Evaluation eines multimedialen Expertensystems für Laienhelfer

One of the most important lacks in preclinical care of emergency victims is insufficient quality of Basic Life Support provided by layhelpers. Outcome of emergency patients could be significantly enhanced by improving BLS skills of the public. This work evaluated an expert system for mobile multimedia devices consisting of a decision making aid component and a direct instruction progam part. The use of the expert system significantly improved quality of BLS provided by layhelpers

Endovascular therapy of direct dural carotid cavernous fistulas - A therapy assessment study including long-term follow-up patient interviews

Purpose Endovascular embolization nowadays is a well-established treatment option for direct carotid cavernous fistulas (dCCF, Barrow Type A). There are many publications on the complication and success rates of this method. However, little is known on the patients' opinion on the treatment result after several years. We report on this issue also including the "pioneer patients" treated almost two decades ago. Methods We retrospectively reviewed the records of all patient (n = 25) with a more than 24 months follow-up interval after endovascular treatment of a dCCF at our institution from 01/1999 to 08/2018. We determined primary therapy success, complication rate, state of the fistula in the last imaging follow-up and quoted the patient's subjective perception of the long-term treatment success using a standardized interview form. Results Occlusion rate in the last imaging follow up was 96% (24/25) with a complication rate of 8% (2/25). The response rate on our interview request was 96% (24/25) with a rate of considered feedback of 84% (21/25 patients). Duration of our observation interval for the patient reported outcome was 143 months / 11 years (median, range: 35-226 m/2-18 y). Most of them (21/25,84%) felt they benefited from the treatment. Conclusions Endovascular supply of dCCF is a highly effective treatment method leading to a sustainable therapy success with long-lasting stable subjective benefit even to our "pioneer patients" treated almost two decades ago

Pseudo-subarachnoid haemorrhage due to chronic hypoxaemia: case report and review of the literature

Background: The specificity of computed tomography (CT) for subarachnoid haemorrhage (SAH) is very high. However, physicians should be aware of rare false positive findings, also referred to as "pseudo-SAH". We present an unusual case in which such a finding was caused by chronic hypoxaemia. Case presentation: A 37-year-old male patient presented with headaches. His CT-scan showed multiple confluent subarachnoid hyperattenuations, which mimicked SAH. However, the headache was chronic and had no features typical for SAH. The patient suffered from severe chronic hypoxaemia due to congenital heart failure. On CT-angiography diffuse intracranial vessel proliferation was found and laboratory results revealed a highly raised level of haematocrit, which had both probably developed as compensatory mechanisms. A combination of these findings explained the subarachnoid hyperdensities. Magnetic resonance imaging (MRI) showed no signs of SAH and visualized hypoxaemia in cerebral veins. A diagnosis of pseudo-SAH was made. The patient's symptoms were likely due to a secondary headache attributed to hypoxia and/or hypercapnia. Therapy was symptomatic. Conclusions: Severe chronic hypoxaemia should be recognised as a rare cause of pseudo-SAH. Clinical evaluation and MRI help differentiate SAH from pseudo-SAH

Focal subarachnoid haemorrhage mimicking transient ischaemic attack - do we really need MRI in the acute stage?

Background: Acute non-traumatic focal subarachnoid haemorrhage (fSAH) is a rare transient ischaemic attack (TIA)-mimic. MRI is considered to be indispensable by some authors in order to avoid misdiagnosis, and subsequent improper therapy. We therefore evaluated the role of CT and MRI in the diagnosis of fSAH patients by comparing our cases to those from the literature. Methods: From 01/2010 to 12/2012 we retrospectively identified seven patients with transient neurological episodes due to fSAH, who had received unenhanced thin-sliced multiplanar CT and subsequent MRI within 3 days on a 1.5 T scanner. MRI protocol included at least fast-field-echo (FFE), diffusion-weighted imaging (DWI), T2-weighted fluid-attenuated inversion recovery (FLAIR) and time-of-flight (TOF) MRA sequences. By using MRI as gold-standard, we re-evaluated images and data from recent publications regarding the sensitivity to detect fSAH in unenhanced CT. Results: fSAH was detected by CT and by FFE and FLAIR on MRI in all of our own cases. However, DWI and T2w-spinecho sequences revealed fSAH in 3 of 7 and 4 of 6 cases respectively. Vascular imaging was negative in all cases. FFE-MRI revealed additional multiple microbleeds and superficial siderosis in 4 of 7 patients and 5 of 7 patients respectively. Including data from recently published literature CT scans delivered positive results for fSAH in 95 of 100 cases (95%), whereas MRI was positive for fSAH in 69 of 69 cases (100%). Conclusions: Thin-sliced unenhanced CT is a valuable emergency diagnostic tool to rule out intracranial haemorrhage including fSAH in patients with acute transient neurological episodes if immediate MRI is not available. However, MRI work-up is crucial and mandatorily has to be completed within the next 24-72 hours

Early treatment of complex located pediatric low-grade gliomas using iodine-125 brachytherapy alone or in combination with microsurgery

