Wildfire and smoke association with COVID-19 cases in the Pantanal wetland, Brazil

OBJECTIVES

In 2020, Brazil experienced two concurrent public health challenges related to respiratory disease: wildfires and increased mortality due to the coronavirus (COVID-19) pandemic. Smoke from these wildfires contributed to a variety of air pollutants, including fine particulate matter (PM2.5). The present study aims to investigate the effects of environmental and socio-economic factors on COVID-19 hospitalisation in the Pantanal.

STUDY DESIGN

Ecological retrospective study.

METHODS

We applied a multilevel negative binomial model to relate monthly hospitalisation data with environmental variables.

RESULTS

We showed that monthly PM2.5 concentration levels had the greatest influence on the increase in hospitalisations by COVID-19 in the elderly (23 % increase). The Gini index, a coefficient that reflects income inequalities, also had a positive association with COVID-19 hospitalisations (18 % increase). Higher temperatures and humidity were protective factors, showing a 15 % and 14 % decrease in hospitalisations, respectively. The results of the present study suggest that high PM2.5 exposure contributed to the increase in COVID-19 hospitalisations, as did the social inequalities of each municipality.

CONCLUSIONS

The present study highlights the importance of gathering evidence supported by multiple information sources to guide decision-making and identify populations needing better public health systems.

Benefits and challenges of creating veterinary antibiograms for empiric antimicrobial selection in support of antimicrobial stewardship and advancement of one-health goals

Antibiograms are important tools for antimicrobial stewardship that are often underutilized in veterinary medicine. Antibiograms summarize cumulative antimicrobial susceptibility testing (AST) data for specific pathogens over a defined time period; in veterinary medicine, they are often stratified by host species and site of infection. They can aid practitioners with empiric therapy choices and assessment of antimicrobial resistance trends within a population in support of one-health goals for antimicrobial stewardship. For optimal application, consideration must be given to the number of isolates used, the timeframe of sample collection, laboratory analytical methodology, and the patient population contributing to the data (eg, treatment history, geographic region, and production type). There are several limitations to veterinary antibiograms, including a lack of breakpoint availability for bacterial species, a lack of standardization of laboratory methodology and technology for culture and AST, and a lack of funding to staff veterinary diagnostic laboratories at a level that supports antibiogram development and education. It is vital that veterinarians who use antibiograms understand how to apply them in practice and receive relevant information pertaining to the data to utilize the most appropriate antibiogram for their patients. This paper explores the benefits and challenges of developing and using veterinary antibiograms and proposes strategies to enhance their applicability and accuracy. Further detail regarding the application of veterinary antibiograms by privately practicing clinicians is addressed in the companion Currents in One Health article by Lorenz et al (JAVMA, September 2023).

Antibiograms as one-health tools for antimicrobial stewardship: California's experience with livestock antibiogram development

Antibiograms are collections of antimicrobial susceptibility data for a particular bacterial organism and host species. Antibiograms are important tools for antimicrobial stewardship, as they may be used to guide empiric antimicrobial therapy and assess trends in antimicrobial resistance, maximizing treatment success and preserving the efficacy of currently available pharmaceuticals. Targeted use of antimicrobials is critically important to minimize the spread of antimicrobial resistance, which may be conveyed between animals and humans directly but may also be spread through the environment and ecological niches, such as soil, water, and wildlife reservoirs. To effectively utilize antibiograms as part of a comprehensive antimicrobial stewardship plan, veterinarians need to know data characteristics, including the source population, body site (when possible), and number of isolates included, in addition to the animal species and bacterial organisms for which each breakpoint was developed. Although widely used in human health systems, antibiograms are not often available in veterinary medicine. This paper describes antibiogram creation and use, discusses antibiogram development by US veterinary diagnostic laboratories, and shares California's process to create and promote livestock antibiograms. The companion Currents in One Health article by Burbick et al, AJVR, September 2023, addresses the benefits and challenges associated with developing veterinary antibiograms.

Institutional outbreaks of influenza-like illnesses in the state of São Paulo: an analysis of the epidemiological profile during the COVID-19 pandemic

OBJECTIVES

This study aimed to spatiotemporally analyze the profile of influenza-like illness (ILI) outbreaks in the state of São Paulo, Brazil, between 2020 and 2022.

