Kontinuierliches intraoperatives Neuromonitoring des Nervus facialis in der Parotischirurgie

Fragestellung: Die postoperative Gesichtslähmung stellt die häufigste Komplikation der Parotidektomie dar. Die Aufgabe des intraoperatives Neuromonitoring (IONM) ist die Senkung der Pareserate. Diese Methode hat sich aber in der Parotischirurgie nicht weiter - von einer reinen Differenzierung des Nervs vom umgebenden Gewebe - entwickelt. In anderen Anwendungsgebieten gab es in den letzten Jahrzehnten deutliche Fortschritte auf dem Gebiet des IONM. Vor allem in der Schilddrüsenchirurgie sowie der Chirurgie des Kleinhirnbrückenwinkels wurde das IONM durch die ununterbrochene Analyse der Amplituden und Latenzen in Echtzeit zum kontinuierlichen IONM (cIONM) weiter entwickelt. Die Analyse wurde entweder durch aktive kontinuierliche Reizung des Nervs oder passiv durch die Analyse des entladenden Nervenmusters ermöglicht. Das Ziel war, eine drohende Nervenverletzung frühzeitig zu erkennen umso die operativen Manöver zu modifizieren und die drohende Parese abzuwenden. Dies führte zu einer Senkung der Pareserate. Des Weiteren, bietet das cIONM eine Vorhersage bezüglich der postoperativen Nervenfunktion an. Die Einsatz und die sichere Anwendung des cIONM im Rahmen der Parotischirurgie wurden bisher nicht untersucht. Daher untersuchten wir in der vorliegenden Studie die sichere Verwendung der Saxophone-Reizelektrode am Fazialisstamm im Rahmen des cIONM. Methoden: Im Rahmen einer prospektiven, von der Ethikkommission der sächsischen Landesärztekammer genehmigten (EK-BR-53/16-1) und beim deutschen Register für klinische Studien vorab registrierten Studie (DRKS-ID: DRKS00011051, http://www.drks.de) wurde bei 40 Patienten eine Parotidektomie mit kontinuierlicher Reizung des Gesichtsnervs durch die Saxophonelektrode (System AVALANCHE XT, Dr. Langer Medical, Waldkirch) durchgeführt. Die Daten dieser 40 Operationen (cIONM-Gruppe) wurden mit den Daten von 40 Patienten mit Parotidektomie, welche mit demselben System aber ohne Verwendung der Reizelektrode nur intermittierend gereizt wurden (iIONM-Gruppe), verglichen. Alle Patienten wiesen präoperativ eine normale Funktion des Gesichtsnerven (HOUSE-BRACKMANN Grad I) auf. Ergebnisse: Die Reizpegel der cIONM-Gruppe waren im direkten Vergleich signifikant niedriger als bei der iIONM-Gruppe (p<0,0001). Die Rate der frühzeitigen Fazialisparese betrug 50 % in der cIONM und 30 % in der iIONM Gruppe. Langfristig hatten nur 2,5 % Patienten der cIONM-Gruppe und 10 % der Patienten der iIONM-Gruppe eine Fazialisparese. Es bestand kein signifikanter Unterschied weder für die frühe (p=0,11) noch langfristige (p=0,17) Fazialisparese zwischen beiden Gruppen. In der cIONM-Gruppe bestand keine Korrelation zwischen dem Reizpegel (p=0,74) oder der Stimulationsdauer (p=0,51) und einer Fazialisparese. Schlussfolgerung: Das cIONM mit der Saxophonelektrode ist bei der Parotischirurgie sicher, da dadurch nicht mehr Komplikationen entstehen. Die Pareseraten waren zwischen den verglichenen Gruppen statistisch nicht signifikant unterschiedlich. Dieser Nachweis einer sicheren Anwendung macht die zukünftige Weiterentwicklung der Methode möglich. So könnte durch Signalanalyse das Muster der drohenden Nervenverletzung erkannt werden und so – mithilfe optischer/akustischer Warnsysteme – durch Änderung des chirurgischen Vorgehens die Pareserate gesenkt werden. Anzumerken bleibt, dass das cIONM keine 100%ige Sicherheit bietet, da falsch negative Alarme und technische Artefakte unvermeidbar sind. Eine gute Planung der Operation verbunden mit akribischer Präparation ist unumgänglich

