‘Fear not – I have no wish to deprive you of your promised trophy.’


Even so, he would not open this particular discussion with Marius.


Intep Amar of the Thousand Sons was huge in full armour, as red as freshly spilled blood and just as frightening.


‘I trust Abdemon has seen to your needs adequately on the journey?


‘Pech,’ I called, and Ingo Pech increased his pace to come alongside me.


‘I’ve been wondering the same thing,’ said Hathor Maat, appearing at Atharva’s side and scanning their desolate, empty surroundings.


Seeing Corax’s expression flicker distaste, Guilliman, ever the statesman, continued smoothly, ‘But you are also similar to me.


He rose to his feet as a suffocating fear arose in Magnus, a sensation he had not felt since...


‘There are no oceans left on Terra,’ said Stenius, ‘and yet we still tell ourselves tales of captains driven mad and ships lost without trace.’


Besides Fulgrim, he alone fully comprehended the chasm the Legion had only just skirted the edge of, and how easy it would be to slip into it, even now.


‘Lord Corax did try, but the Xeric tribesmen who made up most of the old Legion were too wild to tame.


‘There are people who would call me a traitor for speaking with you,’ Tensat said.


+My lord?+ Phosis T’kar sensed his master’s damaged presence and was instantly aware that something singular and profound had occurred. +Are you… hurt?+


Nairo heard scattered mention of the names of cities – settlements that had been brought into the dominion of the Covenant.


Similarly, the multiple requests for remote audience sent by Admiral Fenc went unanswered.


A scattering of Iocare’s Legion kin had gathered to observe the procedure, arranging themselves in loose rows around the wide banks of armourglass outside the apothecarion.


This was, after all, a warrior whom my father had selected as one of His own, had meticulously gene-crafted, and into whom had gone considerable resources in terms of training and equipment.


He directed a meaningful look at Kor Phaeron as he continued.


In many ways, they were far more diverse than the Dark Angels behind whom we walked.


A tiny bead of liquid slid down Ohna’s neck, but it was not the deep, vital red of human blood.


Among the rediscovered sons of the Emperor he was among the tallest, though not as heavily built as his guest.


The cheers of the crowd had ebbed as they got their first look at the towering forms of the Space Marines.


‘I do not know if this person is me,’ said Perturabo mildly.


‘I wished to find their Librarian, but no one can tell me where he is.


‘I like you, captain,’ said Angron, cuffing away at the blood trickling from his nose and baring the iron pegs that replaced his teeth in a feral grin.


A bolt of flickering plasma took one of Zolan’s men in the chest.


‘Tell me what happened here,’ said Magnus with a slow and measured tone.


He wanted the old warrior to do more than watch; he wanted him to see his worth, to see how his plan would overcome their old ally and open the continent to the domination of Lochos.


‘Well said, brother,’ said Holguin, just as Stenius walked up the steps to the dais.


The Lion turned them over and unsealed them, taking a second to absorb them fully.


I recognised the thing next to me as the remnants of what had surrounded me, in the dim, swirling memories that were all I had of my life before that point.


He is the Khagan, the conqueror of conquerors, and you will be his blood-kin.


‘We only knew you as the Wolf King, son of the Allfather.


‘More time accounts for only part of your skill,’ said Corax, recovering some of his good humour.


The other Legions I have served with had a stronger presence of warriors from the Throneworld.’


For a moment, I was not sure how he was going to react.


‘On this day, brothers,’ the Khan said, ‘we show them the storm.’


‘It has been said that the Lord of Ultramar sees little else besides the primacy of his own culture.


The flagship of the Blood Angels Legion was as much an object of beauty as an instrument of war.


If you will not serve this Legion and the Emperor as free men, then you shall serve me in chains.


‘That old woman, as you call her, is a respected diplomat and a member of one of the oldest noble houses of ancient Terra.


The Khan looked at her a little longer, considering whether to press the question.


Even so, the vehemence of Sirras’ tone coupled with how quietly he was speaking made Hierax uneasy.


The sheer calculation required to manually bend a Legion to one being’s command was mind-breaking: several hundred ships, a hundred and fifty thousand warriors, tens of millions of ancillaries, auxiliaries and mortal support staff, all of them scattered across scores of distant warzones.


‘I have thirty thousand Legiones Astartes here, in this system,’ said Corax.


We can throw everything into keeping the orks here, away from the Taras System.’


Many of the Destroyers wore raptor icons suspended from the belts at their waists.


‘She has been impounded by the Wrath of Caliban and nothing more has been heard of her since.


His flesh was pellucid and incandescent, an angelic form to equal anything born of Baal.


You will do what you must to preserve what we have built, even without instruction, even if…’ He trailed off, and sighed.


‘I don’t know exactly what that means, but I swear no harm will come to you while I watch over you,’ promised Forrix.


The plastered walls were painted with elaborate murals that reminded Kor Phaeron of illustrations from the oldest holy books of Colchis – depictions of the Empyrean he had studied for long years before the arrival of the Emperor and the XVII Legion.


Silence fell across the plaza, and Fulgrim felt a small thrill of pleasure.


I had not told either him or my father where I was going, or what I intended; indeed, I had deliberately been shielding my thoughts from him.


Not one of the atrocities I have committed can possibly compare to a lie of that scale.


Across the Ullanor Sector, fortresses were toppled, fleets put to the torch, tyrants cast down, glory cut from the heart of the mightiest of humanity’s foes, and every victory brought the Emperor and Horus nearer to the throneworld of the last great xenos empire.


‘You should keep a better count,’ Abdemon said, lifting his sword.


This was not how he had imagined being a member of the Legion to be.


‘There are other parties who believe your priesthood is destabilising the guilds itself,’ said Tensat.


‘Where is your captain?’ asked Mago, spurring his company on to fight their way closer.


The more of us that are found and the more time I spend with our brothers the more astounded I am by the majesty of the Emperor’s plan.


Pneumatic bombards and electric hypervelocity guns of the sort not seen on Terra since Old Night.


For a moment even Jorin’s eyesight struggled to compensate, and for a half-second it felt as if he had been hurled into the void.


The Raven Guard weren’t the only ones in the sub-system with infiltration skills.


When I was penetrating the Imperial Palace’s security, I was relying only on myself.


‘What are you?’ said Karzen, his fear pushed aside by unexpected awe.


‘There were so many people who fought for me against the overseers of Lycaeus,’ said Corax emotionlessly.


They’d signed their own death warrant: Eltan and Dercius would swarm the vehicle before it could move again, and would swiftly eliminate the occupants.


‘No man has the right to take freedom from another,’ Corax said, in the argot of Carinae.


The instinct to protect the home world was ingrained in the very being of every native of Nocturne.


The only sign of the warrior’s near death was a slight limp, but Ahriman saw a dark halo wreathing him, an effect that ancient shamans had known and feared as a death mark.


When the last of the mob went down under a hail of shells, Guilliman looked at the legionaries before him.


The walls of the crevasse shook and Numeon heard the hiss and crack of rock melting and falling below.


I am Chancellor Corynth of the Continental Government of Chalkedon-et-Byzas, and I extend to you the hospitality of the Gubernatorial Throne, and all the protections and rights thereof.’


‘I will remember that, my master,’ said Lorgar, with a quiet vehemence that set a flutter of agitation in Kor Phaeron’s chest.


‘What if it does not work as anticipated, my lord?’ said Tzurin.


The Blood Angels had housed them in a tower complex in the northeast corner of the enormous fortress.


You will swear by the Powers that you will be a defender of the Truth.


He was too wise to call the First Captain’s plan out for idiocy, but put his concern into the tone of what he said.


For many it is what binds them to you, to the Imperium.


The more I see of the Crusade, the more I see its weaknesses.


‘I come in the name of the Emperor of All Mankind, Lord of Terra and All Known Space, to welcome Byzas and all its peoples at last into the Imperium of Man.


The subaltern’s voice was frightened enough to distract Perturabo from his screeds of data.


The new constitution was written in fine handwriting on creamy paper soft as water; Nostramo’s violent nature distilled into beauty.


The chill of the ice world became the chill of the empty Palace, and the sunlight faded to the dull grey of Terra’s winter.


Ferrus could no longer even visualise him without seeing the radiance of the Emperor upon him, their father’s favoured right hand.


‘I have created an archive for you, so that your achievement may be recognised for posterity – the Library of the Primarchs.’


The sadness was hidden away again, so that Perturabo doubted he had ever seen it, and was ashamed he could impute such an emotion to so perfect a being.


If I can acquire enough, I will build a weapon of such awful potency that it will end war on Olympia forever.’


The captain sighed as a sudden fireball consumed the Thunderhawk and its escorting fighters, drenching his pale, hideously black-veined face with light.


It matters not that you dwell in the wild places, cast from civilisation into the desert like animals, for we are all nothing but tenants on the lands of the Powers.


Unlike Hierax’s wounds, which had accumulated over the length of his career, the mark of Kletos’ injury had come all at once.


He raised the Hand of Dominion, and he answered the orks with a roar of his own.


Next to Orasus were three others who had all served, at one time or another, in squads commanded by Numeon before his elevation to first captain.


One of the Luna Wolves, inspired by that vision, tried to join him then, to add his blade to his, and it took Qin Xa to hold him back.


‘But they exploit division and weakness and I find only brotherhood and courage in the soul of the First.


Besides, they would have targeted military installations, ammunition dumps and communication relays, not memorials to fallen heroes, or the statues of the First Founders.


‘Listen, father…’ Kor Phaeron winced at the use of the patriarchal title.


The magnetically pressurised jets of plasma ejected by the weapons of the Dreadwing were flames that burned many times more violently than the hottest star.


‘By your will,’ said Alajos, sending the order to his assembled paladin squad via the closed comm-link.


Such had become his skill with languages and linguistics, the Ecclesiarch needed only to spend a day in the presence of a native, or to read a handful of the texts of the faithless, to understand their idioms and beliefs, their culture and morals.


‘We should fight together again, you and I,’ Horus said to the Khan.


He understood now that the duty to protect was not limited to Nocturne.


Every decision Hereditary Governor Pandion made likely required the agreement of one or more of the families.


‘Do please try not to collapse the mountain on us, first captain,’ said Caelius.