STUDY DESIGN

This was a cross-sectional retrospective study.

METHODS

Outbreaks of ILI with final diagnoses of COVID-19, influenza, or other respiratory viruses (ORVs) recorded between January 2020 and November 2022, obtained from the Notifiable Diseases Information System (SINAN NET) Outbreak module, were analyzed. Kernel density estimates and Getis-Ord Gi∗ statistics were performed to identify spatial clusters.

RESULTS

A total of 13,314 ILI outbreaks were identified, involving 130,568 cases and 2649 deaths. Of these, 104,399 (80%) were confirmed as COVID-19, 15,861 (12%) were confirmed as ORV, and 10,308 (8%) were confirmed as influenza. The year 2021 had the highest number of outbreaks and cases. Schools recorded the most outbreaks and cases, followed by long-term care facilities for older adults (LTCs). The highest average number of cases per outbreak and the highest attack rates occurred at social gatherings and prisons. Prisoners were three times more likely to contract COVID-19 during outbreaks than people in other institutions. The highest hospitalization and mortality rates for all virus types occurred in the LTC group. The occurrence and intensity of outbreaks were highly heterogeneous among the different institutions after the introduction of new SARS-CoV-2 variants in the state.

CONCLUSIONS

ILI outbreaks were not randomly distributed; they clustered in specific areas. Transmissibility varied among different institutions with different responses to the COVID-19 pandemic. These results can be used as a basis for prioritizing actions and allocating resources during future pandemics.

Multiscale architecture: Mechanics of composite cytoskeletal networks

Different types of biological cells respond differently to mechanical stresses, and these responses are mainly governed by the cytoskeleton. The main components of this biopolymer network are actin filaments, microtubules, and intermediate filaments, whose mechanical and dynamic properties are highly distinct, thus opening up a large mechanical parameter space. Aside from experiments on whole, living cells, "bottom-up" approaches, utilizing purified, reconstituted protein systems, tremendously help to shed light on the complex mechanics of cytoskeletal networks. Such experiments are relevant in at least three aspects: (i) from a fundamental point of view, cytoskeletal networks provide a perfect model system for polymer physics; (ii) in materials science and "synthetic cell" approaches, one goal is to fully understand properties of cellular materials and reconstitute them in synthetic systems; (iii) many diseases are associated with cell mechanics, so a thorough understanding of the underlying phenomena may help solving pressing biomedical questions. In this review, we discuss the work on networks consisting of one, two, or all three types of filaments, entangled or cross-linked, and consider active elements such as molecular motors and dynamically growing filaments. Interestingly, tuning the interactions among the different filament types results in emergent network properties. We discuss current experimental challenges, such as the comparability of different studies, and recent methodological advances concerning the quantification of attractive forces between filaments and their influence on network mechanics.

Opportunistic osteoporosis screening in multi-detector CT images via local classification of textures

Our study proposed an automatic pipeline for opportunistic osteoporosis screening using 3D texture features and regional vBMD using multi-detector CT images. A combination of different local and global texture features outperformed the global vBMD and showed high discriminative power to identify patients with vertebral fractures.

INTRODUCTION

Many patients at risk for osteoporosis undergo computed tomography (CT) scans, usable for opportunistic (non-dedicated) screening. We compared the performance of global volumetric bone mineral density (vBMD) with a random forest classifier based on regional vBMD and 3D texture features to separate patients with and without osteoporotic fractures.

METHODS

In total, 154 patients (mean age 64 ± 8.5, male; n = 103) were included in this retrospective single-center analysis, who underwent contrast-enhanced CT for other reasons than osteoporosis screening. Patients were dichotomized regarding prevalent vertebral osteoporotic fractures (noFX, n = 101; FX, n = 53). Vertebral bodies were automatically segmented, and trabecular vBMD was calculated with a dedicated phantom. For 3D texture analysis, we extracted gray-level co-occurrence matrix Haralick features (HAR), histogram of gradients (HoG), local binary patterns (LBP), and wavelets (WL). Fractured vertebrae were excluded for texture-feature and vBMD data extraction. The performance to identify patients with prevalent osteoporotic vertebral fractures was evaluated in a fourfold cross-validation.

