Mammal responses to global changes in human activity vary by trophic group and landscape

Wildlife must adapt to human presence to survive in the Anthropocene, so it is critical to understand species responses to humans in different contexts. We used camera trapping as a lens to view mammal responses to changes in human activity during the COVID-19 pandemic. Across 163 species sampled in 102 projects around the world, changes in the amount and timing of animal activity varied widely. Under higher human activity, mammals were less active in undeveloped areas but unexpectedly more active in developed areas while exhibiting greater nocturnality. Carnivores were most sensitive, showing the strongest decreases in activity and greatest increases in nocturnality. Wildlife managers must consider how habituation and uneven sensitivity across species may cause fundamental differences in human-wildlife interactions along gradients of human influence.

Attitudes Toward Engagement in Citizen Science Increase Self-Related, Ecology-Related, and Motivation-Related Outcomes in an Urban Wildlife Project

Citizen science projects are crucial for engaging citizens in conservation efforts. Although attitudes toward engagement in citizen science were mostly considered an outcome of citizen science participation, citizens may also have a certain attitude toward engagement in citizen science when starting with a citizen science project. Moreover, there is a lack of citizen science studies that consider changes over longer periods of time. Therefore, in this research, we present two-wave data from four field studies of a citizen science project about urban wildlife ecology using cross-lagged panel analyses. We investigated the influence of attitudes toward engagement in citizen science on self-related, ecology-related, and motivation-related outcomes. We found that positive attitudes toward engagement in citizen science at the beginning of the project had positive influences on the participants' psychological ownership and pride in their participation, their attitudes toward and enthusiasm about wildlife, and their internal and external motivation 2 months later. We discuss the implications for citizen science research and practice.

Data-integration of opportunistic species observations into hierarchical modeling frameworks improves spatial predictions for urban red squirrels

The prevailing trend of increasing urbanization and habitat fragmentation makes knowledge of species’ habitat requirements and distribution a crucial factor in conservation and urban planning. Species distribution models (SDMs) offer powerful toolboxes for discriminating the underlying environmental factors driving habitat suitability. Nevertheless, challenges in SDMs emerge if multiple data sets - often sampled with different intention and therefore sampling scheme – can complement each other and increase predictive accuracy. Here, we investigate the potential of using recent data integration techniques to model potential habitat and movement corridors for Eurasian red squirrels (Sciurus vulgaris), in an urban area. We constructed hierarchical models integrating data sets of different quality stemming from unstructured on one side and semi-structured wildlife observation campaigns on the other side in a combined likelihood approach and compared the results to modeling techniques based on only one data source - wherein all models were fit with the same selection of environmental variables. Our study highlights the increasing importance of considering multiple data sets for SDMs to enhance their predictive performance. We finally used Circuitscape (version 4.0.5) on the most robust SDM to delineate suitable movement corridors for red squirrels as a basis for planning road mortality mitigation measures. Our results indicate that even though red squirrels are common, urban habitats are rather small and partially lack connectivity along natural connectivity corridors in Berlin. Thus, additional fragmentation could bring the species closer to its limit to persist in urban environments, where our results can act as a template for conservation and management implications.

Evidence for a male‐biased sex ratio in the offspring of a large herbivore: The role of environmental conditions in the sex ratio variation

Numerous studies have examined whether the primary and/or secondary sex ratio in mammals, including humans, deviates from an equilibrium of 1:1. Although effect size in the sex ratio variation is expected to be low, a large sample size allows the identification of even small deviations from parity. In this study, we investigated whether the sex ratio of roe deer (Capreolus capreolus) offspring at birth approaches parity, using a large data set from roe deer offspring tagged in Baden‐Württemberg (Germany, 1972–2019, N = 12,437). In addition, a systematic re‐analysis of available data on the secondary sex ratios of roe deer was conducted to test whether our finding withstood the accumulation of further data. The null hypothesis that the sex ratio of roe deer (prenatal sex ratio and sex ratio at birth) approaches parity was rejected. Moreover, the secondary sex ratio of roe deer offspring deviated from the male‐biased mean for relatively cold or warm weather conditions during autumn and winter. Our study provides strong evidence for a male‐biased sex ratio in a large herbivore and weak evidence for variations in the secondary sex ratio owing to environmental conditions. The pattern is highly relevant in the context of climate change and its impact on the population dynamics of large herbivores.

