Smoking histories: a bioarchaeological approach to tobacco consumption in two skeletal populations from The Netherlands (1300-1829 CE).

Over the past decade, the history of tobacco's introduction to Europe and its societal impact has been extensively studied, resulting in prevailing narratives about its adoption and consumption. In the Netherlands, historical records generally concur that: (I) tobacco rose in popularity among all socioeconomic classes between 1590 and 1630 CE; and (II) it spread throughout the Country as a male habit. However, the presence and consumption of tobacco have exhibited profound variations across diverse societies throughout history, manifesting dissimilar patterns of employment and significance over varying temporal and spatial dimensions. By analysing a sample of 351 human skeletons dating from 1300 to 1829 CE, the present study challenges the limited historical narratives presented above and emphasizes the diverse contextual factors that influenced tobacco's prevalence in two different Dutch centres. Our results suggest that in certain areas of the Netherlands tobacco was likely present and widely consumed well before 1630 CE, while also highlighting overall substantial female participation in the practice. Furthermore, our analysis hints at the possibility of divergent methods of tobacco consumption between sexes, suggesting that the historical narrative of tobacco as solely a male habit may warrant reconsideration. Overall, our study contributes to a deeper understanding of the complex history of tobacco in the Netherlands, shedding light on historical trends and cultural practices.

Keratin films for ocular surface reconstruction: Wound healing in an in-vivo model.

The most commonly used tissue substitute for ocular surface reconstruction is human amniotic membrane (AM). Because of its low biomechanical strength and intransparency there is a need to search for alternatives of consistent quality. This study, further explored the biocompatibility of Keratin Film (KF) and its ability to sustain corneal epithelial wound healing. In three equal groups of 5 New Zeeland white rabbits a 4 mm superficial keratectomy was created in the right eye. Five eyes received a KF, five a human AM graft and the remaining five no implant. All eyes were treated with ofloxacin and dexamethasone eye drops and followed up for 10 days. Corneal fluorescein staining, vascularization, and transparency were assessed using slit lamp biomicroscopy according to a standardized grading score during and at the end of follow-up. The corneal-scleral-button was excised and processed for histology. After 10 days all eyes which had received a KF showed complete epithelial healing and no signs of neovascularization. In the AM group 1 eye showed a persistent epithelial defect at day 10 and 2 eyes showed neovascularization at day 7 resolving at day 10. Transparency improved progressively both in the KF group as well as in the AM group towards the end of the follow. Histology showed a multilayer epithelium firmly adherent to the KF with no evidence of keratocyte migration or inflammatory reaction in the corneal stroma. In this study on rabbit eyes KF better supported corneal epithelial wound healing than amniotic membrane.

Precarious adolescence: Adolescent rickets and anterior sacral angulation in two Dutch skeletal collections from the 18th-19th centuries.

OBJECTIVE: This project aims to provide an objective approach to suggesting cases of adolescent rickets using the presence of anterior sacral angulation and interglobular dentine. MATERIALS: Sacra from 49 individuals from Hattem and 150 individuals from Middenbeemster, and second and third molars from five individuals from Hattem were analyzed. Both sites date to the 17th to 19th centuries. METHODS: The sacra were visually assessed for sacral angulation and measured to quantify anterior sacral angulation. The sampled molars were thin sectioned to look for the presence of interglobular dentine. RESULTS: Metric analysis determined that seven individuals had significantly anteriorly angled sacra. Three of the five individuals with sampled molars had interglobular dentine formed during adolescence. CONCLUSIONS: Adolescent rickets may be associated with anterior sacral angulation. SIGNIFICANCE: Anterior sacral angulation may help identify possible cases of adolescent rickets in archaeological human remains. LIMITATIONS: The small sample size for the molars prevented the identification of more individuals with interglobular dentine present during adolescence. Several individuals with visibly angled sacra were unmeasurable due to post-mortem damage and lacked molars. SUGGESTIONS FOR FURTHER RESEARCH: Research on a larger sample would allow us to understand better the association between anterior sacral angulation and adolescent rickets.