HEAD AND NECK CARCINOMA STEM CELLS. DIAGNOSTIC, PROGNOSTIC AND THERAPEUTIC TARGETS

Head and neck carcinoma arise from the mucosal lining of the upper aerodigestive tract, affecting more than half a million people worldwide each year. Although cancer tissue has many heterogeneous cells with different phenotypes, only a subset of these cancer cells proliferate extensively and have the potential to give rise to all other tumor cells. They are named carcinoma stem cells (CSC). CSCs can persist in tumors and cause relapse and metastasis by producing a new tumor. Head and neck carcinoma stem cells (HNCSC) share a common CD44+ phenotype. What drives a normal stem cell into a malignant stem cell is insufficiently understood. Many regulating pathways were analyzed, such as:Receptor Tyrosine Kinases, Sonic Hedgehog, Notch, Wnt, and Bmi1. Also, the miRNA ratio or epigenetic alteration pattern is potential subject of further studies. This would enable better therapy and survival rate in HNSCC

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Kontinuierliches intraoperatives Neuromonitoring des Nervus facialis in der Parotischirurgie

Fragestellung: Die postoperative Gesichtslähmung stellt die häufigste Komplikation der Parotidektomie dar. Die Aufgabe des intraoperatives Neuromonitoring (IONM) ist die Senkung der Pareserate. Diese Methode hat sich aber in der Parotischirurgie nicht weiter - von einer reinen Differenzierung des Nervs vom umgebenden Gewebe - entwickelt. In anderen Anwendungsgebieten gab es in den letzten Jahrzehnten deutliche Fortschritte auf dem Gebiet des IONM. Vor allem in der Schilddrüsenchirurgie sowie der Chirurgie des Kleinhirnbrückenwinkels wurde das IONM durch die ununterbrochene Analyse der Amplituden und Latenzen in Echtzeit zum kontinuierlichen IONM (cIONM) weiter entwickelt. Die Analyse wurde entweder durch aktive kontinuierliche Reizung des Nervs oder passiv durch die Analyse des entladenden Nervenmusters ermöglicht. Das Ziel war, eine drohende Nervenverletzung frühzeitig zu erkennen umso die operativen Manöver zu modifizieren und die drohende Parese abzuwenden. Dies führte zu einer Senkung der Pareserate. Des Weiteren, bietet das cIONM eine Vorhersage bezüglich der postoperativen Nervenfunktion an. Die Einsatz und die sichere Anwendung des cIONM im Rahmen der Parotischirurgie wurden bisher nicht untersucht. Daher untersuchten wir in der vorliegenden Studie die sichere Verwendung der Saxophone-Reizelektrode am Fazialisstamm im Rahmen des cIONM. Methoden: Im Rahmen einer prospektiven, von der Ethikkommission der sächsischen Landesärztekammer genehmigten (EK-BR-53/16-1) und beim deutschen Register für klinische Studien vorab registrierten Studie (DRKS-ID: DRKS00011051, http://www.drks.de) wurde bei 40 Patienten eine Parotidektomie mit kontinuierlicher Reizung des Gesichtsnervs durch die Saxophonelektrode (System AVALANCHE XT, Dr. Langer Medical, Waldkirch) durchgeführt. Die Daten dieser 40 Operationen (cIONM-Gruppe) wurden mit den Daten von 40 Patienten mit Parotidektomie, welche mit demselben System aber ohne Verwendung der Reizelektrode nur intermittierend gereizt wurden (iIONM-Gruppe), verglichen. Alle Patienten wiesen präoperativ eine normale Funktion des Gesichtsnerven (HOUSE-BRACKMANN Grad I) auf. Ergebnisse: Die Reizpegel der cIONM-Gruppe waren im direkten Vergleich signifikant niedriger als bei der iIONM-Gruppe (p<0,0001). Die Rate der frühzeitigen Fazialisparese betrug 50 % in der cIONM und 30 % in der iIONM Gruppe. Langfristig hatten nur 2,5 % Patienten der cIONM-Gruppe und 10 % der Patienten der iIONM-Gruppe eine Fazialisparese. Es bestand kein signifikanter Unterschied weder für die frühe (p=0,11) noch langfristige (p=0,17) Fazialisparese zwischen beiden Gruppen. In der cIONM-Gruppe bestand keine Korrelation zwischen dem Reizpegel (p=0,74) oder der Stimulationsdauer (p=0,51) und einer Fazialisparese. Schlussfolgerung: Das cIONM mit der Saxophonelektrode ist bei der Parotischirurgie sicher, da dadurch nicht mehr Komplikationen entstehen. Die Pareseraten waren zwischen den verglichenen Gruppen statistisch nicht signifikant unterschiedlich. Dieser Nachweis einer sicheren Anwendung macht die zukünftige Weiterentwicklung der Methode möglich. So könnte durch Signalanalyse das Muster der drohenden Nervenverletzung erkannt werden und so – mithilfe optischer/akustischer Warnsysteme – durch Änderung des chirurgischen Vorgehens die Pareserate gesenkt werden. Anzumerken bleibt, dass das cIONM keine 100%ige Sicherheit bietet, da falsch negative Alarme und technische Artefakte unvermeidbar sind. Eine gute Planung der Operation verbunden mit akribischer Präparation ist unumgänglich