Behavioural reactions to oncoming vehicles as a crucial aspect of wildlife-vehicle collision risk in three common wildlife species

Wildlife-vehicle collisions (WVC) strongly impact road safety. While technical aspects of collision risk and the effects of roads on animal populations are well studied, knowledge about wildlife behaviour prior to and during contact with oncoming vehicles as a crucial aspect of collision risk is still lacking. We analysed 28,400 hours of video data (thermal network cameras at 14 road sections in south-west Germany) with 2,841 animal-vehicle encounters (1,960 roe deer, Capreolus capreolus, 696 red fox, Vulpes vulpes and 185 wild boar, Sus scrofa) and classified animal behaviour before and during contact with a vehicle. We fitted two sets of models to the data. In the first step, we modelled the intensity of the behavioural reaction exhibited by the animals as a function of behavioural and environmental predictors using ordinal Bayesian mixed-effect regression models. In a second step, we modelled the probability of a positive vs. a negative behavioural response in terms of WVC risk using binomial mixed-effect regression models. Both the intensity of behavioural reactions as well as the degree of risk during the interaction with oncoming vehicles differed among the species and as a function of road section layout. Our results showed that animal attentiveness, the behaviour a priori, access to cover, vehicle type and biological seasonality were important predictors of an animal's response to oncoming vehicles. More specifically, roe deer reacted to oncoming vehicles mostly with short movements away from the road, foxes often reacted unpredictably and wild boar behaviour appeared to be least affected by oncoming vehicles. Thus, we suggest that collision risk for common European mammals is shaped by the interplay of vehicle type, the road layout as well as the species-specific behavioural repertoire including the attentiveness of the animal and the behavioural state prior to an approaching vehicle. In addition, wildlife warning reflectors, a frequently used technique in WVC mitigation, did not alter behavioural reactions and thus failed to reduce WVC risk.

Spatiotemporal interactions of a novel mesocarnivore community in an urban environment before and during SARS-CoV-2 lockdown

Studying species interactions and niche segregation under human pressure provides important insights into species adaptation, community functioning and ecosystem stability. Due to their high plasticity in behaviour and diet, urban mesocarnivores are ideal species for studying community assembly in novel communities.

We analysed the spatial and temporal species interactions of an urban mesocarnivore community composed of the red fox Vulpes vulpes and the marten Martes sp. as native species, the raccoon Procyon lotor as invasive species, and the cat Felis catus as a domestic species in combination with human disturbance modulated by the SARS‐CoV‐2 lockdown effect that happened while the study was conducted.

We analysed camera trap data and applied a joint species distribution model to understand not only the environmental variables influencing the detection of mesocarnivores and their use intensity of environmental features but also the species’ co‐occurrences while accounting for environmental variables. We then assessed whether they displayed temporal niche partitioning based on activity analyses, and finally analysed at a smaller temporal scale the time of delay after the detection of another focal species.

We found that species were more often detected and displayed a higher use intensity in gardens during the SARS‐CoV‐2 lockdown period, while showing a shorter temporal delay during the same period, meaning a high human‐induced spatiotemporal overlap. All three wild species spatially co‐occurred within the urban area, with a positive response of raccoons to cats in detection and use intensity, whereas foxes showed a negative trend towards cats. When assessing the temporal partitioning, we found that all wild species showed overlapping nocturnal activities. All species displayed temporal segregation based on temporal delay. According to the temporal delay analyses, cats were the species avoided the most by all wild species. To conclude, we found that although the wild species were positively associated in space, the avoidance occurred at a smaller temporal scale, and human pressure in addition led to high spatiotemporal overlap.

