Efficacy of silver-bearing external ventricular drainage catheters: a retrospective analysis

Catheter-related infection of CSF is a potentially life-threatening complication of external ventricular drainage (EVD). When using EVD catheters, contact between the ventricular system and skin surface occurs and CSF infection is possible. The aim of this analysis was to compare the efficacy of silver-bearing EVD catheters for reducing the incidence of infection with standard nonimpregnated EVD catheters in neurosurgical patients with acute hydrocephalus.

Low levels of mannan-binding lectin or ficolins are not associated with an increased risk of cytomegalovirus disease in HIV-infected patients

Background In HIV-infected patients, prediction of Cytomegalovirus (CMV) disease remains difficult. A protective role of mannan-binding lectin (MBL) and ficolins against CMV disease has been reported after transplantation, but the impact in HIV-infected patients is unclear. Methods In a case-control study nested within the Swiss HIV Cohort Study, we investigated associations between plasma levels of MBL/ficolins and CMV disease. We compared HIV-infected patients with CMV disease (cases) to CMV-seropositive patients without CMV disease (controls) matched for CD4 T-cells, sampling time, and use of combination antiretroviral therapy. MBL and M-ficolin, L-ficolin, and H-ficolin were quantified using ELISA. Results We analysed 105 cases and 105 matched controls. CMV disease was neither associated with MBL (odds ratio [OR] 1.03 per log10 ng/mL increase (95% CI 0.73–1.45)) nor with ficolins (OR per log10 ng/mL increase 0.66 (95% CI 0.28–1.52), 2.34 (95% CI 0.44–12.36), and 0.89 (95% CI 0.26–3.03) for M-ficolin, L-ficolin, and H-ficolin, respectively). We found no evidence of a greater association between MBL and CMV disease in patients with low CD4 counts; however in the multivariable analysis, CMV disease was more likely in patients with an increased HIV RNA (OR 1.53 per log10 copies/mL; 95% CI 1.08–2.16), or a shorter duration of HIV-infection (OR 0.91 per year; 95% CI 0.84–0.98). Conclusions CMV disease is not associated with low levels of MBL/ficolins, suggesting a lack of a protective role in HIV-infected patients.

[How can the mentally ill achieve sustained employment? Supported employment versus pre-vocational training]

People with severe mental disorders are often without work, although work may have a positive effect on their health. The paper presents some results in this field from the German S3 guidelines on psychosocial therapies. In terms of evidence-based medicine supported employment (SE - first place then train) has proven to be most effective. Nevertheless, SE is still rare in Germany. Pre-vocational training, however, follows the concept first train then place and is offered in rehabilitation of the mentally ill (RPK) centres in Germany. There is some evidence that the programs are beneficial for users. The UN Convention for the Rights of Persons with Disabilities outlines an obligation for work on an equal basis with others and for vocational training. So far, the German mental health system only partly meets these requirements.

Canine neurological diseases in a referral hospital population between 1989 and 2000 in Switzerland

OBJECTIVES: To merge clinical information from partly overlapping medical record databases of the Small Animal Teaching Hospital of the Vetsuisse Faculty, University of Berne. To describe the frequencies and localisations of neurological diseases in dogs, as well as their age, gender, breed and geographical distributions. METHODS: In this retrospective study, a new database, with specific variables and a diagnosis key list 'VITAMIN D', was created and defined. A total of 4497 dogs (average of 375 per year) with a well-documented neurological disease were included in the study. A key list for the diagnoses was developed and applied to either the presumptive or the clinical and neurohistopathological diagnosis, with a serial number, a code for localisation and a code for differential diagnoses. RESULTS: Approximately 1159 dogs (26 per cent) had a neurohistopathological diagnosis confirmed, 1431 (32 per cent) had a clinical diagnosis confirmed and 1491 (33 per cent) had a presumptive diagnosis. The most frequent breeds were mixed-breed dogs (577 of 4497, 13 per cent), followed by German shepherd dogs (466 of 4497, 10 per cent). The most common localisations were the forebrain (908 of 4497, 20 per cent) and the spinal cord at the thoracolumbar area (840 of 4497, 19 per cent). Most dogs were diagnosed with degenerative diseases (38 per cent), followed by inflammatory/infectious diseases (14 per cent). The highest number of submissions originated from geographic regions around the referral hospital and from regions with higher human population densities. CLINICAL SIGNIFICANCE: By defining closed-list fields and allocating all data to the corresponding fields, a standardised database that can be used for further studies was generated. The analysis of this study gives examples of the possible uses of a standardised database.

