American Society for Microbiology - Zika Virus Press Conference 2016 @ASMZika

Watch a panel of Zika virus experts who speak about the latest developments on Zika virus research and a wide range of fields that touch on flaviviruses. Moderated by: Lynn Enquist, Ph. D. ASM President and Zika conference convener, Henry L. Hillman Professor in Molecular Biology and Pro...

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Virus Watch: Counting Viruses

In this episode of Virus Watch, I show how to do my favorite assay in all of virology - the plaque assay.

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TWiP 111: Bug bites

The TWiP trio solve the case of the bug bites all in a row, and talk about a secreted Toxoplasma protein that is central to the parasite's manipulation of host cells.

Hosts: Vincent Racan...

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Exhausted paramedics: 7 recommendations to reduce impacts of fatigue

Errors in patient care and EMS provider health concerns are raising awareness of the risks of prolonger work hours

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Cerebral microbleeds and neuropsychiatric symptoms in an elderly Asian cohort

Objectives

Neuropsychiatric symptoms (NPS) are commonly found in patients with cerebral small vessel disease such as white matter hyperintensities and lacunar infarcts. However, the association between cerebral microbleeds (CMBs) and NPS has not been examined. Hence the present study sought to investigate the relation between CMBs and NPS in an elderly population.

Methods

This is a cross-sectional study of elderly Asians living in the community, who were assessed on a comprehensive neuropsychological battery and underwent clinical examinations as well as brain MRI scans. The 12-item neuropsychiatric inventory (NPI) was administered to a reliable informant. Total scores for individual symptoms and for NPI global performance were calculated and compared across three groups: no CMB, presence of 1 CMB and presence of multiple CMBs, controlling for demographics, vascular risk factors and other MRI markers.

Results

A total of 802 participants were included in the analysis. Participants with multiple CMBs had higher NPI total score compared to those with no CMB (1.06 vs 2.66, p=0.03). On individual symptom scores, higher score on depression (0.16 vs 0.53, p=0.02) and disinhibition (0.01 vs 0.14, p=0.04) was found in those elderly with multiple CMBs, independent of demographic and vascular risk factors, history of stroke, and other small vessel and large vessel disease markers.

Conclusions

The presence of multiple CMBs is associated with high global neuropsychiatric disorder burden, in particular symptoms of depression and disinhibition. Future studies are recommended to investigate the importance of CMBs in the pathogenesis and longitudinal progression of neuropsychiatric disorders in the general elderly population.

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Defining SOD1 ALS natural history to guide therapeutic clinical trial design

Importance

Understanding the natural history of familial amyotrophic lateral sclerosis (ALS) caused by SOD1 mutations (ALS^SOD1) will provide key information for optimising clinical trials in this patient population.

Objective

To establish an updated natural history of ALS^SOD1.

Design, setting and participants

Retrospective cohort study from 15 medical centres in North America evaluated records from 175 patients with ALS with genetically confirmed SOD1 mutations, cared for after the year 2000.

Main outcomes and measures

Age of onset, survival, ALS Functional Rating Scale (ALS-FRS) scores and respiratory function were analysed. Patients with the A4V (Ala-Val) SOD1 mutation (SOD1^A4V), the largest mutation population in North America with an aggressive disease progression, were distinguished from other SOD1 mutation patients (SOD1^non-A4V) for analysis.

Results

Mean age of disease onset was 49.7±12.3 years (mean±SD) for all SOD1 patients, with no statistical significance between SOD1^A4V and SOD1^non-A4V (p=0.72, Kruskal-Wallis). Total SOD1 patient median survival was 2.7 years. Mean disease duration for all SOD1 was 4.6±6.0 and 1.4±0.7 years for SOD1^A4V. SOD1^A4V survival probability (median survival 1.2 years) was significantly decreased compared with SOD1^non-A4V (median survival 6.8 years; p<0.0001, log-rank). A statistically significant increase in ALS-FRS decline in SOD1^A4V compared with SOD1^non-A4V participants (p=0.02) was observed, as well as a statistically significant increase in ALS-forced vital capacity decline in SOD1^A4V compared with SOD1^non-A4V (p=0.02).

Conclusions and relevance

SOD1^A4V is an aggressive, but relatively homogeneous form of ALS. These SOD1-specific ALS natural history data will be important for the design and implementation of clinical trials in the ALS^SOD1 patient population.

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Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis investigating the influence of acetylcholinesterase inhibitors (AChEIs) therapy on nutritional status and weight across observational and interventional studies. Two authors searched major electronic databases from inception until 10/14/2015 for longitudinal, open-label and randomised double-blind placebo controlled (randomised controlled trials (RCTs)) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10 792 patients with dementia were meta-analysed. In longitudinal studies (median follow-up 6 months), a significant cumulative incidence of weight loss between baseline and follow-up evaluation was observed (studies=2; 5%; 95% CI 1% to 34%, p<0.0001; I²=95%). These findings were confirmed in open-label trials (6%; 95% CI 4% to 7%, p<0.0001; I²=78%). In 9 RCTs (median follow-up 5 months), those taking AChEIs more frequently experienced weight loss than participants taking placebo (OR=2.18; 95% CI 1.50 to 3.17, p<0.0001; I²=29%). AChEIs therapy contributes to weight loss in patients with dementia, with a 2-fold increased risk observed in the meta-analysis of RCTs. Clinicians should carefully consider the benefit and risk of prescribing AChEIs. Nutritional status should be routinely evaluated in patients with dementia treated with AChEIs.

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Why patients with dementia need a motor examination

About 25 years ago, the world of neurodegenerative diseases was dominated by a clear and intuitively appealing distinction. On one hand, there were dementias, disorders of cognition, in which patients could develop problems with memory, language, attention or orientation, but in which motor functions were assumed to be preserved. On the other hand, there were motor disorders, affecting movement but leaving cognition intact. Dementia and movement specialists rarely interacted; they attended different conferences, read different journals (or at least articles) and used different assessment tools. The division was stronger in the Anglo-Saxon countries than in Continental Europe, with its tradition of linking neurology and psychiatry.

Since then, dozens of clinical studies have shown that cognitive symptoms are frequent in so-called motor disorders and vice versa.1 Advances in basic sciences have unearthed a large amount of overlap in molecular biology and genetics between 'motor' and 'cognitive' disorders. Theoretical models have been...

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Successful laparoscopic distal gastrectomy with D2 lymph node dissection preserving the common hepatic artery branched from the left gastric artery for advanced gastric cancer with an Adachi type VI (group 26) vascular anomaly

Abstract

We report a case of successful laparoscopic distal gastrectomy with D2 lymph node dissection preserving the common hepatic artery branched from the left gastric artery for advanced gastric cancer with an Adachi type VI (group 26) vascular anomaly. A 76-year-old female patient was admitted with a diagnosis of advanced gastric cancer at the anterior wall to the lesser curvature of the antrum (cT3N0M0 cStage IIA). Dynamic computed tomography showed the ectopia of the common hepatic artery branched from the left gastric artery. We made a diagnosis of an Adachi type VI (group 26) vascular anomaly and performed the abovementioned operation. In this anomaly pattern, scrupulous attention is required to remove the suprapancreatic lymph nodes because the portal vein is located immediately dorsal to those lymph nodes and is at increased risk for the injury in this situation. The common hepatic artery is branched from the left gastric artery, and the hepatic perfusion from the superior mesenteric artery is not present in group 26. Planning to preserve the artery will improve safety when it is possible oncologically. There were no postoperative complications, and the patient was discharged 9 days after the operation. To our knowledge, the present case is the first reported case of a laparoscopic distal gastrectomy with D2 lymph node dissection with an Adachi type VI (group 26) vascular anomaly. Preoperative diagnostic imaging is very important to prevent surgical complications because the reliable identification of vascular anomaly during an operation is very difficult.

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Law Enforcement Officer: EMT/Paramedic - Remote Medical International

**This is an unarmed position** Seeking an adventurous role' This position can take you to a variety of countries throughout the world providing a high level of medical support and instruction. You would travel around the globe teaching local national police forces and government agencies the basics of tactical medicine and law enforcement techniques. In addition to instructing responsibilities, you ...

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Pedunculated-type T1 colorectal carcinoma with lung carcinoma metastasis at the deepest invasive portion

Abstract

We present a rare case of colorectal T1 carcinoma with metastasis of previous lung carcinoma found at the deepest invasive portion. A 61-year-old man presented with cervical lymphadenopathy 18 years after undergoing surgery for right lung carcinoma [poorly differentiated adenocarcinoma stage IIb (T3N0M0)]. Contrast-enhanced computed tomography showed enlarged lymph nodes (LNs) in the neck and mediastinal regions. Combined hybrid-F-fluorodeoxyglucose positron emission-computerized tomography showed increased radionuclide uptake in multiple cervical LNs and mediastinal LNs. LN biopsy revealed a poorly differentiated adenocarcinoma, suspected to be a metastatic tumor of the lung. Subsequent colonoscopy revealed a pedunculated-type lesion with a depressed area in the ascending colon. We performed polypectomy as total excisional biopsy; this tumor was composed mainly of moderately differentiated adenocarcinoma, partially mixed with mucinous adenocarcinoma. The pathological findings of the invasive front of the colorectal carcinoma showed poorly differentiated adenocarcinoma with a morphological pattern similar to that of the previous lung carcinoma. Furthermore, immunohistochemical results for the histological type of the deepest invasive portion of the tissue specimen were positive for thyroid transcription factor-1 but negative for Caudal-type homeobox 2. From these morphological and immunohistochemical findings, the final diagnosis was moderately differentiated lung carcinoma, pTX N3 M1b (LN, colon) Stage IV.

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An investigation of the factors effecting high-risk individuals’ decision-making about prophylactic total gastrectomy and surveillance for hereditary diffuse gastric cancer (HDGC)

Abstract

Hereditary diffuse gastric cancer has an early onset and poor prognosis, therefore, individuals who carry a pathogenic (CDH1) mutation in the E-cadherin gene (CDH1) are offered endoscopic surveillance and advised to undergo prophylactic total gastrectomy (PTG) in their early to mid-twenties. Patients not ready or fit to undergo gastrectomy, or in whom the genetic testing result is unknown or ambiguous, are offered surveillance. Little is known about the factors that influence decisions to undergo or decline PTG, making it difficult to provide optimal support for those facing these decisions. Qualitative interviews were carried out with 35 high-risk individuals from the Familial Gastric Cancer Study in the UK. Twenty-seven had previously undergone PTG and eight had been identified as carrying a pathogenic CDH1 mutation but had declined surgery at the time of interview. The interviews explored the experience of decision-making and factors influencing risk-management decisions. The data suggest that decisions to proceed with PTG are influenced by a number of potentially competing factors: objective risk confirmation by genetic testing and/or receiving a positive biopsy; perceived familial cancer burden and associated risk perceptions; perceptions of post-surgical life; an increasing inability to tolerate endoscopic procedures; a concern that surveillance could miss a cancer developing and individual's life stage. These findings have implications for advising this patient group.

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Coordination of muscles to control the footpath during over-ground walking in neurologically intact individuals and stroke survivors

Abstract

The central nervous system (CNS) is believed to use the abundant degrees of freedom of muscles and joints to stabilize a particular task variable important for task success, such as footpath during walking. Stroke survivors often demonstrate impaired balance and high incidences of falls due to increased footpath variability during walking. In the current study, we use the uncontrolled manifold (UCM) approach to investigate the role of motor abundance in stabilizing footpath during swing phase in healthy individuals and stroke survivors. Twelve stroke survivors and their age- and gender-matched controls walked over-ground at self-selected speed, while electromyographic and kinematic data were collected. UCM analysis partitioned the variance of muscle groups (modes) across gait cycles into "good variance" (i.e., muscle mode variance leading to a consistent or stable footpath) or "bad variance" (i.e., muscle mode variance resulting in an inconsistent footpath). Both groups had a significantly greater "good" than "bad" variance, suggesting that footpath is an important task variable stabilized by the CNS during walking. The relative variance difference that reflects normalized difference between "good" and "bad" variance was not significantly different between groups. However, significant differences in muscle mode structure and muscle mode activation timing were observed between the two groups. Our results suggest that though the mode structure and activation timing are altered, stroke survivors may retain their ability to explore the redundancy within the neuromotor system and utilize it to stabilize the footpath.

