Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis

<p>Abstract</p> <p>Objective</p> <p>Pneumatosis intestinalis has been increasingly detected in recent years with the more frequent use of computed tomography for abdominal imaging of the intestine. The underlying causes of the gas found during radiographic studies of the bowel wall can vary widely and different hypotheses regarding its pathophysiology have been postulated. Pneumatosis intestinalis often represents a benign condition and should not be considered an argument for surgery. However, it can also require life-threatening surgery in some cases, and this can be a difficult decision in some patients.</p> <p>Methods</p> <p>The spectrum of pneumatosis intestinalis is discussed here based on various computed tomographic and surgical findings in patients who presented at our University Medical Centre in 2003-2008. We have also systematically reviewed the literature to establish the current understanding of its aetiology and pathophysiology, and the possible clinical conditions associated with pneumatosis intestinalis and their management.</p> <p>Results</p> <p>Pneumatosis intestinalis is a primary radiographic finding. After its diagnosis, its specific pathogenesis should be ascertained because the appropriate therapy is related to the underlying cause of pneumatosis intestinalis, and this is sometimes difficult to define. Surgical treatment should be considered urgent in symptomatic patients presenting with an acute abdomen, signs of ischemia, or bowel obstruction. In asymptomatic patients with otherwise inconspicuous findings, the underlying disease should be treated first, rather than urgent exploratory surgery considered. Extensive and comprehensive information on the pathophysiology and clinical findings of pneumatosis intestinalis is provided here and is incorporated into a treatment algorithm.</p> <p>Conclusions</p> <p>The information presented here allows a better understanding of the radiographic diagnosis and underlying aetiology of pneumatosis intestinalis, and may facilitate the decision-making process in this context, thus providing fast and adequate therapy to particular patients.</p

Empathy without borders? Cross-cultural heart and mind-reading in first-year medical students

Background: This cross-cultural study was designed to examine cultural differences in empathy levels of first-year medical students.Methods: A total of 257 students from the academic year 2010/11, 131 at Jimma University, Ethiopia, and 126 at the Ludwig Maximilian University, Munich, Germany, completed the Balanced Emotional Empathy Scale (BEES), the Reading the Mind in the Eyes (RME-R) test, and a  questionnaire on sociodemographic and cultural characteristics. Furthermore, we conducted a qualitative analysis of the students’ personal views on the definition of empathy and possible influencing factors. Group comparisons and correlation analyses of empathy scores were performed for the entire cohort and for the Jimma and Munich students separately. We used a regression tree analysis to identify factors influencing the BEES.Results: The male students in Jimma (39.1 ± 22.3) scored significantly higher in the BEES than those male students from Munich (27.2 ± 22.6; p = 0.0002). There was no significant difference between the female groups. We found a moderate, positive correlation between the BEES and RME-R test, i.e. between emotional and cognitive empathy, within each university. Nevertheless, the RME-R test, which shows only Caucasian eyes, appears not to be suitable for use in other cultures.Conclusions: The main findings of our study were the influence of culture, religion, specialization choice, and gender on emotional empathy (assessed with the BEES) and cognitive empathy (assessed with the RME-R test) in first-year medical students. Further research is required into the nature of empathy in worldwide medical curricula.Keywords: Balanced Emotional Empathy Scale, Cross-cultural, Empathy, Medical Student

The periodicity of phytoplankton in Lake Constance (Bodensee) in comparison to other deep lakes of central Europe

Phytoplankton periodicity has been fairly regular during the years 1979 to 1982 in Lake Constance. Algal mass growth starts with the vernal onset of stratification; Cryptophyceae and small centric diatoms are the dominant algae of the spring bloom. In June grazing by zooplankton leads to a lsquoclear-water phasersquo dominated by Cryptophyceae. Algal summer growth starts under nutrient-saturated conditions with a dominance of Cryptomonas spp. and Pandorina morum. Depletion of soluble reactive phosphorus is followed by a dominance of pennate and filamentous centric diatoms, which are replaced by Ceratium hirundinella when dissolved silicate becomes depleted. Under calm conditions there is a diverse late-summer plankton dominated by Cyanophyceae and Dinobryon spp.; more turbulent conditions and silicon resupply enable a second summer diatom growth phase in August. The autumnal development leads from a Mougeotia — desmid assemblage to a diatom plankton in late autumn and winter. Inter-lake comparison of algal seasonality includes in ascending order of P-richness Königsee, Attersee, Walensee, Lake Lucerne, Lago Maggiore, Ammersee, Lake Zürich, Lake Geneva, Lake Constance. The oligotrophic lakes have one or two annual maxima of biomass; after the vernal maximum there is a slowly developing summer depression and sometimes a second maximum in autumn. The more eutrophic lakes have an additional maximum in summer. The number of floristically determined successional stages increases with increasing eutrophy, from three in Königsee and Attersee to eight in Lake Geneva and Lake Constance

Phylogenetic placement of environmental sequences using taxonomically reliable databases helps to rigorously assess dinophyte biodiversity in Bavarian lakes (Germany).

