phase-controlled few-cycle laser pulses and perform a systematic theoretical analysis of the resulting near-field driven photoemission. In particular, we analyze the impacts of charge interaction and local field ellipticity on the near-field driven electron acceleration. Our semiclassical transport simulations predict strong quenching of the electron emission and enhanced electron energies due to the ionization induced space charge. Though single surface backscattering remains the main emission process for the considered parameter range, we find a substantial contribution of double rescattering that increases with sphere size and becomes dominant near the cutoff energy for the largest investigated spheres. The growing importance of the double recollision process is traced back to the increasing local field ellipticity via trajectory analysis and the corresponding initial to final state correlation. Finally, we compare the carrier-envelope phase-dependent emission of single and double recollision electrons and find that both exhibit a characteristic directional switching behavior.

Field propagation-induced directionality of carrier-envelope phase-controlled photoemission from nanospheres.

Near-fields of non-resonantly laser-excited nanostructures enable strong localization of ultrashort light fields and have opened novel routes to fundamentally modify and control electronic strong-field processes. Harnessing spatiotemporally tunable near-fields for the steering of sub-cycle electron dynamics may enable ultrafast optoelectronic devices and unprecedented control in the generation of attosecond electron and photon pulses. Here we utilize unsupported sub-wavelength dielectric nanospheres to generate near-fields with adjustable structure and study the resulting strong-field dynamics via photoelectron imaging. We demonstrate field propagation-induced tunability of the emission direction of fast recollision electrons up to a regime, where nonlinear charge interaction effects become dominant in the acceleration process. Our analysis supports that the timing of the recollision process remains controllable with attosecond resolution by the carrier-envelope phase, indicating the possibility to expand near-field-mediated control far into the realm of high-field phenomena.

Anticoagulation management during multivessel coronary artery bypass grafting: a randomized trial comparing individualized heparin management and conventional hemostasis management.

BACKGROUND: Individualized heparin management (IHM) uses heparin dose-response curves to improve hemostasis management during cardiac surgery as compared with activated clotting time-based methods. OBJECTIVES: IHM was compared with conventional hemostasis management (CHM) in a randomized, prospective study (ID DRKS00007580). METHODS: One-hundred and twenty patients undergoing multivessel coronary artery bypass grafting (CABG) were enrolled. Heparin and protamine consumption, blood losses, blood transfusions and administration of hemostatic agents were recorded. Time courses of platelet counts and of coagulation parameters were determined. Coagulation was analyzed at intensive care unit (ICU) arrival by thromboelastometry. RESULTS: IHM patients received significantly lower initial heparin doses (289.3IU kg(-1) [interquartile range (IQR) 221.5-376.2 IU kg(-1) ] versus 350.5 IU kg(-1) [IQR 346.8-353.7 IU kg(-1) ], P < 0.0001) but similar total heparin doses (418.5 IU kg(-1) [IQR 346.9-590.5 IU kg(-1) ] versus 435.8 IU kg(-1) [IQR 411.7-505.1 IU kg(-1) ]). IHM patients received significantly less protamine, resulting in protamine/total heparin ratios of 0.546 [IQR 0.469-0.597] versus 0.854 [IQR 0.760-0.911] in CHM patients (P < 0.0001). Activated partial thromboplastin time (50.5 s [IQR 40.0-60.0 s] versus 37.0 s [IQR 33.0-40.0 s], P < 0.0001), activated clotting time (136 s [IQR 129.0-150.5 s] versus 126.5 s [IQR 120.3-134.0 s], P = 0.0002) and INTEM clotting times (215 s [IQR 192-237] versus 201 s [IQR 191-216 s], P = 0.0397) were significantly longer in IHM patients than in CHM patients at ICU arrival, with no difference in prothrombin time (P = 0.538). IHM patients lost significantly more blood within 12 h postoperatively (420 mL [IQR 337.5-605.0 mL] versus 345 mL [IQR 230.0-482.5 mL], P = 0.0041), and required significantly more hemostatic agents to control bleeding. Red blood cell transfusion requirements and time courses of platelet counts did not differ between groups. CONCLUSIONS: Multivessel CABG patients did not benefit from IHM in comparison with our established protocol based on activated clotting time.

[Critical incidents in preclinical emergency airway management : Evaluation of the CIRS emergency medicine databank]. / Kritische Zwischenfälle im Atemwegsmanagement der präklinischen Notfallmedizin : Auswertung der Datenbank CIRS-Notfallmedizin.