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Left-handers show no self-advantage in detecting a delay in visual feedback concerning an active movement

Abstract

Right-handed people show an advantage in detecting a delay in visual feedback concerning an active movement of their right hand when it is viewed in a natural perspective compared to when it is seen as if viewing another person's hand (Hoover and Harris in Exp Brain Res 233:1053–1060, 2012. doi:10.1007/s00221-014-4181-9; Exp Brain Res 222:389–397, 2015a. doi:10.1007/s00221-012-3224-3). This self-advantage is unique to their dominant hand and may reflect an enhanced sense of ownership which contributes to how right-handed people relate to the world. Here we asked whether left-handers show the same pattern of performance for their dominant hand. We measured the minimum delay that could be detected by 29 left-handers when viewing either their dominant or non-dominant hand from 'self' or 'other' perspectives and compared their thresholds to an age-matched sample of 22 right-handers. Right-handers showed a significant signature self-advantage of 19 ms when viewing their dominant hand in an expected 'self' perspective compared to 'other' perspectives. Left-handers, however, showed no such advantage for either their dominant or non-dominant hand. This lack of self-advantage in detecting delayed visual feedback might indicate a less secure sense of body ownership amongst left-handers.

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Subthalamic nucleus deep brain stimulation induces impulsive action when patients with Parkinson’s disease act under speed pressure

Abstract

The subthalamic nucleus (STN) is proposed to modulate response thresholds and speed–accuracy trade-offs. In situations of conflict, the STN is considered to raise response thresholds, allowing time for the accumulation of information to occur before a response is selected. Conversely, speed pressure is thought to reduce the activity of the STN and lower response thresholds, resulting in fast, errorful responses. In Parkinson's disease (PD), subthalamic nucleus deep brain stimulation (STN-DBS) reduces the activity of the nucleus and improves motor symptoms. We predicted that the combined effects of STN stimulation and speed pressure would lower STN activity and lead to fast, errorful responses, hence resulting in impulsive action. We used the motion discrimination 'moving-dots' task to assess speed–accuracy trade-offs, under both speed and accuracy instructions. We assessed 12 patients with PD and bilateral STN-DBS and 12 age-matched healthy controls. Participants completed the task twice, and the patients completed it once with STN-DBS on and once with STN-DBS off, with order counterbalanced. We found that STN stimulation was associated with significantly faster reaction times but more errors under speed instructions. Application of the drift diffusion model showed that stimulation resulted in lower response thresholds when acting under speed pressure. These findings support the involvement of the STN in the modulation of speed–accuracy trade-offs and establish for the first time that speed pressure alone, even in the absence of conflict, can result in STN stimulation inducing impulsive action in PD.

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Can short-term oral fine motor training affect precision of task performance and induce cortical plasticity of the jaw muscles?

Abstract

The aim was to test the hypothesis that short-term oral sensorimotor training of the jaw muscles would increase the precision of task performance and induce neuroplastic changes in the corticomotor pathways, related to the masseter muscle. Fifteen healthy volunteers performed six series with ten trials of an oral sensorimotor task. The task was to manipulate and position a spherical chocolate candy in between the anterior teeth and split it into two equal halves. The precision of the task performance was evaluated by comparing the ratio between the two split halves. A series of "hold-and-split" tasks was also performed before and after the training. The hold force and split force along with the electromyographic (EMG) activity of jaw muscles were recorded. Motor-evoked potentials and cortical motor maps of the right masseter muscle were evoked by transcranial magnetic stimulation. There was a significant effect of series on the precision of the task performance during the short-term oral sensorimotor training (P < 0.002). The hold force during the "hold-and-split" task was significantly lower after training than before the short-term training (P = 0.011). However, there was no change in the split force and the EMG activity of the jaw muscles before and after the training. Further, there was a significant increase in the amplitude of the motor-evoked potentials (P < 0.016) and in the motor cortex map areas (P = 0.033), after the short-term oral sensorimotor training. Therefore, short-term oral sensorimotor task training increased the precision of task performance and induced signs of neuroplastic changes in the corticomotor pathways, related to the masseter muscle.

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Detecting traces of consciousness in the process of intending to act

Abstract

An intention to act has different onsets when it is measured in different ways. When participants provide a self-initiated report on the onset of their awareness of intending to act, the report occurs around 150 ms prior to action. However, when the same participants are repeatedly asked about their awareness of intending at different points in time, the onset of intending is found up to 2 s prior to action. This 'probed' awareness has its onset around the same time as the brain starts preparing the act, as measured using EEG. First of all, this undermines straightforward interpretations about the temporal relation between unconscious brain states and conscious intentions and actions. Secondly, we suggest that these results present a problem for the view that intentions are mental states occurring at a single point in time. Instead, we suggest the results to support the interpretation of an intention to act as a multistage process developing over time. This process of intending seems to develop during the process of acting, leaving reportable traces in consciousness at certain points along the road.

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Cognition overrides orientation dependence in tactile viewpoint selection

Abstract

Humans are capable of extracting spatial information through their sense of touch: when someone strokes their hand, they can easily determine stroke direction without visual information. However, when it comes to the coordinate system used to assign the spatial relations to the stimulation, it remains poorly understood how the brain selects the appropriate system for passive touch. In the study reported here, we investigated whether hand orientation can determine coordinate assignment to ambiguous tactile patterns, whether observers can cognitively override any orientation-driven perspectives on touch, and whether the adaptation transfers across body surfaces. Our results demonstrated that the orientation of the hand in the vertical plane determines the perspective taken: an external perspective is adopted when the hand faces the observer and a gaze-centred perspective is selected when the hand faces away. Participants were then adapted to a mirror-reversed perspective through training, and the results revealed that this adapted perspective holds for the adapted surface and generalises to non-adapted surfaces, including across the body midline. These results reveal plasticity in perspective taking which relies on low-level postural cues (hand orientation) but also on higher-order somatosensory processing that can override the low-level cues.

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Approaching threat modulates visuotactile interactions in peripersonal space

Abstract

The region surrounding our body (i.e. peripersonal space) is coded in a multimodal representation by fronto-parietal bimodal neurons integrating tactile stimuli on the body with nearby visual stimuli. This has often been suggested to serve a defensive purpose, which we propose could be mediated through visuotactile predictions. An approaching threat would then be of particular interest to peripersonal space processing. To investigate this, we asked participants to respond as fast as possible to a tactile stimulus on the hand, while looking at an animation of an approaching or receding spider or butterfly. Tactile stimulation was applied at one of 25 possible time points during the animation. Tactile reaction times were faster when an approaching stimulus was closer to the hand at the time of tactile presentation. Critically, this effect of distance on reaction times was larger when participants saw an approaching spider compared to an approaching butterfly, but only for participants who were afraid of spiders. This finding demonstrates that the perceived threat of an approaching stimulus modulates visuotactile interactions in peripersonal space and is consistent with the idea that visuotactile predictions are important for defensive purposes and maintaining bodily integrity.