Our study sheds light to the complex patterns underlying the interactions in a mesocarnivore community both spatially and temporally, and the exacerbated effect of human pressure on community dynamics.

[Effects of the SARS-CoV‑2 pandemic on the otolaryngology university hospitals in the field of research, student teaching and specialist training]

Hintergrund

Ab Frühjahr 2020 kam es zur weltweiten Verbreitung von SARS-CoV‑2 mit der heute als erste Welle der Pandemie bezeichneten Phase ab März 2020. Diese resultierte an vielen Kliniken in Umstrukturierungen und Ressourcenverschiebungen. Ziel unserer Arbeit war die Erfassung der Auswirkungen der Pandemie auf die universitäre Hals-Nasen-Ohren(HNO)-Heilkunde für die Forschung, Lehre und Weiterbildung.

Material und Methoden

Die Direktorinnen und Direktoren der 39 Universitäts-HNO-Kliniken in Deutschland wurden mithilfe einer strukturierten Online-Befragung zu den Auswirkungen der Pandemie im Zeitraum von März bis April 2020 auf die Forschung, Lehre und die Weiterbildung befragt.

Ergebnisse

Alle 39 Direktorinnen und Direktoren beteiligten sich an der Umfrage. Hiervon gaben 74,4 % (29/39) an, dass es zu einer Verschlechterung ihrer Forschungstätigkeit infolge der Pandemie gekommen sei. Von 61,5 % (24/39) wurde berichtet, dass pandemiebezogene Forschungsaspekte aufgegriffen wurden. Von allen Kliniken wurde eine Einschränkung der Präsenzlehre berichtet und 97,5 % (38/39) führten neue digitale Lehrformate ein. Im Beobachtungszeitraum sahen 74,4 % der Klinikdirektoren die Weiterbildung der Assistenten nicht gefährdet.

Schlussfolgerung

Die Ergebnisse geben einen Einblick in die heterogenen Auswirkungen der Pandemie. Die kurzfristige Bearbeitung pandemiebezogener Forschungsthemen und die Einführung innovativer digitaler Konzepte für die studentische Lehre belegt eindrücklich das große innovative Potenzial und die schnelle Reaktionsfähigkeit der HNO-Universitätskliniken, um auch während der Pandemie ihre Aufgaben in der Forschung, Lehre und Weiterbildung bestmöglich zu erfüllen.

Influence of cochlear parameters on the current practice in cochlear implantation : Development of a concept for personalized medicine

Since the introduction of cochlear implants into clinical routine, the interest in measuring cochlear parameters, particularly the cochlear duct length (CDL) has increased, since these can have an influence on the correct selection of the electrode. On the one hand, coverage of an optimal frequency band is relevant for a good audiological result, and on the other hand, cochlear trauma due to too deep insertion or displacement of the electrode must be avoided. Cochlear implants stimulate the spiral ganglion cells (SGC). The number of SGC and particularly their distribution can also have an influence on the function of a cochlear implant. In addition, the frequency assignment of each electrode contact can play a decisive role in the postoperative success, since the frequency distribution of the human cochlea with varying CDL shows substantial interindividual differences. The aim of this work is to provide an overview of the methods used to determine the cochlear parameters as well as of relevant studies on the CDL, the number and distribution of SGZ, and the frequency assignment of electrode contacts. Based on this, a concept for individualized cochlear implantation will be presented. In summary, this work should help to promote individualized medicine in the field of cochlear implants in the future, in order to overcome current limitations and optimize audiological outcomes.

