Osteonecrosis of the jaw: surgical treatment results before and during the COVID-19 pandemic in one of the reference hospitals in Poland.

OBJECTIVE: The COVID-19 pandemic has had a huge impact not only on everyday life but, above all, on the functioning of medical entities. During its duration, there were problems with access to health care, including maxillofacial surgery departments. The aim of the study is to analyze how the pandemic affected the surgical results of the treatment of osteonecrosis of the jaws at the Clinic of Maxillofacial Surgery in Poznan which delivers services in maxillofacial surgery for almost 4.5 million inhabitants in Poland. PATIENTS AND METHODS: We conducted a retrospective analysis of patients' medical records before and during the pandemic restrictions. The data was obtained by entering the appropriate passwords and ICD-10 diagnoses (e.g., M87) in the hospital's IT system. The obtained information was subjected to statistical analysis. RESULTS: The number of patients before and during the pandemic did not differ significantly. During the COVID-19 pandemic, the waiting time of patients after admission to the hospital for surgery and the total time of hospitalization were shortened. The number of complications was similar in both groups. However, the waiting time for a follow-up visit was longer during restriction time. CONCLUSIONS: The COVID-19 pandemic had an impact on the course of surgical treatment in patients with osteonecrosis of the jaws. The outcomes of the medical procedure remained consistent with the ones observed before the implementation of restrictions. This is likely due to the urgency of the illness. Despite the pandemic, a critical condition called osteonecrosis of the jaw was treated promptly.

The new method of ZnIn2S4 synthesis on the titania nanotubes substrate with enhanced stability and photoelectrochemical performance.

In this work, ZnIn2S4 layers were obtained on fluorine doped tin oxide (FTO) glass and TiO2 nanotubes (TiO2NT) using a hydrothermal process as photoanodes for photoelectrochemical (PEC) water splitting. Then, samples were annealed and the effect of the annealing temperature was investigated. Optimization of the deposition process and annealing of ZnIn2S4 layers made it possible to obtain an FTO-based material generating a photocurrent of 1.2 mA cm-2 at 1.62 V vs. RHE in a neutral medium. In contrast, the highest photocurrent in the neutral electrolyte obtained for the TiO2NT-based photoanode reached 0.5 mA cm-2 at 1.62 V vs. RHE. In addition, the use of a strongly acidic electrolyte allowed the generated photocurrent by the TiO2NT-based photoanode to increase to 3.02 mA cm-2 at 0.31 V vs. RHE. Despite a weaker photoresponse in neutral electrolyte than the optimized FTO-based photoanode, the use of TiO2NT as a substrate allowed for a significant increase in the photoanode's operating time. After 2 h of illumination, the photocurrent response of the TiO2NT-based photoanode was 0.21 mA cm-2, which was 42% of the initial value. In contrast, the FTO-based photoanode after the same time generated a photocurrent of 0.02 mA cm-2 which was only 1% of the initial value. The results indicated that the use of TiO2 nanotubes as a substrate for ZnIn2S4 deposition increases the photoanode's long-term stability in photoelectrochemical water splitting. The proposed charge transfer mechanism suggested that the heterojunction between ZnIn2S4 and TiO2 played an important role in improving the stability of the material by supporting charge separation.

The valance state of vanadium-key factor in the flexibility of potassium vanadates structure as cathode materials in Li-ion batteries.

Potassium hexavanadate (K2V6O16·nH2O) nanobelts have been synthesized by the LPE-IonEx method, which is dedicated to synthesis of transition metal oxide bronzes with controlled morphology and structure. The electrochemical performance of K2V6O16·nH2O as a cathode material for lithium-ion batteries has been evaluated. The KVO nanobelts demonstrated a high discharge capacity of 260 mAh g-1, and long-term cyclic stability up to 100 cycles at 1 A g-1. The effect of the vanadium valence state and unusual construction of the nanobelts, composed of crystalline and amorphous domains arranged alternately were also discussed in this work. The ex-situ measurements of discharged electrode materials by XRD, MP-AES, XAS and XPS show that during the subsequent charge/discharge cycle the potassium in the K2V6O16·nH2O structure are replacing by lithium. The structural stability of the potassium hexavandate during cycling depends on the initial vanadium valence state on the sample surface and the presence of the "fringe free" domains in the K2V6O16·nH2O nanobelts.