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Repetitive transcranial magnetic stimulation of the dorsolateral prefrontal cortex enhances working memory

Abstract

Neuroimaging and electrophysiological studies have unequivocally identified the dorsolateral prefrontal cortex (DLPFC) as a crucial structure for top-down control of working memory (WM) processes. By modulating the excitability of neurons in a targeted cortical area, transcranial magnetic stimulation (TMS) offers a unique way to modulate DLPFC function, opening the possibility of WM facilitation. Even though TMS neuromodulation effects over the left DLPFC have successfully improved WM performance in patients with depression and schizophrenia in a multitude of studies, raising the potential of TMS as a safe efficacious treatment for WM deficits, TMS interventions in healthy individuals have produced mixed and inconclusive results. Here, we stimulated the left DLPFC of healthy individuals using a high-frequency repetitive TMS protocol and evaluated behavioral performance in a battery of cognitive tasks. We found that TMS treatment enhanced WM performance in a verbal digit span and a visuospatial 2-back task.

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The effect of 6 h of running on brain activity, mood, and cognitive performance

Abstract

Long-duration exercise has been linked with the psychological model of flow. It is expected that the flow experience is characterized by specific changes in cortical activity, especially a transient hypofrontality, which has recently been connected with an increase in cognitive performance post-exercise. Nevertheless, data on neuro-affective and neuro-cognitive effects during prolonged exercise are rare. The cognitive performance, mental state, flow experience, and brain cortical activity of 11 ultramarathon runners (6 female, 5 male) were assessed before, several times during, and after a 6-h run. A decrease in cortical activity (beta activity) was measured in the frontal cortex, whereas no changes were measured for global beta, frontal or global alpha activity. Perceived physical relaxation and flow state increased significantly after 1 h of running but decreased during the following 5 h. Perceived physical state and motivational state remained stable during the first hour of running but then decreased significantly. Cognitive performance as well as the underlying neurophysiological events (recorded as event-related potentials) remained stable across the 6-h run. Despite the fact that women reported significant higher levels of flow, no further gender effects were noticeable. Supporting the theory of a transient hypofrontality, a clear decrease in frontal cortex activity was noticeable. Interestingly, this had no effect on cognitive performance. The fact that self-reported flow experience only increased during the first hour of running before decreasing, leads us to assume that changes in cortical activity, and the experience of flow may not be linked as previously supposed.

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Near-infrared light (670 nm) reduces MPTP-induced parkinsonism within a broad therapeutic time window

Abstract

We have shown previously that near-infrared light (NIr), when applied at the same time as a parkinsonian insult (e.g. 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine; MPTP), reduces behavioural deficits and offers neuroprotection. Here, we explored whether the timing of NIr intervention—either before, at the same time or after the MPTP insult—was important. Mice received MPTP injections (total of 50 mg/kg) and, at various stages in relation to these injections, extracranial application of NIr. Locomotor activity was tested with an open-field test, and brains were processed for immunohistochemistry. Our results showed that regardless of when NIr was applied in relation to MPTP insult, behavioural impairment was reduced by a similar magnitude. The beneficial effect of NIr was fast-acting (within minutes) and long-lasting (for several days). There were more dopaminergic cells in the NIr-treated MPTP groups than in the MPTP group; there was no clear indication that a particular combination of NIr treatment and MPTP injection resulted in a higher cell number. In summary, irrespective of whether it was applied before, at the same time as or after MPTP insult, NIr reduced both behavioural and structural measures of damage by a similar magnitude. There was a broad therapeutic time window of NIr application in relation to the stage of toxic insult, and the NIr was fast-acting and long-lasting.

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Automatic adjustments toward unseen visual targets during grasping movements

Abstract

We investigated whether control of hand movements can be driven by visual information that is not consciously perceived. Subjects performed reach-to-grasp movements toward 2D virtual objects that were projected onto a rigid surface. On perturbed trials, the target object was briefly presented at a different orientation (±20° rotation) or different size (±20 % scaling) during movement. The perturbed objects were presented for 33 ms, followed by a 200-ms mask and reappearance of the original target object. Subjects perceived only the mask and were not aware of the preceding perturbed stimuli. Unperturbed trials were identical except that there was no change in the target object before the mask. Despite being unaware of the brief perturbed stimuli, subjects showed corrective adjustments to their movements: rotation of the grip axis in response to orientation perturbations, and scaling of grip aperture in response to size perturbations. Responses were detectable 250–300 ms after the perturbation onset and began to reduce 250–300 ms after the reappearance of the original target. Our results demonstrate that the visuomotor system can utilize visual information for control of grasping even when this information is not available for conscious perception. We suggest that this dissociation is due to different temporal resolution of visual processing mechanisms underlying conscious perception and control of actions.

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Cognitive costs of motor planning do not differ between pointing and grasping in a sequential task

Abstract

Neurophysiologic studies have shown differences in brain activation between pointing and grasping movements. We asked whether these two movement types would differ in their cognitive costs of motor planning. To this end, we designed a sequential, continuous posture selection task, suitable to investigate pointing and grasping movements to identical target locations. Participants had to open a column of drawers or point to a column of targets in ascending and descending progression. The global hand pro/supination at the moment of drawer/target contact was measured. The size of the motor hysteresis effect, i.e., the persistence to a former posture, was used as a proxy for the cognitive cost of motor planning. A larger hysteresis effect equals higher cognitive cost. Both motor tasks had similar costs of motor planning, but a larger range of motion was found for the grasping movements.

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Prior knowledge of spatiotemporal configuration facilitates crossmodal saccadic response

Abstract

Saccadic reaction times from a focused-attention task with a visual target and an acoustic nontarget support the hypothesis that the amount of saccadic facilitation in the presence of a nontarget increases with the prior knowledge of alignment with the target across different blocks of trials. The time-window-of-integration model can account for the size of the effect by having window size depend on the prior knowledge of alignment. Some efforts to identify the neural correlates of the effect are discussed.

