The key role of topography in altering North Atlantic atmospheric circulation during the last glacial period

The Last Glacial Maximum (LGM; 21 000 yr before present) was a period of low atmospheric greenhouse gas concentrations, when vast ice sheets covered large parts of North America and Europe. Paleoclimate reconstructions and modeling studies suggest that the atmospheric circulation was substantially altered compared to today, both in terms of its mean state and its variability. Here we present a suite of coupled model simulations designed to investigate both the separate and combined influences of the main LGM boundary condition changes (greenhouse gases, ice sheet topography and ice sheet albedo) on the mean state and variability of the atmospheric circulation as represented by sea level pressure (SLP) and 200-hPa zonal wind in the North Atlantic sector. We find that ice sheet topography accounts for most of the simulated changes during the LGM. Greenhouse gases and ice sheet albedo affect the SLP gradient in the North Atlantic, but the overall placement of high and low pressure centers is controlled by topography. Additional analysis shows that North Atlantic sea surface temperatures and sea ice edge position do not substantially influence the pattern of the climatological-mean SLP field, SLP variability or the position of the North Atlantic jet in the LGM

Patient Perceptions of Effectiveness in Treatments for Menière's Disease: a National Survey in Italy

Objective: The aim of this study was to investigate current treatment practices and self-reported effectiveness in Menière's disease. Materials and Methods: Members of two Italian Menière's disease support (n=170) with ≥6-month history of Menière's disease were administered an online survey about recent treatments. Vertigo episode count, work absenteeism, and limitations in family life, social life,work or travel, as included in the Social Life and Work Impact of Dizziness (SWID) Questionnaire before and after recent treatments were queried. Results: Twenty-four different treatments were reported for Menière's disease, with dietary modifications (55%), diuretics (47%), and betahistine (41%) being most common. The majority (71%) received multiple simultaneous treatments. Prior to the most recent treatments 78-89% of respondents indicated limitations in family or social life, work or traveling. After their most recent treatment, respondents reported improvements in mean vertigo episode counts (5.7±7.6 vs. 2.6 ±4.6, p<0.001), days off work per month (10.1 ±9.2 vs. 4.2 ±6.7, p<0.001), and proportions indicating limitations in any functional measure assessed (p<0.05). These findings were consistent regardless of treatment approach (all p<0.05). Intratympanic gentamicin provided the greatest reductions in vertigo count, functional limitations, and work absenteeism (all p<0.01) as well as the fewest respondents reporting post-treatment functional limitations (16-37%). Conclusions: Despite numerous treatment approaches targeting different proposed pathophysiology for Menière's disease in this cross-sectional survey, all treatments are reported as effective by patients. These findings support a prominent placebo effect in Menière's disease and highlight challenges in studying treatment outcomes; there is a critical need to better understand Menière's disease

Bovine Dermal Matrix as Coverage of Facial Nerve Grafts

Introduction. Soft tissue defects over functional structures represent a challenge for the reconstructive surgeon. Often complex, reconstructive procedures are required. Occasionally, elderly or sick patients do not qualify for these extensive procedures. Case. We present the case of a 91-year-old lady with large hemifacial defect with exposed bone and nerves after tumor resection. We first performed radical resection including the fascia of the temporalis muscle and the frontal branch of the facial nerve. Due to the moribund elderly patient with a potentially high perioperative risk, we decided against flap reconstruction but to use bovine collagen/elastin matrix and split thickness skin graft. Results. No postoperative complications occurred and STSG and matrix healed uneventfully. Discussion. In selected cases, where complex reconstruction is not appropriate, this procedure can be a safe, easy, and fast alternative for covering soft tissue defects even on wound grounds containing nerve grafts

Successful Therapy for a Patient With an Infected Ascending Aortic Graft and Sternal Osteomyelitis Without Graft Removal