To analyze efficacy, functional outcome, and treatment toxicity of low-dose rate I-125 brachytherapy (SBT) alone or in combination with best safe resection (in case of larger tumor volumes) as first-line treatment for pediatric low-grade gliomas (PLGGs) not suitable for complete resection. Consecutively treated (2000-2014) complex located circumscribed WHO grade I/II PLGGs were included. For small tumors (4cm in diameter) SBT alone was performed;for larger tumors best safe resection and subsequent SBT was chosen. Temporary Iodine-125 seeds were used (median reference dose: 54Gy). Treatment response was estimated with the modified MacDonald criteria. Analysis of functional outcome included ophthalmological, endocrinological and neurological evaluation. Survival was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from proportional hazards models. Toxicity was categorized according to the Common Terminology Criteria for Adverse Events. Fifty-eight patients were included treated either with SBT alone (n=39) or with SBT plus microsurgery (n=19). Five-year progression-free survival was 87%. Two patients had died due to tumor progression. Among survivors, improvement/stabilization/deterioration of functional deficits was seen in 20/14/5 patients, respectively. Complete/partial response had beneficial impact on functional scores (P=0.02). The 5-year estimated risk to receive adjuvant radiotherapy/chemotherapy was 5.2%. The overall early (delayed) toxicity rate was 8.6% (10.3%), respectively. No permanent morbidity occurred. In complex located PLGGs, early SBT alone or combined with best safe resection preserves/improves functional scores and results in tumor control rates usually achieved with complete resection. Long-term analysis is necessary for confirmation of these results

Genetic Variation and Breeding Potential of Phytate and Inorganic Phosphorus in a Maize Population

Seed P is predominantly bound in the organic compound phytate, which makes the bioavailability of P low for monogastric animals fed maize (Zea mays L.)-based diets. Decreasing phytate and increasing inorganic P (Pi, an available form of P) concentrations in maize grain would be desirable to help ameliorate environmental problems associated with high P in feces. Our objective was to investigate the potential of improving the P profile of maize grain through breeding and selection. Ninety S1 families from the BS31 population were evaluated at two locations for phytate, Pi, and other grain quality and agronomic traits. Phytate concentrations ranged from 1.98 to 2.46 g kg−1, and the broad-sense heritability (H) was relatively low (0.60). Both genetic variance and H (0.84) were much greater for Pi Few unfavorable genetic correlations were observed between either Pi or phytate and other key economic traits. Also, selection differentials of multiple trait indices indicated that the P profile of maize grain and grain yield and moisture could be improved simultaneously. Many cycles of selection will be needed, however, to reach desirable phytate and Pi concentrations, especially when selecting for multiple traits. Regardless, our results are encouraging given that the families evaluated were related S1 families and the number of families was relatively small

Hahn-Steinthal fracture: a case report

Isolated fracture of the capitellum is rare. We present clinical and radiological data on a single case of a fracture of capitellum. We came across a 31 year old woman who sustained an isolated Hahn Steinthal type of fracture. It was treated operatively by open reduction and internal fixation using mini fragment screws. The elbow was immobilized for 4 weeks. The patient regained full range of movement at 12 weeks post operatively. We reiterate that anatomical reduction and fixation is the right way to treat this injury

Quantitative Determination of Phytate and Inorganic Phosphorus for Maize Breeding

Phytate is the dominant storage form of phosphorus (P) in mature cereal and oil grains. Phosphorus bound in phytate is nutritionally unavailable to monogastric animals and thus contributes to water pollution because it is excreted in the waste. Also, phytate can chelate certain minerals and exacerbate human mineral deficiencies. Our primary objective was to develop a rapid and inexpensive method of measuring phytate and inorganic P (Pi) concentrations in maize (Zea mays L.). The procedure reported herein was derived from previously published assays and used to screen 50 inbred lines to determine its potential in a selection program. Grain yield, protein, oil, methionine, lysine, tryptophan, and kernel weight were also measured. Field repeatability values for phytate and Pi (0.78 and 0.91, respectively) suggest that our protocol can be used to make heritable measurements on both traits. Phytate measurements taken with the procedure reported herein matched closely those obtained through ion exchange. The combination of adequate precision and simplicity make this method ideal for breeders interested in improving Pi and phytate levels simultaneously. The positive phytate:protein correlation reported commonly was also detected in this study. A relationship between phytate and kernel weight indicates that selection for low phytate may result in larger kernels

The effect of artificial selection on phenotypic plasticity in maize

Remarkable productivity has been achieved in crop species through artificial selection and adaptation to modern agronomic practices. Whether intensive selection has changed the ability of improved cultivars to maintain high productivity across variable environments is unknown. Understanding the genetic control of phenotypic plasticity and genotype by environment (G × E) interaction will enhance crop performance predictions across diverse environments. Here we use data generated from the Genomes to Fields (G2F) Maize G × E project to assess the effect of selection on G × E variation and characterize polymorphisms associated with plasticity. Genomic regions putatively selected during modern temperate maize breeding explain less variability for yield G × E than unselected regions, indicating that improvement by breeding may have reduced G × E of modern temperate cultivars. Trends in genomic position of variants associated with stability reveal fewer genic associations and enrichment of variants 0–5000 base pairs upstream of genes, hypothetically due to control of plasticity by short-range regulatory elements