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Modality dependence and intermodal transfer in the Corsi Spatial Sequence Task: Screen vs. Floor

Abstract

Four versions of the Corsi Spatial Sequence Task (CSST) were tested in a complete within-subject design, investigating whether participants' performance depends on the modality of task presentation and reproduction that put different demands on spatial processing. Presentation of the sequence (encoding phase) and the reproduction (recall phase) were each carried out either on a computer screen or on the floor of a room, involving actual walking in the recall phase. Combinations of the two different encoding and recall procedures result in the modality conditions Screen–Screen, Screen–Floor, Floor–Screen, and Floor–Floor. Results show the expected decrease in performance with increasing sequence length, which is likely due to processing limitations of working memory. We also found differences in performance between the modality conditions indicating different involvements of spatial working memory processes. Participants performed best in the Screen–Screen modality condition. Floor–Screen and Floor–Floor modality conditions require additional working memory resources for reference frame transformation and spatial updating, respectively; the resulting impairment of the performance was about the same in these two conditions. Finally, the Screen–Floor modality condition requires both types of additional spatial demands and led to the poorest performance. Therefore, we suggest that besides the well-known spatial requirements of CSST, additional working memory resources are demanded in walking CSST supporting processes such as spatial updating, mental rotation, reference frame transformation, and the control of walking itself.

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Brain activation is related to smoothness of upper limb movements after stroke

Abstract

It is unclear whether additionally recruited sensorimotor areas in the ipsilesional and contralesional hemisphere and the cerebellum can compensate for lost neuronal functions after stroke. The objective of this study was to investigate how increased recruitment of secondary sensorimotor areas is associated with quality of motor control after stroke. In seventeen patients (three females, fourteen males; age: 59.9 ± 12.6 years), cortical activation levels were determined with functional magnetic resonance imaging (fMRI) in 12 regions of interest during a finger flexion–extension task in weeks 6 and 29 after stroke. At the same time points and by using 3D kinematics, the quality of motor control was assessed by smoothness of the grasp aperture during a reach-to-grasp task, quantified by normalized jerk. Ipsilesional premotor cortex, insula and cerebellum, as well as the contralesional supplementary motor area, insula and cerebellum, correlated significantly and positively with the normalized jerk of grasp aperture at week 6 after stroke. A positive trend towards this correlation was observed in week 29. This study suggests that recruitment of secondary motor areas at 6 weeks after stroke is highly associated with increased jerk during reaching and grasping. As jerk represents the change in acceleration, the recruitment of additional sensorimotor areas seems to reflect a type of control in which deviations from an optimal movement pattern are continuously corrected. This relationship suggests that additional recruitment of sensorimotor areas after stroke may not correspond to restitution of motor function, but more likely to adaptive motor learning strategies to compensate for motor impairments.

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La coloscopie en 2015 : de la préparation au diagnostic. Résultats de l’enquête annuelle de la Société Française d’Endoscopie Digestive

Résumé

Objectifs

Les enquêtes de la SFED, initiées en 1998 et réalisées annuellement depuis 2001, ont pour objectif de décrire les caractéristiques des patients bénéficiant d'une coloscopie, les conditions de prise en charge, le rendement diagnostique et les éventuelles complications.

Méthodes

À partir d'un questionnaire envoyé par voie électronique, la pratique de l'endoscopie est évaluée pendant cinq jours consécutifs. En 2015, certaines modalités techniques ont été intégrées comme le délai entre la préparation et l'examen coloscopique, l'évaluation du score de qualité, ainsi que les corrélations entre certains items. Les données de l'enquête ont été extrapolées sur la population totale des 2 600 gastroentérologues pratiquant des endoscopies digestives, puis sur les années d'exercice précédentes. L'enquête a été réalisée du 1^er au 7 juin 2015.

Résultats

L'enquête SFED 2015 sur l'exercice de la coloscopie en France met en évidence plusieurs points : une participation en baisse, une stabilité du nombre de coloscopies réalisées, une amélioration de la qualité des coloscopies probablement liée à une évolution de la qualité de la préparation et du matériel d'endoscopie, l'importance du diagnostic histologique ainsi que l'effet positif du dépistage et de la surveillance sur le diagnostic du cancer colorectal.

Conclusions

Les données fournies par les enquêtes de la SFED représentent un outil important dans l'évaluation de l'activité endoscopique en France et sont une image quasi unique en Europe. La baisse notable de la participation met l'accent sur la nécessité de motiver les gastroentérologues à répondre à cette enquête.

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Dispatcher gives life-saving CPR instructions for 2-year-old

BEDFORD COUNTY, Va. —  A 911 dispatcher helped save the life of a toddler after guiding a frantic father through CPR on May 29. 

Michael Miller, a Bedford County dispatcher, answered a call for a toddler pulled from a lake and not breathing.

"My first goal was to make sure that child was breathing. And when I found he wasn't breathing … I helped administer CPR over the phone," Miller told WDBJ7. 

Miller instructed the father and other bystanders to perform chest compressions on the child until he became responsive.

"The child's father said he was breathing. I was better, we all had a sigh of relief that that child was okay," Miller said. 

Miller said dispatchers can summon help as quickly as possible and they can offer live-saving information and support over the phone. 

The boy was transported to the hospital and was later released. 

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AEMT prepares for Ms. United States competition

Many EMS providers have a second or even third job. AEMT Page Glass has a unique second job as the reigning Ms. Tennessee United States.

When she was asked if she "actually works" Glass gave her Facebook fans a reality check about her work as a full-time AEMT, Ms. Tennessee responsibilities and being a mom.

We caught up with Glass as she prepares for Ms. United States competition in Las Vegas later this summer.

What inspired you to compete for Ms. Tennessee?
I have competed in pageantry for almost fifteen years. This particular pageant sparked my interest because I set a goal for myself many years ago that I would someday obtain a state title. I have tried to win a state title four other times in three different pageant systems and always came up short.

I was talking with an individual about my pageantry goal about a year ago who said, "You're a mother now so you have to set your dreams aside and be a parent to your son."

That moment stuck with me and gave me with the motivation to show everyone that you can still pursue your dreams and be a very dedicated mother. I pride myself on being dedicated to my two year old son, Sawyer.

I am also proud that I will be able to show him that you are never too old to pursue your dreams. My son was present the night I won Ms. Tennessee United States. Him running on stage after the pageant was over is a moment I will cherish forever.

AEMT Page Glass with her son after winning Ms. Tennnessee title

What is your EMS background and role?
My current role in EMS is working as an AEMT in the field. Now that I'm a mom I prefer not working 24-hour shifts, but I love working 12-hour shifts because it allows me more time at home and gives me a better opportunity to attend charity events in the community.

Glass on the job at Moore Care Ambulance

I have a Bachelor's of Science in Health Care Administration and I worked full-time in EMS while I attended school full-time. I also did an internship during my undergraduate studies with Vanderbilt LifeFlight.

