RADIAL head arthroplasty: does ligaments repair influence outcomes? A minimum two years follow-up radiographic multi-center study.

PURPOSE: The current indication for comminuted radial head fractures is radial head arthroplasty (RHA). The main purpose of this study was to investigate any statistical differences in terms of prosthesis revision or removal and radiographic degenerative changes by comparing patients who underwent RHA and ligaments repair to those who underwent only RHA implant at minimum two years follow-up. The secondary aim was to delineate a trend profile of RHA implants. METHODS: All patients who underwent RHA surgery for traumatic pathology between January 2012 and December 2017 were eligible. Two researchers independently and retrospectively reviewed the patients' charts and collected the following data: type of prosthesis, associated surgical procedures and revision surgery. They also looked for any radiographic sign of prosthesis loosening, overstuffing, capitellar osteopenia, heterotopic ossification and degenerative changes. No clinical evaluation was performed. RESULTS: In 6 years, 124 RHA were implanted (74 female, 50 male, mean age 56). The main diagnoses were: terrible triad, trans-olecranon fracture and isolated radial head fracture. It was found no significant statistical difference between the 2 groups; nevertheless, the cohort of patients that underwent ligaments repair had a lower revision rate in comparison with the other. Suture of the annular ligament seems to be critical. The overall revision rate was 10.5%. CONCLUSION: This multi-center study found no evidence that ligaments repair, as an associated surgical procedure, improves RHA longevity, except for annular ligament. Nevertheless, it seems to prevent degenerative changes at midterm follow-up.

Clinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study.

Background. Visceral leishmaniasis (VL) caused by Leishmania infantum is endemic in the Mediterranean area. In the last decades a northward spread of the parasite has been observed in Italy. This paper describes a VL outbreak in Modena province (Emilia-Romagna, Northern Italy) between 2012 and 2015. Methods. Retrospective, observational study to evaluate epidemiological, microbiological characteristics, and clinical management of VL in patients referring to Policlinico Modena Hospital. Results. Sixteen cases of VL occurred in the study period. An immunosuppressive condition was present in 81.3%. Clinical presentation included anemia, fever, leukopenia, thrombocytopenia, and hepatosplenomegaly. Serology was positive in 73.3% of cases, peripheral blood PCR in 92.3%, and bone marrow blood PCR in 100%. Culture was positive in 3/6 cases (50%) and all the isolates were identified as L. infantum by ITS1/ITS2 sequencing. The median time between symptom onset and diagnosis was 22 days (range 6-131 days). All patients were treated with liposomal amphotericin b. 18.8% had a VL recurrence and were treated with miltefosine. Attributable mortality was 6.3%. Conclusions. VL due to L. infantum could determine periodical outbreaks, as the one described; thus it is important to include VL in the differential diagnosis of fever of unknown origin, even in low-endemic areas.

Method for Assessing Contrast Performance under Lighting Conditions such as Entering a Tunnel on Sunny Day.

