Search Results (34)

Piglets are highly susceptible to iron deficiency. This randomized clinical trial evaluated the effectiveness of four iron dosing schemes in preventing anemia. Two herds with different farrowing management systems were included. In each herd, 40 litters (6 piglets/litter) were selected on day 3 of age. A 2 × 2 factorial design was applied, combining two intramuscular iron dextran injection schemes [37.5 mg Fe/kg (low injection; LI) or 150 mg Fe/kg (high injection; HI)] with two oral ferrous sulphate feed supplementation schemes [125 mg Fe/kg (low feed; LF) or 200 mg Fe/kg (high feed; HF)]. Blood samples were collected at 4 and 20 days of age, and piglets were weighed at 3 and 20 days. Data were analyzed using linear mixed models, with significance set at p < 0.05. In Herd A, HI-LF piglets showed increased body weight, whereas no growth differences were observed in Herd B. Creep-feed intake did not differ between treatments. HI consistently improved red-cell indices in Herd A, while in Herd B LI piglets initially showed higher values at day 4, but HI piglets surpassed them by day 20. Leukocyte responses were limited. High-dose iron injections were effective in preventing anemia, while oral supplementation had minimal impact. Full article

Background/Objectives: To compare changes in the thickness of retinal layers between patients with amyotrophic lateral sclerosis (ALS) and healthy controls using optical coherence tomography. Amyotrophic lateral sclerosis is a degenerative disease of the upper and lower motoneurons with a rapidly progressive course, but non-motor symptoms such as decreased ocular motility and reduced visual acuity have also been reported. Specific biomarkers or surrogate parameters assessing neurodegeneration in ALS are of interest. Methods: In a retrospective, longitudinal study using optic coherence tomography of the retinal layers, we compared changes in the thickness of the layers between patients with ALS and healthy controls. Correlations to clinical scores, such as the modified ranking scale, were analyzed. Results: In our cohort of patients with early ALS (disease duration 5.15 ± 21.4 months at baseline), we neither observed differences in retinal layer thickness at baseline nor did the thickness changes in any retinal layer differ in comparison to healthy controls at baseline. Moreover, we observed no significant thickness changes over the course of the observational period in our patients with ALS. However, a correlation analysis revealed a negative association of the thickness change rates in the complex of ganglion cell and inner plexiform layer and the inner nuclear layer with a higher modified Rankin scale at follow-up. Conclusions: This study adds to the notion that OCT may not be a suitable tool to monitor atrophy and disease progression in ALS. However, further longitudinal studies with longer follow-up times and larger cohorts are warranted. Full article

Background: Up to 10% of emergency department (ED) patients present with palliative care needs. Despite rising demand for palliative expertise in acute care, ED processes for these patients remain heterogeneous, and data from German EDs are limited. Methods: This retrospective cohort study included all patients presenting to the ED of a 754-bed academic hospital in 2023 who were later admitted to the palliative care ward. Demographics, symptom burden at ED and palliative care admission, length of stay (LOS), and discharge outcomes were analyzed after ethics approval (EK 24-062). Patients transferred to palliative care later during hospitalization (group 1) were compared with those directly transferred after ED treatment (group 2). Results: Among 229 included patients, 190 were identified as group 1 and 39 as group 2 patients. Demographics and cancer prevalence were comparable (68.4% vs. 69.2%). In group 1, fatigue, neurological symptoms, dyspnea, and anxiety/restlessness significantly increased during hospitalization, while anxiety/restlessness decreased significantly in group 2. Before palliative admission, LOS in group 1 was 15.2 ± 13.9 days; 36.8% required intensive or stroke unit care. LOS in the palliative ward (8.0 ± 6.6 vs. 9.3 ± 10.3 days, p = 0.45) and discharge alive rates (27.1% both groups) did not differ. Conclusions: Early recognition and management of palliative needs in the ED may reduce symptom burden. Once specialized palliative care was established, LOS and mortality were comparable across groups, highlighting the value of standardized assessments for early identification and integration of palliative care in acute settings. Full article

Smart-grid technologies are essential to achieving sustainable high-level grid resilience. Integrating sensors and monitoring devices throughout grid infrastructure provides additional data on weather-related parameters in real-time, enabling the smart grid to respond appropriately to inclement weather and its associated challenges. The recording of all these data associated with each extreme weather event helps in the study and development of methodological tools for decision-making on issues of restoration and modification of the electricity network, with a view to enhancing its resilience and consequently ensuring the uninterrupted supply of electricity, even during the occurrence of these weather phenomena. This article focuses on enabling the utilization of meteorological data archives of past events, which demonstrate that natural disasters and extreme weather phenomena nowadays require network designs that can cope with the more frequent occurrence (high frequency) of events that have a significant impact (high impact) on the smooth operation of the network. Full article