Glass completed an internship with Vanderbilt LifeFlight

I was an expecting mother during my senior year of college, but still managed to graduate with cum laude honors. I am very proud of those accomplishments.

My work experience has involved management, quality control, and field staff. Being a manager was not ideal for me because I prefer to be in the midst of prehospital care, instead of managing others who are performing the duties I am passionate about.

I have a two year old son, Sawyer. My long-time boyfriend and Sawyer's father, Jacob, is a veterinarian so he is also passionate about medicine. I like to think I am a very genuine person with a "cup half full" mentality in all aspects of life.

How has your EMS experience made you a better pageant contestant?
Working in EMS allows me to encounter a lot of different types of people. I have been able to learn how to eloquently speak to many different personalities and in turn it has made me a very approachable person.

My highest scoring portion of the competition is typically interview and I attribute most of that success to the many different types of conversations I have at work on a weekly basis. EMS work has made the interview portion of the competition a very comfortable setting for me because talking with people is my job.

EMS has helped Glass be a stronger paegent contestant

EMS has also given me thick skin which has allowed me to take criticism from the judges and use it constructively to become a better competitor.

What are some misconceptions people have about pageants?
One of the biggest misconceptions people have about pageants is that we are "plastic" people who are materialistic and self-involved. In reality we are very involved in the community. I like to joke that "We have the will to save the world, but we want to try to look good while we do it!"

There are many different pageant systems, which can be confusing. The Miss USA pageant gets aired on NBC. The Miss America system involves performing a talent. There is also the Miss Earth organization

I like the Miss United States system because they help us to defy the odds. It is the only system that gives single mothers, older women, widows and divorcees an opportunity to pursue their dreams that might have been put on hold when they had the opportunity to compete in the other systems.

What are some of the duties or expectations of being Ms. Tennessee United States?
Being Ms. Tennessee involves countless hours spent in community service and appearances at local hospitals and charity events to give back to the community. Being Ms. Tennessee gives me an opportunity to be a voice for people who don't have the exposure that I do.

I like to consider myself a voice for the homeless. I take any opportunity I can to give things to the homeless, whether it is blankets to help keep warm, or sharing a case of water.

Knoxville has one of the largest homeless populations in the southeast region. We are always seeking volunteers. I work with the Hearts for Homeless campaign which feeds people who are homeless in the Knoxville community with the Knox Area Rescue Ministries. I also assisted with a black tie gala fundraiser for the Salvation Army in Knoxville.

Many EMS providers struggle to eat healthy and be physically fit. How do you stay fit enough to model and compete in pageants while working in EMS?
It's definitely a matter of balance for me. I competed in a pageant as Miss Ambulance a few years ago.

Sometimes my partner will bring donuts at the start of shift and I will have a donut. I certainly don't starve myself and I know that food is energy.

I try to eat well and I work out at least four days every week. I am naturally very athletic and I enjoy being fit. I just make eating well a priority.

I only have one shot at Ms. United States so I cannot allow lack of self-discipline to keep me from feeling prepared when I get on the stage.

I try my best to drink a gallon of water everyday so you can imagine how my partner feels when I have to request bathroom stops frequently, which has become a big joke among my co-workers who say the "water goes right through me."

How can readers learn more and support your efforts?
Readers can keep up with me on the Ms. Tennessee United States Facebook page.

I am also seeking sponsors to help with my competition expenses, approximately $4,000.00 for my travel and wardrobe. I have to pay my own way to Las Vegas and the competition has a dance, swimsuit, evening gown and interview competition.  

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Cytokine profile in adult-onset Still's disease: Comparison with systemic juvenile idiopathic arthritis

Publication date: Available online 3 June 2016
Source:Clinical Immunology
Author(s): Natsumi Inoue, Masaki Shimizu, Shinichiro Tsunoda, Mitsuhiro Kawano, Masami Matsumura, Akihiro Yachie
To compare pro-inflammatory cytokine profiles and kinetics in patients with adult-onset Still's disease (AOSD) to those in patients with systemic juvenile idiopathic arthritis (s-JIA), we analyzed serum cytokine concentrations in 33 patients with AOSD and 77 patients with s-JIA and compared them with clinical features. Patients with AOSD and s-JIA shared a common cytokine profile pattern of a significant increase in IL-18. Patients with AOSD were classified into two subgroups based on serum IL-6 and IL-18 levels. The number of patients with arthritis was significantly higher in the IL-6-dominant subgroup. The cytokine patterns associated with s-JIA and AOSD share common features, such as a significant and predominant increase in IL-18. Distinct IL-6- and IL-18-based cytokine profiles might be responsible for distinct clinical manifestations. The presence of two distinct subgroups in patients with both diseases further supports the view that s-JIA and AOSD share a disease category.



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A Healthy Female with C3 Hypocomplementemia and C3 Nephritic Factor

Publication date: Available online 2 June 2016
Source:Clinical Immunology
Author(s): Maureen Egan, Kathleen Sullivan, Ashley Frazer-Abel, Charlotte Cunningham-Rundles
We present the case of a healthy 16-year-old female with mild myalgias who was found to have a persistently decreased C3 and C3 Nephritic Factor despite the absence of characteristic findings such as renal disease or infections.



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Nichtinvasive Beatmung und Schlaf

Zusammenfassung

Hintergrund

Die nichtinvasive Beatmung (NIV) ist die Standardtherapie zur Behandlung einer nächtlichen Hypoventilation auf dem Boden einer pulmonalen oder extrapulmonalen Erkrankung. Sie verbessert nicht nur die klinische Symptomatik und die Hyperkapnie, sondern auch die Qualität und Effektivität des Schlafes. Hierzu stehen verschiedene Beatmungsmodi zur Verfügung, deren Spanne von einer Spontanatmung mit Druckunterstützung bis zur vollständig kontrollierten Beatmung reicht.

Einschätzung

Unter einer NIV kann es aber auch durch eine Patienten-Ventilator-Asynchronität oder durch eine zu hohe Leckage zu einer Beeinträchtigung nicht nur des Gasaustausches, sondern auch des Nachtschlafes kommen.

Schlussfolgerung

Daher sollte die Beatmungseinstellung bei der Einleitung einer NIV durch eine Polysomnographie oder Polygraphie überprüft werden.

