Visual function in human ocular toxoplasmosis

AIM: To assess functional impairment in terms of visual acuity reduction and visual field defects in inactive ocular toxoplasmosis. METHODS: 61 patients with known ocular toxoplasmosis in a quiescent state were included in this prospective, cross-sectional study. A complete ophthalmic examination, retinal photodocumentation and standard automated perimetry (Octopus perimeter, program G2) were performed. Visual acuity was classified on the basis of the World Health Organization definition of visual impairment and blindness: normal (> or =20/25), mild (20/25 to 20/60), moderate (20/60 to 20/400) and severe (<20/400). Visual field damage was correspondingly graded as mild (mean defect <4 dB), moderate (mean defect 4-12 dB) or severe (mean defect >12 dB). RESULTS: 8 (13%) patients presented with bilateral ocular toxoplasmosis. Thus, a total of 69 eyes was evaluated. Visual field damage was encountered in 65 (94%) eyes, whereas only 28 (41%) eyes had reduced visual acuity, showing perimetric findings to be more sensitive in detecting chorioretinal damage (p<0.001). Correlation with the clinical localisation of chorioretinal scars was better for visual field (in 70% of the instances) than for visual acuity (33%). Moderate to severe functional impairment was registered in 65.2% for visual field, and in 27.5% for visual acuity. CONCLUSION: In its quiescent stage, ocular toxoplasmosis was associated with permanent visual field defects in >94% of the eyes studied. Hence, standard automated perimetry may better reflect the functional damage encountered by ocular toxoplasmosis than visual acuity.

Myofibroblasts induce ectopic activity in cardiac tissue

Focal ectopic activity in cardiac tissue is a key factor in the initiation and perpetuation of tachyarrhythmias. Because myofibroblasts as present in fibrotic remodeled myocardia and infarct scars depolarize cardiomyocytes by heterocellular electrotonic interactions via gap junctions in vitro, we investigated using strands of cultured ventricular cardiomyocytes coated with myofibroblasts, whether this interaction might give rise to depolarization-induced abnormal automaticity. Whereas uncoated cardiomyocyte strands were invariably quiescent, myofibroblasts induced synchronized spontaneous activity in a density dependent manner. Activations appeared at spatial myofibroblast densities >15.7% and involved more than 80% of the preparations at myofibroblast densities of 50%. Spontaneous activity was based on depolarization-induced automaticity as evidenced by: (1) suppression of activity by the sarcolemmal K(ATP) channel opener P-1075; (2) induction of activity in current-clamped single cardiomyocytes undergoing depolarization to potentials similar to those induced by myofibroblasts in cardiomyocyte strands; and (3) induction of spontaneous activity in cardiomyocyte strands coated with connexin 43 transfected Hela cells but not with communication deficient HeLa wild-type cells. Apart from unveiling the mechanism underlying the hallmark of monolayer cultures of cardiomyocytes, ie, spontaneous electromechanical activity, these findings open the perspective that myofibroblasts present in structurally remodeled myocardia following pressure overload and infarction might contribute to arrhythmogenesis by induction of ectopic activity.

Climate and human impact during the past 2000 years as recorded in the Lagunas de Yala, Jujuy, northwestern Argentina

210Pb, 137Cs and 14C dated sediments of two late Holocene landslide lakes in the Provincial Park Lagunas de Yala (Laguna Rodeo, Laguna Comedero, 24°06′S, 65°30′W, 2100 m asl, northwestern Argentina) reveal a high-resolution multi-proxy data set of climate change and human impact for the past ca. 2000 years. Comparison of the lake sediment data set for the 20th century (sediment mass accumulation rates MARs, pollen spectra, nutrient and charcoal fluxes) with independent dendroecological data from the catchment (fire scars, tree growth) and long regional precipitation series (from 1934 onwards) show that (1) the lake sediment data set is internally highly consistent and compares well with independent data sets, (2) the chronology of the sediment is reliable, (3) large fires (1940s, 1983/1984–1989) as documented in the local fire scar frequency are recorded in the charcoal flux to the lake sediments and coincide with low wet-season precipitation rates (e.g., 1940s, 1983/1984) and/or high interannual precipitation variability (late 1940s), and (4) the regional increase in precipitation after 1970 is recorded in an increase in the MARs (L. Rodeo from 100 to 390 mg cm−2 yr−1) and in an increase in fern spores reflecting wet vegetation. The most significant change in MARs and nutrient fluxes (Corg and P) of the past 2000 years is observed with the transition from the Inca Empire to the Spanish Conquest around 1600 AD. Compared with the pre-17th century conditions, MARs increased by a factor of ca. 5 to >8 (to 800 +130, −280 mg cm−2 yr−1), PO4 fluxes increased by a factor of 7, and Corg fluxes by a factor of 10.5 for the time between 1640 and 1930 AD. 17th to 19th century MARs and nutrient fluxes also exceed 20th century values. Excess Pb deposition as indicated by a significant increase in Pb/Zr and Pb/Rb ratios in the sediments after the 1950s coincides with a rapid expansion of the regional mining industry. Excess Pb is interpreted as atmospheric deposition and direct human impact due to Pb smelting.