DMEK after penetrating keratoplasty: cohort with DMEK grafts and descemetorhexis larger than full-thickness graft.

PURPOSE: The study aims to evaluate visual outcome, central corneal thickness, and rebubbling rate in a cohort with oversized DMEK grafts after failed penetrating keratoplasty (PK). The unique feature of the study is a descemetorhexis diameter larger than the full-thickness graft, i.e., peripheral to the PK interface. METHODS: A monocentric, retrospective evaluation of all patients with endothelial graft failure after PK treated with an oversized DMEK graft and descemetorhexis outside of the PK interface (i.e., in host tissue) between January 2015 and July 2019 at the Department of Ophthalmology at the University of Düsseldorf (Germany) was performed. RESULTS: Eleven eyes of 10 patients were identified. Mean age was 69 years. On average (arithmetic mean ± standard deviation), 1.7 ± 1.0 previous PKs have been performed per eye in this cohort. The mean time between last PK and DMEK was 10.1 ± 7.3 years (range 2 to 23 years). In all cases, the graft diameter exceeded the diameter of the previous PK and descemetorhexis was performed in host tissue, that is, peripheral to the graft-host interface. Rebubbling was performed in 18.2% of the patients (n = 2 eyes) because of central graft detachment. Mean central corneal thickness showed a statistically significant improvement at 5.3 ± 3.5 months after surgery from 688.23 ± 151.01 to 527.75 ± 88 µm (p = 0.002). Visual acuity increased significantly by 5 lines from 1.24 ± 0.5 logMAR (range from 0.5 to 2) to 0.73 ± 0.76 logMAR (range from 0.1 to 2) within 3 months (p = 0.006). Excluding patients without visual potential and transplant failure, visual acuity improved significantly by 8 lines (p < 0.001), and stayed stable until the last follow-up at 15.1 ± 11.4 months (range 6 to 39 months, p < 0.001, n = 8) after surgery. CONCLUSION: DMEK can be successfully used to treat endothelial cell failure after PK, and can provide good postoperative results with regards to visual acuity. This study shows that stripping of Descemet's membrane (DM) peripheral to the PK interface is surgically feasible. Overlapping, larger DMEK grafts with more endothelial cells can be used without increasing rebubbling rates and may potentially improve long-term graft survival.

A novel method for calibrating head models to account for variability in conductivity and its evaluation in a sphere model.

The accuracy in electroencephalography (EEG) and combined EEG and magnetoencephalography (MEG) source reconstructions as well as in optimized transcranial electric stimulation (TES) depends on the conductive properties assigned to the head model, and most importantly on individual skull conductivity. In this study, we present an automatic pipeline to calibrate head models with respect to skull conductivity based on the reconstruction of the P20/N20 response using somatosensory evoked potentials and fields. In order to validate in a well-controlled setup without interplay with numerical errors, we evaluate the accuracy of this algorithm in a 4-layer spherical head model using realistic noise levels as well as dipole sources at different eccentricities with strengths and orientations related to somatosensory experiments. Our results show that the reference skull conductivity can be reliably reconstructed for sources resembling the generator of the P20/N20 response. In case of erroneous assumptions on scalp conductivity, the resulting skull conductivity parameter counterbalances this effect, so that EEG source reconstructions using the fitted skull conductivity parameter result in lower errors than when using the standard value. We propose an automatized procedure to calibrate head models which only relies on non-invasive modalities that are available in a standard MEG laboratory, measures under in vivo conditions and in the low frequency range of interest. Calibrated head modeling can improve EEG and combined EEG/MEG source analysis as well as optimized TES.

Medium-grade proteinuria is a risk factor for incident markers of chronic kidney disease.

OBJECTIVE: Medium-grade proteinuria (100-500 mg/g creatinine) is common among people living with HIV/AIDS (PLWHA) but is often undetected or ignored. This prospective, observational cohort study examined medium-grade proteinuria as a risk factor for markers of chronic kidney disease (CKD). METHODS: Quantitative urine samples were collected from 241 PLWHA without known renal disease at baseline between January 2009 and February 2011 and at follow-up 240 weeks later. Multivariate analysis was performed to assess medium-grade proteinuria as a risk factor for incident markers of CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m2 , albuminuria, phosphaturia). RESULTS: Incident markers of CKD were identified in 33 patients (14%), of whom 24 (74%) had medium-grade proteinuria at baseline. Of these, 22 even had proteinuria of < 200 mg/g creatinine. Multivariate analysis showed an adjusted relative risk (aRR) of 2.4 for patients with baseline medium-grade proteinuria to develop signs of CKD. Age was identified as an additional independent predictor. By testing for interaction, tenofovir disoproxil fumarate (TDF)-independent proteinuria was strongly associated with incident CKD markers (aRR = 12.1). CONCLUSION: Medium-grade proteinuria of 100-500 mg/g creatinine is both frequent in PLWHA and a significant risk factor for developing markers of CKD, especially in the absence of TDF. Relevant risk seems to be associated with proteinuria levels as low as 100-200 mg/g creatinine. Current guidelines recommend specific action for proteinuria exceeding 135-200 mg/g but still will miss a relevant number of PLWHA potentially at risk for CKD. An even lower cut-off to trigger nephrological work-up and potentially renoprotective interventions appears to be indicated.

Student perspectives on using egocentric video recorded by smart glasses to assess communicative and clinical skills with standardised patients.

INTRODUCTION: This exploratory study evaluated student perceptions of their ability to self- and peer assess (i) interpersonal communication skills and (ii) clinical procedures (a head and neck examination) during standardised patient (SP) interactions recorded by Google Glass compared to a static camera. METHODS: Students compared the Google Glass and static camera recordings using an instrument consisting of 20 Likert-type items and four open- and closed-text items. The Likert-type items asked students to rate how effectively they could assess specific aspects of interpersonal communication and a head and neck examination in these two different types of recordings. The interpersonal communication items included verbal, paraverbal and non-verbal subscales. The open- and closed-text items asked students to report on more globally the differences between the two types of recordings. Descriptive and inferential statistical analyses were conducted for all survey items. An inductive thematic analysis was conducted to determine qualitative emergent themes from the open-text questions. RESULTS: Students found the Glass videos more effective for assessing verbal (t22 = 2.091, P = 0.048) and paraverbal communication skills (t22 = 3.304, P = 0.003), whilst they reported that the static camera video was more effective for assessing non-verbal communication skills (t22 = -2.132, P = 0.044). Four principle themes emerged from the students' open-text responses comparing Glass to static camera recordings for self- and peer assessment: (1) first-person perspective, (2) assessment of non-verbal communication, (3) audiovisual experience and (4) student operation of Glass. DISCUSSION AND CONCLUSION: Our findings suggest that students perceive that Google Glass is a valuable tool for facilitating self- and peer assessment of SP examinations because of students' perceived ability to emphasise and illustrate communicative and clinical activities from a first-person perspective.

[Tintelnotia destructans: new enemy at the gates]. / Tintelnotia destructans: Ein neuer Feind vor dem Tore.

Tintelnotia destructans is a fungal species described for the first time in 2016, which can cause infections of the nails and of the cornea. We describe the second known case worldwide of Tintelnotia destructans-associated keratitis and its therapy. A good sensitivity for amphotericin B and voriconazole was demonstrated in the resistogram for the first time and the successful clinical course was confirmed. The present case study also shows the importance of intensive diagnostics in atypical microbial keratitis.

[Health-related quality of life after implantation of a keratoprosthesis with biological haptic]. / Gesundheitsbezogene Lebensqualität nach Implantation einer Keratoprothese mit biologischer Haptik.