Multiple sclerosis (MS), an auto-immune disease of the central nervous system (CNS) with inflammatory and neurodegenerative properties, remains an insufficiently understood disease despite more than 150 years of research. In contrast to diseases from other medical fields such as, for instance, oncology, a description of its clinical and non-clinical features based on readouts such as biomarkers is still in its infancy. While, in this regard, neurofilament light chain (NfL) seems to be a promising new tool, the significant intra- and interindividual variation of this serological marker somewhat limits its widespread applicability in everyday clinical reality. This has sparked novel studies in which glial fibrillary acidic protein (GFAP) was proposed as an on-top marker serving to improve overall specificity. In this context, it was found that MS disease progression was significantly more often associated with increased levels of both NfL and GFAP compared to increased NfL levels alone. This highlights the complexity of the disease while also emphasizing the potential benefits of introducing additional markers to enhance current options. We propose that nitrosative stress markers, such as nitrate, nitrite, and nitrotyrosine (3NT), could serve this purpose effectively. Full article

The RELY-CD study investigated the long-term clinical response to botulinum neurotoxin type A in cervical dystonia within a multicenter, real-world setting. This retrospective study focused on patients treated with complex-free (incobotulinumtoxinA) and complex-containing (onabotulinumtoxinA and abobotulinumtoxinA) BoNT/A formulations over an up to 10-year period. The novel dose–effect parameter “DEff” was introduced to quantify the relationship between dose adjustments and clinical outcomes, enabling the identification of partial treatment failures. The primary endpoint was a comparison of a clinically meaningful worsening in DEff in treatment year 7 compared to year 2 between complex-free and complex-containing botulinum neurotoxin type A. The RELY-CD study provides unique insights into long-term treatment patterns, clinical resistance phenomena, and the implications of formulation differences on treatment outcomes, addressing a critical gap in the literature on real-world botulinum neurotoxin type A application. The study methodology, including the definition and calculation of the novel DEff, as well as clinical baseline characteristics, are presented. Full article

Background: In patients requiring dual-chamber pacemaker (DDD) implantation, optimal atrial lead position remains a matter of debate. While most centers prefer implantation in the right atrial appendage position (Non-BB-P), due to a speculated favorable impact on atrial conduction characteristics, often, a Bachman bundle pacing (BB-P) is recommended. However, data investigating clinical outcomes in these patients are still rare. Methods: To evaluate this issue, in this retrospective single-center study, one-year clinical follow-up, pacemaker interrogations and available echocardiography findings in 301 consecutive patients (BB-P: age 76 ± 10 years, 46.7% female, n = 169; Non-BB-P: 77.6 ± 9 years, 50% female, n = 132, p = n.s.) scheduled for dual-chamber implantation were analyzed. Results: During follow-up, the incidence of atrial fibrillation (AF) remained similar in both groups (BB-P: 38.3%, n = 154 vs. Non-BB-P: 34.2%, n = 117 p = n.s.). However, we detected significantly more mode switch episodes in the BB-P group (BB-P: 51.9%, n = 154 vs. Non-BB-P: 38.8%, n = 116, p = 0.032). Furthermore, left ventricular functional parameters, including left ventricular ejection fraction (BB-P: 57.1 ± 8.4%, n = 60 vs. Non-BB-P: 56.0 ± 9.6, n = 45 p = n.s.) and incidence of diastolic dysfunction (BB-P: 55.2%, n = 67 vs. Non-BB-P: 38.3%, n = 47, p = n.s.), as well as the rate of left (BB-P: 58.8%, n = 68 vs. Non-BB-P: 42.0%, n = 50, p = n.s.) and right atrial dilatation (BB-P: 27.9%, n = 68 vs. Non-BB-P: 28.0%, n = 50 p = n.s.), were not significantly affected by the atrial lead position. However, stimulated p-waves were significantly shorter in BB-P vs. Non-BB-P (BB-P: 132.9 ± 23.7 ms, n = 127 vs. Non-BB-P: 139.6 ± 23.4 ms, n = 93, p = 0.031). Conclusions: In patients requiring dual-chamber implantation, the position of the atrial lead significantly altered atrial conduction, but this did not seem to affect left ventricular function parameters or the occurrence of atrial fibrillation within our follow-up period. Interestingly, we even detected more mode switch episodes in the BB-P group, hinting at an even proarrhythmic potential of BB-P. On the other hand, we found a decreased ventricular stimulation percentage in BB-P vs. Non-BB-P. Further studies should investigate the impact of Bachmann bundle pacing on clinical outcomes. Full article