This way, in the event that his father lost control and disappeared into the depths of the Conqueror, Khârn and the Legion would be able to find him.


‘They were not ready for you until this moment, and you were not ready for them,’ the Emperor told him.


There are different versions all over Colchis, from every converted city and tribe and pilgrimage.


He is a primarch, Armillus, and therefore the embodiment of the Emperor’s will, and his Legion are blessed to have him.’


The Gardinaal claimed they knew him, but no one knew him.


Well, in that case, I’m surprised there’s only one of you.’


‘Beneath the masquerade of the Covenant there are sects and cults still dedicated to the Powers.


The Iron Warrior was wreathed in the corrosion and dust of an unending war fought in the darkness of a far future.


I’ve had reports of local armour being deployed against the Nigris bridge-forts and of infighting amongst the fort’s defenders.’


He was not of the Two Hundred like Abdemon or the Spider, but he had fought and bled alongside humans for decades.


‘Thank you for your aid,’ I said, as I reached them.


But the apothecarion was beginning to flourish anew, under Fabius’ somewhat distracted care.


Sometimes talking to her felt like reporting to the entirety of the War Council.


I simply need to know which planet you were evacuated from, and then I can leave you in peace.’


Do I need Captain Akurduana to take every opportunity to demonstrate the frailty of my Legion as well?’


Dorn or Perturabo will tell you that a structure can only be as strong as the materials from which is it made, and yet no one seemed to apply the same logic to a society.


The road ahead would be dark, and bitter, but he would do anything to preserve the Legion.


If you have something to say to me, I would be grateful if you could say it and then leave.’


‘If Magos Tancorix can develop an inverse algorithm capable of breaking down the mathematics of these flows...’


Do you know what the Twenty-Eighth Grand Battalion did to Irex?’


Forged from pure ores, drawn from deep veins and shaped according to the traditions of the Sulpha people.


It was Kor Phaeron’s role to guide him to that conclusion.


‘Now this is something I could make use of,’ he murmured softly.


Her people were pariahs, even among the workers of Kiavahr, who were almost as oppressed.


‘The wrong way,’ argued Kora, Fabri Tal’s elder brother, who had already expressed his favour for the plan of Fan Morgai.


We endured the long aeons here when Terra was but a myth or childish dream.


You must learn to pay more attention if you are to seek the Truth.


‘What will you do?’ asked Eugon Ptolemiades, whose city Kardis was.


At that moment, hanging over Ynniu, he observed the product of his Legion’s mastery of violence.


‘They will make contact with our operatives on Volda Beta to find eyewitnesses and verify the truth of these claims, as well as getting an exact location of the sightings.’


Now I relied on others: those I’d trusted and trained, or those they had in turn trusted and trained, and so on.


‘But these are not commands, are they, truly?’ the Khan said.


To overthrow him, to replace him with a council of unknowns, or worse, a group of men the common people of Byzas hated, was to risk planet-wide upheaval.


What had once been the seabed ripped wide open, and the burning sectors of Attar tumbled into a hellish fiery chasm.


It was as if Antaeum had spat out a monster forged from fire and rock and animalistic rage.


I taught that all men and women were equal beneath the gaze of the Powers.’


But he had turned the battlefield over to Numeon, and that decision was the right one.


The Lion looked no better – his cloak hung about him in greasy tatters, and his shoulders were slumped.


He and his company had passed through the furnace, as Vulkan had done, and brought destruction to the orks at the moment the xenos had believed their victory in hand.


‘You could have told me that I worked at the same mystery as my brothers,’ said Duriel.


I pass it to you, for the Powers have spoken and declared that the message must be heard.


Even through the nightmarish storms, Perturabo – and Perturabo alone – could still see the distant star-maelstrom, its unnatural energies swirling like a whirlpool in a stagnant ocean.


‘Kor Phaeron’s elevation by my efforts in no way diminishes my achievements.’


The Imperial stated it matter-of-factly, no hint of boastfulness or exaggeration.


He waited for his brother to approach, the Lion Sword in one hand, the evidence of his kill in the other.


Where Kardis had once stood there now blazed a firestorm haemorrhaging black smoke under a dispersing nuclear cloud.


The Dark Angels fell back from the wall in stages, using the flames and debris as cover.


Here, at one of the highest points of the Vhanagir desolation, snow was more common than rain, but it was not yet the season for such bounty from the Powers.


Fragments of the chains with which Curze had bound him to the seat still hung there.


He doubted the others in the Seventh Tactical Squad felt the same trepidation he did.


‘A long time ago, you told me what you had learned of your coming to Fenris.


And yet, my brothers and I can go against the Emperor’s wishes, even when we do not intend to.


There was Ev Tenn, not four metres away, one of the few men close to his own age at the function.


He fetched the water ewer from the table and handed it to Lorgar, who drank from it as though it were a cup, downing the contents in two mouthfuls.


Within an hour of the assault’s commencement, half the city was under Imperial control.


Vharadesh stands ready to receive its true lord, Lorgar the Bearer of the Word.


Barban Falk had emerged from the fighting, dragging the bloodied, struggling form of Konrad Vargha behind him.


The reduced Twenty-Seventh Expeditionary Fleet returned to Kiavhar under Corax’s command.


That statement troubled me, but I had no more time to reflect upon it, for we had reached our destination: a dark door with local numerals scrawled on it in white paint.


It could be a small band of malcontents, or even an individual, though I admit that’s unlikely.’


They were all XVI Legion, though seemingly from many different squads.


The Emperor’s disregard for Lorgar, His contempt for the great work done in His name, provided opportunity.


It was huge, too great for any mere Space Marine to operate alone.


While Nova-Basilos was firmly under the control of the continental army, Fulgrim was not so foolish as to leave the Hereditary Governor completely unprotected.


The haste of our departure from Vesta necessitated that the bulk of my Legion and all of its mortal auxiliaries be left behind.


Guilliman and Dorn, by contrast, were masters of their own realms.


The Rout had been thorough, as ever, enacting a tactical sequence drawn up while in the warp from Galamandro, but even then the losses had been significant.


‘Make no mistake; I can do all that I have said and more.


‘I should be able to see what it is that makes them love Him.’


‘Does it really matter if I’m in one piece when you kill me?’


If she had been operating entirely from a position of rationality, she would have been nowhere near the bomb when it went off, but Phelinia was far too invested emotionally in liberty’s struggle for that.


I was using my gift again, but I would still be a tall, powerful shape in their minds.


Elver drank in knowledge unfiltered, comprehending suddenly and completely that Curze only half-believed what he said.


He exuded such a high level of threat that Elver’s teeth and bladder ached with his urge to run away.


‘They still do not have enough warriors to conquer us all,’ said Hord.


They needed overwhelming numbers to tilt the battle in their favour, and for now, Resalt had succeeded in carving out a space for her vessel.


The lava had pushed the Legion’s heavy armour together in a great hill of ruined metal.


A significant minority of Curze’s fifty ships had been resistant to the primarch’s orders.


It was hot, almost as hot as Baal had been, though he did not know whether this was from the munitions unleashed in the atmosphere, or because Ullanor had always been that way.


The colour drains from Hexx’s face, his lips speckling with the pale blue of the newly dead.


The situation was the same as it had been over Corcyra.


He had been honoured to do so, and he had found true kinship with the Iron Hands of Ferrus Manus.


‘We have been told you might have seen something remarkable, before you were evacuated,’ I said softly.


Stenius, though he masked it as well as any lord of Caliban, was assuredly one of them.


A new shadow appeared, stretching over Khârn where he crouched atop his mutilated kin.


Caelius was an observer of the bleak humour of war, while Blasius was taciturn but relentless.


Caution warred with expectation across Vaion’s aura, where a clinical calm permeated Korit’s.


The orks of the Thoas Empire had taken Machon’s head in the final stages of the campaign to purge them from the Aletho system.


I’d made it home, grabbed Sev and Seddy, and we’d run for the space port.


Fan Morgai said nothing but swallowed hard, meeting Kor Phaeron’s gaze for only a moment.


‘Until now you were no man’s servant save the Emperor in this place,’ Hasik said.


‘I thought you wanted to help,’ Lorgar said with a pout.


Azkaellon and the Khan regarded one another and both seemed satisfied with what they saw – warriors of the most strenuous breed, immaculate and uncompromising.


He was the master of the Horde of the Earth now, a commander of thousands of the finest troops ever created, a conqueror of worlds and a scourge of empires.


And we did it again, at Brujo, and Holu, and Trikaton, and Cestus Four.


But the Khan had not sent his sons blindly into battle.


However, neither could do anything about it, and so like all in Lochos, they played the parts expected of them in the great tragedy of life.


‘I do not work with fools, even pleasant ones,’ Fulgrim said.


‘The only thing that burns in Hell is the part of you that won’t let go of life: your memories, your attachments.


The 22nd Chapter was operating at the northernmost edge of the Ultramarines front.


Then Vaughn was falling as the beast was swept up by the molten rock.


But I have also seen him before those battles, and after them.


It had been much the same on Chemos before his ascension.


I barely take orders from my Father, let alone anyone else.


You speak, too, from your heart, as I am forced to do now.


They formed firing lines in the wider halls and avenues, shutting off major access ways with tanks and Dreadnoughts ordered to kill anything that moved on sight.


Vaughn was in the base, replenishing his ammunition, when Xerexenia contacted him over the vox, asking for an audience in the command centre.


Why does Regent Ikthileon not present himself, and stand here now to make account for the silence of Ninety-Three Fifteen?’


It still couldn’t touch the agility of a Xiphon, and even if it could, no mortal pilot could pull off the aerobatics that a Space Marine was capable of.


I merely punished those who had wronged, just as your false Emperor now seeks to punish me.


Spectral CT is gaining increasing clinical importance with multiple potential applications, including oncological imaging.


Spectral CT-specific image data offers multiple advantages over conventional CT image data through various post-processing algorithms, which will be highlighted in the following review.


The purpose of this review article is to provide an overview of potential useful oncologic applications of spectral CT and to highlight specific spectral CT pitfalls.


The technical background, clinical advantages of primary and follow-up spectral CT exams in oncology, and the application of appropriate spectral tools will be highlighted.