BACKGROUND: Many studies report comparatively good long-term results among patients with keratoprostheses with biological haptic. However, overall costs are correspondingly high. A clear cost-benefit relationship is therefore desirable. OBJECTIVE: This study investigates health-related quality of life after implantation of a keratoprosthesis with biological haptic. MATERIALS AND METHODS: We present a retrospective analysis of medical data of 25 patients treated between 1996 and 2006 at the Department of Ophthalmology, University Hospital Homburg/Saar and the Klinikum Offenburg. Health-related quality of life was assessed by means of a questionnaire based on validated instruments, with particular emphasis on physical symptoms, mental health, functional limitations, and social interactions. RESULTS: At a patient age of 49.8 ± 15.7 years (minimum-maximum: 19-78 years; 6 female, 19 male), the mean duration of corneal blindness was 13.8 ± 13.1 years (minimum-maximum: 1-47 years). Changes in visual acuity and subjective satisfaction were statistically significant (p <0.001). Quality of life (on a scale of 1 to 6: median 2) at the time "before the onset of eye disease" and ≥15 months after surgery were identical. Patients with a postoperative visual acuity ≤0.1 (n =11) also showed a statistically significant (p =0.016) benefit in this context. CONCLUSION: The expenditures and costs of keratoprosthetics can be justified by an improvement in the health-related quality of life of the persons concerned. Even a postoperative visual acuity of ≤0.1 correlates with a statistically significant improvement in the subjective quality of life of these patients.

[Descemetectomy : An alternative to transplantation?] / Descemetektomie : Eine Alternative zur Transplantation?

Due to rising demand worldwide it is becoming increasingly more difficult to satisfy the needs for human corneal transplants. At this point transplantation is the only possible cure for endothelial diseases, such as Fuchs endothelial dystrophy. In this article we present descemetectomy, a circumscribed removal of Descemet's membrane (DMx) without subsequent transplantation, as new possible treatment option on the basis of a clinical case.

Development of a conjunctival tissue substitute on the basis of plastic compressed collagen.

Ocular surface disorders, such as pterygium, cicatricial pemphigoid and external disruptions, can cause severe inflammation, scarring, fornix shortening as well as ankyloblepharon. Current treatments do not resolve these conditions sufficiently. The aim of this study was to evaluate clinical applicability and suitability of plastic compressed collagen to serve as a substrate for the expansion of human conjunctival epithelial cells in order to develop an epithelialized conjunctival substitute for fornix reconstruction. Human conjunctival epithelial cells were expanded on plastic compressed collagen gels. Epithelial cell characteristics were evaluated by haematoxylin and eosin staining, electron microscopy and cytokeratin expression. The expression of putative epithelial progenitor cell markers p63α, ABCG2 and CK15 was assessed by immunostaining. The proliferative capacity and clonal growth of the cells was evaluated before (P0) and after expansion (P1) on the plastic compressed collagen gels by colony forming efficiency assay. The potential clinical applicability of this gel substitutes was evaluated by assessment of their biomechanical properties as well as their surgical handling. Human conjunctival epithelial cells cultured on plastic and plastic compressed collagen gels formed a confluent cell layer and expressed CK19. The cells showed expression of the putative epithelial progenitor cell markers p63α, ABCG2 and CK15 and sustained colony forming ability. The compressed collagen gels showed a high ultimate tensile strength and elasticity and the surgical handling of gels was comparable to amniotic membrane. An epithelialized conjunctival tissue construct on the basis of compressed collagen might therefore be a promising alternative bioartificial tissue substitute for conjunctival reconstruction. Copyright © 2015 John Wiley & Sons, Ltd.

[New approaches to ocular surface reconstruction beyond the cornea]. / Neue Ansätze zur Rekonstruktion der Augenoberfläche jenseits der Hornhaut.