Objective: Following open-heart surgery, sternal osteomyelitis or infection of the graft may be a serious complication with high mortality rates. The recommended treatment of an infected graft is its explantation. Because of the poor performance status of the patient, this may not always be an option. We report a successful treatment concept without removal of the infected graft. Methods: The infected ascending aortic graft and the remaining sternum of a critically ill 60-year-old man were covered with a bilateral pectoralis muscle flap. Results: Postoperatively, the laboratory test values normalized and the patient was discharged 1 month after the intervention. One year after surgery, the patient was in good condition and the examination showed no signs of infection. Conclusion: The thus demonstrated treatment concept with insertion of well-vascularized tissues in combination with a specific antibiotic regime in our hands proved to be an additional option for the successful management of life-threatening infections of a sternal osteomyelitis in combination of an infected aortic graft

Modified triangular posterior osteosynthesis of unstable sacrum fracture

We report preliminary results for unstable sacral fractures treated with a modified posterior triangular osteosynthesis. Seven patients were admitted to our trauma center with an unstable sacral fracture. The average age was 31years (22-41). There were four vertical shear lesions of the pelvis and three transverse fracture of the upper sacrum. The vertical shear injuries were initially treated with an anterior external fixator inserted at the time of admission. Definitive surgery was performed at a mean time of 9days after trauma. The operation consisted in a posterior fixation combining a vertebropelvic distraction osteosynthesis with pedicle screws and a rod system, whereby the transverse fixation was obtained using a 6mm rod as a cross-link between the two main rods. Late displacement of the posterior pelvis or fracture was measured on X-ray films according to the criteria of Henderson. The patients were followed-up for a minimum time of 12months. Four patients who presented with a pre-operative perineal neurological impairment made a complete recovery. No iatrogenic nerve injury was reported. One case of deep infection was managed successfully with surgical debridement and local antibiotics. All patients complained of symptoms related to the prominence of the iliac screws. The metalwork was removed in all cases after healing of the fracture, at a mean time of 4.3months after surgery. No loss of reduction of fracture was seen at final radiological follow-up. The preliminary results are promising. The fixation is sufficiently stable to allow an immediate progressive weight-bearing, and safe nursing care in polytrauma cases. The only problem seems to be related to prominent heads of the distal screw

External Validation and Comparison of Prostate Cancer Risk Calculators Incorporating Multiparametric Magnetic Resonance Imaging for Prediction of Clinically Significant Prostate Cancer

PURPOSE: To externally validate recently published prostate cancer risk calculators (PCa-RCs) incorporating multiparametric magnetic resonance imaging (mpMRI) for the prediction of clinically significant prostate cancer (csPCa) and compare their performance to mpMRI-naïve PCa-RCs. MATERIAL AND METHODS: Men without previous PCa diagnosis undergoing transperineal template saturation prostate biopsy with fusion-guided targeted biopsy between 11/2014 and 03/2018 in our academic tertiary referral center were identified. Any Gleason pattern ≥4 was defined to be csPCa. Predictors (age, PSA, DRE, prostate volume, family history, previous prostate biopsy and highest region of interest according to PIRADS) were retrospectively collected. Four mpMRI-PCa-RCs and two mpMRI-naïve PCa-RCs were evaluated for their discrimination, calibration and clinical net benefit using a ROC analysis, calibration plots and a decision curve analysis, respectively. RESULTS: Out of 468 men, 193 (41%) were diagnosed with csPCa. Three mpMRI-PCa-RCs showed similar discrimination with area-underneath-the-receiver-operating-characteristic-curves (AUC) from 0.83 to 0.85, which was significantly higher than the other PCa-RCs (AUCs: 0.69-0.74). Calibration-in-the-large showed minimal deviation from the true amount of csPCa by 2% for two mpMRI-PCa-RCs, while the other PCa-RCs showed worse calibration (11-27%). A clinical net benefit could only be observed for three mpMRI-PCa-RCs at biopsy thresholds ≥15%, while none of the six investigated PCa-RCs demonstrated clinical utility against a biopsy all strategy at thresholds <15%. CONCLUSIONS: Performance of the mpMRI-PCa-RCs varies, but they generally outperform mpMRI-naïve PCa-RCs in regard to discrimination, calibration and clinical usefulness. External validation in other biopsy settings is highly encouraged

Guilt is effectively induced by a written auto-biographical essay but not reduced by experimental pain.