[Pyelonephritis treatment in children in 2007: current literature review]

Four studies, including two being published as an abstract, have recently demonstrated the feasibility of oral treatment of pyelonephritis in children, with no increased risk of treatment failure, early urinary tract re-infection, or renal scars. To do so, the pediatrician must ensure that: (1) the patient does not appear toxic, has no vomiting; (2) there is no known severe obstructive or refluxing uropathy and (3) parents are deemed to be adherent to the treatment. If these criteria are fulfilled, the pediatrician can start an oral treatment with a 3rd generation cephalosporine for 10 to 14 days. Ambulatory follow-up is crucial, and persistance of fever after 3 days is a reason for a new outpatient visit, additional or supplementary imaging studies (renal ultrasonography) and eventually a switch to intravenous treatment.

Recurrence due to neoplastic seeding in head and neck cancer: report of two cases and review of the literature

AIMS AND BACKGROUND Tumor progression due to seeding of tumor cells after definitive treatment for squamous cell carcinomas of the head and neck is an uncommon condition that can considerably worsen the outcome of patients with head and neck cancer. METHODS AND STUDY DESIGN We report two cases of recurrence due to neoplastic seeding from oropharyngeal and oral cancer, respectively. We performed a literature review with MEDLINE as the main search engine. RESULTS Seeding was found to occur most often in tracheotomy scars and gastrostomy sites. The oral cavity, hypopharynx and oropharynx were the primary sites in most cases, and advanced tumor stage seemed to be a risk factor for seeding. Treatment options include salvage surgery, which requires thorough resections, radiotherapy when possible, and palliative management. The prognosis of such events is poor. CONCLUSION Although neoplastic seeding is a well-known phenomenon in cancer surgery, many questions remain unanswered, especially regarding preventive measures and management strategies.

Long-term perspective on wildfires in the western USA

Understanding the causes and consequences of wildfires in forests of the western United States requires integrated information about fire, climate changes, and human activity on multiple temporal scales. We use sedimentary charcoal accumulation rates to construct long-term variations in fire during the past 3,000 y in the American West and compare this record to independent fire-history data from historical records and fire scars. There has been a slight decline in burning over the past 3,000 y, with the lowest levels attained during the 20th century and during the Little Ice Age (LIA, ca. 1400-1700 CE Common Era]). Prominent peaks in forest fires occurred during the Medieval Climate Anomaly (ca. 950-1250 CE) and during the 1800s. Analysis of climate reconstructions beginning from 500 CE and population data show that temperature and drought predict changes in biomass burning up to the late 1800s CE. Since the late 1800s, human activities and the ecological effects of recent high fire activity caused a large, abrupt decline in burning similar to the LIA fire decline. Consequently, there is now a forest ``fire deficit'' in the western United States attributable to the combined effects of human activities, ecological, and climate changes. Large fires in the late 20th and 21st century fires have begun to address the fire deficit, but it is continuing to grow.

Pulsed versus continuous wave CO2 laser excisions of 100 oral fibrous hyperplasias: a randomized controlled clinical and histopathological study

