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Objectives: The COVID-19 pandemic has led to major adjustments in health care systems and significantly affected medical education. Accordingly, our mentoring program had to expand its virtual elements, in order to continue to meet the needs for mentoring at the medical faculty of the .Methods: Here we report on our recently implemented online formats to facilitate training for currently coached peer mentors, as well as the introduction of an online consultation hour and a new social mentoring event called .Results: First results demonstrated feasibility of the above-mentioned virtual formats, which were positively rated by the participants in small voluntary evaluation questionnaires. Utilization rates indicate existing need for mentoring during the pandemic. In addition, the new event promotes social interaction among peers during isolation due to COVID-19.Conclusion: With the transition to online formats, mentoring at the Medical Faculty could be continued during COVID-19. The newly introduced mentoring event will be repeated. However, it remains unclear to what extent online formats can replace in-person one-to-one mentoring conversations or peer mentoring meetings.

The article presents the case of five patients who were rushed to the eye hospital at Ludwig Maximilian University of Munich in Germany to discuss the locally increased incidence of periorbital necrotizing fasciitis (PNF) in the country. Also cited are the possible complications of PNF due to systemic toxicity like septicemia, cutaneous injuries, and multiorgan failures.

Soil respiration of terrestrial ecosystems, a major component in the global carbon cycle is affected by elevated atmospheric CO2 concentrations. However, seasonal differences of feedback effects of elevated CO2 have rarely been studied. At the Gießen Free-Air CO2 Enrichment (Gi-FACE) site, the effects of +20% above ambient CO2 concentration have been investigated since 1998 in a temperate grassland ecosystem. We defined five distinct annual seasons, with respect to management practices and phenological cycles. For a period of 3 years (2008-2010), weekly measurements of soil respiration were carried out with a survey chamber on vegetation-free subplots. The results revealed a pronounced and repeated increase of soil respiration under elevated CO2 during late autumn and winter dormancy. Increased CO2 losses during the autumn season (September- October) were 15.7% higher and during the winter season (November-March) were 17.4% higher compared to respiration from ambient CO2 plots. However, during spring time and summer, which are characterized by strong above- and below-ground plant growth, no significant change in soil respiration was observed at the GiFACE site under elevated CO2. This suggests (1) that soil respiration measurements, carried out only during the growing season under elevated CO2 may underestimate the true soil-respiratory CO2 loss (i.e. overestimate the C sequestered), and (2) that additional C assimilated by plants during the growing season and transferred below-ground will quickly be lost via enhanced heterotrophic respiration outside the main growing season. [ABSTRACT FROM AUTHOR]

Background: Unfractionated heparin (UFH) bolus is occasionally administered during endovascular treatment (EVT) to reduce thrombotic complications in acute ischemic stroke patients. However, the MR CLEAN-MED trial showed an increase in symptomatic intracranial hemorrhages (sICH) and a non-significant shift towards worse functional outcome with UFH administration. We aimed to analyze the impact of periprocedural UFH bolus in a real-world setting in anterior (ACS) and posterior circulation stroke (PCS) patients., Methods: We analyzed data from the German Stroke Registry-Endovascular Treatment using propensity score matching. Primary outcome was the modified Rankin Scale at 3 months, and secondary outcome measures included mortality, angiographic outcomes, post-EVT National Institute of Health Stroke Scale scores and ICH at 24 hours., Results: Among 13,082 patients, 7948 with ACS (UFH bolus use in 15%) and 841 with PCS (UFH bolus use in 16.3%) were included in the propensity score matching analysis. Applying MR CLEAN-MED study criteria, UFH bolus was associated with worse functional outcomes (odds ratio [OR] 1.44; 95% CI 1.06-1.96). Analyzing all ACS and PCS patients, UFH bolus did not provide any net benefit. In ACS patients treated with intravenous thrombolysis (IVT), UFH bolus use was associated with worse