Smartphone-based thermography to determine shunt patency in patients with hydrocephalus.

BACKGROUND: When shunt dysfunction is suspected, radiation exposure due to X-rays or a CT-scan is inevitable. Less-invasive and more reliable methods are warranted. In this study, we aimed to assess the usability of smartphone-based thermography to detect shunt patency in patients with hydrocephalus. METHODS: This prospective observational pilot study evaluated the use of smartphone-based video thermography to detect flow of cerebrospinal fluid in the shunt of 51 patients from the Department of Neurosurgery at a tertiary referral institute. Patients with a shunt for hydrocephalus without the suspect of dysfunction were included in the study from December 2021 to May 2022. RESULTS: We included 51 patients with a mean age of 53.3 years. Of these patients 14 were male (27.5%) and 37 were female (72.5%). The most frequent cause of the hydrocephalus was the normal pressure hydrocephalus followed by the congenital hydrocephalus. Most patients (96%) had a ventriculoperitoneal shunt, whereas two had a ventriculo-atrial shunt. In total, 43 patient (84%) had a shunt on the right side and 8 patient (16%) had the shunt located on the left side. In 45 patients (88.2%), we observed a clear flow of cerebrospinal fluid in the cooled shunt trajectory. CONCLUSIONS: The findings of this study indicate that in patients with a shunt to treat hydrocephalus, the smartphone-based video thermography may be a safe and simple alternative to show shunt patency without the exposure to radiation.

[Robotic Rectal Cancer Surgery]. / Roboterassistierte Rektumkarzinomchirurgie.

BACKGROUND: The oncological outcome of patients with rectal cancer has improved considerably over the past few decades. This is mainly due to the introduction of the surgical concept of total mesorectal excision (TME) and the implementation of multimodal treatment strategies. Additionally, it has recently been demonstrated that the oncological results of open and laparoscopic TME are comparable. For some time there has been an ongoing debate on the potential relevance of robotic assistance systems in visceral surgery. The aim of this study was to evaluate the operative and perioperative outcomes of patients with rectal or rectosigmoid cancer, who were operated on using the Da Vinci Surgical System. PATIENTS AND RESULTS: We retrospectively analysed the outcomes of 202 consecutive patients, who were operated between September 2010 and November 2015 in three Surgical Centers. The cohort consisted of 136 men and 66 women with a mean BMI of 28. We performed the following procedures: 49 anterior rectal resections, 119 low anterior rectal resections, and 34 abdominoperineal excisions. Conversion to an open procedure was required in 13 patients. Non-surgical complications (n = 27) occurred in 24 patients (12%) and surgical complications (n = 67) in 62 patients (31%). Most complications were due to abdominal or sacral wound infections (n = 25) and anastomotic leaks (n = 18). The mortality rate within 30 days was 2%. The rate of R0 resections was 95%, with circumferential resection margins being negative in 98% of the patients. The quality of the mesorectal resection was scored as good in 91% of the patients. CONCLUSIONS: The Da Vinci Surgical System can be used safely and with a low complication rate for surgical treatment of rectal cancer. While primary evidence suggests that the outcome of robotic-assisted surgery is comparable with open and laparoscopic surgery, its definitive value has to be determined upon publication of the prospective randomized ROLARR trial. The main advantages of the Da Vinci system are its endowristed instruments with multiple degrees of freedom and its optimised visualisation (3D, stable camera platform controlled by the surgeon). Another positive feature is the significant ergonomic advantage for the surgeon.

Towards patient-specific finite-element simulation of MitralClip procedure.

MitralClip is a novel minimally invasive procedure to treat mitral valve (MV) regurgitation. It consists in clipping the mitral leaflets together to close the regurgitant hole. A careful preoperative planning is necessary to select respondent patients and to determine the clipping sites. Although preliminary indications criteria are established, they lack prediction power with respect to complications and effectiveness of the therapy in specific patients. We propose an integrated framework for personalized simulation of MV function and apply it to simulate MitralClip procedure. A patient-specific dynamic model of the MV apparatus is computed automatically from 4D TEE images. A biomechanical model of the MV, constrained by the observed motion of the mitral annulus and papillary muscles, is employed to simulate valve closure and MitralClip intervention. The proposed integrated framework enables, for the first time, to quantitatively evaluate an MV finite-element model in-vivo, on eleven patients, and to predict the outcome of MitralClip intervention in one of these patients. The simulations are compared to ground truth and to postoperative images, resulting in promising accuracy (average point-to-mesh distance: 1.47 +/- 0.24 mm). Our framework may constitute a tool for MV therapy planning and patient management.

A statistical model for quantification and prediction of cardiac remodelling: application to tetralogy of Fallot.

Cardiac remodelling plays a crucial role in heart diseases. Analyzing how the heart grows and remodels over time can provide precious insights into pathological mechanisms, eventually resulting in quantitative metrics for disease evaluation and therapy planning. This study aims to quantify the regional impacts of valve regurgitation and heart growth upon the end-diastolic right ventricle (RV) in patients with tetralogy of Fallot, a severe congenital heart defect. The ultimate goal is to determine, among clinical variables, predictors for the RV shape from which a statistical model that predicts RV remodelling is built. Our approach relies on a forward model based on currents and a diffeomorphic surface registration algorithm to estimate an unbiased template. Local effects of RV regurgitation upon the RV shape were assessed with Principal Component Analysis (PCA) and cross-sectional multivariate design. A generative 3-D model of RV growth was then estimated using partial least squares (PLS) and canonical correlation analysis (CCA). Applied on a retrospective population of 49 patients, cross-effects between growth and pathology could be identified. Qualitatively, the statistical findings were found realistic by cardiologists. 10-fold cross-validation demonstrated a promising generalization and stability of the growth model. Compared to PCA regression, PLS was more compact, more precise and provided better predictions.

[PrefCheck: patient-centered treatment planning with older multimorbid patients. Method and design]. / PräfCheck: Patientenzentrierte Behandlungsplanung mit älteren multimorbiden Patienten. Methodik und Design.

BACKGROUND: The aim of the study is to develop and test a consultation guide (PrefCheck) for general practitioners (GPs) based on geriatric assessment results. The goal of the consultation guide is to facilitate priority setting and treatment planning based on building a partnership with geriatric patients with multiple chronic diseases. METHODS AND AIMS: The mixed method study consists of three complementary parts: (A) health and treatment priorities of 32 patients and their 8 GPs are determined and explored on the basis of assessment results. These findings lead to the development of the consultation guide, which is subsequently tested in a cluster-randomized controlled intervention study (B) with 40 GPs and 320 patients. The aim of this study is to assess whether PrefCheck results in improved agreement in the number of health and treatment priorities between patients and their doctors. The study concludes with an evaluation study (C) with 5 GPs and 15 patients. CONCLUSIONS: Results will be presented in a future publication. In particular it will be demonstrated whether the consultation guide can strengthen the position of older patients in the doctor-patient relationship, increase the level of information on both sides, and contribute to a shared and holistic treatment planning.

Embryonic and postnatal development of the serotonergic raphe system and its target regions in 5-HT1A receptor deletion or overexpressing mouse mutants.