RESULTS

The random forest classifier showed a high discriminatory power (AUC = 0.88). Parameters of all vertebral levels significantly contributed to this classification. Importantly, the AUC of the proposed algorithm was significantly higher than that of volumetric global BMD alone (AUC = 0.64).

CONCLUSION

The presented classifier combining 3D texture features and regional vBMD including the complete thoracolumbar spine showed high discriminatory power to identify patients with vertebral fractures and had a better diagnostic performance than vBMD alone.

High-Frequency Oscillatory Ventilation and Nitric Oxide: Alternative or Complementary to ECMO

One hundred and seventy-seven term or near-term neonates were referred to an ECMO center for severe PPHN-associated diseases. In 2 time periods from 1987 to 1991 and from 1992 to April 1995 alternative treatment modes were tried in an attempt to obviate ECMO. During the first time period patients underwent trial high-frequency oscillatory ventilation before ECMO. In the second time period patients first received inhaled NO followed by HFOV in a non-responders. If this also failed HFOV was combined with I NO. In both time periods about 40% of the patients were spared ECMO treatment by these alternative treatment modalities. I NO only benefited 15% of the ECMO candidates who apparently had fared just as well on HFOV alone in the preceding time period. While patients who were improved by I NO were spared HFOV with its potential severe complications, i.e. air leaks and cardiocirculatory instability, more extended long-term studies will have to show which of these 2 treatment modalities (INO or HFOV) should be given first priority in an attempt to avoid ECMO in neonates with severe respiratory failure.

Prognosis and Outcome of Neonates Treated Either with Veno-Arterial (VA) or Veno-Venous (VV) ECMO

A comparison was done between neonates requiring veno-arterial (VA) ECMO (too small jugular vein, inability to insert a 12 Fr double lumen catheter or cardio-circulatory instability) and neonates treated with veno-venous (VV) ECMO in the same period of time. From 1991-1995 ECMO was done in 48 neonates after failure of maximum conventional treatments, NO-inhalation and HFOV. 30/48 babies were treated with VV-ECMO, with a switch to VA-ECMO later on in 3 of them. In 18 infants VA-ECMO was installed primarily. Differences between the VA- and VV-ECMO group were: the 01 was higher in the VV-treated babies (62±20 vs. 48±13, p < 0.03), as were birth weight (3385±570 vs. 2963±653 g, p< 0.04), gestational age (39.7 ± 1.6 vs. 37.9 ± 2.7 weeks, p< 0.01) and MAP (18.7 ± 2.2 vs. 17.1 ± 2.4 cm H2O, p< 0.05). Severe ICH's occurred more frequently in the VA-treated babies (29 vs. 7%, p< 0.05), the rate of other complications was equal. The mortality rates were 43% (VA) and 15% (VV), p< 0.05. About one third of neonatal ECMO candidates will be treated with VA-ECMO, even if the VV-ECMO technique is available. Need for VA-ECMO implies - due to a higher number of preterm babies and a greater severity of illness before ECMO - a higher incidence of ICH's and a higher mortality rate.

Die Leitlinie „Akutes Skrotum im Kindes und Jugendalter“ kurzgefasst

The guideline "The Acute Scrotum in Children and Adolescents" has been developed by representatives of the German Society of Pediatric Surgery, the German Society for Urology, and the German Society for Pediatric Radiology confirmed by the German Society for Pediatric and Adolescent Medicine. It went online in December 2015. The core statements of the guideline will be summarised. All relevant references can be found in the original [1]. Conclusions agreed within the team of authors are marked (#).

ZNF804A genetic variation (rs1344706) affects brain grey but not white matter in schizophrenia and healthy subjects

BACKGROUND

Genetic variation in the gene encoding ZNF804A, a risk gene for schizophrenia, has been shown to affect brain functional endophenotypes of the disorder, while studies of white matter structure have been inconclusive.

METHOD

We analysed effects of ZNF804A single nucleotide polymorphism rs1344706 on grey and white matter using voxel-based morphometry (VBM) in high-resolution T1-weighted magnetic resonance imaging scans of 62 schizophrenia patients and 54 matched healthy controls.