BACKGROUND: Clinical assessment of dark adaptation is time consuming and requires a specialised instrumentation such as a nyktometer. It is therefore not surprising that dark adaptation is rarely tested in practice. As for the case of testing fitness of a driver, demands on adaptation in daily driving tasks mostly depart from settings in a nyktometer. In daily driving, adaptation is stressed by high and fast transitions of light levels, and the period of time which is relevant to safe driving starts right after a transition and ends several seconds later. In the nyktometer dark adaptation is tested after completion of the adaptation process. RESULTS of a nyktometer test may therefore deliver little information about adaptation shortly after light transitions. In an attempt to develop a clinical test aiming to fulfill both a short measurement time and offering test conditions comparable to conditions in driving, we conducted a preliminary study in which contrast sensitivity thresholds were recorded for light transitions as found in daily driving tasks and for various times after transition onsets. Contrast sensitivity performance is compared to dark adaptation performance as assessed by a myktometer. MATERIAL AND METHODS: Contrast sensitivity thresholds were recorded in 17 participants by means of a twin projection apparatus. The apparatus enabled the projection of an adapting field and of a Landolt ring both with a variable luminance. Five different stepwise transitions in levels of adapting luminance were tested. All transitions occurred from bright to dark. The Landolt ring was flashed 100 or 500 ms after the transition had occurred. Participants were instructed to report the orientation of the Landolt ring. A Rodenstock Nyktometer, Plate 501, was used to record dark adaptation threshold. RESULTS: Experimental data from the proposed test revealed a noticeably increasing contrast detection threshold measured in dark adaptation in the stronger transition from 14 000 to 8 cd/m2 than in the weaker transition from 2000 to 8 cd/m2. By raising the dark adaption luminance level from 8 to 60 cd/m2 in the stronger transition case, the contrast detection threshold was then improved by a factor of four. Another main finding showed that for the adaptation process from strong glare stimuli to the dark adaptation, a peak deterioration in contrast sensitivity occurred at the light adaptation level of 6000 cd/m2. Comparing the contrast performance assessed by the proposed test with that of the nyktometer test, there was no clear correlation between the two methods. CONCLUSIONS: Our suggested method to assess dark adaptation performance proved to be practical in use and, since the patient does not have to spend a long time to attain complete dark adaptation, the method required a short time for measurement. Our negative experience in the use of the myktometer was in agreement with reported experience in the literature.

A field report on self-screening visual acuity using a computerized vision screener.

BACKGROUND: Large-scale examinations are costly and time consuming. Costs could be reduced by asking patients to carry out tests by themselves. This study aimed to gain practical experience on how patients handle self-administered acuity tests. MATERIAL AND METHODS: We developed two computerized self-test acuity screening devices consisting out of a commercially available vision screener, an answering box and a PC. The answering box served to record the responses of the participants and to present verbal instructions to the participants. Participants took acuity tests for far (5 m, OS, OD, OU) and an acuity test for near (40 cm, OU) using the self-test screener. For the reason of privacy personal data like age, gender and habitual correction was entered on a separate PC. The devices were installed in two different locations and run without supervision. RESULTS: Personal data records of 2528 participants (4% women) were collected in both locations. The age in 45% of the participants ranged between 41 and 50 years. 31% of the participants declared to wear spectacles and 3% contact lenses. 66% of participants declared not to need a correction. A total of 1078 participants completed four acuity tests (OD far, OS far, OU far, OD near) using the self-test screening device. Depending on the acuity test and location, the average duration required to complete one acuity test ranged between 29.7 s to 39.1 s. The total duration for completing the four acuity tests was on average 133 ± 46 s. CONCLUSIONS: The duration for completing the acuity tests is considered as being short. Made experience speaks in favor of feasibility of self-tests in acuity screening.

Working towards a test for screening visual skills in a complex visual environment.

We developed a test for screening visual skills under similar conditions as at workplace. The test was administered to 207 participants, recruited in the working population. Six-digit numbers were super-imposed on a video of a drive and presented for 300 ms in the central visual field and in the periphery. Participants reported whether or not the integer '3' was included in the numbers. Normative data for the test were computed using 150 data sets of participants reporting not to take drugs and with an age ranging between 15 y and 67 y. Participants performed better in the central visual field than in periphery. The test could successfully be completed by participants of all ages without the need of adjustment of settings. Comparison of 46 data sets recorded in participants taking drugs (30 y-68 y) with age matched participants not taking drugs demonstrates an additional potential application of the test. Practitioner Summary: Developed test delivers comparative estimates of visual skills within short time and appears as valuable and cheap complementation to current testing procedures in industrial practice. The test can be used in a preventive and in educative manner to monitor effects of factors like fatigue, sleep deprivation or drug consumption.

Information access at the point of care: what can we learn for designing a mobile CPR system?