[The incidence of Dicrocoelium dendriticum in Emmental]

A cross-sectional field study on the prevalence of Dicrocoelium dendriticum was performed in the Emmental. The study included 211 bovines, 170 equines, 20 ovines, 46 caprines and 23 rabbits (from 119 farms). In addition, laboratory routine diagnostic data obtained from 2.840 animals--all originating from the same area of investigation--were assessed in the same way. The infection extent concerning the different animal species were the following: bovines 46%, equines 12%, ovines 30%, caprines 48% and rabbits 9%. Univariate analyses of baseline epidemiological data identified no significant risk factors, with the exception of the type of stable used. Bovines kept in a modern free ranging stable had a significantly lower chance of infection with D. dendriticum than cattle in conventional tie stalls. The epidemiological data characterizing the area of investigation suggest the following procedure to reduce the problem of dicrocoeliosis: Pasturing animals of all ages should be regularly dewormed (e.g. every six week during pasture) using a compound effective against D. dendriticum. A treatment is especially indicated at the time after pasture in autumn or before housing the animals in winter. In spring, only animals having pastured the year before need to be treated prior to pasture in the new year. However, it is recommended to perform an economic analysis comparing costs of treatment versus putative costs of damage prior to the initiation of a strategic campaign: animal welfare aspects have to be considered. The laboratory routine diagnostic data showed infection extent similar to those of the cross-sectional study: bovines 60%, equines 24%, ovines 26%, caprines 31%, rabbits 32%. Atypical hosts such as dogs and cats exhibited low infection extent (3% and 1%, respectively), rather reflecting a gastro-intestinal passage of parasite eggs ingested by consumption of infected livers or by coprophagy of ruminant faeces.

Vascular remodeling and antitumoral effects of mTOR inhibition in a rat model of hepatocellular carcinoma

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is amenable to only few treatments. Inhibitors of the kinase mTOR are a new class of immunosuppressors already in use after liver transplantation. Their antiproliferative and antiangiogenic properties suggest that these drugs could be considered to treat HCC. We investigated the antitumoral effects of mTOR inhibition in a HCC model. METHODS: Hepatoma cells were implanted into livers of syngeneic rats. Animals were treated with the mTOR inhibitor sirolimus for 4 weeks. Tumor growth was monitored by MR imaging. Antiangiogenic effects were assessed in vivo by microvessel density and corrosion casts and in vitro by cell proliferation, tube formation and aortic ring assays. RESULTS: Treated rats had significantly longer survival and developed smaller tumors, fewer extrahepatic metastases and less ascites than controls. Sirolimus decreased intratumoral microvessel density resulting in extensive necrosis. Endothelial cell proliferation was inhibited at lower drug concentrations than hepatoma cells. Tube formation and vascular sprouting of aortic rings were significantly impaired by mTOR inhibition. Casts revealed that in tumors treated with sirolimus vascular sprouting was absent, whereas intussusception was observed. CONCLUSIONS: mTOR inhibition significantly reduces HCC growth and improves survival primarily via antiangiogenic effects. Inhibitors of mTOR may have a role in HCC treatment.

Basistests Suisse Sport Test Konzept: Validierung einer sportmotorischen Basistestbatterie für den Schul- und Nachwuchssport