RESULTS

We found a significant (p < 0.05, family-wise error corrected for multiple comparisons) interaction effect of diagnostic group x genotype for local grey matter in the left orbitofrontal and right and left lateral temporal cortices, where patients and controls showed diverging effects of genotype. Analysing the groups separately (at p < 0.001, uncorrected), variation in rs1344706 showed effects on brain structure within the schizophrenia patients in several areas including the left and right inferior temporal, right supramarginal/superior temporal, right and left inferior frontal, left frontopolar, right and left dorsolateral/ventrolateral prefrontal cortices, and the right thalamus, as well as effects within the healthy controls in left lateral temporal, right anterior insula and left orbitofrontal cortical areas. We did not find effects of genotype of regional white matter in either of the two cohorts.

CONCLUSIONS

Our findings demonstrate effects of ZNF804A genetic variation on brain structure, with diverging regional effects in schizophrenia patients and healthy controls in frontal and temporal brain areas. These effects, however, might be dependent on the impact of other (genetic or non-genetic) disease factors.

The progestin levonorgestrel disrupts gonadotropin expression and sex steroid levels in pubertal roach (Rutilus rutilus)

The aim of the present study was to investigate the effects of the synthetic progestin levonorgestrel (LNG) on the reproductive endocrine system of a teleost fish, the roach (Rutilus rutilus). Pubertal roach were exposed for 28 days in a flow-through system to four concentrations of LNG (3, 31, 312, and 3124 ng/l). Both males and females treated with 3124 ng/l LNG exhibited the upregulated levels of vitellogenin and oestrogen receptor 1 mRNA in the liver. At the same concentration, LNG caused a significant upregulation of the mRNA expression of the gene encoding luteinising hormone β-subunit (lhβ) and the suppression of the mRNA expression of the gene encoding follicle-stimulating hormone β-subunit (fshβ) in the pituitary of both male and female roach. A lower LNG concentration (312 ng/l) suppressed mRNA expression of fshβ in males only. Females treated with 3124 ng/l LNG exhibited significantly lower plasma 11-ketotestosterone (11-KT) and oestradiol (E2) concentrations, whereas their testosterone (T) level was higher compared with the control. Females exposed to 312 ng/l LNG presented significantly lower plasma E2 concentrations. Males exposed to ≥31 ng/l LNG exhibited significantly reduced 11-KT levels. As determined through a histological analysis, the ovaries of females were not affected by LNG exposure, whereas the testes of males exposed to 31 and 312 ng/l LNG exhibited a significantly higher percentage of spermatogonia B compared with the control. The results of the present study demonstrate that LNG disrupts the reproductive system of pubertal roach by affecting the pituitary gonadotropin expression and the sex steroid levels. This disruption was determined to occur in males after exposure to an environmentally relevant concentration (31 ng/l). Moreover, the highest tested concentration of LNG (3124 ng/l) exerted an oestrogenic effect on fish of both sexes.

Migration of Ag- and TiO2-(Nano)particles from textiles into artificial sweat under physical stress: experiments and exposure modeling

Engineered nanoparticles (ENP) are increasingly used to functionalize textiles taking advantage, e.g., of the antimicrobial activity of silver (Ag)-ENP or the UV-absorption of titania (TiO2)-ENP. Mobilization and migration of ENPs from the textile into human sweat can result in dermal exposure to these nanoobjects and their aggregates and agglomerates (NOAA). In this study we assessed exposure to NOAA migrating from commercially available textiles to artificial sweat by an experimental setup that simulates wear-and-tear during physical activity. By combining physical stress with incubation in alkaline and acidic artificial sweat solutions we experimentally realized a worst case scenario for wearing functionalized textiles during sports activities. This experimental approach is not limited to NOAA, but can be used for any other textile additive. Out of four investigated textiles, one T-shirt and one pair of trousers with claimed antimicrobial properties were found to release Ag <450 nm in detectable amounts (23-74 μg/g/L). Textiles containing TiO2 for UV protection did not release significant amounts of TiO2 <450 nm, but the antimicrobial T-shirt released both TiO2 and Ag <450 nm. The silver was present in dissolved and particulate form, whereas TiO2 was mainly found as particulate. On the basis of our experimental results we calculated external dermal exposure to Ag and TiO2 for male and female adults per use. For silver, maximal amounts of 17.1 and 8.2 μg/kg body weight were calculated for total and particulate Ag <450 nm, respectively. For TiO2, the exposure levels amount to maximal 11.6 μg/kg body weight for total (mainly particulate) TiO2. In comparison with other human exposure pathways, dermal exposure to NOAA from textiles can be considered comparably minor for TiO2-NOAA, but not for Ag-NOAA.