Spectral CT imaging offers multiple advantages over conventional CT imaging, particularly in the field of oncology.


The combination of virtual native and low monoenergetic images leads to improved detection and characterization of oncologic lesions.


Iodine-map images may provide a potential imaging biomarker for assessing treatment response. · The most important spectral CT reconstructions for oncology imaging are virtual unenhanced, iodine map, and virtual monochromatic reconstructions.. ·


The combination of virtual unenhanced and low monoenergetic reconstructions leads to better detection and characterization of the vascularization of solid tumors.. ·


Iodine maps can be a surrogate parameter for tumor perfusion and potentially used as a therapy monitoring parameter.. · For radiotherapy planning, the relative electron density and the effective atomic number of a tissue can be calculated.. · Sauerbeck J, Adam G, Meyer M. Onkologische Bildgebung mittels Spektral-CT.


Breast cancer is the most prevalent cancer in the female population.


Autologous tissue is often used for reconstruction after mastectomy.


The deep inferior epigastric (DIEP) flap is a favorite for breast reconstruction because it entails careful perforator dissection with less muscle destruction.


Recently, minimally invasive techniques in DIEP flap harvest have increased in popularity but their complication rate and security profile may vary from one technique to another.


The purpose of this review study is to evaluate and compare two minimally invasive surgical approaches to abdominal based free flap harvest: the transabdominal pre-peritoneal robotic assisted DIEP flap harvest and total extra-peritoneal laparoscopic DIEP flap harvest.


Perioperative management in patients suffering from systemic mastocytosis is challenging.


Most recommendations regarding anesthetic management in these patients are based on clinical reports, and there are controversies about the use of rocuronium and sugammadex.


We present a case report of a patient with systemic mastocytosis who was given sugammadex for rocuronium reversal.


Tryptase levels were monitored during the first postoperative 24 h, without evidence of elevation.


We also performed a systematic review to provide an overview of current evidence regarding the safety of using sugammadex in patients suffering from systemic mastocytosis.


The search strategy included PubMed and Google Scholar.


All studies published up to and including January 2021 concerning anesthetic management in systemic mastocytosis were included.


Of the 122 articles located, 9 articles were included: 2 reviews and 7 case reports.


Data from reviewed studies confirm that sugammadex can safely be administered in patients suffering from systemic mastocytosis.


Risk factors for a first episode of primary uveitis in horses have not been determined.


In addition, disease progression and the proportion of horses that develop recurrence following the original episode are not known.


To determine the risk factors for the development of a first episode of primary uveitis in horses in the UK and to document the proportion of cases that experience recurrence following this first episode.


Prospective case-control longitudinal study.


Horses with a first episode of primary uveitis between July 2014 and August 2018 were recruited to the study.


For each case, two controls were selected.


A questionnaire was completed for each horse and multivariable logistic regression analysis was carried out to identify associations between horse and management-level variables and the risk of uveitis.


Each case was then followed longitudinally to determine the rate of recurrence of uveitis.


Twenty-three cases and 46 controls were recruited.


Being close to a pig farm (OR 27.8, CI 1.31-592.06) and a recent history of flooding of the pasture (OR 15.43, CI 2.80-84.98) was associated with increased risk of uveitis.


Being in the same owner's possession for a longer amount of time had a protective effect (OR 0.79, CI 0.68-0.93).


Horses recovered uneventfully following treatment and showed no evidence of recurrence in 59.1% of the cases (n = 13).


In five horses (22.7%), the initial episode of uveitis could not be controlled and required surgical therapy.


Recurrence was observed in four horses (18.2%).


Recall bias from owners for some of the data.


Clinicians can use this information to identify horses with increased risk of uveitis and provide advice to the owners of these horses.


The proportion of cases that experience recurrence appears low in the UK.


Our aim was to determine the risk factors of postoperative systemic inflammatory response syndrome (SIRS) in patients with transcatheter aortic valve replacement (TAVR), identify those with a high risk of SIRS, and help reduce SIRS occurrence.


A retrospective cohort study was conducted to collect the clinical data of patients who underwent TAVR from January 2014 to December 2019 at a tertiary hospital in Zhejiang Province.


The study included 156 men and 94 women.


Patients were divided into SIRS and non-SIRS groups.


The pre-, intra-, and postoperative indices of the two groups were recorded.


The data of the two groups were compared, and univariate analysis was performed.


All statistically significant factors were assessed using binary logistic regression analysis to clarify the risk factors of SIRS after TAVR.


Overall, 30 patients developed SIRS after TAVR, with an incidence rate of 12%, an odds ratio (OR) of 0.571, and a 95% confidence interval (CI) of 0.469-0.694 (p = 0.000).


Multivariate regression analysis demonstrated that age (OR: 1.190, 95%CI: 1.073-1.319, p = 0.001) and body mass index (BMI; OR: 0.559, 95% CI: 0.447-0.698, p = 0.000) were independent risk factors for postoperative SIRS in patients with TAVR.


The incidence of SIRS after TAVR was 12%.


There was a significant correlation between SIRS and albumin, glucose, and hypertension.


The independent risk factors for SIRS after TAVR were age and BMI.


To evaluate and compare patients' oxidative stress parameters and antioxidant status with fixed orthodontic appliances during the pubertal and postpubertal growth periods.


Saliva samples of 20 pubertal (mean age: 12.94 ± 0.34 years) and 20 postpubertal (mean age: 16.34 ± 0.45 years) patients were collected just before the application of fixed orthodontic appliances (T0), 4-5 h (T1), and 7 days (T2) after the initial orthodontic activation.


Myeloperoxidase (MPO), nitric oxide (NO), 8‑hydroxydeoxyguanosine (8-OHdG) levels, and superoxide dismutase (SOD) activity in the saliva were examined.


Repeated measures analysis of variance (ANOVA), least significant difference (LSD) pairwise comparison, and independent sample t‑tests were used to analyze the differences between the time points and growth periods, respectively.


MPO levels in the saliva of patients in the pubertal period showed a significantly higher increase within the first days of treatment (T2-T1) than in patients in the postpubertal period (p < 0.05).


The SOD antioxidant enzyme activity decreased in the samples from T0 to T1 in the patients in the pubertal and postpubertal groups and returned to baseline values (T0) at T2 (p < 0.01).


No significant differences in the other biochemical parameters between groups were observed.


Comparing the pubertal and postpubertal groups, orthodontic force application with fixed orthodontic appliances did not change the final levels (on day 7) of antioxidant status or oxidative stress markers, except for MPO in saliva.


A course on sexual anamnesis based on peer teaching was developed, piloted, and evaluated at the medical school of the University of Würzburg.


The course is part of the expansion of the communication curriculum and in order to close existing gaps in medical education.


An implementation of the course in the curriculum is meant to give all students the opportunity to acquire professional skills in this area.


The course consists of knowledge transfer, interactive exercises, role plays with structured feedback, and an exchange with practitioners.


A standardized online evaluation of the course took place in regard to teaching quality, subjective learning success, and acceptance.


The voluntary course was conducted online in the summer semester of 2021 and in person in the winter semester of 2021/22.


The training of the tutors was realized in cooperation with the 'Deutsche Aidshilfe' (DAH).


The course was successfully conducted online and in person.


A total of 60 students participated in the evaluation.


More than 80% of the students rated the course as structured.


They assessed an adequate mix of knowledge transfer and practical exercises.


More than half of the students reported that they were more confident in performing sexual anamnesis after they participated in the course.


There was an open exchange among the students.


More than 90% of the students found the peer teaching by the tutors helpful.


The implementation of the course closes a relevant gap of the curriculum in Würzburg.


Sexual anamnesis will be a regular part of the curriculum starting in the winter semester 2022/23.


The concept can also be transferred to other universities.


The present study was conducted to assess the determinants of the intention to receive the COVID-19 vaccination among the Iranian population.


In this cross-sectional study, 1,056 individuals of the general population living in Hamadan County were studied from April to June 2021.


Using a proportional stratified sampling method, subjects were selected from those covered by 34 comprehensive health service centers and health bases.


Then, the subjects were selected by simple random sampling.


Data were collected by sending a questionnaire link to eligible individuals, who completed it online.


The questionnaire determined demographic data and constructs of the Theory of Planned Behavior.


1,056 subjects answered the study; women accounted for 57.9% of the respondents.


According to the findings, the majority of respondents (79.5%) reported that they would strongly agree and agree to get vaccinated against COVID-19.


Older age, male gender, occupation, underlying chronic disease, death of relatives and friends due to COVID-19, and history of influenza vaccinations were significantly related to the intention to get vaccinated against COVID-19 (P>0.05).


Also, the intention was associated with increased scores in the attitude toward the behavior, subjective norm, and perceived behavioral control.


Despite doubt about the details of the intention to receive COVID-19 vaccination, most subjects reported intending to be vaccinated against COVID-19, but the real rate of vaccination may be lower.


Vaccination intention reflects overall vaccination attitudes, subjective norms, and perceived behavioral control.


Intra-operative fractures in knee revision surgery are relatively rare and have not been well studied.


They may occur during joint exposition, removal of the prosthesis or cement, or implantation of trial or original components.


The fractures affect both the metaphyseal area and diaphysis of the tibia and femur.


Tibial fractures are slightly more common than femur fractures.


On the femur, the medial condyle is most frequently affected, followed by the femur diaphysis.


The use of non-cemented stems is associated with a greater risk of intra-operative diaphyseal fractures than that of cemented stems.


Overall, women and patients with an osteopenic bone structure have a higher risk of fractures.


It is common that fractures are diagnosed post-operatively.


In these cases, conservative therapy may be successful, depending on the stability of the prosthesis and bones.


The most common surgical fixation options are cerclages and screws, followed by stem extensions for bridging the fracture.


Plate fixation or use of strut grafts are also sensible therapy options.


Overall, intraoperative fractures have a high healing potential with stable and good joint function.


The revision rate is still 15%, which is most often caused by peri-prosthetic infection.


Motorized spiral enteroscopy (MSE) is a recent modality for diagnostic and therapeutic examination of the small bowel using a spiral-shaped overtube with an integrated electric motor attached to an endoscope.


With growing evidence of its efficacy, MSE is increasingly being used by endoscopic facilities.