The neurotransmitter 5-HT regulates early developmental processes in the CNS. In the present study we followed the embryonic and postnatal development of serotonergic raphe neurons and catecholaminergic target systems in the brain of 5-HT1A receptor knockout (KO) and overexpressing (OE) in comparison with wild-type (WT) mice from embryonic day (E) 12.5 to postnatal day (P) 15.5. Up to P15.5 no differences were apparent in the differentiation and distribution of serotonergic neurons in the raphe area as revealed by the equal number of serotonergic neurons in the dorsal raphe in all three genotypes. However, the establishment of serotonergic projections to the mesencephalic tegmentum and hypothalamus was delayed at E12.5 in KO and OE animals and projections to the cerebral cortex between E16.5 and E18.5 were delayed in OE mice. This delay was only transient and did not occur in other brain areas including septum, hippocampus and striatum. Moreover, OE mice caught up with WT and KO animals postnatally such that at P1.5 serotonergic innervation of the cortex was more extensive in the OE than in KO and WT mice. Tissue levels of 5-HT and of its main metabolite 5-hydroxyindoleacetic acid as well as 5-HT turnover were considerably higher in brains of OE mice and slightly elevated in KO mice in comparison with the WT, starting at E16.5 through P15.5. The initial differentiation of dopaminergic neurons and fibers in the substantia nigra at E12.5 was transiently delayed in KO and OE mice as compared with WT mice, but no abnormalities in noradrenergic development were apparent in later stages. The present data indicate that 5-HT1A receptor deficiency or overexpression is associated with increased 5-HT synthesis and turnover in the early postnatal period. However, they also show that effects of 5-HT1A KO or OE on the structural development of the serotonergic system are at best subtle and transient. They may nonetheless contribute to the establishment of increased or reduced anxiety-like behavior, respectively, in adult mice.

Use of a plasmid of a yersinia enterocolitica biogroup 1A strain for the construction of cloning vectors.

A plasmid with a size of 2,682 base pairs isolated from the Yersinia enterocolitica biogroup 1A strain # 29807 was characterized in respect to its suitability as a basic replicon for cloning vectors. The copy number of the plasmid was determined to be approximately 14 copies per cell and it was shown to be compatible with vectors with an origin of replication derived from ColE1 and p115A. The replication region of the plasmid encodes a primer RNAI and countertranscript RNAII. Two vectors, pIV1 and pIV2, containing a kanamycin resistance gene and the lacZalpha fragment with the multiple cloning site of pBluescriptSK + were constructed. A mobilizable derivative was successfully introduced into different bacteria belonging to the family Enterobacteriacea. To prove the applicability of the novel vectors for cloning purposes, a 13 kb hemolysin operon of Escherichia coli was inserted into pIV1, and the resulting recombinant plasmid was stably maintained and expressed in E. coli and Y. enterocolitica.

Cardiac manifestations in patients with HLA B27-associated juvenile arthritis.

Cardiac involvement is common in adult patients with the presence of HLA B27 with or without the HLA B27-associated spondyloarthropathy ankylosing spondylitis. Most patients with juvenile spondyloarthropathy, which begins at age 16 or younger, do not have spinal involvement and there are only few reports of cardiac involvement. This study sought to assess the prevalence of carditis in patients with HLA B27-associated juvenile arthritis (B27-JA). In a controlled study, 40 patients with B27-JA, among them only 1 with ankylosing spondylitis, were examined by electrocardiogram and echocardiography with pulsed and color-flow Doppler at rest and at the termination of a bicycle exercise and compared to an age- and sex-matched control group negative for HLA B27. Four patients with B27-JA, and none in the control group, had inflammatory aortic regurgitation. Late diastolic flow velocity was significantly increased in patients with B27-JA at the termination of exercise. HLA B27 is a risk factor for endo-/myocardial damage in patients with B27-JA, even in the presence of only short and mild articular disease. Patients with B27-JA should be screened for the presence of aortic regurgitation.

CXCR5-deficient mice develop functional germinal centers in the splenic T cell zone.

The chemokine receptor CXCR5 is thought to be essential for the migration of B cells into the network of follicular dendritic cells in the spleen. However, as shown here, B cells and follicular dendritic cells do co-localize, albeit aberrantly, even in the absence of CXCR5. In mice lacking CXCR5 both cell types are found in a broad ring around the sinuses of the marginal zones. Upon immunization with the T cell-dependent antigen 2-phenyl-oxazolone, ectopic germinal centers develop in the periarteriolar lymphocyte sheath. A network of follicular dendritic cells forms in the vicinity of the central arteriole within which the antigen-activated B cells proliferate. The analysis of the expressed V gene repertoire revealed that during B cell proliferation, hypermutation is activated and V region genes accumulate somatic mutations. The pattern of somatic mutations suggests that affinity selection may occur. This analysis confirms that in CXCR5-deficient mice, the organization of splenic primary follicles is severely impaired. However, within the T cell zone a micro-environment is built up, which provides all requirements needed for the affinity maturation to take place.