OBJECTIVES: Hospitals have started to migrate their paper-based records to computerized patient records (CPR). The majority of today's CPR systems are stationary, which means that physicians use a clinical workstation to access CPR information. But health care professionals need to request and enter information at different locations, for example, on their daily ward round. This suggests the use of mobile computers, enabling an ubiquitous access to needed data. Different studies show that health care professionals are reluctant to use poorly designed mobile CPR systems, as the work at the point of care is very time-pressured and hectic. To design a system with high acceptance, it is essential to obtain empirical insight into the work practices and context in which the mobile CPR system will be used. METHOD: We investigated the physicians' work with the patient record during their daily round. With the help of a compact notation method, the physicians' interaction with the information system was recorded in real time. Fourteen physicians from three different departments (internal medicine, surgery, and geriatrics) of a middle-sized Swiss hospital participated in our study. RESULTS: Physicians have clear access preferences when they interact with the patient record during their daily round. There exists a clear profile of access frequencies and patterns, respectively. As an example, approximately 50% of all patient record accesses concern information about medications, vital signs and lab test results. DISCUSSION/CONCLUSION: A CPR system which is designed to reflect the access frequencies and patterns should improve the efficiency of data entry and retrieval and thus result in a system with high acceptance among physicians in the demanding environment during hospital rounds.

Evaluation of two algorithms for counting forward saccades in a reading task.

We compared two algorithms, which are used to assess the number of forward saccades in a reading task from records of eye movements. In one algorithm saccades are detected analysing the velocity of eye movements. The third derivate of eye position in time (jerk) is used in the second algorithm for the detection of saccades. Both algorithms were applied on the same set of data, recorded using 24 subjects reading a German text, which was presented on two different displays. Our subjects read the text at a mean reading speed of 258.5 word/min. Both algorithms were found to produce a similar rate of artefacts in the number of detected saccades (2.5%), provided the threshold for detection (velocity or jerk) is set at an appropriate level and the same level of threshold is applied to all data. In both algorithms, the rate of artefacts increases with increasing distance of the threshold from its optimum. Inter-individual variation of the rate of artefacts increases more pronounced in the algorithm based on jerks. Eye blinks were identified as a major source of artefacts. A remedy is proposed, by means of which the rate of artefacts can be reduced.

[Technical realization of an LCD-based vision test device]. / Technische Realisierung eines LCD-basierten Sehtestgerätes.

We describe a computer-aided self-test vision screener for testing near and far visual acuity. The device generates images separately for each eye on a LCD. Acuity can be measured in the range between 0.1 and 1.6 for any distance between 0.34 m and 6 m. In addition, it also enables testing for colour deficiency, phoria, stereopsis and contrast sensitivity. The device is fully automatic and enables self-testing of the above mentioned functions. Initial practical application in an industrial environment has demonstrated the practicability of the device.

Molecular typing and long-term comparison of clostridium difficile strains by pulsed-field gel electrophoresis and PCR-ribotyping.

Thirty-two related and 68 unrelated isolates of Clostridium difficile, isolated in different Italian hospitals since 1987, were analysed by PFGE and PCR-ribotyping to investigate their genetic relatedness. The isolates were classified into 28 groups by PFGE and 20 ribotypes by PCR-ribotyping. A single clone of C. difficile was recognised as the cause of three geographically and chronologically distant outbreaks. The correlation between PFGE and PCR-ribotyping results was good, with agreement for 77 (84%) of the 92 isolates typed by both methods. However, among sporadic isolates the discriminatory power of PFGE was more evident. Eight isolates that were untypable by PFGE could be analysed by PCR-ribotyping. The dendrograms generated showed that the genetic relatedness of the C. difficile isolates obtained by both techniques was comparable. The majority of the isolates in recent years appeared to be genetically unrelated to isolates from past infections. However, two clonal groups identified in all time periods had a common origin and this seems to indicate that they share some advantageous biological characteristics. The constant monitoring of C. difficile epidemiology will allow acquisition of further important data on this nosocomial pathogen.