We herein present an uncommon case of the detachment of the spiral overtube from the endoscope during MSE.


We performed antegrade MSE in a 75-year-old female under general anesthesia for coagulation of multiple small-bowel arteriovenous malformations and resection of a polyp detected on a previous capsule endoscopy.


The management was successful, and we had no passage difficulties.


However, during the withdrawal phase of the enteroscope, the entire spiral overtube disconnected from the endoscopic shaft and became stuck in the esophagus and pharynx.


Attempts to remove the lodged spiral using various endoscopic forceps, graspers, snares, or a dilatation balloon failed.


Also, the laryngoscopic use of Magill forceps did not allow grabbing the spiral properly.


Eventually, the spiral could be retrieved laryngoscopically with arthroscopic grasping forceps.


This incident caused laryngeal swelling and bleeding lacerations of the upper esophagus, which were clipped on a subsequent gastroscopy.


No further long-lasting complications occurred in the patient.


Detachment of the spiral from the enteroscope is a potentially life-threatening and challenging complication of MSE.


Artificial ventilation under observation by an anesthesiologist allowed for calm management of this dangerous situation and increased the overall safety of the procedure.


Hence, we believe that in the context of antegrade MSE, general anesthesia with endotracheal intubation should be mandatory.


To highlight the typical histological and ultrastructural features of severe infectious crystalline keratopathy (ICK) in a corneal graft, which required excimer laser-assisted repeat penetrating keratoplasty (PKP) and to present the challenging treatment conditions associated with ICK.


An 85-year-old female patient underwent PKP for secondary graft failure after Descemet membrane endothelial keratoplasty (DMEK) for Fuchs' endothelial corneal dystrophy in the left eye.


One year later, white branched opacities were observed in the superficial corneal stroma of the graft without surrounding inflammation in the left eye.


The patient underwent excimer laser-assisted repeat PKP (8.0/8.1 mm) in the left eye after prolonged refractory topical anti-infectious treatment for 1 month.


The corneal explant was further examined by light and transmission electron microscopy (TEM).


The light microscopic examination of the corneal explant demonstrated aggregates of coccoid bacteria in the superficial and mid-stromal region that were positive for periodic acid-Schiff (PAS) and Gram stain.


The bacterial aggregates extended into the interlamellar spaces, showed a spindle-shaped appearance, and were not surrounded by an inflammatory cellular reaction.


TEM demonstrated lamellae separation within the anterior corneal stroma with spindle-shaped aggregates of bacteria, which were embedded in an extracellular amorphous matrix with incipient calcification, being consistent with a biofilm.


No inflammatory cellular reaction was evident by TEM.


At discharge from hospital, the corrected visual acuity was 20/80 in the left eye.


ICK is often challenging due to the difficult diagnosis and treatment conditions.


The refractory courses are mainly attributed to a biofilm formation, which inhibits effective topical anti-infectious treatment.


In such cases, (repeat) PKP may be necessary to completely remove the pathology, prevent recurrences, and improve vision.


Specifying peri- and postnatal factors in children born very preterm (VPT) that affect later outcome helps to improve long-term treatment.


To enhance the predictability of 5-year cognitive outcome by perinatal, 2-year developmental and socio-economic data.


92 VPT infants, born 2007-2009, gestational age<32 weeks and/or birthweight of 1500 g, were assessed longitudinally including basic neonatal, socio-economic (SES), 2-year Mental Developmental Index (MDI, Bayley Scales II), 5-year Mental Processing Composite (MPC, Kaufman-Assessment Battery for Children), and Language Screening for Preschoolers data.


5-year infants born VPT were compared to 34 term controls.


The IQ of 5-year infants born VPT was 10 points lower than that of term controls and influenced independently by preterm birth and SES.


MDI, SES, birth weight and birth complications explained 48% of the variance of the MPC.


The MDI proved highly predictive (r=0.6, R2=36%) for MPC but tended to underestimate the cognitive outcome.


A total of 61% of the 2-year infants born VPT were already correctly classified (specificity of .93, sensitivity of .54).


CHAID decision tree technique identified SES as decisive for the outcome for infants born VPT with medium MDI results (76-91): They benefit from effects associated to a higher SES, while those with a poor MDI outcome and a birth weight≤890 g do not.


Developmental follow-up of preterm children enhances the quality of prognosis and later outcome when differentially considering perinatal risks and SES.


Inflammatory interdigital nodules (IIN) affecting the paws of dogs is a multifactorial and painful condition.


Surgery using carbon dioxide (CO 2 ) laser has been shown to be helpful in the management.


To assess a postoperative treatment protocol without use of antibiotics following CO2 laser surgery for IIN treatment.


Forty-seven paws, in 30 client-owned dogs, with IINs affecting the interdigital web between the 4th and 5th digits of the forepaws, surgically treated using CO2 laser, were included.


Medical records were reviewed for demographic details, medication use and wound healing using a set wound care protocol.


Time to resolution of the surgical wounds and the postoperative outcome were assessed.


Resolution was seen in 42 of 47 paws with complications in five paws (11%), including development of new fistulae or nonhealing granulation tissue.


Surgery was repeated in those five cases.


Relapse occurred during the follow-up period of five-19 months in six paws (13%).


This study shows that surgical treatment with CO2 laser for interdigital nodules is successful in most cases.


The postoperative outcome using a wound-healing protocol avoiding use of antimicrobials can be used without compromising patient care whilst following antimicrobial stewardship guidelines.


Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored.


The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community.


This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19.


Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%).


At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents' psychosocial functioning.


Adolescents completed scales regarding attachment and psychosocial functioning.


Results showed a significant decrease in caregivers' prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents' reports of attachment security on the Security Scale.


These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.


Since the introduction of shared electric scooters in Germany in June 2019, surgeons have been treating injuries caused by these devices.


In our Institution, we implemented the first registry to examine the pattern of injuries and to gather epidemiological data on persons injured while riding electric scooters.


We conducted a prospective analysis of all patients treated in our Emergency Department for an injury sustained while riding an electric scooter between June 2019 and June 2020.


All patients were noted in a registry (E-SCORE = E-Scooter Register).


The study was approved by the institutional ethics board.


Outcomes were first time of use, injuries, imaging, alcohol and helmet use, age, length of hospital stay and surgical therapy.


Mean age was 35.6 years (± 15.4); 65.5% were male.


We diagnosed 32 fractures and 7 ligament injuries.


Injuries to the head were found in 38 patients; 8 had relevant intracerebral or maxillofacial injuries.


Alcohol use was noted in 18 (20%) patients, only 2 of whom wore a helmet (2.2%).


29 patients (32.2%) required surgical intervention.


This study highlights the significant number of head injuries in patients riding electric scooters.


Nevertheless, there are also a significant number of injuries to the bones and ligaments, which required surgical treatment.


Hardly any of the patients was wearing a helmet and alcohol use was not unusual.


In our opinion, scooter related injuries are leading to an growing number of vehicle related injuries and could probably benefit from some legal regulations, such as a blood alcohol limit and recommendation for helmet use.


Implementation of a nationwide registry might be useful in evaluating injuries related to electric scooters.


Mobile knee spacers can be utilized in the first stage of a two-stage exchange in periprosthetic joint infection or septic arthritis of the knee to prevent soft tissue contraction, enable local antibiotic elution, and improve patient mobility.


Commercially made moulds enable the surgeon to prepare a reproducible spacer design and match the preparation of the arthroplasty, which will be carried out in a second step.


Periprosthetic joint infection of the knee and severe cases of septic arthritis of the knee with advanced destruction/infiltration of the cartilage.


Antibiotic resistance of the microbiological pathogen to available antibiotic agents, incompliant patient, large osseous defect preventing proper fixation, known allergy to polymethylmethacrylate (PMMA) or antibiotic, severe soft tissue damage with high ligament instability, especially deterioration of extensor mechanism and insufficient patella/quadricep tendon.


After thorough debridement and removal of all foreign material, cutting blocks are used to shape femur and tibia to the implant design required.


Using a silicone mould, PMMA with suitable antibiotics is moulded into the shape of the future implant.


After polymerization, the implants are fixed onto the bone with additional PMMA without pressurize for the sake of easy removal.


Partial weight bearing with no restriction of flexion/extension while spacer is in place; second stage reimplantation as soon as infection is controlled.


In all, 22 cases were treated, mostly with a PMMA spacer containing gentamicin and vancomycin.


Pathogens were detected in 13 of 22 cases (59%).


Twenty of 22 patients (86%) were reimplanted with a new arthroplasty; 16 of the 20 patients remained revision-free and infection-free at the last follow-up (average time to follow-up 13 months, range 1-46 months).


Average range of motion in flexion and extension at follow-up was 98°.


A healthy, air-filled lung can only be visualized by its artifacts, and pathologies of the lung are revealed by changes in these artifacts.


Because ultrasound artifacts are predominantly used in pulmonary sonography to assess pathologic processes, the variability of sonographically imageable phenomena is limited.


For this reason, different pulmonary diseases may present very similarly in ultrasound.


Therefore, a correct interpretation of the findings is only possible in the clinical context, taking into account the age-dependent differential diagnoses.


The particular relevance of lung ultrasound in the treatment of neonatal patients results from a close correlation between the extent of sonographically-depictable pathologies and parameters of respiratory insufficiency.


This suggests a direct correlation between ultrasound findings and the severity of lung injury.


Lung ultrasound thus represents a unique, ubiquitously available, bedside, serial method for monitoring the pulmonary status.


While the core principles of medical education remain the same, the students' socioecological backgrounds, values and learning requirements are constantly changing.


Bridging the generation gap between teachers and students is a key challenge of medical didactics.


To meet the demands of today's classroom, we piloted a novel three-stage peer teaching and key feature concept.


First, an on-demand key feature video case was presented.


Second a background video was launched, followed by a self-assessment tool.


Third, a live case discussion webinar focusing on clinical reasoning was held.


The contents were created by near-peers experienced in medical didactics and checked by clinical experts.


The elective format resonated with 652 participating graduate students and 1250 interactions per webinar, suggesting that students' strengths and weaknesses were addressed adequately.


We aim to provide educators with input for creating a flexible and integrative learning environment utilising modern technological and didactic tools that shape the healthcare workers of tomorrow.