[Special characteristics of physician involvement in AIDS counseling]. / Besonderheiten im Tätigkeitsfeld des Arztes in der AIDS-Beratung.

Characteristic features of medical work at an AIDS Information Centre are pointed out with particular regard to the present situation in the city and district of Crenter? Hannover. Persons infected with HIV are reviewed, drawing particular attention to the extreme stress of living with the knowledge of being HIV-infected. The arising social problems of HIV-positive patients are described together with the doctor's adviser of easing the patient's stress and guiding him into accepting the necessary changes in life. Intensive cooperation hospital doctors, GP's and social workers is described.

[Medical management of HIV infected and AIDS patients in the Hannover metropolitan area as an interdisciplinary construct]. / Die medizinische Versorgung von HIV-Infizierten und AIDS-Kranken im Grossraum Hannover als interdisziplinäres Konstrukt.

Two wards for consultation of AIDS have opened in Hannover in 1987, one in the Public Health Department for the city of Hannover, the other in the Public Health Department for the surroundings. It was a big step towards prevention of AIDS. At the same time a centre, especially for AIDS, was opened at the Medical college of Hannover, consisting of an ambulance and beds in a ward. An official laboratory tests the medical analyses. Today the doctor in the Public Health Department plays an important part: he is the first partner with whom the infected patient can talk. He must also maintain contact with all institutions including the family doctor for optimum patient care.

[10 years of dental care of hemophiliacs]. / 10 Jahre stomatologische Betreuung Hämophiler.

Increased consciousness of oral hygiene, improvement of sanitation degree and decrease of the number tooth extractions have been proved a success and an expression of high compliance within the scope of long-term interdisciplinary care of haemophilic patients. At the same time both patients registration and concentration at an out-patient department facilitate cooperation with the paediatricians and internal specialists being in charge of them, in addition a change-over from children to adult dispensary care is ensured. Haemophilic patients suffering from hepatitis B or HTLV-III/HIV antibodies carrier may be registered immediately. All patients undergoing dispensary care are subject to preventive test obligations.

[The influence of different fiber types on the fecal nitrogen excretion and the content of volatile fatty acids in the feces of broiler hen breeds]. / Einfluss verschiedener Faseraten auf die fäkale Stickstoff-ausscheidung und den Gehalt an flüchtigen Fettsäuren im Kot bei Briolerzuchthennen.

4 colostomized adult broiler breeding hens each received 120 g mixed feed per day. In addition, the animals were given 10, 20, 30 and 40 g/day cellulose powder or apple pectin resp. and 10, 20, 30 g/day straw cellulose. The DM content of the faeces was increased by cellulose powder and decreased by pectin (P less than 0.01) in comparison to the control group. DM excretion in g/animal and day increased more quickly after supplementing cellulose powder than after supplementing pectin. Straw cellulose produced results in between. The fibre supplements increased N excretion in faeces. It was, however, only significantly increased per 100 g DM intake by large pectin supplements (greater than 20 g). The TCA soluble N quota in the total N of the faeces remained largely unchanged after pectin supplements and increased after cellulose and straw cellulose supplements. Pectin supplements significantly increased the formation of acetate, propionate and butyrate in comparison to the other groups. Propionate could sporadically be detected in the faeces of the other test animals, butyrate not at all. In combination with 40 g apple pectin/animal and day, Bisergon (chinoxalin derivative) increased the formation of the 3 volatile fatty acids significantly.

[Efficiency criteria and priorities in school age pedodontic care]. / Uber Bewertungskriterien und Schwerpunkte kinderstomatologischer Betreuung im Schulalter.