First-line nivolumab plus ipilimumab versus chemotherapy in patients with unresectable malignant pleural mesothelioma: 3-year outcomes from CheckMate 743.

BACKGROUND: In the phase III CheckMate 743 study (NCT02899299), first-line nivolumab plus ipilimumab significantly improved overall survival (OS) versus chemotherapy in patients with unresectable malignant pleural mesothelioma (MPM). We report updated data with 3-year minimum follow-up. PATIENTS AND METHODS: Adults with previously untreated, histologically confirmed, unresectable MPM and Eastern Cooperative Oncology Group performance status of ≤1 were randomized 1 : 1 to nivolumab (3 mg/kg every 2 weeks) plus ipilimumab (1 mg/kg every 6 weeks) for up to 2 years, or six cycles of platinum plus pemetrexed chemotherapy. This report includes updated efficacy and safety outcomes, exploratory biomarker analyses including four-gene inflammatory expression signature score, and a post hoc efficacy analysis in patients who discontinued treatment due to treatment-related adverse events (TRAEs). RESULTS: With a median follow-up of 43.1 months, nivolumab plus ipilimumab continued to prolong OS versus chemotherapy. Median OS was 18.1 versus 14.1 months [hazard ratio (95% confidence interval), 0.73 (0.61-0.87)], and 3-year OS rates were 23% versus 15%, respectively. Three-year progression-free survival rates were 14% versus 1%, and objective response rates were 40% versus 44%. At 3 years, 28% versus 0% of responders had an ongoing response. Improved survival benefit with nivolumab plus ipilimumab versus chemotherapy was observed across subgroups, including histology. A high score of the four-gene inflammatory signature appeared to correlate with improved survival benefit with nivolumab plus ipilimumab. No new safety signals were observed with nivolumab plus ipilimumab, despite patients being off therapy for 1 year. In patients who discontinued nivolumab plus ipilimumab due to TRAEs, median OS was 25.4 months, and 34% of responders maintained their responses for ≥3 years after discontinuation. CONCLUSIONS: With 3 years' minimum follow-up, nivolumab plus ipilimumab continued to provide long-term survival benefit over chemotherapy and a manageable safety profile, supporting the regimen as standard-of-care treatment for unresectable MPM, regardless of histology.

Comorbidities Associated with Worse Outcomes Among Inpatients Admitted for Acute Gastrointestinal Bleeding.

BACKGROUND: Multimorbidity increases healthcare resource utilization. Little is known on specific comorbidity combinations. AIMS: To identify comorbidities associated with increased resource utilization among inpatients admitted for gastrointestinal bleeding (GIB). METHODS: This retrospective cross-sectional study, 1/2010-5/2018 at the University Hospital Zurich, Switzerland, analyzed electronic health records of patients with upper (UGIB) and lower (LGIB) GIB, focusing on length of stay (LOS) and 30-day readmissions for resource use and clinical outcomes, investigated by multivariable regression adjusted for antithrombotics. RESULTS: Of 1101 patients, 791 had UGIB and 310 LGIB, most often melena and bleeding diverticula, respectively. In UGIB, thromboembolic events showed a trend toward 27% increased LOS (1.27; 95% confidence interval [CI] 1.00-1.61), antithrombotics independently associated with 46% increased LOS (1.46; 95% CI 1.32-1.62). Cancer (odds ratio [OR] 2.86; 95% CI 1.68-4.88) independently associated with 30-day readmissions, anemia showed a trend (OR 1.68; 95% CI 1.00-2.84). In LGIB, none of the investigated comorbidities associated with increased LOS, but antithrombotics independently associated with 25% increased LOS (1.25; 95% CI 1.07-1.46). Atrial fibrillation/flutter (OR 2.69; 95% CI 1.06-6.82) and cancer (OR 4.76; 95% CI 1.40-16.20) associated strongly with 30-day readmissions. CONCLUSIONS: In both groups, cancer associated with 30-day readmissions, antithrombotics with increased LOS. Thromboembolic events and anemia showed clinically important trends in UGIB. Atrial fibrillation/flutter associated with 30-day readmissions in LGIB. Prospective studies are needed to investigate these complex multimorbid populations and establish appropriate guidelines.