Increasing exposure to climate warming-related drought and heat threatens forest vitality in many regions on earth, with the trees' vulnerability likely depending on local climatic aridity, recent climate trends, edaphic conditions, and the drought acclimatization and adaptation of populations.


Studies exploring tree species' vulnerability to climate change often have a local focus or model the species' entire distribution range, which hampers the separation of climatic and edaphic drivers of drought and heat vulnerability.


We compared recent radial growth trends and the sensitivity of growth to drought and heat in central populations of a widespread and naturally dominant tree species in Europe, European beech (Fagus sylvatica), at 30 forest sites across a steep precipitation gradient (500-850 mm year<sup>-1</sup> ) of short length to assess the species' adaptive potential.


Size-standardized basal area increment remained more constant during the period of accelerated warming since the early 1980s in populations with >360 mm growing season precipitation (April-September), while growth trends were negative at sites with <360 mm.


Climatic drought in June appeared as the most influential climatic factor affecting radial growth, with a stronger effect at drier sites.


A decadal decrease in the climatic water balance of the summer was identified as the most important factor leading to growth decline, which is amplified by higher stem densities.


Inter-annual growth variability has increased since the early 1980s, and variability is generally higher at drier and sandier sites.


Similarly, within-population growth synchrony is higher at sandier sites and has increased with a decrease in the June climatic water balance.


Our results caution against predicting the drought vulnerability of trees solely from climate projections, as soil properties emerged as an important modulating factor.


We conclude that beech is facing recent growth decline at drier sites in the centre of its distribution range, driven by climate change-related climate aridification.


Kangaroo care is a safe and effective alternative method to conventional neonatal care for newborn babies.


The aim of this study was to evaluate the effect of kangaroo care on the transition time to full oral feeding in preterm infants fed by gavage.


This study was conducted in a level III neonatal intensive care unit of a university hospital in eastern Turkey 50 premature babies with a birth weight of≥1000 g and a gestational age of 27-36 weeks, and their mothers were included in the study.


The cases were randomly divided into two groups: kangaroo care, which would be applied up to five days a week, and standard care.


Records of cases were kept regularly from their hospitalization until they reached full oral feeding.


Premature babies in the kangaroo care group reached full oral feeding at 29.20±8.06 days after birth, while babies in the standard care group reached full oral feeding at 44.60±21.90 days.


The transition period from gavage feeding to reaching full oral feeding was 13.60±6.83 days in the kangaroo care group, and 22.10±7.38 days in the standard care group.


The difference was statistically significant (p=0.007).


Kangaroo care is an effective method to reduce the transition time from gavage feeding to full oral feeding for premature babies.


Sclerostin, a regulator of bone metabolism and vascular calcification involved in regulating the Wnt/β-catenin signaling pathway, has been shown to be involved in the pathogenesis of rheumatoid arthritis (RA).


However, current results regarding the circulating sclerostin level of RA patients are debatable.


This study aimed to evaluate the circulating level of sclerostin in RA patients and briefly summarize its role.


PubMed, EMBASE, and the Cochrane Library databases were systematically searched till May 27, 2021, for eligible articles.


Useful data from all qualified papers were systematically extracted and analyzed using Stata 12.0 software (Stata Corp LP, College Station, TX, USA).


Overall, 13 qualifying studies including 1030 cases and 561 normal controls were analyzed in this updated meta-analysis.


Forest plot of this meta-analysis showed that RA patients had higher circulating sclerostin levels (P < 0.001, standardized mean difference [SMD] = 0.916, 95% CI: 0.235-1.597) compared to normal controls.


Subgroup analyses implied that age, region, and assay method were associated with sclerostin level in RA patients.


RA patients have higher circulating sclerostin levels, and these was influenced by age, region, and assay method.


Anxiety is a comorbidity that is not routinely addressed in patients with chronic obstructive lung disease (COPD) exacerbation in the emergency department (ED).


Anxiety in patients with COPD exacerbation can be related with negative outcomes.


The Generalized Anxiety Disorder 7 (GAD-7) score is an easy-to-use tool to determine anxiety.


This study aimed to investigate the relationship between GAD‑7 score and patient outcomes in patients with COPD exacerbation in the ED.


A prospective, cross-sectional study was conducted in a tertiary academic ED between July 2019 and January 2021.


Patients admitted to the ED with COPD exacerbation were included.


A GAD‑7 score of ≥ 10 was defined as clinically significant anxiety.


Negative outcomes were defined as a composite outcome that included recurrent ED visits, intensive care unit admission, and mortality.


The relationship between clinically significant anxiety and negative outcomes within 30 days was determined.


A total of 92 patients were assessed for eligibility and 80 were included in the study.


Thirty-seven patients (46.3%) experienced negative outcomes.


Although no significant difference was detected in median GAD‑7 scores between patients with positive and negative outcomes, negative outcomes were significantly higher in patients who had a GAD‑7 score of ≥ 10 (n = 25, p = 0.03).


A sensitivity of 43.2%, specificity of 79.1%, positive likelihood ratio of 2.1 and negative likelihood ratio of 0.7 were determined for GAD‑7 score in predicting negative outcome.


In patients with COPD exacerbation in the ED, a GAD‑7 score of ≥ 10 was associated with 30-day negative outcomes.


In this article, we highlight current research directions in the Technikpsychologie research area, using the example of the interdisciplinary research work of FAI (Work and Engineering Psychology Research Group at the Technical University of Darmstadt) and the articles included in this special issue.


To this end, we relate the articles in this special issue from the research areas of road traffic planning (Hupfer et al.), usable IT security and privacy solutions (Renaud), social aspects of technically mediated communication (Diefenbach), human-centered interface design (Mucha et al.), aviation safety (Santel), human-centered design of autonomous vehicles (Lindner & Stoll), and perceptual psychology-oriented product design (Zandi & Khanh) to current research projects at FAI.


<i>Practical Relevance</i> Technical products only offer added value by efficiently supporting users in achieving their goals if they have been developed appropriately for the context of use and the individual characteristics of the users.


The human-centered design of-especially technical-products reflects this through an iterative and participatory development process.


In this article, we describe nine examples of such human-centered design of technology products.


The research results and the methods presented provide insights for developers and decision-makers in the fields of transportation, IT, vehicle development and general product design.


Initial treatment in patients with haemophilia remains challenging.


The choice of therapy, timing, dose and frequency have been and are still under intense debate.


New treatment options like novel factor concentrates and non-factor therapies broaden the discussion.


The German Paediatric Haemophilia Research Database (GEPHARD) is a multicentre prospective observational study including children and adolescents with haemophilia A or B (FVIII or FIX levels <25 IU/dL) in a German treatment centre after January 1st, 2017.


A cross-sectional analysis was performed in June 2021.


249 children and adolescents from 22 participating centres in Germany were analysed in this cross-sectional analysis.


203 patients suffered from haemophilia A (PwHA) and 46 from haemophilia B (PwHB).


The median age at diagnosis for Pw severe HA or HB was 6 or 2 months, the median age at analysis was 33 or 35 months for Pw severe HA or B, respectively.


117 Pw severe HA received treatment, including plasma derived concentrates (n = 43), standard recombinant concentrates (n = 23), extended half live concentrates (n = 33) and non-replacement therapies (n = 18).


For Pw severe HB, plasma derived concentrates (n = 3), standard recombinant concentrates (n = 8) and extended half live concentrates (n = 14) were used.


Current inhibitors were reported in 16 PwHA and 1 PwHB.


GEPHARD was successfully established as a national cohort for newly diagnosed PwH in Germany.


Epidemiological and treatment data were presented.


Longitudinal analyses of this growing cohort will allow to value treatment strategies and their outcome in the evolving treatment landscape.


We investigated the role of European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for the prediction of LN among children with SLE.


The data of the patients with childhood-onset SLE diagnosed based on 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria were retrospectively evaluated.


Based on 2019 EULAR/ACR classification criteria, the scoring was done at the time of renal biopsy.


Fifty-two patients (12 with LN, 40 without LN) were included.


The mean score was higher in patients with LN than those without (30.8±6.14, 19.8±7.76, respectively, p=0.000).


The score value had indicative value for LN (area under curve [AUC]:0.863±0.055, cut-off value:22.5, p=0.000).


Lymphocyte counts had a predictive value for LN (cut-off value:905/mm3, AUC:0.688±0.087, p=0.042).


The score was positively associated with SLE disease activity index (SLEDAI) and activity index (r=0.879, p=0.000; r=0.811, p=0.001, respectively).


There were significant negative associations between score value and GFR (r=-0.582, p=0.047).


The patients with renal flare had higher the mean score than those of without renal flare (35±2/25.4±5.57, respectively, p=0.019).


The EULAR/ACR criteria score could reflect the activity of disease and severity of nephritis in childhood-onset SLE.


A point of 22.5 as score value might be an indicator for LN.


During scoring, it should be taken into account that lymphopenia might guide the prediction of LN.


Insuffient time for learning activities makes learning very difficult.


Weaker students need more time to appropriately manage their learning objectives.


To ensure enough study time, curriculum designers must monitor potential mismatches between needed versus provided study time.


This study was conducted to measure students' time loads and compare them to the workload determined by the curriculum and measured in European Credit Transfer and Accumulation System (ECTS) credits.


Time load entry using the Studo mobile application consisted of entering the time required for all learning activities, categorized into attendance, self-study, and writing student papers, per course.


In addition to time load measures, socio-demographic information on travel time, care obligations, and employment status was recorded.


Over six semesters (2018/2019-2021), the average response rate per semester was low (8%-17%).


Of the 75 piloted courses (4-16 per semester), 2 exceeded the number of hours specified in the curriculum.


Regarding socio-demographic data, 3%-34% of the evaluated students worked part time (≥ 10 hours per week).


In summary, students were disinclined to measure their learning time.


With consideration of potential nonresponse bias, no significant evidence of curriculum workload exceedance was found for the evaluated courses at the University of Veterinary Medicine, Vienna.


However, some students are under increased individual time pressure due to part-time employment.


The ratio of measured to estimated time should be monitored as a key component to improve performance and enhance student learning.


Health service providers play a significant role in crafting and implementing health policies and programs that manage adolescent sexual health-related issues at different health system levels.