Suzbijanje kukuruzove zlatice Diabrotica virgifera virgifera

Western corn rootworm (WCR) was registered for the first time in Europe near the Surčin international airport in Serbia in 1992. The spread of WCR on the territory of Serbia and its population density increased fast. The Serbian territory was entirely populated in the following few years, while major damages occurred on corn grown for two or more years in the same field. Data on damages caused to over 140,000 ha under corn until 1999 were collected by organized monitoring. After 2000 and 2003, population abundance of D.v. virgifera, as well as the number of damaged corn fields, significantly decreased due to drought and application of crop rotation. Corn rootworm has one generation per year. It overwinters in the egg stage. Under the climatic conditions of Serbia larvae hatching starts around May 15th. The highest number of larvae on root is observed around June 20th when feeding is most intensive and plants become lodged as they lose roots. First adults emerge by the end of June. Their abundance increases during July and reaches maximum by the end of the month. From the second decade of August the abundance decreases. Adults are present in the field until the first frosts. Larvae are much more harmful and significant than adults. Larvae feed on roots or into roots by boring. Roots can be entirely destroyed under heavy attack and the host plants lodged already at the end of June. Under our climatic and agrotechnical conditions, adults are sporadic pests. Adults are a threat only when sowing is done after the optimal sowing date or in case of stubble corn sowing. Crop rotation is an efficient and most widespread means of WCR control. No damage on corn grown in crop rotation has been registered in Serbia for now. In the first year of production corn does not require protection from Diabrotica virgifera virgifera LeConte larvae. Several insecticides have performed high efficacy by application at sowing and have been registered for commercial use. On the other hand, soil insecticides have never been applied on a significant area in Serbia.Kukuruzova zlatica je prvi put registrovana 1992. godine pored međunarodnog aerodroma Surčin. Širenje zlatice po teritoriji Srbije i porast gustine njene populacije je bilo brzo. Celokupna teritorija Srbije je naseljena u narednih nekoliko godina, pri čemu su se značajne štete javile na kukuruzu u ponovljenoj setvi. Sakupljeni su podaci o štetama na preko 140.000 ha kukuruza u periodu do 1999. godine. Posle 2000. i 2003. godine brojnost popualcije D.v. virgifera kao i broj oštećenih kukuruzovih polja je značajno smanjen zbog suše i masovne primene plodoreda. Kukuruzova zlatica ima jednu generaciju godišnje. Prezimljava u stadijumu jajeta. U klimatskim uslovima Srbije piljenje larvi počinje oko 15. maja. Najveći broj larvi se nalazi na korenu kukuruza oko 20. juna kada je ishrana larvi najintenzivnija. Zbog gubitka korena dolazi do poleganja biljaka. Odrasli insekti se javljaju krajem juna. Njihova brojnost raste tokom jula i dostiže maksimum krajem tog meseca. Od druge dekade avgusta brojnost imaga opada. Odrasli insekti se mogu naći u polju sve do prvih mrazeva. Larve se hrane na korenu ili se ubušuju u njega. U slučaju velikog napada koren može biti potpuno uništen i takve biljke već krajem juna poležu. U našim klimatskim i agrotehničkim uslovima odrasli insekti su sporadične štetočine. Oni mogu biti štetni u slučajevima kasnije setve ili postrne setve. Plodored je efikasan i najrasprostranjeniji način suzbijanja kukuruzove zlatice. Do sada se u Srbiji nisu javile štete na kukuruzu u plodoredu. Stoga se u kukuruzu u plodoredu ne primenjuju zaštitne mere. Više insekticida pokazuje dobre rezultate u suzbijanju kukuruzove zlatice kada se primenjuju sa setvom i imaju dozvolu za primenu u Srbiji. Međutim, zemljišni insekticidi nisu nikada do sada primenjeni na većim površinama za suzbijanje kukuruzove zlatice