[Virtual retinal display system with nodal point image of a laser beam: construction example and evaluation of subjective brightness perception]. / Netzhautanzeigesystem ("virtual retinal display") mit Knotenpunktabbildung eines Laserstrahles: Konstruktionsbeispiel und Bewertung des subjektiven helligkeitseindruckes.

We investigated the perception of brightness for red monochromatic laser light. For this purpose, a modified virtual retinal display (VRD) was constructed. The modification involved projecting the laser beam into the eye. In our VRD, the laser beam pivots in the nodal point of the eye (badal system). The displayed image therefore does not depend on the refractive state of the eye. Brightness perception was assessed by means of psychophysical experiments. The results of these experiments indicate that perception of brightness at 652 nm increases more rapidly with increasing physical stimulus than does the perception of white light (colour temperature 2'935 K). At a wavelength of 652 nm, an optical power of 79 nW is required to produce an image subtending 2 degrees of equal brightness, as is perceived with an image of about 2'900 cd/m2 subtending 2 degrees.

Bacteroides fragilis enterotoxin induces the expression of IL-8 and transforming growth factor-beta (TGF-beta) by human colonic epithelial cells.

Bacteroides fragilis toxin (BFT) has been shown to be capable of inducing intestinal mucosal inflammation in animals. Such inflammation may be responsible for diarrhoea, which occurs in some, but not all human carriers of enterotoxigenic strains of B. fragilis (ETBF). We have studied responses to BFT by different human intestinal epithelial cell lines and subsequently investigated the expression of IL-8 and TGF-beta by T84 cells. The latter were selected because their responses to BFT, characterized by morphological changes and cell death by apoptosis, were similar to those we have recently observed in primary human colonocytes. We show that BFT dose-dependently increased the expression of transcripts and protein of the polymorphonuclear cell chemoattractant IL-8. BFT also dose-dependently induced the release of TGF-beta, which has been shown to enhance the repair of the injured intestinal epithelium. However, the secreted TGF-beta was almost exclusively in the biologically inactive form, as determined by Mv1Lu bioassay. Our studies therefore suggest that exposure of colonic epithelial cells in vivo to high concentrations of BFT can initiate an inflammatory response via secreted IL-8. BFT-induced release of latent TGF-beta may facilitate the subsequent repair of the injured epithelium, following its activation by proteases from neighbouring cells. Variation in cytokine responses by colonic epithelial cells in vivo could be an important determinant in the development of mucosal disease and symptoms in response to ETBF.

Heterogeneity in responses by primary adult human colonic epithelial cells to purified enterotoxin of Bacteroides fragilis.

BACKGROUND: Enterotoxigenic strains of Bacteroides fragilis (ETBF) have been implicated in diarrhoeal illness in livestock and children, but their role in adult human colonic disease is unknown. AIMS: To investigate responses by primary adult human colonic epithelial cells to purified B fragilis toxin (BFT). METHODS: BFT was purified from culture supernatant of a highly toxigenic strain of ETBF. Morphological changes to primary colonic epithelial cells, in response to purified BFT, were studied in organ culture of colonic biopsy specimens from 15 adults. RESULTS: BFT induced epithelial cell cytotoxicity in colonic biopsy specimens from 12/15 subjects. The BFT induced morphological changes were characterised by epithelial cell rounding, separation from adjacent cells, and detachment from the basement membrane. In severely affected specimens, almost all the epithelial cells were affected. There was heterogeneity between subjects in the rate at which BFT induced epithelial cell cytotoxicity occurred. Furthermore, in colonic biopsy specimens from three subjects, exposure to BFT did not induce any significant morphological changes to epithelial cells. CONCLUSION: BFT is capable of inducing cytotoxicity in primary adult human colonic epithelial cells. Such an effect of ETBF derived BFT on epithelial cells in the colon in vivo would be expected to lead to mucosal inflammation and diarrhoea. Heterogeneity in responses by primary colonocytes probably reflects the outcome of host-BFT interactions. Such interactions in vivo could determine the occurrence of colonic disease in some individuals but not others.