BACKGROUND In experimental animal studies, pulsing the CO2 laser beam has been shown to reduce the thermal damage zone of excised oral mucosal tissue. However, there is still controversy over whether this is borne out under clinical conditions. OBJECTIVE To compare the outcome following excisional biopsies of fibrous hyperplasias using a pulsed (cf) versus a continuous wave (cw) CO2 laser mode regarding the thermal damage zone, duration of surgeries, intra- and postoperative complications, postoperative pain sensation, scarring and/or relapse during the initial 6 months. MATERIALS AND METHODS One hundred Swiss-resident patients with a fibrous hyperplasia in their buccal mucosa were randomly assigned to the cw mode (5 W) or the cf mode (140 Hz, 400 microseconds, 33 mJ, 4.62 W) group. All excisions were performed by one single oral surgeon. Postoperative pain (2 weeks) was recorded by visual analogue scale (VAS; ranging from 0 to 100). Intake of analgesics and postoperative complications were recorded in a standardized study form. The maximum width of the collateral thermal damage zone was measured (µm) in excision specimens by one pathologist. Intraoral photographs at 6-month follow-up examinations were evaluated regarding scarring (yes/no). RESULTS Median duration of the excision was 65 seconds in the cw and 81 seconds in the cf group (P = 0.13). Intraoperative bleeding occurred in 16.3% of the patients in the cw and 17.7% of the cf group. The median value of the thermal damage zone was 161(±228) μm in the cw and 152(± 105) μm in the cf group (P = 0.68). The reported postoperative complications included swelling in 19% and minor bleeding in 6% without significant differences between the two laser modes. When comparing each day separately or the combined mean VAS scores of both groups between Days 1-3, 1-7, and 1-15, there were no significant differences. However, more patients of the cw group (25%) took analgesics than patients of the cf group (9.8%) resulting in a borderline significance (P = 0.04). Scarring at the excision site was found in 50.6% of 77 patients after 6 months, and more scars were identified in cases treated with the cf mode (P = 0.03). CONCLUSIONS Excision of fibrous hyperplasias performed with a CO2 laser demonstrated a good clinical outcome and long-term predictability with a low risk of recurrence regardless of the laser mode (cf or cw) used. Scarring after 6 months was only seen in 50.6% of the cases and was slightly more frequent in the cf mode group. Based on the findings of the present study, a safety border of 1 mm appears sufficient for both laser modes especially when performing a biopsy of a suspicious soft tissue lesion to ensure a proper histopathological examination.

Muller’s phlebectomy

More than 50 years ago, the Swiss dermatologist Dr Robert Muller developed ambulatory phlebectomy, a brilliant demonstration of the major role of dermatologists in the field of phlebology. The technique is safe, reliable and cost-effective, while at the same time producing aesthetically pleasing results. Patients can usually resume normal daily activities immediately after the procedure or are off work for a few days at most. Indications for ambulatory phlebectomy include incompetent saphenous veins (except the junctions) and their tributaries, perforators, reticular veins and reticular feeder veins, large spider veins and dilated veins in other areas such as around the eyes, on the arms or on the back of the hands. The tiny skin incisions do not usually leave any scars or give rise to complications. Phlebectomy can be used alone or in combination with other procedures such as sclerotherapy, endovenous techniques and surgery.

Achieving a more realistic assessment of rockfall hazards by coupling three-dimensional process models and field-based tree-ring data

Sound knowledge of the spatial and temporal patterns of rockfalls is fundamental for the management of this very common hazard in mountain environments. Process-based, three-dimensional simulation models are nowadays capable of reproducing the spatial distribution of rockfall occurrences with reasonable accuracy through the simulation of numerous individual trajectories on highly-resolved digital terrain models. At the same time, however, simulation models typically fail to quantify the ‘real’ frequency of rockfalls (in terms of return intervals). The analysis of impact scars on trees, in contrast, yields real rockfall frequencies, but trees may not be present at the location of interest and rare trajectories may not necessarily be captured due to the limited age of forest stands. In this article, we demonstrate that the coupling of modeling with tree-ring techniques may overcome the limitations inherent to both approaches. Based on the analysis of 64 cells (40 m × 40 m) of a rockfall slope located above a 1631-m long road section in the Swiss Alps, we illustrate results from 488 rockfalls detected in 1260 trees. We illustrate that tree impact data cannot only be used (i) to reconstruct the real frequency of rockfalls for individual cells, but that they also serve (ii) the calibration of the rockfall model Rockyfor3D, as well as (iii) the transformation of simulated trajectories into real frequencies. Calibrated simulation results are in good agreement with real rockfall frequencies and exhibit significant differences in rockfall activity between the cells (zones) along the road section. Real frequencies, expressed as rock passages per meter road section, also enable quantification and direct comparison of the hazard potential between the zones. The contribution provides an approach for hazard zoning procedures that complements traditional methods with a quantification of rockfall frequencies in terms of return intervals through a systematic inclusion of impact records in trees.

The Rendez-vous technique for treatment of caesarean scar defects: a novel combined endoscopic approach.