Outcomes from the use of computerized neurocognitive testing in a recurrent glioblastoma clinical trial.

Assessment of neurocognitive function (NCF) is important in brain tumor clinical trials, however there are varying methodologies available. We used the Cogstate computerized NCF testing battery and the mini-mental state examination (MMSE) to prospectively assess cognition in adult patients with recurrent glioblastoma (GBM) enrolled in the CABARET randomized phase II clinical trial of bevacizumab versus bevacizumab plus carboplatin chemotherapy. We determined completion rates; compared NCF results between trial arms; and assessed baseline NCF as a predictor of survival outcome. 93 of 103 eligible patients completed baseline Cogstate NCF testing. Completion rates were between 60 and 100% across each timepoint, and 38% at disease progression. There was no evidence of difference between arms in time to deterioration in NCF using either test. Prior to disease progression, deterioration on the Cogstate tests was substantially more common (90%) than deterioration on the MMSE (37%), and decline in the Cogstate composite score within the first 8 weeks was associated with shorter overall survival. This testing methodology may be useful when determining net clinical benefit for therapies in patients with recurrent GBM.

Thermal Index for early non-invasive assessment of brain injury in newborns treated with therapeutic hypothermia: preliminary report.

Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method.

Standardising clinical outcomes measures for adult clinical trials in Fabry disease: A global Delphi consensus.

BACKGROUND: Recent years have witnessed a considerable increase in clinical trials of new investigational agents for Fabry disease (FD). Several trials investigating different agents are currently in progress; however, lack of standardisation results in challenges to interpretation and comparison. To facilitate the standardisation of investigational programs, we have developed a common framework for future clinical trials in FD. METHODS AND FINDINGS: A broad consensus regarding clinical outcomes and ways to measure them was obtained via the Delphi methodology. 35 FD clinical experts from 4 continents, representing 3389 FD patients, participated in 3 rounds of Delphi procedure. The aim was to reach a consensus regarding clinical trial design, best treatment comparator, clinical outcomes, measurement of those clinical outcomes and inclusion and exclusion criteria. Consensus results of this initiative included: the selection of the adaptative clinical trial as the ideal study design and agalsidase beta as ideal comparator treatment due to its longstanding use in FD. Renal and cardiac outcomes, such as glomerular filtration rate, proteinuria and left ventricular mass index, were prioritised, whereas neurological outcomes including cerebrovascular and white matter lesions were dismissed as a primary or secondary outcome measure. Besides, there was a consensus regarding the importance of patient-related outcomes such as general quality of life, pain, and gastrointestinal symptoms. Also, unity about lysoGb3 and Gb3 tissue deposits as useful surrogate markers of the disease was obtained. The group recognised that cardiac T1 mapping still has potential but requires further development before its widespread introduction in clinical trials. Finally, patients with end-stage renal disease or renal transplant should be excluded unless a particular group for them is created inside the clinical trial. CONCLUSION: This consensus will help to shape the future of clinical trials in FD. We note that the FDA has, coincidentally, recently published draft guidelines on clinical trials in FD and welcome this contribution.

Sexual function in women with androgen excess disorders: classic forms of congenital adrenal hyperplasia and polycystic ovary syndrome.

PURPOSE: We compared the sexual function in women with classic forms of congenital adrenal hyperplasia (CAH) and polycystic ovary syndrome (PCOS) to find if the cause of androgen excess determines sexual functioning. METHODS: Hundred and four women (21 with CAH, 63 with PCOS and 20 healthy controls) aged 18-40 years were included into the study. All participants completed a questionnaire regarding their sociodemographic background and underwent anthropometric and basic biochemical measurements. Plasma levels of total testosterone, androstenedione, and 17-hydroxyprogesterone were measured with immunoassay. To assess the sexual functions, the Female Sexual Function Index (FSFI) questionnaire was applied. RESULTS: Apart from the higher physical activity in PCOS patients (P = 0.017), we found no significant sociodemographic differences between the studied groups. In clinical assessment, women with CAH had a lower incidence of acne (P = 0.006). Their plasma levels of 17OHP (P = 0.005) and insulin resistance index (P = 0.0248) were higher, while total testosterone (P = 0.0495) and glucose (P = 0.0061) was lower compared to the PCOS group. Significantly more women with CAH were homosexual (P = 0.003) and bisexual (P = 0.006). CAH group showed a lower total FSFI score (P = 0.0043) and lower scores in three domains: lubrication (P = 0.0131), sexual satisfaction (P = 0.0006), and dyspareunia (P < 0.0001). Higher physical activity was associated in all women with higher total FSFI score (P = 0.009) and scores in the domain of desire (P = 0.034) and sexual satisfaction (P = 0.01), while in CAH women apart from the total score (P = 0.03) and sexual satisfaction (P = 0.002) also in the domains of orgasm (P = 0.005), and pain (P = 0.03). CONCLUSIONS: CAH women present more often homosexual and bisexual orientation, while their sexual functions are impaired compared to PCOS patients.