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) of still unclear etiology. In recent years, the search for biomarkers facilitating its diagnosis, prognosis, therapy response, and other parameters has gained increasing attention. In this regard, in a previous meta-analysis comprising 22 studies, we found that MS is associated with higher nitrite/nitrate (NOx) levels in the cerebrospinal fluid (CSF) compared to patients with non-inflammatory other neurological diseases (NIOND). However, many of the included studies did not distinguish between the different clinical subtypes of MS, included pre-treated patients, and inclusion criteria varied. As a follow-up to our meta-analysis, we therefore aimed to analyze the serum and CSF NOx levels in clinically well-defined cohorts of treatment-naïve MS patients compared to patients with somatic symptom disorder. To this end, we analyzed the serum and CSF levels of NOx in 117 patients (71 relapsing–remitting (RR) MS, 16 primary progressive (PP) MS, and 30 somatic symptom disorder). We found that RRMS and PPMS patients had higher serum NOx levels compared to somatic symptom disorder patients. This difference remained significant in the subgroup of MRZ-negative RRMS patients. In conclusion, the measurement of NOx in the serum might indeed be a valuable tool in supporting MS diagnosis. Full article

This case report describes the surgical management of a patient with a complex hand trauma. This injury included tendon, vascular, and nerve injuries, a partial amputation of the index finger, fractures of the third proximal phalanx, and destruction of the metacarpophalangeal joint of the fifth finger. Firstly, the acute treatment of a complex hand injury is described. Secondly, the planning and execution of a joint reconstruction using a vascularized lateral femoral condylar flap, assisted by an individual 3D model, is illustrated. Precise reconstruction of the affected structures resulted in good revascularization as well as an anatomical bone consolidation. Intensive physical therapy, including autonomous proprioceptive range-of-motion exercises by the patient, resulted in significant functional improvement of the hand in daily life. Overall, we report on the successful reconstruction of a metacarpophalangeal joint by using a vascularized flap from the lateral femoral condyle. Furthermore, this case report highlights the efficacy of integrating individualized 3D printing technology to plan complex reconstructions, opening up promising opportunities for personalized and optimized interventions. Full article

Background: The aim of this study was to demonstrate that both neurological and hepatic symptoms respond to copper chelation therapy in Wilson disease (WD). However, the time course of their recovery is different. Methods: Eighteen patients with neurological WD from a single specialized center who had been listed for liver transplantation during the last ten years and two newly diagnosed homozygous twins were recruited for this retrospective study. The mean duration of conventional treatment was 7.3 years (range: 0.25 to 36.2 years). A custom Wilson disease score with seven motor items, three non-motor items, and 33 biochemical parameters of the blood and urine, as well as the MELD score, was determined at various checkup visits during treatment. These data were extracted from the charts of the patients. Results: Treatment was initiated with severity-dependent doses (≥900 mg) of D-penicillamine (DPA) or triethylene-tetramin-dihydrochloride (TRIEN). The motor score improved in 10 and remained constant in 8 patients. Worsening of neurological symptoms was observed only in two patients who developed comorbidities (myasthenia gravis or hemispheric stroke). The neurological symptoms continuously improved over the years until the majority of patients became only mildly affected. In contrast to this slow recovery of the neurological symptoms, the MELD score and liver enzymes had already started to improve after 1 month and rapidly improved over the next 6 months in 19 patients. The cholinesterase levels continued to increase significantly (p < 0.0074) even further. One patient whose MELD score indicated further progression of liver disease received an orthotopic liver transplantation 3 months after the diagnosis of WD and the onset of DPA treatment. Conclusions: Neurological and hepatic symptoms both respond to copper chelation therapy. For patients with acute liver failure, the first 4 months are critical. This is the time span in which patients have to wait either for a donor organ or until significant improvement has occurred under conventional therapy. For patients with severe neurological symptoms, it is important that they are treated with fairly high doses over several years. Full article

The aim of this study was to detect clinical hints regarding the development of secondary treatment failure (STF) in patients with focal dystonia who were exclusively treated with incobotulinumtoxin/A (incoBoNT/A). In total, 33 outpatients (26 with idiopathic cervical dystonia, 4 with Meige syndrome and 3 with other cranial dystonia) who were treated with repeated injections of incoBoNT/A for a mean period of 6.4 years without interruptions were recruited to draw the course of their disease severity (CoD) from the onset of symptoms to the onset of BoNT therapy (CoDB graph) and from the onset of BoNT therapy to recruitment (CoDA graph). At the time of recruitment, the patients assessed the change in severity as a percentage of the severity at the onset of BoNT therapy. Blood samples were taken to test the presence of neutralizing antibodies (NABs) using the mouse hemidiaphragm assay (MHDA). Patients reported an improvement of about 70% with respect to the mean. None of the patients tested positive for MHDA. Three different types of CoDB and three different types of CoDA graphs could be distinguished. The patients with different CoDB graphs reported different long-term outcomes, but there was no significant difference in long-term outcomes between patients with different CoDA graphs. None of the patients produced a CoDA graph with an initial improvement and a secondary worsening as a hint for the development of STF. A primary non-response was not observed in any of the patients. During long-term treatment with BoNT/A, NABs and/or STF may develop. However, in the present study on patients with incoBoNT/A long-term monotherapy, no hints for the development of NABs or STF could be detected, underlining the low antigenicity of incoBoNT/A. Full article