functional outcomes (OR 2.40; 95% CI 1.34 to 5.06)., Conclusion: Our findings show transferability of the MR CLEAN-MED results into a real-world setting, confirming a negative effect of periprocedural UFH on functional outcome in this subgroup of patients. Considering all ACS and PCS patients, periprocedural UFH did not provide a net benefit and appears to be harmful, particularly in IVT-treated patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Endovascular treatment has become the standard care for acute basilar artery occlusion (BAO). Uncertainty persists about the optimal thrombectomy technique., Objective: To compare aspiration thrombectomy with stent retriever thrombectomy in patients with BAO in a multicenter real-world patient population., Methods: We analyzed data from the German Stroke Registry-Endovascular Treatment (GSR-ET). Patients with isolated BAO who underwent either aspiration or stent retriever thrombectomy were compared, including propensity score matching (PSM). The primary outcome measure was the modified Rankin Scale shift analysis at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH), procedure complications, and metrics., Results: Of 13 082 patients in the GSR-ET, 387 patients (mean age 72.0±13.1 years; 45.0% female) fulfilled the inclusion criteria. The thrombectomy technique was aspiration only in 195 (50.4%) and stent retriever only in 192 (49.6%) patients. Functional outcome did not differ between the groups, either before (common OR (cOR) 0.94; 95% CI 0.64 to 1.38) or after PSM (cOR=1.37; 95% CI 0.90 to 2.09). There was no significant difference in sICH (2.6 vs 5.5%; P=0.231; OR=0.46; 95% CI 0.14 to 1.47), but aspiration thrombectomy demonstrated fewer procedure-related complications (4.6% vs 12.5%; P=0.017), a shorter procedure duration (24 vs 48 min; P<0.001), and higher first pass recanalization rates (75.1% vs 44.8%; P<0.001)., Conclusions: In this study both aspiration and stent retriever thrombectomy showed equal efficacy in terms of functional outcome in patients with BAO. However, procedure complications and metrics might favor aspiration over stent retriever thrombectomy., Competing Interests: Competing interests: LKel has received funding for travel or speaker honoraria from Alexion, AstraZeneca, Bayer Vital, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, and Pfizer outside of this study. CHN has received funding for travel or speaker honoraria from Alexion, Astra-Zeneca, Bayer Vital, Bristol-Myers Squibb, Daiichi Sankyo, Pfizer, and Takeda., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Canine visceral leishmaniasis (CVL), caused by the protozoan Leishmania infantum , affects several organs, including the skin. Dogs are considered the major domestic reservoir animals for leishmaniasis, and through their highly parasitized skin, they can serve as a source of infection for sandfly vectors. Therefore, studies of the skin parasite-host relationship can contribute to the understanding of the infectious dissemination processes of parasites in the dermis and help to identify targets for diagnosis and treatment. Thus, the aim of this study was to evaluate the association of anatomical vascular differences and Leishmania -induced vascular morphological changes with clinical signs and parasite load by analyzing the ear and abdominal skin from dogs naturally infected with L. infantum . Paired samples of ear and abdominal skin from L. infantum -positive dogs ( n = 26) were submitted for histological and immunohistochemistry analyses. The ear skin samples showed a more intense and more diffusely distributed granulomatous inflammatory reaction, a higher number and larger diameter of blood vessels, increased parasite load, higher expression of VEGF+ (vascular endothelial growth factor) and MAC 387+ (calprotectin) recently infiltrating cells, and more intense collagen disruption compared to the abdominal skin samples. Intracellular amastigotes were observed in blood vessels and inside endothelial cells and were diffusely distributed throughout the dermis in the ear skin samples. The NOS2/MAC387+ cell ratio was lower in the ear skin samples than in those of the abdomen, suggesting that in the ear dermis, the inflammatory infiltrate was less capable of producing NO and thereby control the parasite load. Together, these findings indicate how parasites and immune cells are distributed in the skin and suggest an important role for dermal vascularization in cellular influx and thereby in parasite dissemination through the skin of naturally infected dogs.