Introduction The aim of the present study was (1) to validate the method of guilt-induction by means of a written auto-biographical essay and (2) to test whether experimental pain is apt to alleviate the mental burden of guilt, a concept receiving support from both empirical research and clinical observation. Methods Three independent groups of healthy male participants were recruited. Group allocation was not randomized but within group pain/sham administration was counterbalanced over the two test-days. Groups were tested in the following consecutive order: Group A: guilt induction, heat-pain/sham, N = 59; Group B: guilt induction, cold-pressure-pain/sham, N = 43; Group C: emotionally neutral induction, heat-pain/sham, N = 39. Guilt was induced on both test-days in group A and B before pain/sham administration. Visual analog scale (VAS) guilt ratings immediately after pain/sham stimulation served as the primary outcome. In a control group C the identical heat-pain experiment was performed like in group A but a neutral emotional state was induced. Results A consistently strong overall effect of guilt-induction (heat-pain: p < 0.001, effect size r = 0.71; CPT-pain p < 0.001, r = 0.67) was found when compared to the control-condition (p = 0.25, r = 0.08). As expected, heat- and cold-pressure-stimuli were highly painful in all groups (p < 0.0001, r = 0.89). However, previous research supporting the hypothesis that pain is apt to reduce guilt was not replicated. Conclusion Although guilt-induction was highly effective on both test-days no impact of pain on behavioral guilt-ratings in healthy individuals could be identified. Guilt induction per se did not depend on the order of testing. The result questions previous experimental work on the impact of pain on moral emotions

Life years lost associated with mental illness: A cohort study of beneficiaries of a South African medical insurance scheme.

BACKGROUND People with mental illness have a reduced life expectancy, but the extent of the mortality gap and the contribution of natural and unnatural causes to excess mortality among people with mental illness in South Africa are unknown. METHODS We analysed reimbursement claims from South African medical insurance scheme beneficiaries aged 15-85 years. We estimated excess life years lost (LYL) associated with organic, substance use, psychotic, mood, anxiety, eating, personality, developmental or any mental disorders. RESULTS We followed 1,070,183 beneficiaries for a median of three years, of whom 282,926 (26.4 %) received mental health diagnoses. Men with a mental health diagnosis lost 3.83 life years (95 % CI 3.58-4.10) compared to men without. Women with a mental health diagnosis lost 2.19 life years (1.97-2.41) compared to women without. Excess mortality varied by sex and diagnosis, from 11.50 LYL (95 % CI 9.79-13.07) among men with alcohol use disorder to 0.87 LYL (0.40-1.43) among women with generalised anxiety disorder. Most LYL were attributable to natural causes (men: 3.42, women: 1.94). A considerable number of LYL were attributable to unnatural causes among men with bipolar (1.52) or substance use (2.45) disorder. LIMITATIONS Mental diagnoses are based on reimbursement claims. CONCLUSIONS Premature mortality among South African individuals with mental disorders is high. Our findings support interventions for the prevention, early detection, and treatment of physical comorbidities in this population. Targeted programs for suicide prevention and substance use treatment, particularly among men, can help reduce excess mortality from unnatural causes

Ethylene supports colonization of plant roots by the mutualistic fungus Piriformospora indica

The mutualistic basidiomycete Piriformospora indica colonizes roots of mono- and dicotyledonous plants, and thereby improves plant health and yield. Given the capability of P. indica to colonize a broad range of hosts, it must be anticipated that the fungus has evolved efficient strategies to overcome plant immunity and to establish a proper environment for nutrient acquisition and reproduction. Global gene expression studies in barley identified various ethylene synthesis and signaling components that were differentially regulated in P. indica-colonized roots. Based on these findings we examined the impact of ethylene in the symbiotic association. The data presented here suggest that P. indica induces ethylene synthesis in barley and Arabidopsis roots during colonization. Moreover, impaired ethylene signaling resulted in reduced root colonization, Arabidopsis mutants exhibiting constitutive ethylene signaling, -synthesis or ethylene-related defense were hyper-susceptible to P. indica. Our data suggest that ethylene signaling is required for symbiotic root colonization by P. indica