Stuck in time – a new Chaenothecopsis species with proliferating ascomata from Cunninghamia resin and its fossil ancestors in European amber

Resin protects wounded trees from microbial infection, but also provides a suitable substrate for the growth of highly specialized fungi. Chaenothecopsis proliferatus is described growing on resin of Cunninghamia lanceolata from Hunan Province, China. The new fungus is compared with extant species and two new fossil specimens from Eocene Baltic and Oligocene Bitterfeld ambers. The Oligocene fossil had produced proliferating ascomata identical to those of the newly described species and to other extant species of the same lineage. This morphology may represent an adaptation to growing near active resin flows: the proliferating ascomata can effectively rejuvenate if partially overrun by fresh, sticky exudate. Inward growth of fungal hyphae into resin has only been documented from Cenozoic amber fossils suggesting comparatively late occupation of resin as substrate by fungi. Still, resinicolous Chaenothecopsis species were already well adapted to their special ecological niche by the Eocene, and the morphology of these fungi has since remained remarkably constant.     

Is prevention of atopic eczema with hydrolyzed formulas cost-effective? A health economic evaluation from Germany

To cite this article: Mertens J, Stock S, Lüngen M, Berg AV, Kr?mer U, Filipiak-Pittroff B, Heinrich J, Koletzko S, Grübl A, Wichmann H-E, Bauer C-P, Reinhardt D, Berdel D, Gerber A. Is Prevention of Atopic Eczema with Hydrolyzed Formulas Cost-Effective? A Health Economic Evaluation from Germany. Pediatr Allergy Immunol 2012: 23: 597-604. ABSTRACT: Objective: The German Infant Nutritional Intervention (GINI) trial, a prospective, randomized, double-blind intervention, enrolled children with a hereditary risk for atopy. When fed with certain hydrolyzed formulas for the first 4?months of life, the risk was reduced by 26-45% in PP and 8-29% in intention-to-treat (ITT) analyses compared with children fed with regular cow's milk at age 6. The objective was to assess the cost-effectiveness of feeding hydrolyzed formulas. Patients and Methods: Cost-effectiveness was assessed with a decision tree model programmed in TreeAge. Costs and effects over a 6-yr period were analyzed from the perspective of the German statutory health insurance (SHI) and a societal perspective at a 3% effective discount rate followed by sensitivity analyses. Results: The extensively hydrolyzed casein formula would be the most cost-saving strategy with savings of 478?€ per child treated in the ITT analysis (CI95%: 12?€; 852?€) and 979?€ in the PP analysis (95%CI: 355?€; 1455?€) from a societal perspective. If prevented cases are considered, the partially whey hydrolyzed formula is cost-saving (ITT -5404?€, PP -6358?€). From an SHI perspective, the partially whey hydrolyzed formula is cost-effective, but may also be cost-saving depending on the scenario. An extensively hydrolyzed whey formula also included into the analysis was dominated in all analyses. Conclusions: For the prevention of AE, two formulas can be cost-effective or even cost-saving. We recommend that SHI should reimburse formula feeding or at least the difference between costs for cow's milk formula and the most cost-effective formula.     

Efficient application of volatile anaesthetics: total rebreathing or specific reflection?

The circle system has been in use for more than a 100 years, whereas the first clinical application of an anaesthetic reflector was reported just 15 years ago. Its functional basis relies on molecular sieves such as zeolite crystals or activated carbon. In a circle system, the breathing gas is rebreathed after carbon dioxide absorption; a reflector on the other hand specifically retains the anaesthetic during expiration and resupplies it during the next inspiration. Reflection systems can be used in conjunction with intensive care ventilators and do not need the permanent presence of trained qualified staff. Because of easy handling and better ventilatory capabilities of intensive care ventilators, reflection systems facilitate the routine use of volatile anaesthetics in intensive care units. Until now, there are three reflection systems commercially available: the established AnaConDa? (Sedana Medical, Uppsala, Sweden), the new smaller AnaConDa-S?, and the Mirus? (Pall Medical, Dreieich, Germany). The AnaConDa consists only of a reflector which is connected to a syringe pump for infusion of liquid sevoflurane or isoflurane. The Mirus represents a technical advancement; its control unit includes a gas and ventilation monitor as well as a gas dispensing unit. The functionality, specific features, advantages and disadvantages of both systems are discussed in the text.     

Der Resektionsrand und seine Beurteilung

In recent years there has been an intensive discussion about how to define a negative surgical resection margin. Despite the impact of radiation and systemic therapy a positive margin in breast surgery is associated with an increased risk of local recurrence. Thus, a positive margin confirmed by the pathologist results in further surgery that is troublesome for the patient in several ways and can also delay the initiation of adjuvant treatment. Therefore, the field of intraoperative margin assessment was intensively investigated and methods and technologies have been developed to support the breast surgeon in the operating theater. Some of these developments, such as frozen sections, touch imprint cytology, intraoperative ultrasound and radiofrequency spectroscopy are now established in the clinical routine. Others, such as near-infrared optical imaging, X-ray diffraction, high-frequency ultrasound and micro-computed tomography (CT) are still in the experimental stage. This article illustrates the current status of defining a negative surgical margin and gives an overview of the various and innovative technologies for intraoperative margin assessment.     

Differential effects of bifrontal tDCS on arousal and sleep duration in insomnia patients and healthy controls

Background

Arousal and sleep represent basic domains of behavior, and alterations are of high clinical importance.

Repair of Left Ventricular Assist Device Driveline Damage Directly at the Transcutaneous Exit Site

With increasing support duration of cardiac assist devices, transcutaneous drivelines remain a weak point of the therapy. First, they can be an entry point for infections, and second, cable lesions and even electrical failures due to material fatigue and eventual carelessness can occur. We report a case of a damaged outer sheath of a ventricular assist device driveline cable directly at the exit site, where the standard repair procedure with self‐fusing tape may lead to biocompatibility problems and irritation of the entrance through the skin. Therefore, a new procedure was developed using a special sleeve expander tool and a highly expandable latex tubing to stabilize the defect in a flexible and biocompatible manner. A patient experienced a fracture of the outer sheath of a HeartWare HVAD driveline directly at the skin entrance (approximately 15 mm long, 5 mm distal from the skin). The metal strands and the electrical functionality were yet not affected, therefore, a pump exchange was not indicated. After considering several conventional solutions for repair as not applicable, a new approach was developed: a sleeve expander tool was applied, which allowed radial stretching of the latex tubing. After preparations of the tool and the cable site, the pump was briefly disconnected, the tubing was moved over the connector and was released at the site of fracture. The problem could be solved by keeping the cable's flexibility and without additional risks to the skin. Within a still ongoing (5‐month) follow‐up, the skin entrance returned to perfect condition and no further intervention was necessary. In conclusion, this method allows a quick stabilization and repair of damaged driveline isolations even near the exit site, resulting in a biocompatible surface and consistent flexibility of the cable.