Impact of temperature on the physicochemical, structural and biological features of copper-silica nanocomposites.

Classical wet chemical synthesis was used to fabricate a hybrid composite that contained copper nanoparticles (average size ∼1 nm), which were embedded into a silicon oxide carrier. The structural and chemical alternations in the copper-functionalized silica were investigated in systems that were sintered at 573 K, 873 K, 1173 K, and 1473 K. A general trend, which was associated with the transformation of metallic copper with a cubic structure into copper(II) oxide with a monoclinic structure in the heat-treated systems, was found. XPS and FTIR spectroscopies also revealed the presence of copper(I) oxide, which formed a shell around the CuO. SEM and TEM showed gradual densification of the hybrid system at ever higher sintering temperatures, which corresponded with the gradual copper agglomeration. A temperature of 873 K was determined to be the temperature at which amorphous silica was transformed into cristoballite and tridymite, as well as the formation of a bulk-like copper structure. In relation to the physicochemical and structural data, high antimicrobial features that had a relatively low toxicity effect on the normal human fibroblasts (NHDF) below 250 mg/L was found for the initial copper-silica composite and the samples that were sintered at 573 K. In turn, a significant decrease in the biological impact was observed in the samples that were sintered at temperatures above 573 K. As a result, the paper discusses the model of structural modifications in copper-silica nanocomposite concerning their biological impact that was developed.

Clinical experience and results with a Rhombic Plate for transoral endoscopically-assisted osteosynthesis of fractures of the condylar neck.

The intraoral approach is favoured by many patients and surgeons for the treatment of fractures of the condylar neck, but the limited space offered by this approach can make positioning and fixation of the osteosynthesis plate difficult. A rhombic-shaped plate was designed specifically for use with the intraoral approach, and introduced into our clinical practice in 2012. We present the clinical and functional results in 81 patients with 98 fractures of the condylar neck who we have treated with this technique. Of these six required surgical revision, and ultimately all but two had satisfactory occlusion and mandibular function. Our complication rate of 6/81 (7.4%) compares favourably with those reported elsewhere, and confirms that open reduction and internal fixation of condylar fractures using the Rhombic plate through an intra-oral approach provides good outcomes.

The Viability of Serval (Leptailurus serval) and Pallas Cat (Felis manul) Oocytes after Cryopreservation Using the Rapid-I Method.

BACKGROUND: Vitrification by Rapid-I method could be essential for felid rescue programs to protect wild felid in the future. OBJECTIVE: This study was aimed at adapting the Rapid I method and evaluating the viability of serval and Pallas cat oocytes compared to oocytes of the domestic cat. MATERIALS AND METHODS: Oocytes after collection and in vitro maturation were vitrified using Cryotech medium (Cryotech, Japan) and a Rapid-I device (Vitrolife, Sweden). To evaluate viability, oocytes after warming were stained with fluorescein diacetate and ethidium bromide. RESULTS: Survival rate in the control group (domestic cat) was 75 %. In the experimental group, 70% (serval) and 60% (pallas cat) viable oocytes were found. CONCLUSION: The Rapid-I method can be applied successfully for the vitrification of wild felid oocytes.

Physicochemical and structural features of heat treated silver-silica nanocomposite and their impact on biological properties.