Aim of the study: To compare the course of severity of cervical dystonia (CD) before and after long-term botulinum toxin (BoNT) therapy to detect indicators for a good or poor clinical outcome. Patients and Methods: A total of 74 outpatients with idiopathic CD who were continuously treated with BoNT and who had received at least three injections were consecutively recruited. Patients had to draw the course of severity of CD from the onset of symptoms until the onset of BoNT therapy (CoDB graph), and from the onset of BoNT therapy until the day of recruitment (CoDA graph) when they received their last BoNT injection. Mean duration of treatment was 9.6 years. Three main types of CoDB and four main types of CoDA graphs could be distinguished. The demographic and treatment-related data of the patients were extracted from the patients’ charts. Results: The best outcome was observed in those patients who had experienced a clear, rapid response in the beginning. These patients had been treated with the lowest doses and with a low number of BoNT preparation switches. The worst outcome was observed in those 17 patients who had drawn a good initial improvement, followed by a secondary worsening. These secondary nonresponders had been treated with the highest initial and actual doses and with frequent BoNT preparation switches. A total of 12 patients were primary nonresponders and did not experience any improvement at all. No relation between the CoDB and CoDA graphs could be detected. Primary and secondary nonresponses were observed for all three CoDB types. The use of initial high doses as a relevant risk factor for the later development of a secondary nonresponse was confirmed. Conclusions: Patients’ drawings of their course of disease severity helps to easily detect “difficult to treat” primary and secondary nonresponders to BoNT on the one hand, but also to detect “golden responders” on the other hand. Full article

This case report focuses on a 17-year-old polytrauma patient who suffered a septic wound infection after an open reduction and internal fixation (ORIF) and soft tissue reconstruction with a pedicled flap, which led to a substantial bone and soft tissue defect of the lower leg. After thorough antibiotic treatment and after ensuring a non-septic wound, the defect was reconstructed using a contralateral free fibula flap designed as a flow through flap in a double loop manner to accommodate two fibular fragments and an ipsilateral ALT flap. Early weight bearing was initiated 11 days after the free flap transfer under external fixation, with full weight bearing achieved in 36 days with external fixation. After the removal of external fixation, full weight bearing was able to be reinitiated after 13 days, leading to the patient’s return to normal activity 6 months after the bony reconstruction. This case presents an innovative approach to treating a complex defect, with the final decision on using two separate free flaps instead of a single osteofasciocutaneous free flap resulting in a good bony reconstruction and soft tissue coverage, and with the use of external fixation enabling early rehabilitation. Full article

Background and Objectives: Open fracture of the lower limb can lead to substantial bone and soft tissue damage, resulting in a challenging reconstructive scenarios, especially in presence of bone or periosteal loss, with a relevant risk of non-union. This work analyzes outcomes of using a double approach for orthoplastic reconstruction, adopting the free medial condyle flap to solve the bone defects, associated to a second free flap for specific soft tissue coverage. Indications, outcomes and reconstructive rationales are discussed. Materials and Methods: A retrospective investigation was performed on patients who underwent complex two-flap microsurgical reconstruction from January 2018 to January 2022. Inclusion criteria in this study were the use of a free femoral condyle periostal/bone flap together with a second skin-only flap. Only distal third lower limb reconstructions were included in order to help equalize our findings. Out of the total number of patients, only patients with complete pre- and post-operative follow-up (minimum 6 months) data were included in the study. Results: Seven patients were included in the study, with a total of 14 free flaps. The average age was 49. Among comorbidities, four patients were smokers and none suffered from diabetes. Etiology of the defect was acute trauma in four cases and septic non-union in three cases. No major complications occurred, and all flaps healed uneventfully with complete bone union. Conclusions: Combining a bone periosteal FMC to a second skin free flap for tailored defect coverage allowed achievement of bone union in all patients, despite the lack of initial bone vascularization or chronic infection. FMC is confirmed to be a versatile flap for small-to-medium bone defects, especially considering its use as a periosteal-only flap, with minimal donor site morbidity. Choosing a second flap for coverage allows for a higher inset freedom and tailored reconstruction, finally enhancing orthoplastic success. Full article