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Non-24: eine unterschätzte zirkadiane Schlafstörung bei Blinden

Zusammenfassung

Die Nicht-24-Stunden-Schlaf-Wach-Störung, kurz Non-24, ist eine sehr seltene zirkadiane Rhythmusstörung. Sie kommt jedoch bei der Mehrzahl der völlig blinden Personen aufgrund der fehlenden Lichtempfindung als Zeitgeber für die Adjustierung ihres zirkadianen Schrittmachers, der inneren Uhr, vor. Bis zu 70 % der vollblinden Personen müssen damit leben, dass ihr intrinsischer zirkadianer Rhythmus nicht mit dem 24-Stunden-Tag der Umgebung synchronisiert ist. Die meisten passen sich den sozialen und beruflichen Anforderungen und damit dem regulären 24-stündigen Tag an, obwohl ihr innerer zirkadianer Rhythmus von Schlafen und Wachen nicht dem 24-Stunden-Rhythmus folgt. Schlafstörungen und exzessive Tagesschläfrigkeit sind die Folge. Da die Phasen des 24-Stunden-Tages und ihres endogenen zirkadianen Rhythmus zyklisch zum Teil parallel und dann wieder auseinanderlaufen, sind die Symptome auch zyklisch ab- und zunehmend. Klinisches Bild ist eine intermittierend ausgeprägte Schlafstörung. Diese Besonderheiten einer zyklischen Schlafstörung, verursacht durch eine Non-24-Rhythmik, sind selbst Schlafmedizinern häufig nicht bekannt. Die Diagnose von Non-24 umfasst eine ausführliche Schlafanamnese, einen spezifischen Fragebogen und ein mindestens zweiwöchiges Schlaftagebuch, möglichst mit Aktigraphie und eventuell einer Polysomnographie zur Differenzialdiagnostik. Derzeit basiert die symptomatische Behandlung einer Insomnie oft auf der Anwendung von Hypnotika oder Psychopharmaka und die der Tagesmüdigkeit auf Stimulanzien. Melatonin ist eine Behandlungsoption, in Deutschland aber nicht für die Synchronisation des Schlaf-Wach-Rhythmus zugelassen. Tasimelteon, ein Melatoninrezeptoragonist, der in der EU kürzlich speziell für Non-24 zugelassen wurde, stellt einen kausalen Therapieansatz für Non-24 bei vollblinden Patienten dar. Die Therapie mit Tasimelteon ist in der Lage, einen nicht-synchronisierten intrinsischen zirkadianen Schlaf-Wach-Rhythmus an den 24-Stunden-Tag anzupassen.

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Schlafmedizin und Beatmungsmedizin

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Percutaneous radiofrequency ablation for patients with malignant lung tumors: a phase II prospective multicenter study (JIVROSG-0702)

Abstract

Purpose

This prospective multicenter study aimed to evaluate the efficacy and safety of percutaneous radiofrequency (RF) ablation for lung cancer.

Materials and methods

From May 2008 to April 2012, 33 patients (26 men, 7 women; mean age 70.5 years) were enrolled. RF ablation was performed using an internally cooled or expandable multitined electrode. The primary endpoint was complete response (CR) determined using ¹⁸F fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) performed 6 months after RF ablation. The secondary endpoint was the incidence and grade of adverse events (AEs) evaluated using the Common Toxicity Criteria for Adverse Events, version 3.0.

Results

All patients underwent RF ablation and had efficacy analyses evaluated; however, FDG-PET/CT images before RF ablation were not available for two patients. The CR rate was 68 % (21 of 31 patients). One patient had a grade 5 AE unrelated to RF ablation. Grade ≥3 AEs occurred in 12 % of patients. During the follow-up period (median 37 months; range 1–55 months), five patients developed local tumor progression and nine (29 %) died. Overall survival at 1, 2, and 3 years was 97, 82, and 74 %, respectively.

Conclusion

Percutaneous RF ablation is a safe, feasible, and effective treatment for small malignant lung tumors.

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Lemonade for Mercy Kids

Tags: 

Children

Giving - St. Louis

Mercy Top News

Files: 

Lemonade Stand 2016

Media Contact: 

Bethany Pope

Maggie Schlesinger, Ella Schlesinger, Lily Brockmeier
and Treah Burnett worked together to raise
money for Mercy Kids.

School's out, but these youngsters are still learning and teaching important lessons.

Instead of laying around watching TV or playing video games, Maggie, Ella, Lily and Treah spent the first week of summer operating a lemonade stand. On their own, they decided to donate the proceeds to Mercy Kids child life services. They want kids who end up spending time in the hospital over the summer to be more comfortable while there.

Child Life specialists are pediatric health care professionals who work with children and families in hospitals and other settings to provide distraction and help them cope with challenges of a hospitalization, illness and disability.

"When kids go out of their way to help others, it makes a great impact on all involved," said Alberta Lee, manager of Mercy Kids Child Life Services. "We are honored they thought of us."

Show EMS Sitewide: 

Yes!

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Is there a role for the use of aviation assessment instruments in surgical training preparation? A feasibility study

Background

Selection for surgical residency programmes could potentially be improved through pretraining preparation, after assessment of surgical candidates' sensorimotor skills and personality traits. Existing aviation pilot selection instruments are available to test sensorimotor skills and personality traits. This study examined selected instruments to assess medical trainees' sensorimotor skills and personality traits.

Methods

Aviation's validated computer-based Computerized Pilot Aptitude and Screening System (COMPASS) and Checklist Professional Profile (CPP) were applied to 166 final year medical students during a surgical clerkship between 2013 and 2015.

Results

All trainees completed COMPASS and CPP within the prescribed 2 hours. Compared with an age-matched and gender-matched cohort of 165 pilot candidates, medical trainees scored significantly higher on eye-hand coordination (p<0.001), need for variation (p<0.001), empathy (p=0.006), helpfulness (p<0.001) and autonomy (p<0.001). Pilot candidates scored higher on eye-hand-foot coordination (p<0.001), spatial orientation (p<0.001), persuasiveness (p<0.001), stress tolerance (p<0.001), dominance (p<0.001), ambition (p<0.001) and resilience (p<0.001).

Conclusions

Final year medical trainees from one medical school were able to complete aviation's sensorimotor skills and personality traits selection instruments within the set time frame. They scored differently from aviation trainees on selected skills and personality traits. The applicability and utility of aviation instruments to presurgical training preparation remains to be tested.

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Evaluation of bone mineral density in patients with hemoglobin H disease

Abstract

Objectives

This study was conducted to assess bone mineral density (BMD) and bone mineral content (BMC) of patients with hemoglobin H (HbH) disease.