These influence adolescent sexual behaviours and practices.


This study explored the roles of health service providers in managing adolescent sexual issues and how this impacts their sexual behaviours and practices.


The study further probed the health service providers on how the indigenous health system could be integrated into the modern health system for effective management of adolescent sexual health related issues.


A qualitative cross-sectional survey was conducted on purposively selected health service providers in health facilities in Mberengwa and Umguza districts.


Data was collected using unstructured interviews that were recorded, transcribed verbatim, and thematically analysed.


Findings were presented as clearly defined as superordinate and subordinate themes.


A total of five superordinate themes and 19 subordinate themes emerged from the interrogated data.


The superordinate themes were: overview of adolescent sexual health issues, role of modern health system in adolescent sexual health issues, challenges encountered, indigenous health system factors that could be factored into modern health systems, and strategies to foster the integration of indigenous health system and modern health system.


The subordinate themes explored in-depth the findings of the key stakeholders under the five superordinate themes.


From the findings, it can be concluded that health service providers play an essential role in shaping and providing adolescent sexual health services that adolescents utilise despite challenges that have reduced demand for these services.


Therefore, there is a need to point out that there is a window of opportunity to foster collaborations between the indigenous health system and the modern health system as they strive to serve the adolescents to the best of their ability though in different contextual settings.


The purpose of this study was to evaluate the relationships between interleukin 10 (IL10) (rs1800896) and interleukin 1B (IL1B) (rs16944) genetic polymorphisms and the risk for cervical cancer in a cohort of women from Croatia.


A case-control study of 81 patients with cervical cancer and 80 age-matched healthy controls was performed.


We collected peripheral blood samples, extracted deoxiribonucleic acid (DNA), and analyzed two single-nucleotide polymorphisms (SNPs) rs1800896 and rs16944 using TaqMan assays (Fa. Thermo Fisher Scientific, Waltham, MA, USA) and real-time polymerase chain reaction (PCR).


We investigated a possible association between two cytokine genetic polymorphisms and the occurrence of cervical cancer.


Our results showed no significant difference in the frequency of IL10 (rs1800896) and IL1B (rs16944) genotypes between the patients and the controls (χ2 test, P < 0.05).


In this study, no association was found between IL10 rs1800896 and IL1B rs16944 polymorphisms and cervical cancer development.


Infant and Early Childhood Mental Health Consultation (IECMHC) aims to improve early childhood professionals' abilities to promote children's mental health through relationship building and collaboration.


Using a longitudinal, matched-comparison group design, a 3-year pilot study of a cross-system, embedded model of IECMHC assessed teachers and home visitors in intervention and comparison programs in reflective capacity, burnout, and perceptions of children's behavior.


A sample of 136 staff (n = 72 intervention group; n = 64 comparison group; 21% Black; 51% White; 28% Latina/Hispanic) participated in surveys over a 21-month implementation period.


A subsample of staff (n = 26) participated in interviews that included a narrative measure of reflective capacity; and a smaller subsample of teachers only (n = 21) completed assessments of children.


Staff in the intervention group significantly increased reflective capacity after 21 months.


For the staff interview subsample, receiving the intervention predicted lower levels of burnout at 12-15 months post-baseline.


Among teachers completing child assessments, those with higher reflective capacity rated children's behaviors more positively than teachers with lower reflective capacity.


We conclude that this IECMHC model successfully improved reflective capacity in staff.


Future research should investigate reflective capacity as a potential mechanism of change for IECMHC.


Although cancer-associated thrombosis (CAT) is a frequent complication in patients with malignancies, its treatment remains a challenge in daily practice.


Here, we report the clinical course of a 51-year-old woman presenting with a highly thrombogenic paraneoplastic coagulopathy.


Despite therapeutic anticoagulation with various agents, including rivaroxaban, fondaparinux, and low-molecular-weight heparin, the patient suffered from recurrent venous and arterial thromboembolism.


Locally advanced endometrial cancer was identified.


Tumor cells showed strong expression of tissue factor (TF), and significant concentrations of TF-bearing microvesicles were detected in patient plasma.


Coagulopathy was controlled only by continuous intravenous anticoagulation with the direct thrombin inhibitor, argatroban.


Multimodal antineoplastic treatment, including neoadjuvant chemotherapy followed by surgery and postoperative radiotherapy, resulted in clinical cancer remission, which was paralleled by normalization of tumor markers, CA125 and CA19-9, D-dimer levels, and TF-bearing microvesicles.


In summary, continuous anticoagulation with argatroban and multimodal anticancer treatment may be necessary to control TF-driven coagulation activation with recurrent CAT in endometrial cancer.


In the treatment of upper cervical spine injuries, the semiconservative procedure of the halofixator is now of only secondary importance.


Older studies from the 2000 s showed unsatisfactory rates of consolidation as well as high rates of complications.


However, due to current data on therapy effectiveness, the literature is inconsistent.


The aim of this work is to compare our own experiences and results of treatment with the current literature and to help to clarify the role of the halofixator.


In a monocentric retrospective cohort study, patients with unstable injuries of the axial cervical spine who were to be treated in the halofixator were investigated.


Individual variables (sex, age, concomitant diseases, Charlson Comorbidity Index) and treatment characteristics (duration of treatment, consolidation status, complications) were recorded using the electronic medical record.


Injuries were classified based on CT data at the time of the accident and at the end of treatment, using common classification systems, and assessed with respect to the rate of consolidation.


Possible factors influencing bony consolidation as well as complications were statistically analysed.


A total of 54 patients met the inclusion criteria.


The median duration of treatment was 83 days.


The most common injuries were isolated atlas fracture type III (7; 13%) and isolated dens fracture type III (24; 44%).


Bony consolidation was demonstrated in 34 cases (63%) and tight pseudarthrosis in 13 cases (24%).


Secondary surgical stabilisation was performed in 6 cases (11%).


Isolated type III atlas fractures and type III dens fractures had very high consolidation rates of 86% and 92%, respectively.


In the subgroups of patients older than 65 years or with a CCI ≥ 4, unstable pseudarthroses were found more frequently.


Complications included pin infection (6%), pin dislocation (9%), and pressure ulceration from the halo vest (6%).


Cardiopulmonary complications did not occur.


Good rates of bony consolidation were seen for atlas fractures type III as well as dens fractures type III, which correlate with data in the literature.


Dens fractures type II (isolated and combined) and atlas fractures type III in combination with dens fractures showed a worse radiological outcome, which is also unsatisfactory compared to the literature.


The rates for procedure-specific complications were relatively low.


In particular, work from recent years has demonstrated very good rates for bony consolidation and low complication rates for the treatment of atlas and/or dens fractures with the halofixator, which are confirmed by our results.


In contrast, however, a significantly higher cardiac/respiratory complication rate has been reported than occurred in our own patient population.


Reference intervals for basic liver laboratory diagnostic rely on manufacturers' information, remaining unchanged for more than 20 years.


This ignores known age and sex dependencies.


We performed a retrospective cross-sectional study to compare the age-dependent distribution of flagged and non-flagged laboratory findings between reference limits from 3 distinct sources: manufacturer, published reference study, and the truncated maximum likelihood method applied on a cohort of inpatients aged 18-100 years.


Discordance rates adjusted for the permissible analytical uncertainty are reported for serum levels of albumin (n= 150,550), alkaline phosphatase (n= 433,721), gamma-GT (n=580,012), AST (n= 510,620), and ALT (n= 704,546).


The number of flagged findings differed notably between reference intervals compared, except for alkaline phosphatase.


AST and alkaline phosphatase increased with age in women.


Overall discordance for AP, AST, and ALT remained below 10%, respectively, in both sexes.


Albumin decreased with age which led to discordant flags in up to 22% in patients ≥70 years.


GGT and ALT peaked in 50-59-year-old men with up to 23.5% and 22.8% discordant flags, respectively.


We assessed the impact of different reference limits on liver related laboratory results and found up to 25 % discordant flags.


We suggest to further analyse the diagnostic and economic effects of reference limits adapted to the population of interest even for well-established basic liver diagnostics.


There is limited research regarding the continuity, stability, and role of country of origin in preterm infant temperament across the first year of life.


This prospective longitudinal study examined patterns of mean-level continuity and individual-differences stability of select scales of temperament at 6 and 12 months in preterm infants from three countries, Chile (n = 47), United Kingdom (n = 44), and United States (n = 50).


Temperament was assessed with the Infant Behavior Questionnaire and observed using the Bayley Behavior Rating Scale.


Continuity and stability across infant age, country effects, and interactions of country and age on preterm infant temperament were examined.


Chilean mothers rated infants higher in soothability, duration of orienting, and orientation/engagement compared with mothers from the United Kingdom and/or United States.


Continuity of temperament from 6 to 12 months varied by country: Chilean mothers reported increasing smiling and laughter and activity level from 6 to 12 months, and mothers from the United Kingdom reported decreasing smiling and laughter and increasing fear from 6 to 12 months.


Infant temperament was stable in all three countries.


Correlations evidenced low concordance between maternal reports and examiner observations of infant temperament at 12 months.


However, among Chilean infants, higher maternal reported activity level was associated with higher examiner observed orientation/engagement score.


Sarcopenia is an age-related syndrome characterized by a loss of muscle mass and strength.


As a result, the independence of the elderly is reduced and the hospitalization rate and mortality increase.


The onset of sarcopenia often begins in middle age due to an unbalanced diet or malnutrition in association with a lack of physical activity.


This effect is intensified by concomitant diseases such as obesity or metabolic diseases including diabetes mellitus.


With effective preventative diagnostic procedures and specific therapeutic treatment of sarcopenia, the negative effects on the individual can be reduced and the negative impact on health as well as socioeconomic effects can be prevented.


Various diagnostic options are available for this purpose.


In addition to basic clinical methods such as measuring muscle strength, sarcopenia can also be detected using imaging techniques like dual X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), and sonography.


DXA, as a simple and cost-effective method, offers a low-dose option for assessing body composition.


With cross-sectional imaging techniques such as CT and MRI, further diagnostic possibilities are available, including MR spectroscopy (MRS) for noninvasive molecular analysis of muscle tissue.