Antimicrobial and antioxidative activity of various leaf extracts of Amphoricarpos vis. (Asteraceae) taxa

The antimicrobial and antioxidative activities of diethyl ether, 80% methanol and 50% acetone extracts of the leaves of three Amphoricarpos taxa: A. neumayerianus, A. autariatus ssp. autariatus and A. autariatus ssp. bertisceus (Asteraceae) from the Balkan Peninsula were investigated. The antimicrobial activity was determined by the broth microdilution assay against eight bacterial and eight fungal species. The in vitro antioxidative activity was assessed by the DPPH assay, The total phenolic and flavonoid contents were also determined. The most sensitive bacterial species were Bacillus cereus and Staphylococcus aureus. The best antibacterial potential was obtained for the methanol extract of A. neumayerianus, while the diethyl ether extract of tins species showed the lowest effect. In general, the tested extracts showed higher activity than the commercial antibiotics streptomycin and ampicillin. Also, all micromycetes were sensitive to the tested extracts. The most sensitive was Trichoderma viride. The highest and lowest antifungal effect was determined in A. a. sspo autariatus for the diethyl ether and acetone extracts, respectively. The highest total phenolic and flavonoid contents were determined in the methanol extract of A. a. autariatus. The best antioxidative activity was shown by the methanol extract of A. a. ssp. autariatus as comparing to matching extracts from the other two taxa

Does Microscope Assistance in Cold Steel Tonsillectomy Reduce the Risk of Postoperative Hemorrhage? Results of a Prospective Cohort Study

Background. Posttonsillectomy hemorrhage (PTH) is the most feared complication. Dissection near the tonsillar capsule under microscopic view (TEmic) could be assumed to decrease PTH compared to traditional tonsillectomy (TEtrad). Methods. In this study, patients were evaluated with respect to the need for surgical control (R/N: return/no return to theater (RTT): the day of surgery [0] or thereafter [1]). The findings at resection site and pain were measured. Results. 869 patients were included (183 TEmic; 686 TEtrad). PTH requiring RTT was not seen in the TEmic group on the day of surgery (R0) while PTH requiring RTT subsequently (R1) was seen in 1.1% of the cases. In the TEmic group, hemorrhages without a need for surgical control were observed in 0.6% (N0) and 3.4% (N1), respectively. The corresponding rates for TEtrad were as follows: R0, 0.3%; R1, 1.7%; N0, 0.6%; and N1, 3.6% (p>0.05). Postoperative edema and local infection at resection site were proven to be predictive of PTH (p=0.007). Conclusion. Microscope assistance in tonsillectomy did not statistically have an influence on the PTH even though there was a trend towards lower PTH rate in the TEmic group. Benefit for TEmic was observed in high-volume and long experienced surgeons

UV light-based reprocessing of flexible endoscopes without working channel in Oto-Rhino-Laryngology: an effective method?