[Effects of presbyopia on clinical phoria]. / Auswirkungen der Presbyopie auf die klinische Phorielinie.

BACKGROUND: Due to accommodation-vergence cross-link we can expect that presbyopia will affect vergence as well. From investigations of cross-link as function of age one may assess strain of visual system due to presbyopia. Furthermore, this observation will give hints on innervation of ciliary muscle. MATERIAL AND METHOD: Vergence is assessed as function of stimulus of accommodation in 27 subjects (24-65 years). RESULTS: Presbyops tend to be exophoric for near vision. Vergence is linked to accommodation by means of a quadratic polynome rather than by a linear function. CONCLUSIONS: We may expect, that missing vergence strains visual system of presbyops. Results support Hess-Gullstrand theory of presbyopia and indicate a loss of innervation of ciliary muscle with increasing age.

[Computer-based determination of red/green color vision defects]. / Computer-basierte Bestimmung von Rot/Grün-Farbanomalien.

A commonly used method of investigating colour vision, that is, the ability of the human visual system to discriminate colours, is based on the use of isochromatic colour plates, such as those used in the Ishihara test. The present paper describes a new computer-based method of determining red/green colour vision deficiencies. The method involves the presentation of Ishihara colour plates on a computer monitor. It has been verified experimentally that, despite the differences between the spectral emission of the computer screen and the daylight reflected by the Ishihara plates, the method is capable of distinguishing between subjects with from those without colour vision deficiencies. For screening purposes, the use of a reduced number of plates is suggested. This suggestion makes use of nine instead of 14 plates, and the criterion of two incorrectly recognized plates to determine a colour vision deficiency.

[Video laparoscopy in patients with pain in the right iliac region]. / La videolaparoscopia nel paziente con dolore in regione iliaca destra.

The authors report on their experience of 235 laparotomy operations and 125 laparoscopic operations performed on patients with right lower abdominal pain. Concerning each of these different approaches, the authors analyzed and compared preoperative diagnosis, anatomo-pathological findings, intraoperative and early post operative morbidity and hospital stay. The ratio of negative open-appendectomies was 24.1% (56 cases out of 233). The laparoscopic approach, performed on 88 cases of suspected appendicitis, allowed to document and to treat other pathologies, real causes of the lower right abdominal pain, in 42 cases (47.7%). The rate of conversion from laparoscopic appendectomy to open appendectomy was only 2.19% (2 cases out of 91). The morbidity rate of laparoscopic appendectomy was estimated at 6.5% (4.4% major complications, 2.2% minor complications). The morbidity rate of open appendectomy was estimated at 8.9% (0.4% major complications, 8.5% minor complications). Though the median postoperative stay, after laparotomy approach, was slightly longer (2.6 days versus 2.4 days), the difference was not statistically significant. Based on these results, the authors conclude that the laparoscopic approach should be reserved for fertile female patients, especially when the diagnosis of appendicitis is uncertain.

[Computer-based determination of stereopsis]. / Computer-basierte Bestimmung der Stereopsis.

AIM: A computer-based approach to assess stereopsis for screening purposes is described. This approach is based on random-dot stereograms (RDS). METHOD: The TNO test is a common method to assess stereopsis based on red/green anaglyphs and the use of RDS. This technique was transferred to a computer-based platform. To investigate the validity of the computer-based approach, 25 subjects were tested with both the TNO test and the computer-based approach. RESULTS: With regard to the spectral emission of the monitor screen, accurate separation of red and green for RDS generation was not possible. However, adaptation of the RDS to the colour filters used permitted the best-possible separation. The resolution of the monitor required a viewing distance of 2 m. The results obtained showed no significant differences between the two methods. CONCLUSIONS: For the computer-based screening, RDS and anaglyphs can be employed. The influence of the spectral emission of the monitor screen and its resolution can be reduced by adapting the RDS colours to the filters used and modifying the viewing distance.