CT can also be used in the context of examinations performed for other indications to acquire additional parameters of the skeletal muscles (opportunistic secondary use of CT data), such as abdominal muscle mass (total abdominal muscle area - TAMA) or the psoas as well as the pectoralis muscle index.


The importance of sarcopenia is already well studied for patients with various tumor entities and also infections such as SARS-COV2.


Sarcopenia will become increasingly important, not least due to demographic changes in the population.


In this review, the possibilities for the diagnosis of sarcopenia, the clinical significance, and therapeutic options are described.


In particular, CT examinations, which are repeatedly performed on tumor patients, can be used for diagnostics.


This opportunistic use can be supported by the use of artificial intelligence. · Sarcopenia is an age-related syndrome with loss of muscle mass and strength.. · Early detection and therapy can prevent negative effects of sarcopenia.. · In addition to DEXA, cross-sectional imaging techniques (CT, MRI) are available for diagnostic purposes.. · The use of artificial intelligence (AI) offers further possibilities in sarcopenia diagnostics.. ·


Vogele D, Otto S, Sollmann N et al. Sarcopenia - Definition, Radiological Diagnosis, Clinical Significance. Fortschr Röntgenstr 2023; 195: 393 - 405.


To investigate the clinical value of 68Ga-FAPI-04 PET/CT for initial staging of esophageal cancer.


A total of 44 newly diagnosed patients with esophageal cancer were included in the analysis on the basis of postoperative pathology or clinical and radiologic follow-up.


All primary lesions showed increased 68Ga-FAPI-04 uptake, with an SUVmax of 14.92 ± 6.91.


A total of 561 lymph nodes were verified by surgery (507) or clinical and radiologic follow-up (54), of which 92 lymph nodes were diagnosed as showing metastases.


Seventy-five lymph nodes with metastases showed positive findings on 68Ga-FAPI-04, with a diameter of about 1.06 ± 0.53 cm and SUVmax of 8.10±4.71.


The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for lymph node metastasis detection were 81.5%, 99.3%, 96.6%, 96.2%, and 96.5%, respectively.


68Ga-FAPI-04 PET/CT showed good diagnostic performance in detecting lymph node metastases of esophageal cancer.


This study aimed to update the prevalence estimates of inflammatory rheumatic diseases (IRD) in Germany.


A systematic literature search in PubMed and Web of Science (last search 08 November 2022) identified original articles (regional and nationwide surveys and claims data analyses for arthritides, connective tissue diseases, and vasculitides) on prevalences for the period 2014-2022.


Data sources, collection period, case definition, and risk of bias are reported.


Prevalences were estimated from available national data, with consideration of international data.


Screening by two authors yielded 263 hits, of which 18 claims data analyses and 2 surveys met the inclusion criteria.


Prevalences ranged from 0.42 to 1.85% (rheumatoid arthritis), 0.32-0.5% (ankylosing spondylitis), 0.11-0.32% (psoriatic arthritis), 0.037-0.14% (systemic lupus erythematosus), 0.07-0.77% (Sjögren's disease/sicca syndrome), 0.14-0.15% (polymyalgia rheumatica, ≥ 40 years), 0.04-0.05% (giant cell arteritis, ≥ 50 years), and 0.015-0.026% (ANCA-associated vasculitis).


The risk of bias was moderate in 13 and high in 7 studies.


Based on the results, we estimate the prevalence of IRD in Germany to be 2.2-3.0%, which corresponds to approximately 1.5-2.1 million affected individuals.


The prevalence of juvenile idiopathic arthritis was reported to be around 0.10% (0.07-0.10%) of 0-18-year-olds, corresponding to about 14,000 children and adolescents in Germany.


This systematic review shows an increase in the prevalence of IRD in Germany, which is almost exclusively based on claims data analyses.


In the absence of multistage population studies, the available data are, overall, uncertain sources for prevalence estimates, with a moderate to high risk of bias.


To describe the perinatal outcome of a prospective cohort of late-onset small-for-gestational-age (SGA) fetuses and to test adverse perinatal outcome (APO) prediction using Doppler measurements.


Singleton pregnancies from 32 weeks with suspicion of SGA (followed-up each 2 weeks) and randomly selected healthy controls at a university hospital were included.


The whole SGA group was divided into the FGR subgroup or SGA percentile 3-10 subgroup.


The following Doppler measurements were evaluated prospectively: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, cerebro-placental ratio (CPR), and mean uterine artery (mUtA) PI.


APO was defined as arterial cord blood pH ≤ 7.15 and/or 5-minute Apgar ≤ 7 and/or emergency operative delivery and/or admission to the neonatal unit.


Induction of labor was indicated according to a stage-based protocol.


A total of 149 SGA and 143 control fetuses were included.


The number of operative deliveries was similar between both groups (control: 29 %, SGA: 28 %), especially the cesarean delivery rate after the onset of labor (11 % vs. 10 %).


Most SGA cases ended up in induction of labor (61 % vs. 31 %, p < 0.001).


The areas under the curve (AUC) for APO prediction were similar using the last UA PI, MCA PI, CPR, and mUtA PI and barely reached 0.60.


The AUC was best for the FGR subgroup, using the minimal CPR or maximum mUtA PI z-score of all longitudinal measurements (AUC = 0.63).


SGA fetuses do not have a higher rate of operative delivery if managed according to a risk stratification protocol.


Prediction of APO is best for SGA and FGR using the 'worst' CPR or mUtA PI but it remains moderate.


Coronary artery calcification is a frequent incidental finding on thoracic computed tomography (CT) performed for non-cardiac indications.


On electrocardiogram-gated cardiac CT, it is an established marker of coronary artery disease and is associated with increased risk of subsequent cardiac events.


This review discusses the current evidence and guidelines regarding the reporting of coronary artery calcification on non-electrocardiogram-gated thoracic CT performed for non-cardiac indications.


For patients undergoing routine thoracic CT, coronary artery calcification is associated with an increased risk of myocardial infarction and mortality.


Coronary artery calcification can be accurately assessed on non-gated thoracic CT compared to gated CT.


Guidelines support the reporting of coronary artery calcification on thoracic CT.


The identification of coronary artery calcification on thoracic CT may identify patients with previously unknown coronary artery disease.


For asymptomatic patients this may trigger an assessment of modifiable cardiovascular risk factors and guide the appropriate use of preventative medications.


Future research will address whether changing management based on calcification on thoracic CT will improve outcomes and automated assessment of calcification using machine learning techniques. · Coronary artery calcification is a frequent incidental finding on thoracic CT.. · The presence and severity of coronary artery calcification is associated with cardiac outcomes and mortality.. · Reporting coronary artery calcification on thoracic CT is supported by national and international guidelines.. · Williams MC, Llewellyn O, . What Should We Do About Coronary Calcification on Thoracic CT?.


Fortschr Röntgenstr 2022; 194: 833 - 840.


Many clinicians prepare compounded otic solutions to treat otitis externa (OE).


Research evaluating the stability and antimicrobial efficacy of these solutions is limited.


This study determined the chemical stability and in vitro bactericidal efficacy of compounded solutions of enrofloxacin and gentamicin during storage for 28 days.


Solutions of enrofloxacin (10 mg/mL, 1%) and gentamicin (3 mg/mL, 0.3%) were prepared with normal saline and 1 mg/mL dexamethasone.


Solutions were stored at room temperature (25°C) for 0, 14 and 28 days.


The chemical stability of the antibiotics and dexamethasone were determined using liquid chromatography tandem mass spectrometry in triplicate.


Efficacy assessment was made with 10 isolates of Staphylococcus pseudintermedius obtained from dogs with OE.


Serial 10-fold dilutions of the bacteria with the compounded solutions were prepared and the colony count results were converted into colony-forming units (cfus).


The mean cfu/mL and cfu/mL reduction rates were compared between Day (D)0, D14 and D28.


All of the antimicrobial testing solutions were performed in triplicate.


Chromatography showed that both antibiotics and dexamethasone were stable for 28 days.


No significant differences were observed in the antibiotic bactericidal efficacy of stored solutions at D0, D14 or D28.


Solutions of 1% enrofloxacin and 0.3% gentamicin in normal saline with 0.1% dexamethasone maintained chemical stability and bactericidal efficacy over 28 days.


These solutions can be considered as alternatives to commercial preparations for treatment of canine OE when indicated.


Fracture detection by artificial intelligence and especially Deep Convolutional Neural Networks (DCNN) is a topic of growing interest in current orthopaedic and radiological research.


As learning a DCNN usually needs a large amount of training data, mostly frequent fractures as well as conventional X-ray are used.


Therefore, less common fractures like acetabular fractures (AF) are underrepresented in the literature.


The aim of this pilot study was to establish a DCNN for detection of AF using computer tomography (CT) scans.


Patients with an acetabular fracture were identified from the monocentric consecutive pelvic injury registry at the BG Trauma Center XXX from 01/2003 - 12/2019.


All patients with unilateral AF and CT scans available in DICOM-format were included for further processing.


All datasets were automatically anonymised and digitally post-processed.


Extraction of the relevant region of interests was performed and the technique of data augmentation (DA) was implemented to artificially increase the number of training samples.


A DCNN based on Med3D was used for autonomous fracture detection, using global average pooling (GAP) to reduce overfitting.


From a total of 2,340 patients with a pelvic fracture, 654 patients suffered from an AF.


After screening and post-processing of the datasets, a total of 159 datasets were enrolled for training of the algorithm.


A random assignment into training datasets (80%) and test datasets (20%) was performed.


The technique of bone area extraction, DA and GAP increased the accuracy of fracture detection from 58.8% (native DCNN) up to an accuracy of 82.8% despite the low number of datasets.


The accuracy of fracture detection of our trained DCNN is comparable to published values despite the low number of training datasets.


The techniques of bone extraction, DA and GAP are useful for increasing the detection rates of rare fractures by a DCNN.


Based on the used DCNN in combination with the described techniques from this pilot study, the possibility of an automatic fracture classification of AF is under investigation in a multicentre study.


The provision of implantable hearing aids represents an area with high development and innovation potential.


On the one hand, this review article provides an overview of current indication criteria for the treatment with active middle ear implants.


On the other hand, outcome parameters as well as functional results after implantation of active middle ear implants are demonstrated and discussed.