Improved cancer detection in Waldeyer's tonsillar ring by 68Ga-FAPI PET/CT imaging

Purpose

In cancer of unknown primary (CUP), positron emission tomography/computed tomography (PET/CT) with the glucose analog [¹⁸F]FDG represents the standard imaging approach for localization of the malignant primary. Frequently, however, [¹⁸F]FDG PET/CT cannot precisely distinguish between small occult tumors and chronic inflammation, especially in Waldeyer’s tonsillar ring. To improve the accuracy for detecting primary tumors in the Waldeyer’s tonsillar ring, the novel PET tracer [⁶⁸Ga]Ga-FAPI-4 for specific imaging of fibroblast activation protein (FAP) expression was used as a more specific target for cancer imaging.

Methods

Eight patients with suspicion of a malignant tumor in Waldeyer’s tonsillar ring or a CUP syndrome were examined. PET/CT scans with [¹⁸F]-FDG and [⁶⁸Ga]Ga-FAPI-4 were performed for pre-operative tumor localization. After surgical resection, histopathological and immunohistochemical results were compared to PET/CT findings.

Results

Histopathology revealed a palatine or lingual tonsil carcinoma in all patients. In case of lymph node metastases smaller than 7 mm in size, the [¹⁸F]FDG PET/CT detection rate of cervical lymph node metastases was higher than that of [⁶⁸Ga]FAPI PET/CT, while both tracers identified the primary tumors in all eight cases. The size of the primary and the lymph node metastases was directly correlated to the respective FAP expression, as detected by immunohistochemistry. The mean SUV_max for the primary tumors was 21.29 ± 7.97 for ¹⁸F-FDG and 16.06 ± 6.29 for ⁶⁸Ga-FAPI, respectively (p = 0.2). The mean SUV_max for the healthy contralateral tonsils was 8.38 ± 2.45 for [¹⁸F]FDG and 3.55 ± 0.47 for [⁶⁸Ga]FAPI (p < 0.001). The SUV_max ratio of [⁶⁸Ga]FAPI was significantly different from [¹⁸F] FDG (p = 0.03). Mean TBR_max for the [⁶⁸Ga]Ga-FAPI-4 tracer was markedly higher in comparison to [¹⁸F]FDG (10.90 vs. 4.11).

Conclusion

Non-invasive imaging of FAP expression by [⁶⁸Ga]FAPI PET/CT resulted in a better visual detection of the malignant primary in CUP, as compared to [¹⁸F]FDG imaging. However, the detection rate of lymph node metastases was inferior, presumably due to low FAP expression in small metastases. Nevertheless, by offering a detection method for primary tumors with the potential of lower false positive rates and thus avoiding biopsies, patients with CUP syndrome may benefit from [⁶⁸Ga]FAPI PET/CT imaging.

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

BACKGROUND

Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP.

METHODS

Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months.

RESULTS

A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group.

CONCLUSIONS

Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.

Heartworm control in Grenada, West Indies: Results of a field study using imidacloprid 10% + moxidectin 2.5% and doxycycline for naturally-acquired Dirofilaria immitis infections

Canine heartworm disease (CHD) results from infection with Dirofilaria immitis and while it is of global concern, it is most prevalent in tropical climates where conditions support the parasite and vector life cycles. Melarsomine dihydrochloride is the sole treatment for CHD recommended by the American Heartworm Society. However, in cases where cost or access to melarsomine precludes treatment of an infected dog, therapeutic alternatives are warranted. This randomized, controlled field study evaluated the adulticidal efficacy of a combination therapeutic protocol using 10 % imidacloprid + 2.5 % moxidectin spot-on and a single 28-day course of doxycycline and compared with that of a 2-dose melarsomine dihydrochloride protocol. Of 37 naturally-infected domestic dogs with class 1, 2 or early class 3 CHD enrolled in the study, 30 were evaluated for a minimum of 12 months. Seven dogs were withdrawn due to canine ehrlichiosis, non-compliance, or wrongful inclusion. Dogs were randomly assigned to a control (CP, n = 15) or investigational (IVP, n = 15) treatment group. CP dogs received two injections of melarsomine dihydrochloride (2.5 mg/kg) 24 -hs apart and maintained on monthly ivermectin/pyrantel. IVP dogs were treated with oral doxycycline (10 mg/kg twice daily for 28 days) and topical 10 % imidacloprid + 2.5 % moxidectin once monthly for 9 months. Dogs were evaluated up to 18 months - monthly for the first 9 months, then every 3 months. Parasiticidal efficacy was based on antigen status using the IDEXX PetChek® 34 Heartworm-PF Antigen test. By month 18, antigen was not detected in any study dog except one from the IVP group. One other IVP dog was persistently antigenemic and treated with melarsomine at month 12 according to the initial study protocol. Mean antigen concentration (based on optical density) decreased more rapidly in the CP group and by month 15 was 0.11 for the IVP and 0.07 for CP groups, with equivalent median concentrations (0.04) in both groups. Conversion following heat-treatment of antigen-negative samples occurred frequently and at similar rates in both treatment groups. Based on the bias of diagnostic tests towards detection of female worms, we conclude that monthly application of 10 % imidacloprid + 2.5 % moxidectin for 9 months combined with a course of doxycycline twice daily for 28 days resulted in effective therapy against female adults in CHD. This therapeutic option may be particularly useful in cases where financial constraint or access to melarsomine precludes treatment of an infected individual. This study was supported by Bayer Animal Health.