1. Reliable determination of organisms is a prerequisite to explore their spatial and temporal occurrence and to study their evolution, ecology, and dispersal. In Europe, Bavaria (Germany) provides an excellent study system for research on the origin and diversification of freshwater organisms including dinophytes, due to the presence of extensive lake districts and ice age river valleys. Bavarian freshwater environments are ecologically diverse and range from deep nutrient‐poor mountain lakes to shallow nutrient‐rich lakes and ponds. 2. We obtained amplicon sequence data (V4 region of small subunit‐rRNA, c. 410 bp long) from environmental samples collected at 11 sites in Upper Bavaria. We found 186 operational taxonomic units (OTUs) associated with Dinophyceae that were further classified by means of a phylogenetic placement approach. 3. The maximum likelihood tree inferred from a well‐curated reference alignment comprised a systematically representative set of 251 dinophytes, covering the currently known molecular diversity and OTUs linked to type material if possible. Environmental OTUs were scattered across the reference tree, but accumulated mostly in freshwater lineages, with 79% of OTUs placed in either Apocalathium, Ceratium, or Peridinium, the most frequently encountered taxa in Bavaria based on morphology. 4. Twenty‐one Bavarian OTUs showed identical sequences to already known and vouchered accessions, two of which are linked to type material, namely Palatinus apiculatus and Theleodinium calcisporum. Particularly within Peridiniaceae, delimitation of Peridinium species was based on the intraspecific sequence variation. 5. Our approach indicates that high‐throughput sequencing of environmental samples is effective for reliable determination of dinophyte species in Bavarian lakes. We further discuss the importance of well‐curated reference databases that remain to be developed in the future

Male Attractiveness Is Influenced by UV Wavelengths in a Newt Species but Not in Its Close Relative

Background: Functional communication in the UV range has been reported in Invertebrates and all major groups of Vertebrates but Amphibians. Although perception in this wavelength range has been shown in a few species, UV signalling has not been demonstrated in this group. One reason may be that in lentic freshwater habitats, litter decomposition generates dissolved organic carbon that absorbs UV radiation and thus hinders its use for visual signalling. We tested the effect of male UV characteristics on female sexual preference in two newt species that experience contrasting levels of UV water transmission when breeding. Methodology/Principal Findings: We analysed water spectral characteristics of a sample of breeding ponds in both species. We quantified male ventral coloration and measured male attractiveness under two lighting conditions (UV present, UV absent) using a no-choice female preference design. UV transmission was higher in Lissotriton vulgaris breeding sites. Male UV patterns also differed between experimental males of the two species. We observed a first common peak around 333 nm, higher in L. vulgaris, and a second peak around 397 nm, more frequent and higher in L. helveticus. Male attractiveness was significantly reduced in L. vulgaris when UV was not available but not in L. helveticus. Male attractiveness depended on the hue of the first UV peak in L. vulgaris. Conclusion/Significance: Our study is the first report of functional UV-based communication in Amphibians. Interestingly

Rapid Enzymatic Response to Compensate UV Radiation in Copepods

Ultraviolet radiation (UVR) causes physical damage to DNA, carboxylation of proteins and peroxidation of lipids in copepod crustaceans, ubiquitous and abundant secondary producers in most aquatic ecosystems. Copepod adaptations for long duration exposures include changes in behaviour, changes in pigmentation and ultimately changes in morphology. Adaptations to short-term exposures are little studied. Here we show that short-duration exposure to UVR causes the freshwater calanoid copepod, Eudiaptomus gracilis, to rapidly activate production of enzymes that prevent widespread collateral peroxidation (glutathione S-transferase, GST), that regulate apoptosis cell death (Caspase-3, Casp-3), and that facilitate neurotransmissions (cholinesterase-ChE). None of these enzyme systems is alone sufficient, but they act in concert to reduce the stress level of the organism. The interplay among enzymatic responses provides useful information on how organisms respond to environmental stressors acting on short time scales

Etoricoxib - preemptive and postoperative analgesia (EPPA) in patients with laparotomy or thoracotomy - design and protocols

<p>Abstract</p> <p>Background and Objective</p> <p>Our objective was to report on the design and essentials of the <it>Etoricoxib </it>protocol<it>- Preemptive and Postoperative Analgesia (EPPA) </it>Trial, investigating whether preemptive analgesia with cox-2 inhibitors is more efficacious than placebo in patients who receive either laparotomy or thoracotomy.</p> <p>Design and Methods</p> <p>The study is a 2 × 2 factorial armed, double blinded, bicentric, randomised placebo-controlled trial comparing (a) etoricoxib and (b) placebo in a pre- and postoperative setting. The total observation period is 6 months. According to a power analysis, 120 patients scheduled for abdominal or thoracic surgery will randomly be allocated to either the preemptive or the postoperative treatment group. These two groups are each divided into two arms. Preemptive group patients receive etoricoxib prior to surgery and either etoricoxib again or placebo postoperatively. Postoperative group patients receive placebo prior to surgery and either placebo again or etoricoxib after surgery (2 × 2 factorial study design). The Main Outcome Measure is the cumulative use of morphine within the first 48 hours after surgery (measured by patient controlled analgesia PCA). Secondary outcome parameters include a broad range of tests including sensoric perception and genetic polymorphisms.</p> <p>Discussion</p> <p>The results of this study will provide information on the analgesic effectiveness of etoricoxib in preemptive analgesia and will give hints on possible preventive effects of persistent pain.</p> <p>Trial registration</p> <p>NCT00716833</p