The focus is mainly placed on audiological results as well as the subjective health status. 'Patient Reported Outcome Measures' (PROMs) have become an integral part of the evaluation of hearing implant treatment.


Due to low evidence level criteria, the study situation regarding audiological as well as subjective outcome parameters is not satisfactory.


The lack of an international consensus on accepted outcome parameters makes a meta-analytical analysis of results immensely difficult.


In the studies published to date, patients with sensorineural hearing loss and patients with conductive or mixed hearing loss offered better speech recognition after implantation of an active middle ear implant compared to conventional hearing aids.


Current analyses show a significant improvement in general as well as hearing-specific quality of life after implantation of an active middle ear implant.


To date, no validated, hearing-specific quality-of-life measurement instruments exist for assessing the success of fitting in children.


Especially in children with complex malformations of the outer ear and the middle ear, excellent audiological results were shown.


However, these results need to be substantiated by quality-of-life measurements in future.


There is a need for alternative topical therapies as a consequence of the increased prevalence of meticillin-resistant Staphylococcus pseudintermedius (MRSP) skin infections in dogs.


Sodium oxychlorosene has been used as a topical antibacterial agent in human medicine since 1955.


To determine whether 0.2% and 0.4% sodium oxychlorosene solutions have a bactericidal effect (>3-log reduction) on MRSP strains isolated from canine skin infections.


A genetically heterogeneous collection of MRSP isolates from dogs was assembled from laboratories across the United States.


Time-kill assays were performed with 0.2% and 0.4% sodium oxychlorosene on a 0.5 McFarland standard [approximately 108 colony-forming units (cfu/ml)] suspension of each strain.


The average bacterial counts (cfu/ml) of each MRSP strain then were determined at 5, 10, 20 and 60 s after exposure to sodium oxychlorosene; cfu/ml data were converted to log10 scale to calculate microbial reduction.


The average bacterial counts following exposure to the 0.2% solution at 5, 10, 20 and 60 s were 6.94 × 104 , 5.63 × 103 , 2.96 × 102 and 1.48 × 102  cfu/ml, respectively.


For the 0.4% solution, the average bacterial count at 5 s was 2.12 × 103  cfu/ml.


No bacterial growth was observed for any MRSP strain by 10 s. The greatest reduction in cfu/ml occurred within 5 s following exposure to each solution 3.4-log and 4.9-log reduction for 0.2% and 0.4%, respectively.


0.2% and 0.4% sodium oxychlorosene solutions have a bactericidal effect (>99.9% reduction) against MRSP in vitro.


Further in vivo studies are necessary to determine whether it is an appropriate alternative therapy for canine pyoderma.


The silent substitution technique allows creating photoreceptor-selective stimuli for psychophysical and electrophysiological tests.


In contrast to other techniques, the purpose of silent substitution is not to make the targeted photoreceptor type more sensitive in comparison to the other types, but to make the stimulus invisible ('silent') to the other photoreceptor types.


This allows selectivity independent of the retinal state of adaptation and enables comparing photoreceptor types under identical conditions.


The foundations of these techniques will be explained in this paper.


Furthermore, the importance of postreceptoral processing for the perception of photoreceptor-selective stimuli is discussed here.


Although this technique is currently only available in specialized vision science labs, there is an enormous potential for clinical application.


Developmental dysplasia of the hip (DDH) is characterized by the pathomorphology of inadequate acetabular coverage of the femoral head leading to increased loading of the articular surface and acetabular rim.


If left untreated, this ultimately leads to osteoarthritis.


Germany introduced a nationwide universal ultrasound screening program for all newborn infants in 1996.


Subsequently, the incidence of undiagnosed hip dislocation was significantly reduced.


In this consecutive series of patients who underwent periacetabular osteotomy for the treatment of symptomatic dysplasia of the hip between October 2014 and October 2022 data regarding the U3 screening examination were analyzed.


The data included whether the examination was performed, whether the findings were positive or negative, whether the patients underwent any form of treatment in the case of a positive finding and whether a control X‑ray was performed.


This study provides evidence that acetabular undercoverage cannot be ruled out based on a normal finding in ultrasonography screening.


Furthermore, the study also shows that residual dysplasia may persist despite attempts of conservative treatment.


Emergency Medicine Point-of-Care Ultrasound (EMPoCUS) is a convincing concept.


It has spread rapidly because of its intuitive, simple applicability and low equipment costs.


The speed of its emerging growth frequently outpaces the development of quality assurance and education.


Indeed, education standards vary worldwide, and in some cases seem to neglect the principles of modern competence-based education.


Additional challenges are encountered such as remote or low resource medical practice.


Here, EMPoCUS might be the only ad-hoc imaging modality available.


Once mastery of EMPoCUS is achieved, emergency physicians should be able to independently and efficiently care for their patients using a variety of PoCUS skills.


However, most curricula only define these tasks as non-binding and in general terms or use outdated measures, such as length of training and self-reporting of achieved examinations with variable oversight, or administrative measures to create educational milestones.


This threatens to take quality assurance down the wrong path.


It created a scenario in which concrete EMPoCUS skill outcome measures that would realistically reflect the training objectives and simultaneously would be easily observable and verifiable are lacking.


In view of the dangers of poorly controlled EMPoCUS dissemination and the current lack of European guidelines, we would like to set central standards for European EMPoCUS stewardship based on a critical review of the current situation.


This position paper, which was jointly developed by EuSEM and EFSUMB and endorsed by IFEM and WFUMB, is also intended to accompany the EFSUMB/EuSEM guidelines on PoCUS currently being prepared for publication.


In view of our aging society, co-management with a geriatrician is becoming increasingly important.


While such collaborations have been working successfully in trauma surgery for years, it is still unclear whether they are also helpful for non-trauma patients in orthopedics.


The aim of this study was to investigate the effect of such a cooperation in orthopedic non-trauma patients with native and periprosthetic joint infections on the basis of five key areas.


Analysis was carried out with 59 patients 'with' and 63 'without' geriatric co-management.


In the co-management group, delirium was detected significantly more often (p < 0.001), significantly lower pain intensities were measured at the time of discharge (p < 0.001), transfer ability had clearly improved more (p = 0.04), and renal function was more frequently noted (p = 0.04).


No significant differences were found with respect to principal diagnoses, surgical procedures performed, complication rates, pressure ulcer and delirium incidence, operative revisions, or length of inpatient stay.


Orthogeriatric co-management in orthopedic patients with native and periprosthetic joint infections and nontraumatic surgery appears to have positive impacts on recognition and treatment of delirium, pain management, transfer performance, and attention to renal function.


Further studies should follow in order to conclusively assess the value of such co-management in orthopedic nontraumatic surgery patients.


The aim of the study was to evaluate the effect of reduced injected [18F]FDG activity levels on the quantitative and diagnostic accuracy of PET images of patients with non-lesional epilepsy (NLE).Nine healthy volunteers and nine patients with NLE underwent 60-min dynamic list-mode (LM) scans on a fully-integrated PET/MRI system.


Injected FDG activity levels were reduced virtually by randomly removing counts from the last 10-min of the LM data, so as to simulate the following activity levels: 50 %, 35 %, 20 %, and 10 % of the original activity.


Four image reconstructions were evaluated: standard OSEM, OSEM with resolution recovery (PSF), the A-MAP, and the Asymmetrical Bowsher (AsymBowsher) algorithms.


For the A-MAP algorithms, two weights were selected (low and high).


Image contrast and noise levels were evaluated for all subjects while the lesion-to-background ratio (L/B) was only evaluated for patients.


Patient images were scored by a Nuclear Medicine physician on a 5-point scale to assess clinical impression associated with the various reconstruction algorithms.


The image contrast and L/B ratio characterizing all four reconstruction algorithms were similar, except for reconstructions based on only 10 % of total counts.


Based on clinical impression, images with diagnostic quality can be achieved with as low as 35 % of the standard injected activity.


The selection of algorithms utilizing an anatomical prior did not provide a significant advantage for clinical readings, despite a small improvement in L/B (< 5 %) using the A-MAP and AsymBowsher reconstruction algorithms.


In patients with NLE who are undergoing [18F]FDG-PET/MR imaging, the injected [18F]FDG activity can be reduced to 35 % of the original dose levels without compromising.


The goal of this study was to assess genes known to be associated with tooth agenesis with next-generation sequencing (NGS) and analyze the relationship between these mutations and tooth agenesis phenotypes.


The study included 49 individuals aged between 6 and 13 years.


A total of 14 genes related to nonsyndromic tooth agenesis were selected for targeted NGS.


Mutations in Msh homeobox 1 (MSX1), Wnt family member 10A (WNT10A), axis inhibition protein 2 (AXIN2), keratin 17 (KRT17), lipoprotein receptor 6 (LRP6), and secreted protein, acidic and rich in cysteine (SPARC)-related modular calcium-binding protein 2 (SMOC2) genes were investigated.


Mutations in six genes were detected in 12 of 49 subjects.


Fifteen variants were identified, including the unknown variants c.657G > C in MSX1, c.2029C > T in AXIN2, and c.1603A > T in LRP6.


Second premolar tooth agenesis was observed in 43.3% of all tooth agenesis cases with mutations, and it was the predominant phenotype observed for each mutated gene, followed by tooth agenesis of the lateral incisors (20%).


Variations in MSX1, WNT10A, AXIN2, KRT17, LRP6, and SMOC2 may be a risk factor for hypodontia or oligodontia in the Turkish population.


There are no studies investigating the correlation between prick test (PT) and intradermal test (IDT) with environmental allergens in dogs with atopic dermatitis (AD).


To investigate the correlation between PT and IDT for two environmental allergens, and to calculate the sensitivity, specificity and Youden index of PT, using IDT as the gold standard.


PT was performed with glycerinated allergen extracts, along with negative and positive controls, using the Greer Prick System.


Reactions were interpreted (positive/negative) subjectively and by using seven objective criteria, by an examiner blinded to the IDT results.


IDT reactions to the same allergens were interpreted, subjectively and objectively, by another masked investigator.


The agreement between PT and IDT, the sensitivity, specificity and Youden index of PT, using IDT as gold standard, were calculated.


On subjective evaluation, the correlation between PT and IDT was poor and sensitivity of PT was 0%.