BACKGROUND A caesarean scar defect is a late complication of caesarean birth with a wide range of prevalence between 56 and 84 % depending on which diagnostic tool and which definition is used [1]. The referred symptoms which include postmenstrual spotting and infertility are fortunately rare. Moreover, severe complications such as caesarean scar pregnancy and uterine rupture in the following pregnancy may occur. Given the increasing incidence of caesarean births, the potential morbidity associated with caesarean scars is likely to become more important. Recently, a few repair techniques were described in the literature including the hysteroscopic resection of scarred tissue or the laparoscopic repair with or without robotic assistance [2, 3]. METHODS Between June 2009 and February 2014, 21 women with caesarean scar defects were operated with the Rendez-vous technique, a minimally invasive surgery combining the laparoscopic and hysteroscopic approach. Data were retrospectively collected. The indications for this surgery included secondary infertility, previous caesarean scar pregnancy, recurrent miscarriage and postmenstrual spotting. Prior to operation, a transvaginal ultrasound was performed to examine the uterine wall defect. RESULTS The patient characteristics are provided in Table 1. In all cases, the operation was successfully completed laparoscopically. The median operation time was 125 min. One case was complicated by recurrence of the scar defect 6 weeks after the operation. No other intra- or post-operative complications were observed, and the median in-patient stay was 3 days. CONCLUSIONS The benefits of the technique include the feasibility and safety of the procedure, the "Halloween sign" (Fig. 1) which indicates the exact extent and localization of the scar defect and the immediate assessment of repair through the hysteroscopy at the end of the surgery. However, before further studies evaluate the efficacy of this method, the routine repair of caesarean scar defects cannot be recommended. A video of the technique is presented.

Animation of micro-computed tomography of bioerosion trace Entobia megastoma made by East Australian bioeroding sponge Cliona celata

Endolithic bioerosion is difficult to analyse and to describe, and it usually requires damaging of the sample material. Sponge erosion (Entobia) may be one of the most difficult to evaluate as it is simultaneously macroscopically inhomogeneous and microstructurally intricate. We studied the bioerosion traces of the two Australian sponges Cliona celata Grant, 1826 (sensu Schönberg 2000) and Cliona orientalis Thiele, 1900 with a newly available radiographic technology: high resolution X-ray micro-computed tomography (MCT). MCT allows non-destructive visualisation of live and dead structures in three dimensions and was compared to traditional microscopic methods. MCT and microscopy showed that C. celata bioerosion was more intense in the centre and branched out in the periphery. In contrast, C. orientalis produced a dense, even trace meshwork and caused an overall more intense erosion pattern than C. celata. Extended pioneering filaments were not usually found at the margins of the studied sponge erosion, but branches ended abruptly or tapered to points. Results obtained with MCT were similar in quality to observations from transparent optical spar under the dissecting microscope. Microstructures could not be resolved as well as with e.g. scanning electron microscopy (SEM). Even though sponge scars and sponge chips were easily recognisable on maximum magnification MCT images, they lacked the detail that is available from SEM. Other drawbacks of MCT involve high costs and presently limited access. Even though MCT cannot presently replace traditional techniques such as corrosion casts viewed by SEM, we obtained valuable information. Especially for the possibility to measure endolithic pore volumes, we regard MCT as a very promising tool that will continue to be optimised. A combination of different methods will produce the best results in the study of Entobia.

Phenotypic evolution in a venerid bivalve species lineage from the late Middle Miocene Central Paratethys Sea: a multi-approach morphometric analysis

A morphometric analysis was performed for the late Middle Miocene bivalve species lineage of Polititapes tricuspis (Eichwald, 1829) (Veneridae: Tapetini). Specimens from various localities grouped into two stratigraphically successive biozones, i.e. the upper Ervilia Zone and the Sarmatimactra Zone, were investigated using a multi-method approach. A Generalized Procrustes Analysis was computed for fifteen landmarks, covering characteristics of the hinge, muscle scars, and pallial line. The shell outline was separately quantified by applying the Fast Fourier Transform, which redraws the outline by fitting in a combination of trigonometric curves. Shell size was calculated as centroid size from the landmark configuration. Shell thickness, as not covered by either analysis, was additionally measured at the centroid. The analyses showed significant phenotypic differentiation between specimens from the two biozones. The bivalves become distinctly larger and thicker over geological time and develop circular shells with stronger cardinal teeth and a deeper pallial sinus. Data on the paleoenvironmental changes in the late Middle Miocene Central Paratethys Sea suggest the phenotypic shifts to be functional adaptations. The typical habitats for Polititapes changed to extensive, very shallow shores exposed to high wave action and tidal activity. Caused by the growing need for higher mechanical stability, the bivalves produced larger and thicker shells with stronger cardinal teeth. The latter are additionally shifted towards the hinge center to compensate for the lacking lateral teeth and improve stability. The deepening pallial sinus is related to a deeper burrowing habit, which is considered to impede being washed out in the new high-energy settings.