Characterization of silver release from commercially available functional (nano)textiles

Silver, both in the nano as well as in other forms, is used in many applications including antimicrobial textiles. Washing of such textiles has already been identified as an important process that results in the release of silver into wastewater. This study thus investigated the release of silver from eight different commercially available silver-textiles during a washing and rinsing cycle. The silver released was size-fractionated and characterized using electron microscopy. In addition, the antimicrobial functionality of the textiles was tested before and after washing. Three of the textiles contained nanosized silver (labeled or confirmed by manufacturers' information), another used a metallic silver wire and four contained silver in undeclared form. The initial silver content of the textiles was between 1.5 and 2925mg Ag/kg. Only four of the investigated textiles leached detectable amounts of silver, of which 34-80% was in the form of particles larger than 450nm. Microscopic analysis of the particles released in the washing solutions identified Ti/Si-AgCl nanocomposites, AgCl nanoparticles, large AgCl particles, nanosilver sulfide and metallic nano-Ag, respectively. The nanoparticles were mainly found in highly agglomerated form. The identified nanotextiles showed the highest antimicrobial activity, whereas some of the other textiles, e.g. the one with a silver wire and the one with the lowest silver content, did not reduce the growth of bacteria at all. The results show that different silver textiles release different forms of silver during washing and that among the textiles investigated AgCl was the most frequently observed chemical form in the washwater.

Release of titanium dioxide from textiles during washing

Nano-TiO(2) has the highest production of all nanomaterials, and pigment-TiO(2) is a commodity used on the million tons/year scale. Information on the release of TiO(2) from consumer products is therefore an important part of analyzing the potential environmental exposure to TiO(2). For this study, we investigated the release of TiO(2) from six different functional textiles during washing. TiO(2) is used in textiles because of its UV-absorbing properties and as pigment. Analysis of fiber cross sections showed that the TiO(2) was contained in the fiber matrix. The sun-protection textiles had Ultraviolet Protection Factors that were between 58 and 6100 after washing and therefore above the labeled factor of 50+. Five of the textiles (sun-protection clothes) released low amounts of Ti (0.01 to 0.06 wt % of total Ti) in one wash cycle. One textile (with antimicrobial functionality) released much higher amounts of Ti (5 mg/L, corresponding to 3.4 wt % of total Ti in one wash cycle). Size fractionation showed that about equal amounts were released as particles below and above 0.45 μm. After 10 washings, only in two textiles significantly lower Ti contents were measured. Electron microscopy showed that the TiO(2) particles released into washing solution had a roundish appearance with primary particle sizes between 60 and 350 nm that formed small aggregates with up to 20 particles. The results indicate that functional textiles release some TiO(2) particles, but that the amounts are relatively low and mostly not in the nanoparticulate range.

SU-D-BRB-01: 4D-CT Lung Ventilation Images Vary with 4D-CT Sorting Techniques

PURPOSE

4D-CT ventilation imaging is a novel promising technique for lung functional imaging and has potential as a biomarker for radiation pneumonitis, but has not been validated in human subjects. The current 4D- CT technique with phase-based sorting results in artifacts at an alarmingly high frequency (90%), which may introduce variations into ventilation calculations. The purpose of this study was to quantify the variability of 4D- CT ventilation imaging to 4D-CT sorting techniques.