BACKGROUND: Many patients are victims of disastrous incidents during medical interventions. One of the obligations of physicians is to identify these incidents and to subsequently develop preventive strategies in order to prevent future events. Airway management and prehospital emergency medicine are of particular interest as both categories frequently show very dynamic developments. Incidents in this particular area can lead to serious injury but at the same time it has never been analyzed what kind of incidents might harm patients during prehospital airway management. MATERIALS AND METHODS: The German website http://www.cirs-notfallmedizin.de (CIRS critical incident reporting systems) offers anonymous reporting of critical incidents in prehospital emergency medicine. All incidents reported between 2005 and 2012 were screened to identify those which were concerned with airway management and four experts in this field analyzed the incidents and performed a root cause analysis. RESULTS: The database contained 845 reports. The authors considered 144 reports to be airway management related and identified 10 root causes: indications for intubation but no intubation performed (n = 8), no indications for intubation but intubation attempt performed (n = 7), wrong medication (n = 25), insufficient practical skills (n = 46), no use of alternative airway management (n = 7), insufficient handling before or after intubation (n = 27), defect equipment (n = 28), lack of equipment (n = 31), others (n = 18) and factors that cannot be influenced (n = 12). CONCLUSIONS: The incidents that were reported via the website http://www.cirs-notfallmedizin.de and that occurred during airway management in prehospital emergency medicine are described. To improve practical airway management skills of emergency physicians are one of the most important tasks in order to prevent critical incidents and are discussed in the article.

Análisis del manejo de fracturas ocultas de escafoides mediante la realización precoz de resonancia magnética / Analysis of the management of occult fractures of the scaphoid through early magnetic resonance imaging

Introducción. Nuestro objetivo es valorar la utilidad de la resonancia magnética (RM) en el diagnóstico de las fracturas ocultas de escafoides, mostrando las ventajas y el coste comparativo frente al protocolo de seguimiento tradicional. Material y método. El protocolo de actuación tradicional en nuestro centro consistía en inmovilización y revisiones clínico-radiológicas periódicas (radiología convencional y tomografía computarizada en la fase final del proceso). En el nuevo protocolo, si en el primer control del traumatólogo (10 días post-traumatismo) la radiología convencional seguía siendo negativa se realizaba un protocolo limitado de RM de muñeca (coronal T1 y T2-supresión grasa). Se valoraron los hallazgos visualizados en RM, el tiempo de inmovilización del paciente, el coste económico de ambos protocolos y la dosis de radiación recibida. Resultados. Se incluyeron 33 casos de pacientes con sospecha clínica de fractura de escafoides y radiología negativa. En 13 pacientes la RM fue negativa. En 12 se confirmó el diagnóstico de fractura de escafoides, 6 asociadas a otra afección. En 8 se diagnosticó otro proceso. El coste del nuevo protocolo fue de 131.06€ por paciente y de 114.41 o 151.06€ para el tradicional, según las revisiones necesarias. Se redujo la dosis de radiación al eliminar la realización de sucesivas exploraciones radiológicas. Conclusiones. El nuevo protocolo mejora el manejo de estos pacientes, reduciendo el tiempo de inmovilización, mejorando la rigidez articular y disminuyendo el periodo de baja laboral. Permite el diagnóstico de otras lesiones radiológicamente ocultas. El coste es similar e incluso inferior en algunos casos, y la irradiación es menor (AU)

Introduction. We aimed to evaluate the usefulness of magnetic resonance imaging (MRI) in the diagnosis of occult fractures of the scaphoid and to determine the advantages and cost in comparison with the traditional follow-up protocol. Material and method. The traditional approach at our center consisted of immobilization and periodic clinical and radiological follow-up (plain-film X-rays and computed tomography in the final phase of the process). The new protocol called for a limited MRI study consisting of coronal T1- and T2-weighted fat suppression sequences if the findings at plain-film X-rays continued to be negative at the first follow-up examination with the traumatologist (10 days after trauma). We evaluated the MRI findings, the time the patient was immobilized, the cost of each protocol, and the dose of radiation received. Results. We included 33 cases of patients with clinically suspected fractures of the scaphoid and negative findings on plain-film X-rays. In 13 patients, the MRI findings were negative. In 12 patients, the MRI findings confirmed the diagnosis of a fracture of the scaphoid, which was associated with other pathology in 6 cases. In 8 patients, another pathological process was diagnosed. The cost of the new protocol was €131.06 per patient; the cost of the traditional protocol was €114.41 or €151.06 per patient, depending on the follow-up studies required. The new protocol reduced the dose of radiation by eliminating successive radiologic studies. Conclusions. The new protocol improved the management of these patients, reducing the time of immobilization, improving joint rigidity, and reducing the time off work. The limited MRI study makes it possible to diagnose other radiologically occult lesions. The cost of the new protocol is similar to that of the traditional protocol and even lower in some cases. The new protocol results in a reduction in the dose of radiation (AU)

[Analysis of the management of occult fractures of the scaphoid through early magnetic resonance imaging]. / Análisis del manejo de fracturas ocultas de escafoides mediante la realización precoz de resonancia magnética.