Geochemistry of Pliocene-Pleistocene volcanic sands of ODP Site 136-842

Several distinct, thin (2-7 cm), volcanic sand layers ("ashes") were recovered in the upper portions of Holes 842A and 842B. These holes were drilled 320 km west of the island of Hawaii on the outer side of the arch that surrounds the southern end of the Hawaiian chain. These layers are Pliocene to Pleistocene in age, graded, and contain fresh glass and mineral fragments (mainly olivine, plagioclase, and clinopyroxene) and tests of Pleistocene to Eocene radiolarians. The glass fragments are weakly vesicular and blocky to platy in shape. The glass and olivine fragments from individual layers have large ranges in composition (i.e, larger than expected for a single eruption). These features are inconsistent with an explosive eruption origin for the sands. The only other viable mechanism for transporting these sands hundreds of kilometers from their probable source, the Hawaiian Islands, is turbidity currents. These currents were probably related to several of the giant debris slides that were identified from Gloria sidescan images around the islands. These currents would have run over the ~500-m-high Hawaiian Arch on their way to Site 842. This indicates that the turbidity currents were at least 325 m thick. Paleomagnetic and biostratigraphic data allow the ages of the sands to be constrained and, thus, related to particular Hawaiian debris flows. These correlations were checked by comparing the compositions of the glasses from the sands with those of glasses and rocks from islands with debris flows directed toward Site 842. Good correlations were found for the 110-ka slide from Mauna Loa and the ~1.4-Ma slide from Lanai. The correlation with Kauai is poor, probably because the data base for that volcano is small. The low to moderate sulfur content of the sand glasses indicates that they were derived from moderately to strongly degassed lavas (shallow marine or subaerially erupted), which correlates well with the location of the landslide scars on the flanks of the Hawaiian volcanoes. The glass sands may have been formed by brecciation during the landslide events or spallation and granulation as lava erupted into shallow water.

Landsat derived percent vegetation cover of Israel (as of 2003)

Wildfires are part of the Mediterranean ecosystem, however, in Israel all wildfires are human caused, either intentionally or un-intentionally. In this study we aimed to develop and test a new method for mapping fire scars from MODIS imagery, to examine the temporal and spatial patterns of wildfires in Israel in the 2000s and to examine the factors controlling Israel's wildfire regime. To map the fires we used two 'off-the-shelf' MODIS fire products as our basis-the 1 km MODIS Collection 5 fire hotspots, the 500 m MCD45A1 burnt areas-and we created a new set of fire scar maps from the 250 m MOD13Q1 product. We carried out a cross comparison of the three MODIS based wildfire scar maps and evaluated them independently against the wild fire scars mapped from 30 m Landsat TM imagery. To examine the factors controlling wildfires we used GIS layers of rainfall, land use, and a Landsat-based national vegetation map. Wildfires occurred in areas where annual rainfall was above 250 mm, mostly in areas with herbaceous vegetation. Wildfire frequency was especially high in the Golan Heights and in the foothills of the Judean mountains, and a high correspondence was found between military training zones and the spatial distribution of fire scars. The use of MODIS satellite images enabled us to map wildfires at a national scale due to the high temporal resolution of the sensor. Our MOD13Q1 based mapping of fire scars adequately mapped large (>1 km**2) fires with accuracies above 80%. Such large fires account for a large proportion of all fires, and pose the greatest threats. This database can aid managers in determining wildfire risks in space and in time.

A fractional vegetation cover remote sensing product on pan-arctic scale with link to geotiff image

The paper presents first results of a pan-boreal scale land cover harmonization and classification. A methodology is presented that combines global and regional vegetation datasets to extract percentage cover information for different vegetation physiognomy and barren for the pan-arctic region within the ESA Data User Element Permafrost. Based on the legend description of each land cover product the datasets are harmonized into four LCCS (Land Cover Classification System) classifiers which are linked to the MODIS Vegetation Continuous Field (VCF) product. Harmonized land cover and Vegetation Continuous Fields products are combined to derive a best estimate of percentage cover information for trees, shrubs, herbaceous and barren areas for Russia. Future work will concentrate on the expansion of the developed methodology to the pan-arctic scale. Since the vegetation builds an isolation layer, which protects the permafrost from heat and cold temperatures, a degradation of this layer due to fire strongly influences the frozen conditions in the soil. Fire is an important disturbance factor which affects vast processes and dynamics in ecosystems (e.g. biomass, biodiversity, hydrology, etc.). Especially in North Eurasia the fire occupancy has dramatically increased in the last 50 years and has doubled in the 1990s with respect to the last five decades. A comparison of global and regional fire products has shown discrepancies between the amounts of burn scars detected by different algorithms and satellite data.