Methods

BMD and BMC were measured by dual energy X-ray absorptiometry of the lumbar spines and femur neck in 21 patients with Hb H disease over the age of 10 years.

An association of BMD with sex, age, hemoglobin, calcium, phosphorus, and serum ferritin level was also evaluated.

Results

Prevalence of BMD below the expected range for age in the lumbar spine and femur neck region in patients with HbH disease were 33.3 and 14.3 %, respectively. Lumbar BMD was significantly lower in the patients compared to healthy individuals (median (min-max) 0.725 (0.595–0.924) vs. 1.061 (0.645–1.238), P < 0.001)). There was no significant relationship between BMD in the lumbar and femur neck with any of the evaluated variables (P value >0.05).

Conclusion

Data regarding bone density in HbH disease is limited; osteoporosis as a common complication of β-thalassemia intermedia syndrome should be considered even in HbH which shows its prevalence is less than β-thalassemia intermedia.

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Dentistry faculty helps rebuild jaw and palate in rare procedure

A team of University of Washington surgeons, including two School of Dentistry faculty members, has rebuilt a patient's upper jaw and hard palate in one day in a rare procedure that utilized three-dimensional computerized design and implant-bone integration technology.

The post Dentistry faculty helps rebuild jaw and palate in rare procedure appeared first on UW School of Dentistry.

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A Glutathione (GSH)-Responsive Near-Infrared (NIR) Theranostic Prodrug for Cancer Therapy and Imaging

Analytical Chemistry

DOI: 10.1021/acs.analchem.6b01135

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A case report of SPG11 mutations in a Chinese ARHSP-TCC family

Autosomal recessive hereditary spastic paraplegia (ARHSP) with thin corpus callosum (TCC) is a complicated form of hereditary spastic paraplegia, characterized by progressive spastic paraplegia, weakness of th...

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New guidelines aim to improve personalized cancer care

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Erratum: Women at low risk for breast cancer recurrence can avoid chemotherapy

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US Preventive Services Task Force issues final recommendations on breast cancer screening

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Association of Community Cancer Centers announces 2016 Patient Assistance and Reimbursement Guide

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Issue Information – TOC – Masthead

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Endoskopische Vakuumtherapie beim Boerhaave-Syndrom

Zusammenfassung

Einleitung

Operative sowie auch interventionelle Therapien des Boerhaave-Syndroms beinhalten zum einen den Verschluss des Ösophagusdefektes zum anderen die Sanierung des septischen Fokus. Erste Berichte über den Einsatz der endoskopischen Vakuumtherapie (EVT) beim Boerhaave-Syndrom liegen vor. Anhand zweier Falldarstellungen wird über die Erfahrungen in der klinischen Anwendung dieses neuen chirurgischen Verfahrens berichtet. Die aktuelle Literatur zur Behandlung des Boerhaave-Syndroms mit EVT wird dargestellt.

Material und Methode

Offenporige Drainagen werden endoskopisch ösophageal entweder durch den transmuralen Defekt hindurch in die extraluminale Wundhöhle (intrakavitäre EVT) oder den Defekt überdeckend im Ösophaguslumen (intraluminale EVT) platziert. Die Anlage eines Unterdrucks an der Drainage führt zu einer aktiven nach luminal gerichteten Drainage und gleichzeitig zum Defektverschluss. Durch diese Maßnahmen kann sowohl der Perforationsdefekt als auch der septische Fokus zur Ausheilung gebracht werden. Offenporige Drainagen werden aus Drainageschläuchen und offenporigen Schäumen oder einer offenporigen Folie hergestellt.

Ergebnisse

Bei beiden Patienten wurden die im distalen Ösophagus gelegenen Perforationsdefekte mit der EVT zur kompletten Abheilung gebracht. Beim ersten Patienten war die alleinige Behandlung mit einer 8 Tage dauernden EVT ausreichend. Bei dem zweiten Patienten wurde die EVT mit einer offenen Thorakotomie zur Dekortikation eines Pleuraempyems kombiniert. Die Therapiedauer der EVT betrug 23 Tage, ein Therapiezyklus wurde mit einem offenporigen Drainageschlauch durchgeführt. Ein operativer Defektverschluss oder eine Ösophagusresektion waren bei keinem der beiden Patienten erforderlich.

In der aktuellen Literatur wird in mehreren Studien und Einzelfalldarstellungen über die EVT beim Boerhaave-Syndrom an insgesamt 13 Patienten berichtet, 11 Patienten (84 %) konnten erfolgreich behandelt werden.

Fazit

Erste klinische Erfahrungen zeigen, dass mit der EVT sowohl die Drainage des septischen Fokus als auch der Verschluss des Boerhaave-Defektes im gastroösophagealen Übergang gelingt. EVT ist eine organerhaltene endoskopische chirurgische Therapie, die eine Alternative und Ergänzung zu operativen Eingriffen darstellen kann.

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Sigmadivertikulitis

Zusammenfassung

Einleitung

Die Divertikelkrankheit ist mit einer Prävalenz von > 60 % bei den über 70-Jährigen ein relevantes Krankheitsbild in Deutschland. Kürzlich wurde erstmals eine S2k-Leitlinie mit Behandlungsempfehlungen der Divertikelkrankheit veröffentlicht. Systematische epidemiologische Daten zu den Behandlungsmodalitäten existieren nicht.

Methoden

Analyse der Behandlungsmodalitäten der Divertikelkrankheit anhand der beim Statistischen Bundesamt erhältlichen Daten.

Ergebnisse

Jährlich gibt es etwa 130.000 stationäre Fälle in Deutschland. Knapp ein Viertel wird operiert, davon etwas weniger als die Hälfte (12.000 Prozeduren) laparoskopisch. Die Komplikationsrate liegt im günstigsten Szenario bei 18 % und im ungünstigsten Szenario bei 85 %. Eine stadiengerechte Zuordnung der Behandlungsmodalität anhand der beim Statistischen Bundesamt erhältlichen Daten ist derzeit praktisch nicht möglich.

Schlussfolgerung

Zur stadiengerechten epidemiologischen Analyse der Divertikelkrankheit ist die Dokumentation der Stadien in einem standardisierten, nachvollziehbaren und auswertbaren System notwendig, das derzeit nicht existiert (z. B. ICD-10-Kodierung). Informationen zur konservativen und interventionellen Therapie sind im OPS-Kodierungssystem nicht enthalten.

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Erratum zu: 12-Jahres-Erfahrungen nach chirurgischer Versorgung von 286 paraösophagealen Hernien

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