The zoonotic visceral leishmaniasis is caused by the protozoan Leishmania infantum and dogs are reservoirs for this parasite. For the diagnosis of Leishmania at the species level in dogs in formalin-fixed, paraffin-embedded skin (FFPES) samples, colorimetric in situ hybridization (CISH) and quantitative real-time polymerase chain reaction (qPCR) are options, but their sensitivities are not well established. Therefore, the aim of this study was to determine the sensitivity of these two techniques in FFPES for the diagnosis of the L. infantum infection in dogs using culture as the reference standard. The FFPES of 48 dogs with cutaneous infection by L. infantum confirmed by culture and by multilocus enzyme electrophoresis were examined by CISH and qPCR using specific probes for L. infantum . The sensitivities of qPCR, CISH and their combination were, respectively, 77.0%, 58.0% and 83.3%. The sensitivities of qPCR in dogs with and without clinical signs were, respectively, 74.2% and 82.4%. The sensitivities of CISH in dogs with and without clinical signs were, respectively, 61.3% and 52.9%. The CISH and qPCR showed satisfactory sensitivities for the diagnosis of L. infantum in the FFPES of dogs, even in dogs without clinical signs, and their combination increases the sensitivity for this diagnosis.

Background: Patients with subarachnoid hemorrhage (SAH) often necessitate intra-hospital transport (IHT) during intensive care treatment. These transfers to facilities outside of the neurointensive care unit (NICU) pose challenges due to the inherent instability of the hemodynamic, respiratory, and neurological parameters that are typical in these patients., Methods: In this retrospective, single-center cohort study, a total of 108 IHTs were analyzed for demographics, transport rationale, clinical outcomes, and pre/post-IHT monitoring parameters. After establishing clinical thresholds, the frequency of complications was calculated, and predictors of thresholds violations were determined., Results: The mean age was 55.7 (+/-15.3) years, with 68.0% showing severe SAH (World Federation of Neurosurgical Societies Scale 5). IHTs with an emergency indication made up 30.8% of all transports. Direct therapeutic consequences from IHT were observed in 38.5%. On average, the first IHT occurred 1.5 (+/-2.0) days post-admission and patients were transported 4.3 (+/-1.8) times during their stay in the NICU. Significant parameter changes from pre- to post-IHT included mean arterial pressure, systolic blood pressure, oxygen saturation, blood glucose levels, temperature, dosages of propofol and ketamine, tidal volume, inspired oxygen concentration, Horovitz index, glucose, pH, intracranial pressure, and cerebral perfusion pressure. Relevant hemodynamic thresholds were violated in 31.5% of cases, while respiratory complications occurred in 63.9%, and neurological complications in 20.4%. For hemodynamic complications, a low heart rate with a threshold of 61/min (OR 0.96, 95% CI 0.93-0.99, p = 0.0165) and low doses of midazolam with a threshold of 17.5 mg/h (OR 0.97, 95% CI 0.95-1.00, p = 0.0232) significantly predicted adverse events. However, the model did not identify significant predictors for respiratory and neurological outcomes., Conclusions: Conclusively, IHTs in SAH patients are associated with relevant changes in hemodynamic, respiratory, and neurological monitoring parameters, with direct therapeutic consequences in 4/10 IHTs. These findings underscore the importance of further studies on the clinical impact of IHTs.

Purpose: To evaluate the rate of misdiagnosis of aneurysmatic pachychoroid type 1 choroidal neovascularization/polypoidal choroidal vasculopathy (PAT1/PCV) among cases diagnosed as non-aneurysmatic pachychoroid neovasculopathy (PNV) and to define optical coherence tomography (OCT) features facilitating their distinction., Methods: The database of the Department of Ophthalmology, Ludwig-Maximilians University Munich, was screened for patients diagnosed with PNV. Multimodal imaging was screened for the presence of choroidal neovascularization (CNV) and aneurysms/polyps. Imaging features facilitating the diagnosis of PAT1/PCV were analysed., Results: In total, 49 eyes of 44 patients with a clinical PNV diagnosis were included, of which 42 (85.7%) had PNV and 7 (14.3%) represented misdiagnosed PAT1/PCV. SFCT was comparable (PNV: 377 ± 92 vs. PAT1/PCV: 400 ± 83 µm; p = 0.39). Whereas no difference was detected in total pigment epithelium detachment (PED) diameter (p = 0.46), maximum PED height was significantly higher in the PAT1/PCV group (199 ± 31 vs. 82 ± 46, p < 0.00001). In a receiver operating characteristic (ROC) analysis, the optimum cutoff for defining "peaking PED" was 158 µm with an area under the curve of 0.969, a sensitivity of 1.0 (95% CI: 0.59-1.0), and a specificity of 0.95 (95% CI: 0.84-0.99). Sub-retinal hyperreflective material (SHRM; p = 0.04), sub-retinal ring-like structures (SRRLS; p < 0.00001), and sub-RPE fluid (p = 0.04) were significantly more frequent in eyes with PAT1/PCV., Conclusion: A relevant percentage of eyes diagnosed with PNV might instead suffer from PAT1/PCV. The detection of a maximum PED height ("peaking PED") exceeding approximately 150 µm, SHRM, SRRLS, and sub-RPE fluid might greatly aid in the production of a more accurate diagnosis., (© 2023. The Author(s).)

