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Background/Aim: This retrospective cohort study enrolled hospitalized women with 24+0 to 33+6 gestational weeks with conditions associated with preterm birth. We evaluated the ability of vaginal swab isolates to guide antibiotic management decisions in the setting of threatened preterm towards a clinical advantage, i.e., longer delay between diagnosis and birth, better neonatal outcomes. Patients and Methods: Vaginal swabs were obtained from all patients and antibiotic resistance profiles determined in case of growth. The cohort was divided into two groups: the antibiogram-noncongruently managed Group 1 and the antibiogram-congruently managed Group 2. Тhese groups were compared in regard to multiple maternal and neonatal endpoints. Results: In total, 698 cases were analyzed – 224 in Group 1 and 474 in Group 2. Antibiotics were ordered/continued by the treating physician in 138 cases (138/698; 19.8%) upon review of vaginal swab cultures results. Forty-five among them (32.6%) received antibiotics inactive against the isolated bacteria. 335 (25.4%) patients had only normal vaginal flora, and 95.6% of them had not received antibiotics. Facultatively pathogenic microorganisms were isolated in 52% patients. Only 5% of the neonates had bacterial isolates identical to those of their mothers. There were no significant differences in outcomes between Group 1 and Group 2. Conclusion: No association was found between a swab-result-guided antibiotic management protocol and maternal or fetal outcome in the setting of preterm birth risk between 24 and 34 gestational weeks. These findings underline the importance of critical re-thinking the frequency of vaginal smears and fine-tuning the indications for antibiotic treatment.

Background/Aim: The objective of this study was to assess the perception of the forensic medical examination (FME) by victims of sexual violence. Based on patient-related outcomes gained in terms of personnel, chronological and spatial parameters, an additional aim was to derive improved examination procedures. Patients and Methods: A total of 49 sexually assaulted women were enrolled in this study. After standardized FME by a forensic doctor followed by a gynecologist, women were asked to complete a questionnaire addressing general perception, preferences regarding attending staff’s sex, sequence and time frame of the examinations performed. The attending gynecologist also completed a questionnaire addressing demographic and medical parameters of the patient as well as assault-related information. Results: The examination setting in general was evaluated positively. Nevertheless, 52% of examined victims perceived the FME as an additional psychological burden. Overall, 85% of the affected women preferred a female forensic physician and 76% a female gynecologist to perform the examination. When women said they experienced a violation of their privacy during the gynecological examination, a male was more often present (60% vs. 35%, p=0.0866). Regarding the sequence of the examination components, 65% of the victims preferred to start with their medical history followed by the forensic and then the gynecological examination. Conclusion: Forensic medical and gynecological examination after sexual assault is an essential procedure, yet it is a potentially further traumatizing experience for the victim. The identified patient preferences should be taken into account in order to diminish further trauma.

Purpose To assess acute cardiac toxicity caused by intraoperative radiotherapy (IORT) with low-energy x‑rays for early breast cancer. Methods We prospectively analyzed pre- and postoperative troponin I and NT-proBNP in 94 women who underwent breast-conserving surgery between 2013 and 2017 at the Department of Gynecology and Obstetrics of the University Medical Center Mannheim, Germany. Thirty-nine women received IORT using low-energy x‑rays during breast-conserving surgery while 55 patients without IORT formed the control group. Demographic and surgical parameters as well as cardiac markers were evaluated. Results There were no significant differences concerning age and side of breast cancer between the groups. Furthermore, no significant difference between the troponin I assays of the IORT and control groups could be found (preoperatively: 0.017 ± 0.006 ng/ml vs. 0.018 ± 0.008 ng/ml; p = 0.5105; postoperatively: 0.019 ± 0.012 ng/ml vs. 0.018 ± 0.010 ng/ml; p = 0.6225). N‑terminal fragment of B‑type natriuretic peptide (NT-proBNP) was significantly higher in the control group 24 h after surgery (preoperatively: 158.154 ± 169.427 pg/ml vs. 162.109 ± 147.343 pg/ml; p = 0.56; postoperatively: 168.846 ± 160.227 pg/ml vs. 232.527 ± 188.957 pg/ml; p = 0.0279). Conclusion Troponin I levels as a marker of acute cardiac toxicity did not show any significant differences in patients who received IORT during breast-conserving surgery compared to those who did not.

Supplemental material, sj-docx-2-cat-10.1177_10760296221137893for Diagnostic and Prognostic Significance of the Prothrombin Time/International Normalized Ratio in Sepsis and Septic Shock by Tobias Schupp, Kathrin Weidner, Jonas Rusnak, Schanas Jawhar, Jan Forner, Floriana Dulatahu, Lea Marie Brück, Ursula Hoffmann, Thomas Bertsch, Julian Müller, Christel Weiß, Ibrahim Akin and Michael Behnes in Clinical and Applied Thrombosis/Hemostasis

Supplemental material, sj-docx-2-cat-10.1177_10760296221137893for Diagnostic and Prognostic Significance of the Prothrombin Time/International Normalized Ratio in Sepsis and Septic Shock by Tobias Schupp, Kathrin Weidner, Jonas Rusnak, Schanas Jawhar, Jan Forner, Floriana Dulatahu, Lea Marie Brück, Ursula Hoffmann, Thomas Bertsch, Julian Müller, Christel Weiß, Ibrahim Akin and Michael Behnes in Clinical and Applied Thrombosis/Hemostasis

Additional file 1.

Additional file 1. Inhibition of the Erk1/2 and p38 signalling pathways by specific inhibitors. HIBCPP cells grown in the inverted culture system and infected for 4 h with the NmB strain MC58siaD- (Nm). Untreated cells were used as controls. The activation of Erk1/2 was inhibited by adding 25 ��M of the inhibitor U0126 (U) and detected using an immunoblot (A). The cells treated with PMA served as positive controls. Phosphorylation of p38 was inhibited by SB203580 (SB) at a concentration of 25 ��M. The functionality of the inhibitor was examined using an immunoblot of the p38 target protein MAPKAPK-2 (B). Treatment with anisomycin (Aniso) was used as positive control.

Additional file 2. Summary of DEG determined by MACE Analysis of the transcriptome of HIBCPP cells during infection with Nm. The DEG were determined by comparing the control conditions (con, con + U0126) with the corresponding treated, infected cells. The lists shown here were filtered for a FDR p-value of < 0.05 as well as a fold change of +/- 4 (log2 fold change +/- 2).

Background Accurate planning of operating times in a surgical clinic is essential. High capacity utilization of operating rooms (ORs) is necessary for economic efficiency. Variable working hours of different team members on a surgical team (such as the anesthesiologist, surgeon, and OR-assistant) must also be respected. In this regard, incorrect planning may lead to conflicts between team members, thus disturbing daily work routine. Most planning of operating times is performed by surgeons. Here, objective and estimated times by surgeons were compared to detect sources of error. Methods In a retrospective analysis, durations of 1809 operations under general anaesthesia (22 different types) by 31 surgeons (12 specialists (S) and 19 residents (R)) of the ear nose throat department at Mannheim University Medical Centre were compared. Incision to suture and preparation and post-processing times of 10 specialists and 17 residents estimated based on questionnaires were compared to objective times. Both comparisons were analyzed by Mann-Whitney-U-tests. Results Comparison of objective times of surgical action showed significant differences between specialists and residents in 6 of 15 types of surgeries. Post-processing times estimated by specialists deviated from objective times in 2 out of 22 surgery types. Post-processing times estimated by residents deviated in 7 out of 15 types. Specialists misjudged incision to suture times in 7 of 22 surgery types, and residents misjudged in 3 out of 15. Preparation times estimated by specialists deviated from objective times in 16 of 22 types of surgeries and in 7 out of 15 estimated by residents. Conclusions A surgeon’s routine must be considered to estimate operating times. Specialists underrated the preparation and post-processing and overrated incision to suture times. Residents underestimated all of these times. Preparation and post-processing times must be considered in the planning and, ideally, determined together with anesthesiologists and OR-assistants.

Background: The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial. Purpose: The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon. Study Design: Controlled laboratory study. Methods: A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t1) was evaluated. In the intervention group, AIS (t2), PIS (t3), and CR (t4) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention. Results: A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t1 vs t4: 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t1 vs t2: 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t2 vs t3: 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t3 vs t4: 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001). Conclusion: The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally. Clinical Relevance: These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure.

Figure S1. Illustration of antibacterial utilization measures. Table S1. Referring departments of the ICU cohort. Table S2. Most common microbiological isolates from blood cultures and bronchioalveolar lavages 2006–2013. Table S3. Basic characteristics of ICU patients with length of stay > 48 h, all and those treated with antibacterials excluding erythromycin. Table S4. Rate ratios for antibacterial classes (patients with length of stay > 48 h). (DOC 135 kb)

E-30 sequence alignments. Positions identical to those of Bastianni are indicated as dots. (A) Amino acid alignment of the P1 region. The VP4, VP3, VP2, and VP1 protein sequences are shown in red, green, blue, and purple, respectively. (B) Amino acid alignment of the P2 region. The protein 2C, 2B, and 2A sequences are shown in raspberry, orange, and light blue, respectively. (C) Amino acid alignment of the P3 region. The 3C protease, VPg, and RNA-dependent RNA polymerase sequences are shown in green, purple, and red, respectively. (D) Nucleotide alignment of 5′UTR regions. (E) Nucleotide alignment of 3′UTR regions. (PDF 3120 kb)