INTRODUCTION: We aimed to evaluate the usefulness of magnetic resonance imaging (MRI) in the diagnosis of occult fractures of the scaphoid and to determine the advantages and cost in comparison with the traditional follow-up protocol. MATERIAL AND METHOD: The traditional approach at our center consisted of immobilization and periodic clinical and radiological follow-up (plain-film X-rays and computed tomography in the final phase of the process). The new protocol called for a limited MRI study consisting of coronal T1- and T2-weighted fat suppression sequences if the findings at plain-film X-rays continued to be negative at the first follow-up examination with the traumatologist (10 days after trauma). We evaluated the MRI findings, the time the patient was immobilized, the cost of each protocol, and the dose of radiation received. RESULTS: We included 33 cases of patients with clinically suspected fractures of the scaphoid and negative findings on plain-film X-rays. In 13 patients, the MRI findings were negative. In 12 patients, the MRI findings confirmed the diagnosis of a fracture of the scaphoid, which was associated with other pathology in 6 cases. In 8 patients, another pathological process was diagnosed. The cost of the new protocol was €131.06 per patient; the cost of the traditional protocol was €114.41 or €151.06 per patient, depending on the follow-up studies required. The new protocol reduced the dose of radiation by eliminating successive radiologic studies. CONCLUSIONS: The new protocol improved the management of these patients, reducing the time of immobilization, improving joint rigidity, and reducing the time off work. The limited MRI study makes it possible to diagnose other radiologically occult lesions. The cost of the new protocol is similar to that of the traditional protocol and even lower in some cases. The new protocol results in a reduction in the dose of radiation.

Extracellular matrix fluctuations during early embryogenesis.

Extracellular matrix (ECM) movements and rearrangements were studied in avian embryos during early stages of development. We show that the ECM moves as a composite material, whereby distinct molecular components as well as spatially separated layers exhibit similar displacements. Using scanning wide field and confocal microscopy we show that the velocity field of ECM displacement is smooth in space and that ECM movements are correlated even at locations separated by several hundred micrometers. Velocity vectors, however, strongly fluctuate in time. The autocorrelation time of the velocity fluctuations is less than a minute. Suppression of the fluctuations yields a persistent movement pattern that is shared among embryos at equivalent stages of development. The high resolution of the velocity fields allows a detailed spatio-temporal characterization of important morphogenetic processes, especially tissue dynamics surrounding the embryonic organizer (Hensen's node).

[A million football fans in a city of 120,000 inhabitants--a nightmare for emergency medicine and disaster management? Euro 2008 and the "Orange wonder of Berne"]. / 1.000.000 Fussballfans in einer Stadt mit 120.000 Einwohnern--ein notfallmedizinischer Albtraum? Die Euro 2008 und das "Oranje-Wunder von Bern"

The 2008 European Football Championship 2008 (Euro 08) is the largest sporting event ever organized in Switzerland. One million visitors came to the city of Berne during the event and the local airport in Bern/Belp registered 261 extra flights. For each football game there were 33,000 fans in the stadium and 100,000 fans in the public viewing zones.The ambulance corps and the Department of Emergency Medicine (ED) at Inselspital, University Hospital Berne, were responsible for basic medical care and emergency medical management. Injuries and illnesses were analyzed by a standardized score (NACA score). The preparation strategy as well as costs and patient numbers are presented in detail.A total of 30 additional ambulance vehicles were used, 4,723 additional working days (one-third medical professionals) were accumulated, 662 ambulance calls were registered and 240 persons needed medical care (62% Swiss, 28% Dutch and 10% other nationalities). Among those needing treatment 51 were treated in 1 of the 4 city hospitals. No injuries with NACA grades VI and VII occurred (NACA I: 4, NACA II: 17, NACA III: 16, NACA IV: 10 and NACA V: 4 patients). The city of Berne compensated the Inselspital Bern with a total of 112,603 Euros for extra medical care costs. The largest amount was spent on security measures (50,300 Euros) and medical staff (medical doctors 22,600 Euros, nurses 29,000 Euros). Because of the poor weather and the exemplary behavior of the fans, the course of events was rather peaceful.