Background: Recent studies have implied that ongoing intravenous thrombolysis (IVT) during endovascular treatment (ET) improves functional outcomes in patients who have undergone stroke caused by a large vessel occlusion (LVO). In this study, we investigated the effect of ongoing IVT until completion of ET on procedure duration, first-pass thrombectomy rate, and periprocedural complications., Methods: We analyzed patients from the German Stroke Registry-Endovascular Treatment dataset, collected between June 2015 and December 2021. Primary outcomes were modified Rankin Scale (mRS) score after 3 months and achievement of a Thrombolysis In Cerebral Infarction (TICI) score of 2b-3. Secondary parameters included ET duration, first-pass thrombectomy, and periprocedural complications., Results: Of the 13,082 patients in the dataset, 1,639 met the study inclusion criteria. A total of n = 317 patients (19.3%) underwent ongoing IVT until completion of ET, while IVT was completed prior to ET in 1,322 patients (80.7%). Ongoing IVT was associated with higher rates of achievement of an mRS score of 0-2 (or a back-to-baseline) after 3 months [odds ratio (OR) 1.53; 95% confidence interval (CI) 1.08-2.17]. Furthermore, ongoing IVT was predictive of achievement of a TICI score of 2b-3 (OR 1.37; 95% CI 1.03-1.83) and of first-pass thrombectomy (OR 2.07; 95% CI 1.51-2.84), while reducing the rate of peri-interventional complications (OR 0.64; 95% CI 0.44-0.94) and reducing ET duration by 24 min [β = -24.35; 95% CI -32.92-(-15.79)]., Conclusion: Our findings suggest that ongoing IVT until ET completion has a favorable impact on both clinical and angiographic outcomes, as well as on periprocedural conditions, regardless of the overall time intervals involved. Therefore, rapid ET after IVT should be sought in order to take advantage of the additive effect of ongoing IVT during ET. Future studies should consider IVT timing in the context of ET as a potential confounder and treatment target., Competing Interests: LKel has received funding for travel or speaker honoraria from Alexion, AstraZeneca, Bayer Vital, Boehringer Ingelheim, Bristol-Meyer-Squibb, Daiichi Sankyo, and Pfizer outside of this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wischmann, Pradhan, Zimmermann, Keidel, Tiedt, Dimitriadis, Liebig, Höglinger and Kellert.)

PRÉCIS: Cystinosis is a lysosomal storage disease leading to an accumulation of cystine crystals in several organs. We aim to comprehensively describe chorioretinal cystine crystals via spectral domain optical coherence tomography (SD-OCT) and elaborate a new biomarker for systemic disease control., Background/aims: Cystinosis is a rare lysosomal storage disease leading to an accumulation of cystine crystals in several organs. This study aims to describe the deposition of retinochoroidal crystals in infantile nephropathic cystinosis and to elucidate their potential value as an objective biomarker for systemic disease control., Methods: This cross-sectional study was carried out by the University Eye Hospital of the Ludwig-Maximilian University (Munich, Germany) in collaboration with the German Cystinosis Study Group. A complete ophthalmologic examination was performed, along with posterior segment SD-OCT (Spectralis; Heidelberg Engineering GmbH, Heidelberg, Germany). Retinochoroidal crystals were graded by employing a novel semiquantitative grading system-the retinochoroidal cystine crystal score (RCCCS). To quantify quality of vision, patients completed a specific questionnaire. A total of 85 eyes of 43 patients with cystinosis were included (mean age 22.3±8.8 years, range 6-39; male:female ratio=23:20)., Results: Cystine crystals were detectable in all neuroretinal layers and the choroid, most frequently in the choriocapillaris. The RCCCS was negatively correlated with cysteamine intake (r=0.533, p=0.001) and positively with cystatin C, a stable parameter of renal function (r=0.496, p=0.016). Moreover, the value of the RCCCS affected subjective quality of vision. Genetic analysis indicated pronounced crystal deposition in patients with heterozygous mutations containing the 57-kb-deletion allele of the CTNS gene., Conclusion: Ocular cystinosis leads to retinochoroidal crystal accumulation in every stage of the disease. Crystal deposition may be markedly influenced by oral cysteamine therapy. Therefore, the presented SD-OCT based grading system might serve as an objective biomarker for systemic disease control., Competing Interests: Competing interests: LK received previous speaker fees and/or travel expenses from Recordati Rare Diseases and Roche Diagnostics GmbH. KH received previous speaker fees from Recordati Rare Diseases. BS received previous speaker fees and travel expenses from Novartis Pharma GmbH and Topcon Corporation. SP received previous speaker fees and/or travel expenses from Novartis Pharma GmbH, Oertli AG, Bayer AG, Alcon Pharma GmbH and Pharm-Allergan GmbH. NL received income from honoraria as a lecturer from Alcon Laboratories, NIDEK Co., and CenterVue SpA. CP received previous speaker fees from Novartis Pharma GmbH and travel expenses from Recordati Rare Diseases Inc., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Mussel production is expanding worldwide, and in Brazil the main species currently produced is the mussel Perna perna. Bucephalid trematodes have been recorded in P. perna but their larval identification is problematic. In this context, the aims of this paper were to evaluate the prevalence of bucephalids in P. perna, perform taxonomic and phylogenetic trematode studies, and analyze potential histopathological alterations in the infected host. Mussels obtained by fishers from Guanabara Bay, Rio de Janeiro, Brazil were weighed and measured, and internal organ tissues and parasites were collected. Of the 69 analyzed mussels, 24.6 % (17/69) were parasitized by bucephalid larvae. Sporocysts were located mainly in host mantle. Mussels presented sporocysts and cercaria within the connective tissue of mantle, all without associated inflammatory reactions. Parasite loads varied from less than 5 % to > 50 % of parasitized tissue. Histopathological examinations indicated that male or female gonads were not observed in 77 % (10/13) of parasitized mussels and in 4 % (2/56) identified as non-parasitized in the histology but previously classified as parasitized in the stereomicroscopic analysis. Thus, the absence of gonads may be associated with parasitism. Prosorhynchoides sp. is reported herein for the first time in mussels sampled on the coast of Rio de Janeiro, with genetic and histological data reported for the intermediate host, sporocysts and cercariae. New 28S rDNA, 18S rDNA and ITS1, 5.8S and ITS2 sequences are provided., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate functional outcome after retinal detachment (RD) repair surgery in eyes with a multifocal intraocular lens (mIOL)., Setting: Ludwig-Maximilians-University, Munich, Germany., Design: Single-center case control study., Methods: 52 pseudophakic eyes with successful anatomical outcome after surgical RD repair were included. Retrospectively, 21 mIOL eyes were compared with a matched group of 21 monofocal eyes over 6 weeks. Prospectively, corrected distance visual acuity (CDVA) was evaluated over 12 months in these eyes. Furthermore, uncorrected distance, intermediate, and near visual acuity (UDVA, UIVA, and UNVA, respectively), defocus curves, and patient-reported outcomes were evaluated at 1 year in 24 mIOL eyes., Results: 52 eyes of 48 patients comprised the study. The mean CDVA (logMAR) improved significantly from 1.35 ± 1.38 to 0.29 ± 0.37 at 6 weeks and remained stable at 12 months postoperatively in monofocal eyes (P = .001) and from 1.16 ± 1.2 to 0.37 ± 0.29 (6 weeks) and 0.20 ± 0.36 (12 months) in mIOL eyes (P = .001). Univariate factorial analysis of variance showed no statistically significant differences in CDVA at 6 weeks or 12 months postoperatively for IOL type or for preoperative macular status (P > .05). In the prospective cohort of 24 mIOL eyes, a mean CDVA of 0.13 ± 0.33 logMAR, UDVA of 0.21 ± 0.34 logMAR, UIVA of 0.17 ± 0.28 logMAR, and UNVA of 0.23 ± 0.32 logMAR was achieved. Macular status did not affect final outcome significantly (P > .05). Most patients stated they usually did not need spectacles; no patient wanted mIOL replacement., Conclusions: 1 year after successful anatomical repair after 23-gauge vitrectomy with gas tamponade, functionality of mIOL was restored, and CDVA was comparable with that of patients with monofocal IOL., (Copyright © 2021 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: The purpose of the present study was to establish a semi-automated threshold-based image segmentation algorithm to detect and objectively quantify corneal cystine crystal deposition in ocular cystinosis with anterior segment optical coherence tomography (AS-OCT)., Methods: This prospective, observational, comparative study included 88 eyes of 45 patients from the German Cystinosis Registry Study as well as 68 eyes of 35 healthy control subjects. All eyes were imaged with AS-OCT (Cirrus HD-OCT 5000, Carl Zeiss Meditec AG, Jena, Germany). As an initial step, B-scan images were subjectively analysed for typical changes in morphology in comparison to healthy controls. Based on the experience gained, an objective semi-automated B-scan image segmentation algorithm was developed using a grey scale value-based threshold method to automatically quantify corneal crystals., Results: On AS-OCT B-scans, corneal crystals appeared as hyperreflective deposits within the corneal stroma. The crystals were distributed either in all stromal layers (43 eyes, 49%) or confined to the anterior (23 eyes, 26%) or posterior stroma (22 eyes, 25%), respectively. The novel automatic B-scan image segmentation algorithm was most efficient in delineating corneal crystals at higher grey scale thresholds (e.g. 226 of a maximum of 255). Significant differences in suprathreshold grey scale pixels were observable between cystinosis patients and healthy controls (p < 0.001). In addition, the algorithm was able to detect an age-dependent depth distribution profile of crystal deposition., Conclusion: Objective quantification of corneal cystine crystal deposition is feasible with AS-OCT and can serve as a novel biomarker for ocular disease control and topical treatment monitoring., (© 2020 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.)

Migraine is a complex neurological disorder affecting approximately 12% of the population. The pathophysiology is not yet fully understood, however the clinical features of the disease, such as the cyclic behaviour of attacks and vegetative symptoms, suggest a prominent role of the hypothalamus. Previous research has observed neuronal alterations at different time points during the migraine interval, specifically just before the headache is initiated. We therefore aimed to assess the trajectory of migraineurs' brain activity over an entire migraine cycle. Using functional magnetic resonance imaging (fMRI) with pseudo-continuous arterial spin labelling (ASL), we designed a longitudinal intra-individual study to detect the rhythmicity of (1) the cerebral perfusion and (2) the hypothalamic connectivity over an entire migraine cycle. Twelve episodic migraine patients were examined in 82 sessions during spontaneous headache attacks with follow-up recordings towards the next attack. We detected cyclic changes of brain perfusion in the limbic circuit (insula and nucleus accumbens), with the highest perfusion during the headache attack. In addition, we found an increase of hypothalamic connectivity to the limbic system over the interictal interval towards the attack, then collapsing during the headache phase. The present data provide strong evidence for the predominant role of the hypothalamus in generating migraine attacks. Due to a genetically-determined cortical hyperexcitability, migraineurs are most likely characterised by an increased susceptibility of limbic neurons to the known migraine trigger. The hypothalamus as a metronome of internal processes is suggested to control these limbic circuits: migraine attacks may occur as a result of the hypothalamus losing control over the limbic system. Repetitive psychosocial stress, one of the leading trigger factors reported by patients, might make the limbic system even more vulnerable and lead to a premature triggering of a migraine attack. Potential therapeutic interventions are therefore suggested to strengthen limbic circuits with dedicated medication or psychological approaches., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Importance: A recently reported randomized clinical trial suggested beneficial effects of vasodilating flavanols in dark chocolate on visual function without objective quantification of retinal perfusion., Objective: To assess the effects of dark chocolate flavanols on subjective visual function and retinal perfusion objectively quantified on optical coherence tomography (OCT) angiography., Design, Setting, and Participants: This randomized, masked double-blind crossover clinical trial analyzed 22 healthy participants at the Department of Ophthalmology, Ludwig-Maximilians-University Munich, Germany, in July 2018. Analysis was intention to treat. Analysis began in July 2018., Interventions: Participants were randomized to consume 20 g of dark chocolate containing 400 mg of flavanols or 7.5 g of milk chocolate. Two hours later, visual function and retinal perfusion on OCT angiography were evaluated. Systemic blood pressure was measured to rule out artifacts on OCT angiography., Main Outcomes and Measures: The primary end point was macular retinal perfusion quantified as vessel density on OCT angiography. The secondary end point was subjective visual function (Early Treatment Diabetic Retinopathy Study visual acuity, Pelli-Robson chart, and Mars chart contrast sensitivity)., Results: All 22 participants (13 women [59.1%]; mean [SD] age, 27.3 [11.1] years) completed the trial. No relevant differences in baseline parameters between groups were identified. No change in the primary outcome measure, retinal perfusion, could be detected after consumption of dark vs milk chocolate (superficial plexus 48.0% vs 47.5%, treatment effect: -0.59 [95% CI, -2.68 to 1.50], P = .56; deep plexus 54.1% vs 54.0%, treatment effect: -1.14 [95% CI, -4.01 to 1.73], P = .42). No differences in changes in the secondary outcome parameters Early Treatment Diabetic Retinopathy Study visual acuity, Pelli-Robson chart, or Mars chart contrast sensitivity could be detected. Potentially confounding effects of changes in blood pressure were excluded., Conclusions and Relevance: In contrast to a previous similarly sized randomized clinical trial reporting beneficial effects on visual function, no short-term effects of flavanol-rich dark chocolate on automatically assessed retinal blood flow on OCT angiography or subjective visual function were observed in this study. As this small trial does not rule out the possibility of benefits, further trials with larger sample sizes would be needed to rule in or out possible long-term benefits confidently., Trial Registration: German Clinical Trials Register identifier: DRKS00015065.

The taxonomy of species of Dollfusentis is rather confused due to the overlap of morphological traits. The aim of this study was to follow an integrative taxonomy approach over the acanthocephalans collected from Orthopristis ruber in Brazil. Dollfusentis lenti n. sp. is described and is characterised by having an elongate trunk with spines sparsely distributed (largest 60-85 μm long) extending from the neck to almost reach the end of proboscis receptacle; additionally, the new species possesses a long proboscis with 12-14 longitudinal rows of 16-17 hooks each; 3-4 posterior hooks reduced in size, well-spaced from the eight ventrolateral crescent hooks, and lemnisci longer than proboscis receptacle. New sequences of 18S rDNA, ITS1, 5.8S and ITS2, 28S rDNA and COI mtDNA are provided. Dollfusentis bravoae is morphologically similar because it possesses the same number of proboscis hooks, although it differs by the size of testes and uterus and by having a higher number of trunk spines; additionally, new scanning electron micrographs and genetic data for both species support its distinction. Phylogenetic analysis obtained either with two nuclear genes or mitochondrial COI gene showed that Dollfusentis spp. belong to Illiosentidae, and the new species is yielded as the sister species of D. bravoae, with D. chandleri as the sister species of the latter two., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Rising atmospheric CO 2 concentrations are expected to increase nitrous oxide (N 2 O) emissions from soils via changes in microbial nitrogen (N) transformations. Several studies have shown that N 2 O emission increases under elevated atmospheric CO 2 (eCO 2 ), but the underlying processes are not yet fully understood. Here, we present results showing changes in soil N transformation dynamics from the Giessen Free Air CO 2 Enrichment (GiFACE): a permanent grassland that has been exposed to eCO 2 , +20% relative to ambient concentrations (aCO 2 ), for 15 years. We applied in the field an ammonium-nitrate fertilizer solution, in which either ammonium ( NH 4 + ) or nitrate ( NO 3 - ) was labelled with 15 N. The simultaneous gross N transformation rates were analysed with a 15 N tracing model and a solver method. The results confirmed that after 15 years of eCO 2 the N 2 O emissions under eCO 2 were still more than twofold higher than under aCO 2 . The tracing model results indicated that plant uptake of NH 4 + did not differ between treatments, but uptake of NO 3 - was significantly reduced under eCO 2 . However, the NH 4 + and NO 3 - availability increased slightly under eCO 2 . The N 2 O isotopic signature indicated that under eCO 2 the sources of the additional emissions, 8,407 μg N 2 O-N/m 2 during the first 58 days after labelling, were associated with NO 3 - reduction (+2.0%), NH 4 + oxidation (+11.1%) and organic N oxidation (+86.9%). We presume that increased plant growth and root exudation under eCO 2 provided an additional source of bioavailable supply of energy that triggered as a priming effect the stimulation of microbial soil organic matter (SOM) mineralization and fostered the activity of the bacterial nitrite reductase. The resulting increase in incomplete denitrification and therefore an increased N 2 O:N 2 emission ratio, explains the doubling of N 2 O emissions. If this occurs over a wide area of grasslands in the future, this positive feedback reaction may significantly accelerate climate change., (© 2018 John Wiley & Sons Ltd.)

The clinical importance of heartworm infection in cats has indeed increased in recent years. Dirofilaria immitis infection has been reported worldwide in cats and continues to be regularly diagnosed in endemic areas. The diagnosis can be overlooked easily, especially in Brazil, where there is not a specific feline immunodiagnostic test, forcing the veterinarians to use a test made for the canine host. In 2015, a 10-year-old female neutered cat was diagnosed with D. immitis using an antigen serological test, based on imunocromatography and designed for dogs. The modified Knott test was negative. As the disease progressed, the cat showed clinical signals of respiratory distress, such as dyspnoea and polypnea in addition to prostration and emaciation, and died a few weeks after the diagnosis. During necropsy, one adult nematode was found in the pulmonary artery. D. immitis infection was confirmed by molecular amplification, performed in the worm fragment. This is the first report of serological diagnosis of feline dirofilariasis in Brazil. A chemoprophylaxis routine in cats should be done, as is done in dogs from endemic areas.

Purpose: To report the impact of increasing minimum lenticule thickness on the safety and efficacy of small incision lenticule extraction (SMILE) in low myopia up to -3.50 diopters (D)., Methods: SMILE was performed in 76 eyes of 76 patients. Thirty-eight eyes of 38 patients with low myopia were prospectively operated on with a programmed minimum lenticule thickness of 15 to 30 μm (thicker lenticule group). Thirty-five eyes suitable for analysis were then retrospectively matched by spherical equivalent to 35 eyes operated on with a minimum standard setting of 10 μm (standard thickness group), as provided in the database of the SMILE Eyes Clinic Linz, Linz, Austria. Comparison of outcomes was performed with the Standard Graphs for Reporting Refractive Surgery and by analysis of higher order aberrations as provided by Scheimpflug imaging., Results: Apart from lenticule thickness, there was no significant difference in preoperative baseline or treatment parameters between both groups. Mean minimum lenticule thickness differed significantly (standard thickness = 10 ± 0 μm; thicker lenticule = 20 ± 5 μm; P < .0001). This also translated into a significant difference in maximum lenticule thickness (standard thickness: 54 ± 11 μm; thicker lenticule: 62 ± 8 μm; P = .0002). Mean SEQ preoperatively was -2.25 ± 0.51 (standard thickness) and -2.24 ± 0.46 (thicker lenticule) D, respectively, and changed to -0.11 ± 0.50 (standard thickness) and +0.01 ± 0.36 (thicker lenticule) D postoperatively (P < .0001 for both comparisons). Uncorrected postoperative visual acuity was -0.08 ± 0.35 (standard thickness) versus -0.10 ± 0.09 (thicker lenticule) logMAR (P = .706). After SMILE, the thicker lenticule group showed better safety (1.20 vs 1.08; P = .025) and efficacy (1.14 vs 0.96; P = .011) indices, translating into more eyes within ±0.50 D from target (91% vs 77%) and with at least 0.0 logMAR visual acuity (97% vs 86%), and fewer eyes losing one (3% vs 17%) and two (0% vs 3%) lines., Conclusions: Increasing minimum lenticule border thickness seems to improve the safety and efficacy of SMILE in low myopia. [J Refract Surg. 2018;34(7):453-459.]., (Copyright 2018, SLACK Incorporated.)