Background!#!Reprocessing of flexible endoscopes (FEs) is often expensive, time consuming, and becomes increasingly complex, due to rising demands of hygiene. After beneficial results in reprocessing of rigid endoscopes using Impelux™ UV-C light technology, we tested the same method for reprocessing of FEs without working channel.!##!Materials and methods!#!Testing was performed on FEs without working channel after routine clinical use (transnasal flexible endoscopy). Disinfection consisted of mechanical precleaning and 60 s exposure to Impelux™ UV-C light technology. Bacterial contamination was tested on 50 FEs before and after disinfection. Further 50 FEs regarding protein residuals. The absolute effectiveness of the D60 was tested on 50 test bodies (RAMS) with a standardized contamination of 10!##!Results!#!The FEs were contaminated with a high average value of 916.7 CFU (± 1057 CFU) after clinical usage. After reprocessing, an average contamination of 2.8 CFU (± 1.6) on 14% (n = 7) of the FEs was detected consisting of non-pathogenic species, the remaining FE were sterile. After reprocessing, all FEs were protein-free (&amp;lt; 1 μg). The artificially contaminated test bodies showed no remaining bacterial contamination after disinfection, resulting in an average absolute germ reduction of about 10!##!Conclusion!#!Impelux™ UV-C light technology efficiently reduces bacterial contamination of FEs and might be useful in daily practice

Diversity of nonacosan-10-ol and n-alkanes among 12 Pinus taxa

The content of nonacosan-10-ol and n-alkanes in needle waxes of twelve Pinus taxa (Pinus halepensis, P. heldreichii, P. mugo, P. nigra ssp. nigra, P. nigra ssp. dalmatica, P. peuce, P. pinaster, P. pinea, P. ponderosa, P. strobus, P. sylvestris, and P. wallichiana) were examined. In eight Pinus taxa (except of P. halepensis, P. pinaster, P. heldreichii and P. peuce) nonacosan-10-ol contents were examined for the first time. In all examined pines C29, C27 or C25 were the main n-alkane compounds. C range was mainly 18-33. In six Pinus taxa (P. mugo, P. nigra ssp. dalmatica, P. sylvestris, P. pinea, P. strobus and P. wallichiana) CPI and ACL values were examined for the first time. In the plane of Axis 1 (PCA), P. strobus, P. mugo, and P. wallichiana were strongly separated from P. heldreichii and P. pinea. In the plane of Axis 2, P. peuce, P. strobus, and P. wallichiana as well as P. heldreichii and P. pinea diverged from other examined species. In DA P. heldreichii, P. strobus, P. peuce, and P. wallichiana diversed. CA divided sections Pinus and Pinaster from section Strobi.This is the peer-reviewed version of the article: Nikolic, B. M.; Đorđević, I.; Todosijevic, M.; Mitic, Z.; Stefanović, M. A.; Stankovic, J. M.; Bojović, S.; Tešević, V.; Marin, P. D. Diversity of Nonacosan-10-Ol and n-Alkanes among 12 Pinus Taxa. Plant Biosystems - An International Journal Dealing with all Aspects of Plant Biology 2020, 0 (0), 1–8. [https://doi.org/10.1080/11263504.2020.1857867

UV light-based decontamination: an effective and fast way for disinfection of endoscopes in otorhinolaryngology?

Background!#!Reprocessing of endoscopes becomes increasingly complex, due to rising demands of hygiene. Established methods are often expensive/time-consuming. Recent studies suggest beneficial aspects of disinfection by UV light. In this study we analyzed the efficiency of UV light disinfection of rigid otorhinolaryngological endoscopes.!##!Materials and methods!#!After mechanical pre-cleaning, the endoscopes were decontaminated for 25 s in the D25 using Impelux™ UV C light technology (UV Smart B.V., Delft, The Netherlands). First, the surface contact samples were taken from 50 used endoscopes to evaluate the bacterial load. Additionally, surface contact samples were taken from further 50 used endoscopes after reprocessing with the D25. Another 50 endoscopes were tested on protein residuals. Furthermore, the absolute effectiveness of the D25 was tested on 50 test bodies (RAMS) with a standardized contamination of 10!##!Results!#!The used endoscopes showed a high bacterial contamination with an average value of 66.908 (± 239.215) CFU. After reprocessing, only a minimal contamination on 10% (n = 5) of the endoscopes with a mean value of 0.12 CFU (± 0.39) was found, resulting in a log-5 reduction in a clinical environment. The documented bacteria were components of the normal skin flora. All tested endoscopes were practically protein-free (&amp;lt; 1 μg). Furthermore, the average absolute germ reduction of the D25 was about 10!##!Conclusion!#!The D25 UV light system seems to be an effective device for the reprocessing of rigid ORL endoscopes, and therefore, might be suitable for the usage in clinical practice on site