METHODS

Two 4D-CT images were generated from the same data set by: (1) phase-based; (2) anatomic similarity- and abdominal displacement-based sorting for five patients. Two ventilation image sets (V_phase and V_anat) were then calculated by deformable image registration of peak-exhale and peak-inhale4D-CT images and quantification of regional volume change based on Hounsfield unit change. The variability of 4D-CT ventilation imaging wasquantified using the voxel-based Spearman rank correlation coefficients and Dice similarity coefficients (DSC) for the spatial overlap of segmented low- functional lung regions. The relationship between the abdominal motionrange variation and ventilation variation was also assessed using linearregression. Furthermore, the correlations between V_phase or V_anat and SPECT ventilation images (assumed ground-truth) were compared.

RESULTS

In general, displacement- and anatomic similarity-based sorting reduced 4D- CT artifacts compared to phase-based sorting. The voxel-based correlationsbetween V_phase and V_anat were only moderate (range, 0.57-0.77). The DSCs for the low-functional lung regions were moderate to substantial (0.58-0.70). The relationship between the motion range variation and ventilation variation was strong on average (R2=0.79±0.25), suggesting that ventilation variations are related to 4D-CT artifacts. Vanat was found to improve correlations with SPECT ventilation images compared to V_phase.

CONCLUSIONS

4D-CT ventilation images vary markedly with 4D-CT sorting techniques. 4D-CT artifacts should be considered as a significant source of variation in 4D-CT ventilation imaging during its validation. This study wassupported in part by NIH/NCI R01 93626. SK and CL are employees ofPhilips Research.

Expression profiles of LHbeta, FSHbeta and their gonadal receptor mRNAs during sexual differentiation of Xenopus laevis tadpoles

The gonadotropins, luteinising hormone (LH) and follicle stimulating hormone (FSH), are important hormones regulating reproductive biology in vertebrates, especially the processes of steroidogenesis and gamete maturation. Despite the role of gonadotropins during the reproductive cycle in amphibians is well established, much less is known about the functional maturation of the hypothalamus-pituitary-gonad axis during larval development. Therefore, the present study aimed to analyze the expression profiles of hypophyseal LHbeta and FSHbeta mRNA and of their corresponding gonadal receptors (LH-R, FSH-R) in Xenopus laevis tadpoles during their ontogeny and sexual differentiation. The first significant elevation of LHbeta and FSHbeta mRNA was observed at late premetamorphosis. A clear raise of LHbeta mRNA was present during prometamorphic stages especially in males, while the LH-R only slowly increased during ontogeny with highest levels during metamorphic climax. In contrast, FSHbeta mRNA expression only slightly increased during ontogeny, however in both sexes the FSH-R mRNA was considerably elevated at prometamorphosis and further at metamorphic climax. Our results suggest that LHbeta and LH-R mRNA expression might be involved in initial maturation events of gametes, at least in males, while the gradually increase of FSH-R mRNA coincided with the advancing process of gamete maturation in both sexes. The present study provides for the first time evidence based on expression of gonadotropins and their corresponding gonadal receptors that the hypothalamus-pituitary-gonad axis evolves already at early stages of ontogeny and sexual differentiation in amphibians.

Genomic SELEX for Hfq-binding RNAs identifies genomic aptamers predominantly in antisense transcripts

An unexpectedly high number of regulatory RNAs have been recently discovered that fine-tune the function of genes at all levels of expression. We employed Genomic SELEX, a method to identify protein-binding RNAs encoded in the genome, to search for further regulatory RNAs in Escherichia coli. We used the global regulator protein Hfq as bait, because it can interact with a large number of RNAs, promoting their interaction. The enriched SELEX pool was subjected to deep sequencing, and 8865 sequences were mapped to the E. coli genome. These short sequences represent genomic Hfq-aptamers and are part of potential regulatory elements within RNA molecules. The motif 5′-AAYAAYAA-3′ was enriched in the selected RNAs and confers low-nanomolar affinity to Hfq. The motif was confirmed to bind Hfq by DMS footprinting. The Hfq aptamers are 4-fold more frequent on the antisense strand of protein coding genes than on the sense strand. They were enriched opposite to translation start sites or opposite to intervening sequences between ORFs in operons. These results expand the repertoire of Hfq targets and also suggest that Hfq might regulate the expression of a large number of genes via interaction with cis-antisense RNAs.

Patient-reported outcomes in hernia repair

BACKGROUND

The project aimed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for groin hernia repair.

METHODS

In two centres for short-stay surgery all patients referred for hernia repair were surveyed between August 1999 and January 2002. Patients reported on health-related quality of life (SF-36), symptoms (Hernia Symptom Checklist, HSCL) and other indicators pre-operatively (T0) and 14 days (T1) and 6 months post-operatively (T2). Three of the eight SF-36 subscales (physical functioning, bodily pain, and role physical) and the HSCL at T2 were considered as main outcome indicators. The main outcomes were analysed by generalized linear models with regard to predictors.

RESULTS

At T0 a total of 342 hernia patients were included. The response rate at T2 was 54.1% (92.4% males, 58.6 years of age). At T2 only 21.1% did not report complaints (i.e. haematoma, pain, numbness) post-operatively. The overall positive course is reflected by the HSCL: from 32.4% pre-operatively, it rises slightly to 38.5% at T1 and decreases to 10.6% at T2 (T0-T2: P < 0.001). The SF-36 subscales "physical functioning", "bodily pain", and "role physical" showed the same course over time (slight decrease of health-related quality of life at T1 and large increase at T2). The main patient-reported outcomes were mainly influenced by the pre-operative level, age, and self-reported post-operative complaints.

CONCLUSION

The low response rate was mainly due to non-delivery of questionnaires at T1 during the regular post-operative visit by the operating physician. Though non-response occurs under conditions of routine care, meaningful information was gained which should be used for quality improvement activities. Because the pre-operative level is a major determinant of the post-operative health outcomes, the prospective pre-post measurement should be standard, in case institutional comparisons are intended.

A geometric model of the beating heart

OBJECTIVES

A comprehensive model of the human heart that covers multiple surfaces, like those of the four chambers and the attached vessels, is presented. It also contains the coronary arteries and a set of 25 anatomical landmarks. The statistical model is intended to provide a priori information for automated diagnostic and interventional procedures.

METHODS

The end-diastolic phase of the model was adapted to fit 27 clinical multi-slice computed tomography images, thus reflecting the anatomical variability to be observed in that sample. A mean cardiac motion model was also calculated from a set of eleven multi-phase computed tomography image sets. A number of experiments were performed to determine the accuracy of model-based predictions done on unseen cardiac images.

RESULTS

Using an additional deformable surface technique, the model allows for determination of all chambers and the attached vessels on the basis of given anatomical landmarks with an average accuracy of 1.1 mm. After such an individualization of the model by surface adaptation the centerlines of the three main coronary arteries may be estimated with an average accuracy of 5.2 mm. The mean motion model was used to estimate the cardiac phase of an unknown multi-slice computed tomography image.

CONCLUSION

The mean shape model of the human heart as presented here complements automated image analysis methods with the required a priori information about anatomical constraints to make them work fast and robustly.

Evaluation von zwei „schnellen” Softwareprogrammen zur Bestimmung der linksventrikulären Volumina in der retrospektiv EKG-gegateten Mehrzeilen-Spiral-CT des Schweineherzens: Biplanare Flächen-Längen-Methode und „Shape-tracking”-Methode

PURPOSE

Evaluation of 2 "fast" software tools, a biplane area-length method, and a new automatic "shape tracking" method, for the calculation of left ventricle volumes (end-diastolic volume EDV, end-systolic volume ESV, stroke volume SV) and ejection fraction (EF) in retrospectively ECG-gated multidetector computed tomography.

MATERIALS AND METHODS

60 contrast-enhanced cardiac CT datasets (16 x 0.75 mm collimation, normal dose: 120-140 kV, 400-500 mAs (eff) [n = 44], low dose 120 kV, 100 mAs (eff) [n = 16]) were acquired from eight intubated healthy pigs on different days. Images were reconstructed with a slice thickness and increment of 2 mm every 10 % of the cardiac cycle. The LV function was evaluated via the common short axis method as the reference method, the biplane area-length method, and the automatic "shape tracking" method. In the latter a three-dimensional triangulated deformable surface model was used to segment the endocardial border of the left ventricle and to track its motion through the cardiac phases. The results were compared using the Bland-Altman-plot, the correlation coefficient, and the Wilcoxon test.

