Rerouting in vascular access infections using a biosynthetic vascular graft (Omniflow® II)

Background Surgical treatment of infected arteriovenous grafts (AVG) while preserving the hemodialysis access remains a challenge. Partial graft excision (PGE) directly followed by interposition grafting (IG) is an established method but is associated with a high rate of local reinfection. This retrospective study investigated the technique of rerouting using a biosynthetic vascular graft (Omniflow® II). Methods This was a retrospective analysis of all patients at a tertiary referral center undergoing surgical treatment for AVG infections using PGE and IG with the rerouting technique using Omniflow® II between January 2009 and December 2018. Follow-up data were collected until May 2021. Results Fifteen patients (53% male, median age 62 years [range 49-81]) were identified for further analysis, thereof twelve received an Omniflow® II vascular graft. Eleven patients had positive local microbial cultures, with Staphylococcus aureus being the most frequently identified pathogen (9 cases). Mortality and reoperation rates within 30 days were both 0%. Median follow-up was 32 months (range 2–101 months) with a median follow-up index of 0.92 (range 0.18–1). During follow-up a surgical intervention for reinfection was necessary in 3 patients with Omniflow® II at a median of 304 days (range 298–485 days). Conclusion Partial graft excision and direct interposition grafting using a biosynthetic Omniflow® II vascular graft is a valid treatment option in selected patients with AVG infections when total graft excision can be avoided. Using a careful rerouting technique, while preserving clinically noninfected graft sections the risk of early reinfection can be minimized and the dialysis access maintained

«Beeinträchtigte Awareness – (k)ein Problem?!» : Handlungsempfehlungen für die Ergotherapie bei Klientinnen und Klienten mit beeinträchtigter Awareness aufgrund einer erworbenen Hirnschädigung

Einleitung: Eine beeinträchtigte Awareness ist eine häufige Folge nach erworbener Hirnschädigung. Die Rehabilitation kann dadurch erheblich beeinträchtigt werden. Aktuell besteht jedoch kein Überblick zu entsprechenden Handlungsempfehlungen für die Ergotherapie. Ziel: Das Ziel der vorliegenden Bachelorarbeit ist es, Handlungsempfehlungen für die Ergotherapie bei Klientinnen und Klienten mit beeinträchtigter Awareness nach erworbener Hirnschädigung darzulegen. Methode: Mittels Literaturrecherche werden sechs Studien für das systematische Literaturreview ausgewählt. Die Hauptstudien werden anhand des Arbeitsinstruments für ein Critical Appraisal eines Forschungsartikels (AICA) zusammengefasst und kritisch gewürdigt. Die Handlungsempfehlungen der ausgewählten Hauptstudien werden dem adaptierten Occupational Therapy lntervention Process Model (OTIPM) zugeordnet. Ergebnisse: Die Ergebnisse zeigen auf, dass die Klientenzentrierung und therapeutische Beziehung für eine erfolgreiche Rehabilitation wichtig sind. In der Evaluations- und Zielsetzungsphase nimmt die klientenzentrierte Zielsetzung einen wichtigen Stellenwert ein. Für die Intervention werden insbesondere Gruppentherapien, Aktivitäten mit der just-right challenge, metakognitives Strategietraining, Videofeedback und Interventionen im häuslichen Umfeld empfohlen. In der Re-Evaluationsphase werden mögliche Assessments und ein Fragebogen zusammengetragen. Zudem nimmt die Angehörigenarbeit einen hohen Stellenwert bei der Awarenessverbesserung ein. Schlussfolgerung: Es bestehen Handlungsempfehlungen für die Ergotherapie, um Klientinnen und Klienten mit beeinträchtigter Awareness professionell zu unterstützen, welche jedoch unterschiedliche Evidenz aufweisen

Atlas : examining the wider context of assistive robotics

We examine the proposition of a stationary assistive robot arm in the kitchen. Based on a preliminary business plan and with the aim of generating engineering requirements, a multi-disciplinary project was established to examine the wider ramifications of such assistive technology in the household, in a Swiss context, in the fields of health and social wellbeing. Additionally the engineering aspects as well as the business aspects were examined. We detail both the individual methodologies used in this study, the results achieved and discuss the results in a wider context

Dextromethorphan abuse among opioid-dependent patients

Background: Among opioid-dependent patients on maintenance therapy, concomitant drug abuse is a serious problem. Dextromethorphan, an over-the-counter antitussive agent that can be purchased without prescription, is a drug with a high potential for misuse, especially when consumed in high doses.The objective of this study was to investigate possible abuse of dextromethorphan among substituted opioid-dependent patients and comparison of subjective and objective findings.Due to its ability to increase serotonin levels, opioid-dependent patients may be particularly susceptible to dextromethorphan misuse. Dextromethorphan misuse may have side effects, including psychiatric symptoms and serotonin syndrome, and may induce assault, suicide, or homicide. Methods: A total of 104 opioid-dependent patients in maintenance treatment were included in this cross-sectional study conducted in the outpatient department of the Psychiatric Hospital, University of Zurich. Study participants were divided into 2 groups based on laboratory results: dextromethorphan abusers (n = 12) and nonabusers (n = 92). The objective use and concentrations of dextromethorphan was detected using 3-month hair toxicology analysis.Statistical analysis was performed by using χ test, Student t test, Mann-Whitney U test, and Barnard exact test. Results: Dextromethorphan was abused by 12 (11.5%) patients, 11 (91.7%) of whom did not report concomitant abuse of dextromethorphan but were identified through hair analysis. In general, there were significant differences among patients abusing dextromethorphan compared with nondextromethorphan consumers in terms of trauma due to sexual maltreatment/violence, multiple traumas, or harmful use of hallucinogenic drugs. Conclusions: Further studies are necessary to examine dextromethorphan and its impact on patients with psychiatric comorbidities and psychiatric medication. According to literature, there is a significant drug interaction risk due to the impact of dextromethorphan misuse on serotonin syndrome and psychiatric symptoms. We recommend active inquiry into and testing for concomitant drug abuse among substituted opioid-dependent patients to reduce the risk of drug interactions and side effects in this especially vulnerable group of patients

A principal component meta-analysis on multiple anthropometric traits identifies novel loci for body shape

Large consortia have revealed hundreds of genetic loci associated with anthropometric traits, one trait at a time. We examined whether genetic variants affect body shape as a composite phenotype that is represented by a combination of anthropometric traits. We developed an approach that calculates averaged PCs (AvPCs) representing body shape derived from six anthropometric traits (body mass index, height, weight, waist and hip circumference, waist-to-hip ratio). The first four AvPCs explain >99% of the variability, are heritable, and associate with cardiometabolic outcomes. We performed genome-wide association analyses for each body shape composite phenotype across 65 studies and meta-analysed summary statistics. We identify six novel loci: LEMD2 and CD47 for AvPC1, RPS6KA5/C14orf159 and GANAB for AvPC3, and ARL15 and ANP32 for AvPC4. Our findings highlight the value of using multiple traits to define complex phenotypes for discovery, which are not captured by single-trait analyses, and may shed light onto new pathways

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms