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Currently, there is no ideal method defined in the repair of complex lateral malleolar defects, and the existing methods (i.e., bone repair, soft tissue or free flap closure) are far from producing functional results in terms of the ultimate recovery of ankle movements. Herein, an operative technique for soft tissue, ligamentous, and osseous reconstruction of fibular defect, using a free vascularized serratus anterior osteomusculocutaneous flap for reconstruction of a fibular deficit and the sixth costa for soft tissue coverage, was described in relation to tissue coverage and functional reconstruction outcome in a 31-year-old male patient with soft tissue and distal fibula defects in the lateral malleolus region caused by a traffic accident. Ankle movement was regained to almost full extent. No complications requiring further intervention was encountered in the donor site or ankle. In conclusion, the described operative technique enabled the repair of functional ligaments of the ankle joint in addition to repair of the soft tissue, lateral malleolus bone and skin defects in one session without the need for further additional operative intervention. Hence, the use of serratus osteomusculocutaneous free flap as a lateral malleolar reconstruction method seems to enable not only the tissue coverage but also to assist with functional reconstruction. [ABSTRACT FROM AUTHOR]

Background: Prior research suggests that the proportion of a shockable initial rhythm in out-of-hospital cardiac arrest (OHCA) declined during the last decades. This study aims to investigate if this decline is still ongoing and explore the relationship between location of OHCA and proportion of a shockable initial rhythm as initial rhythm.Methods: We calculated the proportion of patients with a shockable initial rhythm between 2006-2015 using pooled data from the COSTA-group (Copenhagen, Oslo, Stockholm, Amsterdam). Analyses were stratified according to location of OHCA (residential vs. public).Results: A total of 19,054 OHCA cases were included. Overall, the total proportion of cases with a shockable initial rhythm decreased from 42% to 37% (P < 0.01) from 2006 to 2015. When stratified according to location, the proportion of cases with a shockable initial rhythm decreased for OHCAs at a residential location (34% to 27%; P = 0.03), while the proportion of a shockable initial rhythm was stable among OHCAs in public locations (59%-57%; P = 0.2). During the last years of the study period (2011-2015), the overall proportion of a shockable initial rhythm remained stable (38%-37%; P = 0.45); this was observed for both residential and public OHCA.Conclusion: We found a decline in the proportion of patients with a shockable initial rhythm in OHCAs at a residential location; this decline levelled off during the second half of the study period (2011-2015). In public locations, we observed no decline in shockable initial rhythm over time. [ABSTRACT FROM AUTHOR]

Tritrichomonas foetus is a parasite that causes bovine trichomonosis, a major sexually transmitted disease in cattle. It grows in axenic media as a trophozoite with a pear-shaped body, three anterior flagella, and one recurrent flagellum. However, under some well-controlled experimental conditions in vitro , as well as in vivo in infected bulls, the parasite acquires a spherical or elliptical shape, and the flagella are internalized but the cells do not display a cyst wall. This form, known as the endoflagellar or pseudocystic form, is viable, and can be transformed back to trophozoites with pear-shaped body. We used confocal laser scanning microscopy, and high resolution scanning electron microscopy to examine the changes that take place in the protozoan cytoskeleton during trophozoite-pseudocyst transformation. Results confirmed previous studies and added new structural information to the organization of cytoskeletal structures during the transformation process. We observed that changes take place in the pseudocysts’ axostyle and costa, which acquired a curved shape. In addition, the costa of multinucleated/polymastigont pseudocysts took variable conformations while curved. The costa accessory structure, as well as a network of filaments connecting this structure to the region where the recurrent flagellum associates to the protozoan body, was not seen in pseudocysts. In addition, the axostyle was fragmented during trophozoite-pseudocyst transformation. [ABSTRACT FROM AUTHOR]

Abstract: A generic toolbox for data assimilation called COSTA (COmmon Set of Tools for the Assimilation of data) makes it possible to simplify the application of data assimilation to models and to try out various methods for a particular model. Concepts of object oriented programming are used to define building blocks for data assimilation systems that can be exchanged and reused. The main building blocks in COSTA are the model component and the stochastic observer component. These components can be created by wrapping existing code. The LOTOS–EUROS air quality model will be used for operational smog and aerosol forecasts in the Netherlands in the near future. The COSTA framework will be used in this operational environment to implement the data assimilation techniques. As a first steps towards this operational system the model component of LOTOS–EUROS is created and the performance of various Kalman filter based data assimilation techniques are compared for a real live case study. The ensemble Kalman filter and the ensemble square-root filters converged faster than the other tested techniques for the selected case study setup. [Copyright &y& Elsevier]

We present a case report and review of literature about slipping rib syndrome, a syndrome rarely recognized and often un or misdiagnosed. In literature there is no clear consensus about the diagnosis and treatment. We present a case of a 47 year old man who was diagnosed with slipping rib syndrome after a cycling incident 8 years ago. Also, we developed a flow chart according the diagnostic and therapeutic steps in the treatment of slipping rib syndrome. Central massage Knowledge and treatment of the slipping rib syndrome can prevent chronic complaints and unnecessary comprehensive treatment. [ABSTRACT FROM AUTHOR]