On the basis of findings in 1200 individuals aged between 7 to 16 years, the authors indicate priorities of dental care in the different age-groups. Apart from other criteria, the readiness for treatment and the disciplined behaviour of the children and adolescents during treatment may be used for assessing the dentist's achievements.

[Critical evaluation of the results of systematic pedodontic care]. / Kritische Bewertung von Sanierungsergebnissen systematischer kinderstomatologischer Betreuung.

The authors present and comment upon the clinical and radiological findings obtained from 1200 children in the framework of a caries-statistical cross-sectional study. The statistical data are subdivided into: state of oral rehabilitation, extent of oral rehabilitation, frequency of the different kinds of filling and endodontic treatment measures.

[Pharmacokinetic studies on broad spectrum antibiotic combinations of penicillin and oxacillin in normal volunteers (author's transl)]. / Pharmakokinetische Untersuchungen mit Breitspektrum-Penicillin/Oxacillin-Kombinationen bei freiwilligen Probanden.

After i.v. application of broad spectrum penicillins (ampicillin, mezlocillin, carbenicillin) alone or combined with oxacillin (concomitantly) in different dosages to normal volunteers, the course of serum levels and recovery from urine were assessed and pharmacokinetic data were calculated for a 1-compartment model, in some cases also for a 2-compartment model. The following penicillins were tested alone and combined with oxacillin; ampicillin 3 g, oxacillin 2 g and their combination; ampicillin 2 g, oxacillin 1 g and their combination; mezlocillin 3.75 g, oxacillin 1.25 g and their combination; mezlocillin 2 g, oxacillin 1 g and their combination; carbenicillin 7.5 g, oxacillin 2.5 g and their combination. Apart from one combination (oxacillin 2 g + ampicillin 3 g), all penicillin combinations exceeded the serum levels achieved after individual application at any time. In combinations, the elimination constants decreased, total clearance was lower, and half-lives increased. The distribution volumes varied. With one exception, oxacillin 2.5 g + carbenicillin 7.5 g, all the combinations yielded a higher recovery from urine than did individual administration. When administering i.v. two penicillins simultaneously, a process similar to that following administration of probenecid in association with caronamide must need be considered. It may be assumed that the prolongation and elevation of serum levels after combined administration likewise lead to higher tissue concentrations, which effect might be of clinical consequence.

[Cephradine in open heart serugery. Concentrations of cephradine in pericardial exudate and serum after cardiac surgery (author's transl)]. / Cefradin in der offenen Herzchirurgie. Cefradin-Konzentrationen im Perkardexsudat und Serum nach Herzoperationen.

The diffusion of cephradine into the pericardial exudate was measured in 19 patients undergoing heart surgery. Every patient received 2 grams of cephradine (=30 mg/kg) during a 20 minute infusion period, before, during, and after the operation, and than at intervals of 6 hours, together 8 grams per day. The highest mean serum level, 10 minutes after the end of the first injection was 150 microgram/ml and after repeated dosages 102.5 microgram/ml, and at the end of the infusion interval 3.2 microgram/ml in the mean. At the time of opening the pericardium the concentration of the substance in the pericardial exudate, 15, 30, 45 and 60 minutes after finishing the first injection, varied from 4.1 to 38.6 microgram/ml in the average. The postoperative maximum levels were higher than 50 microgram/ml and 6 hours after the respective administrations the levels varied between 12.83 and 15.77 microgram/ml in each case. These high concentrations of cephradine in the pericardial exudate could not be attributed to seepage of blood into the pericardium.-At specific "check points" bacteriological materials were taken. Out of 1168 specimens only 6.7% were bacteriological positive. Drains in wounds, the pleura or the pericardium were sterile in most cases. Intravenous catheters were contaminated only in 1%. However the contamination rate rises with period of storage. The results show that cephradine exhibits good diffusion into the exudate of pericardium. With the chosen dosage the concentrations of the antibiotic in the pericardial exudate are higher than the MIC values of most pathogen bacteria.