BACKGROUND: Reconstruction of the conjunctiva is an essential part of ocular surface reconstruction. Clinically applied and experimentally tested tissue- and stem-cell-based approaches are presented and evaluated. MATERIALS AND METHODS: Current literature and our own results will be presented. RESULTS: Autologous conjunctiva, mucous membrane of the mouth or nose, and amniotic membrane are routinely used for conjunctival reconstruction. Limitations are limited availability, involvement in autoimmune diseases, donor heterogeneity, and degradation in an inflamed environment. Experimentally tested matrices as tissues made from extracellular matrix proteins, synthetic polymers, temperature-sensitive culture dishes, and decellularized conjunctiva have been tested in vitro and partly in vivo. To replace conjunctival cells, cells of conjunctiva and mucous membrane of mouth and nose have been evaluated and show progenitor cell properties as well as secretory capacity (goblet cell differentiation). CONCLUSIONS: Although different matrices are available for conjunctival reconstruction there is-due to specific limitations of existing tissues-a need for the development of new therapies for conjunctival replacement. Matrices produced in the laboratory have already been partly investigated in vivo and may thus be clinically applicable in the near future. Adult mucous membrane cells show many properties of conjunctival epithelium after expansion in vitro and thus are a promising cell source for conjunctival tissue engineering. Other stem cells sources require further evaluation.

Cryopreservation and hypothermic storage of lacrimal gland: towards enabling delivery of regenerative medicine therapies for treatment of dry eye syndrome.

Severe dry eye syndrome (DES) can cause painful loss of vision and may result from lacrimal gland dysfunction. Current treatments are palliative, so a causative therapy is desirable. The ability to (cryo)preserve lacrimal gland tissue or epithelial cells would simplify this. Here, lacrimal gland tissue was cryopreserved in 10% dimethylsulphoxide in liquid nitrogen, or stored at 4 °C in culture medium for up to 7 days, and compared with fresh tissue using immunohistochemistry. Cultures were initiated from fresh and stored tissue, and cells characterised in P1 for proliferation (WST-1), colony-forming efficiency (CFE) and secretory capacity (immunocytochemistry and ß-hexosaminidase activity assay). Tissue stored for > 3 days at 4 °C displayed grossly altered tissue architecture when compared with fresh tissue, decreased acinus density and increased caspase-3 activity. Cryopreserved tissue showed less obvious signs of damage without caspase-3 activation. Storage at 4 °C and cryopreservation delayed epithelial outgrowth compared with that from fresh tissue initially (p  < â€…0.05) but, by day 9, all explants showed comparable outgrowth (~90%), except tissue stored at 4 °C for 3 or 7 days (p  < â€…0.05 compared with fresh tissue). Epithelial cell yields per explant were similar from fresh and stored tissue, apart from tissue stored at 4 °C for 7 days (p  < â€…0.01). In P1, epithelial cells from fresh and stored tissue were largely equivalent in terms of: proliferation; CFE (~21%); Rab3D, HexA and lysozyme expression; mucin production; and ß-hexosaminidase activity. These data demonstrate that cryo(preservation) of lacrimal gland tissue and cells is possible, which may enable use of autologous cells in regenerative medicine approaches to treating DES. Copyright © 2016 John Wiley & Sons, Ltd.

Medium-grade tubular proteinuria is common in HIV-positive patients and specifically associated with exposure to tenofovir disoproxil Fumarate.

OBJECTIVES: The aim of this cross-sectional study was to evaluate the prevalence and risk factors of medium-grade proteinuria (100-500 mg/g creatinine) among HIV-positive adults. METHODS: Spot urine samples of HIV-positive adults without known renal disease were analyzed quantitatively between January 2009 and February 2011. Demographic and medical data were collected. Multivariate regression models for different patterns of proteinuria were constructed. RESULTS: Among 411 patients, 18 (4.4 %) presented albuminuria >300 mg/g creatinine and/or proteinuria >500 mg/g creatinine and were excluded from further analyses. Among the study population of 393 patients, 181 (46.1 %) had no significant proteinuria or albuminuria (<100 and <30 mg/g creatinine, respectively), 60 (15.3 %) had moderate albuminuria, while 152 (38.7 %) had proteinuria without albuminuria, suggesting tubular proteinuria. Independent predictors for medium-grade tubular proteinuria in multivariate analysis were exposure to tenofovir (DF), a CD4 nadir <500/µl, older age, and anti-HCV-antibodies. There was no association with classic renal risk factors like diabetes mellitus and arterial hypertension, or with estimated glomerular filtration rate (eGFR). CONCLUSIONS: We detected significant proteinuria in 230 (56.0 %) of 411 HIV-positive patients. Among this group, 152 (66.1 %) had medium-grade proteinuria without albuminuria, which was significantly associated with exposure to tenofovir, older age, a lower CD4 nadir and Hepatitis C. Nephrologic or HIV treatment guidelines fail to detect most of these patients but rather identify patients with high cardiovascular risk. In the absence of an association with eGFR the role of medium-grade tubular proteinuria as a potential early marker of chronic kidney disease remains unclear. Prospective studies are needed.