RESULTS

All 60 data sets could be evaluated with all three methods. Good correlations were found for left ventricular functional parameters for all data sets, the normal dose (ND), and low dose (LD) data sets between 0.65 and 0.89 for the "shape tracking" method and between 0.7 and 0.87 for the area-length method. The "shape tracking" method showed a mean overestimation of the EDV of 3.1 (LD, p = 0.38) to 4.3 ml (ND, p < 0.05), the SV of 4.0 (LD, p = 0.08) to 4.9 ml (ND, p < 0.05) and the EF of 1.3 (LD, p = 0.16) to 2.0 % (ND, p < 0.05). The EDV was underestimated between 0.3 (LD, p = 0.7) and 1.1 ml (ND, p = 0.08). The area-length method showed an overestimation of the EDV (6.6 to 6.7 ml [p < 0.05]), the SV (5.9 to 8.4 ml [p < 0.05]), the EF (1.2 to 3.0 % [p < 0.05]) and the normal dose ESV (0.6 ml [p = 0.74]). The low dose ESV was underestimated (1.3 ml [p = 0.21]).

CONCLUSION

The left ventricular functional parameters acquired with both "fast" software methods correlate well with the common semi-automatic short axis method, and both methods significantly overestimate the EDV, SV and EF. Both methods can be used in low dose examinations.

Dental procedures in adult patients with hereditary bleeding disorders: 10 years experience in three Italian Hemophilia Centers

Excessive bleeding after dental procedures are one of the most frequent complications occurring in patients with hereditary bleeding disorders. In this retrospective study we collected data from 10 years of experience in the oral care of patients with congenital haemorrhagic disorders in three Italian Hemophilia Centers. Between 1993 and 2003, 247 patients with inherited bleeding disorders underwent 534 dental procedures including 133 periodontal treatments, 41 conservative dentistry procedures, 72 endodontic treatments and 288 oral surgery procedures. We recorded 10 bleeding complications (1.9%), most of which occurred in patients with severe/moderate haemophilia A undergoing multiple dental extractions. Thus, our protocol of management of patients with hereditary bleeding tendency undergoing oral treatment or surgery has been shown to be effective in preventing haemorrhagic complications.

Prolonged stenting does not prevent obstruction after TIP repair when the glans was deeply incised

PURPOSE

To evaluate whether prolonged postoperative stenting may reduce the risk of obstruction of the neourethra after TIP repair with deep glanular incision.

METHODS

In a 1-year period 27 patients were operated for penile hypospadias using the TIP technique described by Snodgrass. In contrast to a previous study with 8 - 10 days of postoperative catheter drainage, the indwelling transurethral catheter was kept in place for 12 - 14 days. Deep incision of the urethral plate up to the tip of the glans is the most remarkable surgical detail, resulting in a meatus on top of the glans but in a defect on the dorsal rim of the neomeatus as well. After 3 - 6 months 22 patients were re-investigated during an outpatient visit using a scheme to describe the position of the neomeatus. Uroflowmetry was also performed. Information in three toddlers was gained by phone and 2 patients were lost to follow-up.

RESULTS

Two patients returned with significant obstruction including an urethrocutaneous fistula in one. In contrast to the good assessment by parents and compared to the early appearance after catheter removal a change in meatal position was observed in the majority of patients. Only 6 patients presented with an unchanged meatal position whereas in 16 patients the meatus lost its oval or slit-like shape as well as its position on the tip of the glans. However, despite one obstructive meatus in the coronal position 15 patients showed a sufficient size and position of the meatus underneath the tip of the glans. Uroflowmetry revealed reduced peak-flow values (mean: 8.1 ml/s) in some of the 9 patients evaluated.

CONCLUSIONS

Our data indicate that prolonged stenting does not give better results in those TIP repairs, in whom the urethral plate was incised across the rim of the neomeatus. The early excellent aspect of the glans after stent removal is often impaired by partial closure of the glans incision with a short-term change in size and position of the meatus. To prevent this, the rim of the meatus during reconstruction should be kept completely epithelialised.