Detection of enterotoxigenic Bacteroides fragilis by PCR.

Strains of enterotoxigenic Bacteroides fragilis (ETBF) are associated with diarrhea in young farm animals and, at least in particular settings, in children. Enterotoxin production by ETBF is currently detected by a tissue culture assay with HT-29 cells. We have developed a PCR assay based on the detection of the enterotoxin gene to identify ETBF in culture and in stool samples. Overall, 113 bacterial strains were examined, including 3 B. fragilis reference strains, 75 B. fragilis isolates (comprising 40 ETBF isolates), 20 Bacteroides spp. other than B. fragilis, and 15 strains belonging to other genera. Complete agreement was found between the results of the tissue culture assay and those of the PCR for our strains. PCR was also used to detect ETBF directly in fecal samples. Stools from two healthy volunteers were spiked with known numbers of ETBF and were processed by three different methods. A culture method, which required inoculation of the stools on selective plates and the collection of the whole bacterial growth ("sweeps"), was found to be the most sensitive. PCR performed with the plate sweeps yielded amplification products with a detection limit of 10(5) to 10(4) CFU/g of feces. By this method 18 samples of diarrheic stools (10 positive and 8 negative for ETBF) were examined. The results of the PCR were in accordance with the culture results in all cases. The proposed PCR assay represents a diagnostic tool for the rapid identification of ETBF in culture as well as in fecal samples.

Recovery of Bilophila wadsworthiafrom Clinical Specimens in Italy.

This report is the first survey in Italy to evaluate the incidence of recovery of Bilophila wadsworthia in clinical situations. The survey was carried out at the departments of Microbiology in two Northern Italian hospitals over a one-year period. Tests for B. wadsworthia were carried out on a range of specimens from different body sites, when etiology by anaerobes was suspected. Out of a total of 350 samples examined, 67% were positive in bacteriological tests. Mixed anaerobic infections were detected in 53 specimens, corresponding to 23% of all cases. Strains of B. wadsworthia were isolated from 12 samples, equivalent to 5% and 22% of total and mixed/anaerobic infections, respectively. Bilophila wadsworthia was always isolated in mixed infections, mainly from the large intestine (67% of cases). The infectious process of B. wadsworthia was often complicated by abscess formation, regardless of body site. Interestingly, a strain was isolated from one case of bacteremia. The microorganisms most frequently isolated with B. wadsworthia were Escherichia coli for facultative species (38%), and Bacteroides fragilis, from anaerobic isolates (25%). Production of beta-lactamases by B. wadsworthia isolates was found in ten strains (83%), which appeared to be penicillin G resistant at concentration equal to or greater than the break-point (4 microg/mL). Epidemiological and clinical data from this and previous studies point to the involvement of B. wadsworthia in mixed infections. To assess the specific contribution of the species to the disease, studies of pathogenetic factors are to be considered in parallel. Nonetheless, production of beta-lactamases by most B. wadsworthia isolates could easily interfere with the therapeutical approach to infections involving the new species. The addition of a selective medium to culture specimens from the abdominal cavity should be considered in order to detect the presence of B. wadsworthia.

[Microfluctuations in accommodation]. / Mikrofluktuationen der Akkommodation.

BACKGROUND: So called microfluctuations of the power of crystalline lens are uncontested in scientific community. However, there are still open questions about possible artefacts which deserve discussion. PURPOSE: This contribution is intended to reopen discussion of matters concerning fundamentals about microfluctuations of the crystalline lens. METHOD AND RESULTS: Thoughts are outlined which render characteristics or even existence of microfluctuations questionable. CONCLUSION: There is still a need for a conclusive experiment to determine existence and role of microfluctuations.