In the last few decades, many nanostructures with varying properties and possible applications have been developed. These materials have been intended to work in various environmental temperature conditions. In this context, the main challenge has been to comprehend the impact of synergic interaction between individual elements included in non-annealed materials in relation to systems subjected to temperature impact. Another problem has corresponded to the impact of thermal modification on organisms such as bacteria and human cells. Such problems can be solved by the fabrication of a nanocomposite with mono-dispersed 8 nm silver (Ag0 or Ag+) embedded into a silica carrier, followed by the analysis of the impact of heat treatment under various temperature conditions on its physicochemical features. Therefore, methodical studies reported in this text have shown an increase of silver particle size up to 170 nm, a decrease of its concentration, as well as the formation of sub-nanometer Ag+ and/or Ag2+ clusters as the temperature rises to 1173 K. In turn, the structurally disordered silica carrier had been entirely transformed to cristobalite and tridymite only at 1473 K as well as partial reduction of Ag2+ to Ag+. Simultaneously, inhibition of growth of Gram-positive and Gram-negative bacteria, as well as an increase in cytotoxicity towards human cells was observed as the temperature rose. As a final point, for the first time, a "pseudo" phase diagram of the structural alterations in the Ag/SiO2 nanocomposite has been created, as well as a model of silver-silica transformation to biological systems has been developed.

The urine podocin/creatinine ratio as a novel biomarker of cardiorenal syndrome in dogs due to degenerative mitral valve disease.

Dysfunction of heart leads inevitable to the dysfunction of kidney which is termed as the cardiorenal syndrome (CRS). Previous studies have confirmed existence of CRS in dogs with degenerative mitral valve disease (DMVD). The goal of the study was to assess the usefulness of commercial test to measure podocyturia in dogs and test the urine podocine/creatinine ratio (UPoC) as an early marker of kidney injury. Urine podocine/creatinine ratio was calculated because numbers of podocytes is dependent on the urine concentration. Fifty dogs was divided into three groups: fifteen healthy (control group), twenty nine with DMVD class C-chronic according to ACVIM (heart group) and six with chronic kidney disease (kidney group). Each dog underwent a clinical examination: electrocardiography, echocardiography, chest radiograph, abdominal ultrasound, blood haematological and biochemical analysis including symmetric dimethylarginine (SDMA) and cystatin C (Cyst C), routine urine analysis and analysis of podocytes using an ELISA test. UPoC was calculated. Mean value ± standard deviation for UPoC was respectively 9.7 ± 4.8 x 10-10 for control group, 49.0 ± 80.0 x 10-10 for heart group, 33.7 ± 18.0 x 10-10 for kidney group. The UPoC in the heart and kidney group was significantly higher than in the control group (P < 0.0001, sensivity 0.83, specyfity 0.20). Commercial ELISA tests may be used to assess podocyturia in dogs. An UPoC increase exceeding 12.93 x 10-10 indicates glomerular damage in DMVD dogs. Based on UPoC, 79.3% of dogs with C-chronic stage of DMVD developed CRS.

Long-term trends in HIV care entry: over 15 years of clinical experience from Poland.

INTRODUCTION: Delay in HIV diagnosis and consequently late care entry with low CD4 counts remain a major challenge for the control of the HIV/AIDS epidemic. The aim of this study was to analyse the evolution of characteristics of the HIV epidemic in Poland. METHODS: Cross-sectional data were collected for 3972 HIV-infected patients followed up in 14 of 17 Polish HIV treatment centres in the years 2000-2015. Clinical data were analysed and factors associated with late presentation (baseline CD4 count < 350 cells/µL or history of AIDS-defining illness) and advanced HIV disease (baseline CD4 count < 200 cells/µL or history of AIDS) were identified. RESULTS: The majority (57.6%) of patients entered care late, while 35.6% presented with advanced HIV disease. The odds of being linked to care late or with advanced HIV disease increased consistently across age categories, increasing from 2.55 [95% confidence interval (CI) 1.46-4.47] for late presentation and 3.13 (95% CI 1.49-6.58) for advanced disease for the 21-30-year-old category to 5.2 (95% CI 1.94-14.04) and 8.15 (95% CI 2.88-23.01), respectively, for individuals > 60 years of age. Increased risks of late entry and advanced HIV disease were also observed for injecting drug users [adjusted odds ratio (aOR) 1.74 (95% CI 1.16-2.60) and 1.55 (95% CI 1.05-2.30), respectively], with lower aOR associated with the men who have sex with men transmission route [aOR 0.3 (95% CI 0.31-0.59) and 0.39 (95% CI 0.29-0.53), respectively]. The frequencies of cases in which patients were linked to care late and with advanced HIV disease decreased over time from 67.6% (2000) to 53.5% (2015) (P < 0.0001) and from 43.5% (2000) to 28.4% (2015) (P = 0.001), respectively. CONCLUSIONS: Despite improvements over time, most patients diagnosed with HIV infection entered care late, with a third presenting with advanced HIV disease. Late care entry remains common among people who inject drugs and heterosexual groups.