Physical fitness can be evaluated in competitive and school sports with different field tests under different conditions and goals. To produce valid results, a field test must be practical and reach high standards of test criteria (objectivity, reliability, validity). The purpose of this study was to investigate the test criteria and the practicability of a group of field tests called «SUISSE Sport Test Konzept Basis Feldtestbatterie». For 20-m sprint, ventral trunk muscle test, standing long jump, 2-kg medicine ball shot, obstacle course and cooper-test, test quality and practicability were evaluated. 221 children and adolescents from competitive sports and different school levels took part in the study. According to school level, they were divided into 3 groups (P: 7–11.5 y, S1: 11.6–15.5 y, S2: 15.6–21.8 y). Objectivity was tested for time or distance measurement in all tests as well as for error rating in obstacle test. For reliability measurement, 162 subjects performed the field tests twice within a few weeks. For validity results of standing long jump were compared with counter movement jump performance on a force plate. Correlation analysis was performed and level of significance was set for p < 0.05. For accuracy standard error was calculated. All tests achieved sufficient to excellent objectiv - ity with correlation-coefficient (r) lying between 0.85 and 0.99. Reliability was very good (r = 0.84–0.97). In cooper- and trunk test, reliability was higher for athletes than for pupils (trunk test: r = 0.95 vs. r = 0.62, cooper-test: r = 0.90 vs. r = 0.78). In those tests the reliability decreases with increasing age (cooper-test: P: r = 0.84, S1: r = 0.69, S2: r = 0.52; trunk-test: P: r = 0.69, S1: r = 0.71; S2: r = 0.39). Validity for standing long jump was good (r = 0.75–0.86). The standard error of the mean was between 4–8%, with the exception for cooper-test (athletes: 6%, pupils: 11%) and trunk test (athletes: 14%, pupils: 46%). The results show that the evaluated group of field tests is a practicable, objective and reliable tool to determine physical skills in young athletes as well as in a scholar setting over a broad age range. Most of the tests achieved the test criteria with the grades good to excellent. The lower coefficient of reliability for cooper- and trunk test by the pupils could be explained by motivational problems in this setting. For up to 20 subjects, a tester can accomplish the tests within 3 h. Finally, age-dependent grades were elaborated

A shift from oral to intravenous iron supplementation therapy is observed over time in a large swiss cohort of patients with inflammatory bowel disease

BACKGROUND In 2007, leading international experts in the field of inflammatory bowel disease (IBD) recommended intravenous (IV) iron supplements over oral (PO) ones because of superior effectiveness and better tolerance. We aimed to determine the percentage of patients with IBD undergoing iron therapy and to assess the dynamics of iron prescription habits (IV versus PO). METHODS We analyzed anonymized data on patients with Crohn's disease and ulcerative colitis extracted from the Helsana database. Helsana is a Swiss health insurance company providing coverage for 18% of the Swiss population (1.2 million individuals). RESULTS In total, 629 patients with Crohn's disease (61% female) and 398 patients with ulcerative colitis (57% female) were identified; mean observation time was 31.8 months for Crohn's disease and 31.0 months for ulcerative colitis patients. Of all patients with IBD, 27.1% were prescribed iron (21.1% in males; 31.1% in females). Patients treated with steroids, immunomodulators, and/or anti-tumor necrosis factor drugs were more frequently treated with iron supplements when compared with those not treated with any medications (35.0% versus 20.9%, odds ratio, 1.94; P < 0.001). The frequency of IV iron prescriptions increased significantly from 2006 to 2009 for both genders (males: from 2.6% to 10.1%, odds ratio = 3.84, P < 0.001; females: from 5.3% to 12.1%, odds ratio = 2.26, P = 0.002), whereas the percentage of PO iron prescriptions did not change. CONCLUSIONS Twenty-seven percent of patients with IBD were treated with iron supplements. Iron supplements administered IV were prescribed more frequently over time. These prescription habits are consistent with the implementation of guidelines on the management of iron deficiency in IBD.

L'oeuvre de Sade et le conte. Le retour refoulé de Barbe-Bleue

Cet article s’intéresse aux différentes fonctions que l’on peut attribuer aux éléments fabuleux dans les œuvres du marquis de Sade. Il s’agit en particulier d’éclaircir les liens intertextuels entre Barbe-Bleue et un conte allégorique que le marquis publie, en 1800, dans la série de ses Crimes de l’amour, sous le titre de Rodrigue ou la tour enchantée. Dans ce texte, la chambre interdite renvoie aussi à un passé criminel, mais elle ne réveille pas la mauvaise conscience et ne suscite aucun remords. Sade semble vouloir faire du conte de Barbe-Bleue le paradigme d’un refoulement manqué, la figure d’une rechute malencontreuse dans un passé archaïque et indigne d’être examiné moralement. Or, les œuvres de Sade ne peuvent plus admettre l’univers surnaturel des contes de fées, considéré comme tout aussi révolu que cette conscience morale qui s’exprime par le remords.