[Complications of Descemet's membrane endothelial keratoplasty]. / Komplikationen der Descemetmembran-Endothel-Keratoplastik.

Descemet's membrane endothelial keratoplasty (DMEK) is a relatively new, but now established surgical procedure to cure corneal endothelial disorders. However, there are donor- and recipient-associated sources of potential complications, some of which can be identified and addressed prior to the procedure and others that may lead to intra- or postoperative problems. Preoperatively, risk factors for a limited visual outcome (ocular comorbidities, previous ocular surgery, subepithelial/stromal scars) and the specific indication for DMEK should be discussed with the patient. Intraoperatively, young donor age can be associated with a particularly elastic graft, which may be difficult to unfold. Such transplants are not appropriate for particularly difficult recipient situations (very opaque cornea, history of vitreoretinal surgery). Postoperatively, transplant dehiscence is the most common complication, which in many cases can be managed by reinjection of air (or a 20 % SF6 gas/air mix) into the anterior chamber. An elevation of the intraocular pressure after DMEK is often caused by a reaction to topical steroid therapy. Although immune rejections after DMEK are less likely than after Descemet's stripping automated endothelial keratoplasty (DSAEK) and perforating keratoplasty, adequate treatment with topical steroidal drugs is recommended. These common and several rare complications are discussed in this review.

[Comparison of the OSDI and SPEED questionnaires for the evaluation of dry eye disease in clinical routine]. / Vergleich des OSDI- und SPEED-Fragbogens zur Evaluation des Sicca-Syndroms in der klinischen Praxis.

BACKGROUND: For the diagnosis of dry eye, taking an accurate medical history of the patient is critical. For this purpose the ocular surface disease index (OSDI) can be regarded as the established standard questionnaire but the standard patient evaluation of eye dryness (SPEED) questionnaire has recently been developed. The advantages of the SPEED questionnaire are the lower number of questions and easier interpretability. MATERIAL AND METHODS: In a retrospective analysis of 153 patients of our special clinic for dry eyes we performed a comparison of the SPEED with the established OSDI questionnaire regarding the evaluation of the severity of dry eye. In addition, we analyzed possible correlations with various objective parameters for classification of dry eye syndrome. RESULTS: There was a highly significant correlation between OSDI and SPEED values with a correlation coefficient of 0.47 (p < 0.001). In addition, significant correlations between OSDI values and the tear meniscus height (r = - 0.1374, p = 0.0226), Schirmer values (r = - 0.26, p < 0.0001) and lid margins parallel conjunctival folds (r = 0.1261, p = 0.034) were observed. The SPEED values showed a significant correlation with age (r = - 0.2106, p = 0.0107) and lipid layer thickness (r = - 0.159, p = 0.0081). DISCUSSION: The OSDI and SPEED questionnaires are both suitable for detecting the symptoms of dry eye; however the results of the questionnaires cannot be used interchangeably. While the SPEED levels seemed to correlate more with the parameters of evaporative dry eye, the OSDI values were more correlated with parameters of aqueous tear-deficient dry eye. However, a distinction between evaporative and aqueous tear-deficient dry eye is not possible based only on the results of the questionnaires.