Using Rapid I Method for Vitrification of Bovine Oocytes.

BACKGROUND: Vitrification is commonly used for cryopreservation of gametes. OBJECTIVE: The study aimed at evaluating viability and developmental competence of bovine oocytes vitrified by Rapid-I method. MATERIALS AND METHODS: Oocytes after collection (group 1) and IVM (group 2) were vitrified using medium containing 18% Ficoll, 40% ethylene glycol, 0.3 M sucrose. To evaluate viability, oocytes after warming were stained with fluorescein diacetate and ethidium bromide. In experiment 2, oocytes after IVM and vitrification were activated by 0.5 µM ionomycin in TCM 199 combined with 2 mM 6-DMAP in TCM 199 with 10% fetal bovine serum. RESULTS: Survival rate in group 1 was 58%, and 88% in the control. In group 2, 63% viable oocytes were found, compared to 82% in the control group. After parthenogenetic activation 27.2% morulas were observed. This percentage was lower than in the non-vitrified group (31%). CONCLUSION: Maturity stage of bovine oocytes has no effect on their survival after vitrification.

Demonstration of differences in colonic volumes, transit, chyme consistency, and response to psyllium between healthy and constipated subjects using magnetic resonance imaging.

BACKGROUND: In functional gastrointestinal disorders a lack of objective biomarkers limits evaluation of underlying mechanisms. We aimed to demonstrate the utility of magnetic resonance imaging for this task using psyllium, an effective constipation treatment, in patients and controls. METHODS: Two crossover studies: (i) adults without constipation (controls, n = 9) took three treatments in randomized order for 6 days - maltodextrin (placebo), psyllium 3.5 g t.d.s and 7 g t.d.s., (ii) adults with chronic constipation (patients, n = 20) took placebo and psyllium 7 g t.d.s. for 6 days. MRI was performed fasting and postprandially on day 6. Measurements included small bowel and ascending colon water content, colonic volume, transit time, and MR relaxometry (T1, T2) to assess colonic chyme. Stool water percentage was measured. RESULTS: 7 g psyllium t.d.s. increased fasting colonic volumes in controls from median 372 mL (IQR 284-601) to 578 mL (IQR 510-882), and in patients from median 831 mL (IQR 745-934) to 1104 mL (847-1316), P < .05. Mean postprandial small bowel water was higher in controls and patients after 7 g psyllium t.d.s. vs placebo. Whole gut transit was slower in patients than controls (P < .05). T1 of the descending colon chyme (fasting) was lower in patients (213 ms, 176-420) than controls (440 ms, 352-884, P < .05) on placebo, but increased by 7 g psyllium t.d.s. (590 ms, 446-1338), P < .001. Descending colon T1 correlated with baseline stool water content and stool frequency on treatment. CONCLUSIONS AND INFERENCES: MRI measurements can objectively demonstrate the mode of action of therapy targeting intestinal fluid content in constipation.

[Perioperative onset of sarcoidosis : Rare differential diagnosis of a difficult airway]. / Perioperative Erstmanifestation der Sarkoidose : Seltene Differenzialdiagnose des schwierigen Atemwegs.

Sarcoidosis is a rare multisystemic chronic inflammatory condition. Typically, there is a big discrepancy between the patient's subjectively perceived symptoms and the presence of clinical signs. Due to the high number of potential sites of onset (e. g. larynx, lungs, heart, liver, kidneys) the affected organs may show functional restrictions that are relevant for decisions related to anesthesia. Therefore, an anesthetists working in a clinical setting should be familiar with the special needs of this patient collective. This article describes the onset of sarcoidosis in a case of an unexpected difficult airway.