[Mediastinal emphysema after a simple maxillofacial fracture]. / Mediastinalemphysem als Folge einer einfachen Mittelgesichtsfraktur.

Mediastinal emphysema is usually seen in cases of blunt thoracic trauma or cervical injury accompanied by tracheobronchial or esophageal perforation. Characteristic of this injury is severe retrosternal pain. We present the case of a man with extensive mediastinal and cervical emphysema caused by a simple midfacial fracture and accompanied by no symptoms.

Multi-field 3D scanning light microscopy of early embryogenesis.

A computer-controlled microscopy system was devised to allow the observation of avian embryo development over an extended time period. Parallel experiments, as well as extended specimen volumes, can be recorded at cellular resolution using a three-dimensional scanning procedure. The resulting large set of data is processed automatically into registered, focal- and positional-drift corrected mosaic images, assembled as montages of adjacent microscopic fields. The configuration of the incubator and a sterile embryo chamber prevents condensation of the humidified culturing atmosphere in the optical path and is compatible with both differential interference contrast and epifluorescence optics. As a demonstration, recordings are presented showing the large-scale remodelling of the embryonic primordial vascular structure.

Integrins in vascular development.

In recent years, there has been a sustained interest in vascularization processes. Much, if not all, of the work has included the concept of new vessel morphogenesis. Surprisingly, most of the work has not addressed developmental mechanisms directly, but rather as an offshoot of a disease process, wound healing process, or from the perspective of inducing vessels in an ischemic site. One theme has dominated the various studies on capillary or endothelial tube morphogenesis-integrin-mediated cell behavior. Integrin biology impacts virtually every known step of nascent vessel formation. In this review article, we attempted to summarize key findings from the viewpoint of developmental biologists/morphologists. We also attempted to summarize and contrast data obtained using integrin gene ablation approaches in mice with other experimental systems. It is hoped this review will provide a distinct cell biological perspective to vascular scientists from the clinical, molecular, and tissue engineering communities.

Nicardipine for the treatment of Raynaud's phenomena: a double blind crossover trial of a new calcium entry blocker.

Fifteen patients with Raynaud's phenomenon [systemic lupus erythematosus (6), progressive systemic sclerosis (8) and rheumatoid arthritis (1)] and 12 patients with Raynaud's disease participated in a parallel, 4-week/arm, double blind, crossover study of nicardipine, an experimental calcium channel blocker. Nicardipine significantly improved pain (p = 0.03), decreased number of Raynaud's attacks (p less than 0.03), and was preferred over placebo (p less than 0.05) in the patients with Raynaud's disease, but showed an effect only in the number of attacks (p = 0.049) among the group with Raynaud's phenomenon. Plethysmography showed no drug effects. One patient discontinued the trial after developing headaches while taking placebo. Nonlimiting toxicity occurred more commonly with drug than placebo (15 vs 9 times, p less than 0.05). Our study demonstrated that nicardipine improves symptoms in Raynaud's disease, but is not effective in Raynaud's phenomenon.

A strategy for reaching therapeutic salicylate levels in patients with rheumatoid arthritis using standardized dosing regimens.

After one to 2 weeks of 45 mg/kg/day choline magnesium trisalicylate (CMT) in 2 divided doses, 51 of 71 patients with rheumatoid arthritis (72%) had observed steady state serum salicylate concentrations between 150 and 300 mg/l (mean salicylate: 213 +/- 10 mg/l), although 17 later required dose adjustment. CMT dosing was changed in 37 cases by using the formula: dosing rate = total clearance X concentration. The expected and observed concentrations were not different (p = 0.31); thus, this formula can help calculate salicylate dosing changes to bring the serum salicylate level to within the therapeutic range.

[Haemoperfusion with activated charcoal and ion exchanger in phalloidin intoxicated rats (author's transl)]. / Hämoperfusion mit Aktivkohle und Ionenaustauscher bei phalloidin-vergifteten Ratten

Amberlite-XAD-4 and activated charcoal haemoperfusion permit a considerable increase in 14C-methyl-phalloin elimination in vitro which surpasses the effect of haemodialysis treatment. However, in the in-vivo experiment using phalloidin intoxicated rats (1.5 or 2.0 mg/kg i.v.) prolongation of the survival period could not be attained 0y haemoperfusion.