[Effects of the SARS-CoV-2 pandemic on the otorhinolaryngology university hospitals in the field of medical care]

INTRODUCTION

Since December 2019, the SARS-CoV-2 virus has been rapidly spreading worldwide. In Germany, an exponential increase in the number of infections was registered at the beginning of March 2020 and led to a call of the Ministry of Health to create more capacity for intensive medical treatment in hospitals. The aim of the present study was to determine the effects of the SARS-CoV-2 pandemic on Oto-Rhino-Laryngology (ORL) university hospitals regarding patient care.

MATERIALS AND METHODS

An online survey was sent out to all chairmen of the 39 ORL university hospitals in Germany. The answers to the questions referred to the defined period from March 15^th to April 15^th 2020 and were carried out using the online survey tool "SurveyMonkey". 87 questions focused on general information, health care, and structural effects in the respective institution.

RESULTS

All chairmen of the 39 university hospitals in Germany participated in the survey. The collected data prove the considerable impact on organizational, structural and medical aspects of patient care. For example, the surveyed clinics reported a decrease in outpatient cases by 73.8 % to 26.2 ± 14.2 % and in surgical treatments by 65.9 % to 34.1 ± 13.9 %. In contrast, emergency treatment remained unchanged or even increased in 80 % of the facilities and surgical treatment of emergency patients remained unchanged or even increased in more than 90 %. Emergency outpatient and surgical treatment of patients was provided throughout the pandemic in all facilities. In total, about 35 000 outpatients and about 12 000 surgical cases were postponed. As a result of the acute structural changes, the potential danger of falling below current treatment standards was seen in individual areas of patient care.

DISCUSSION

The assessment of the impact of the SARS-CoV-2 pandemic is heterogeneous. The majority of the chairmen are critically aware of the risk of falling below current medical treatment standards or guidelines. In the phase of an exponential increase in the number of infections, significant changes in treatment processes had to be accepted for understandable reasons. However, with the currently significantly reduced number of infections, falling below treatment standards and guidelines should not be allowed to remain constant and tolerated.

SUMMARY

This study shows a differentiated picture with regard to the effects of the SARS-CoV-2 pandemic on outpatient, inpatient and operative patient care at the ORL university hospitals in Germany and illustrates the importance of these institutions for ensuring patient care during this critical phase.

Evidence of a spatial auto-correlation in the browsing level of four major European tree species

The contribution of spatial processes to the spatial patterns of ecological systems is widely recognized, but spatial patterns in the ecology of plant-herbivore interactions have rarely been investigated quantitatively owing to limited budget and time associated with ecological research. Studies of the level of browsing on various tree species reported either no spatial auto-correlation or a small effect size. Further, the effects of disturbance events, such as hurricanes, which create large forest openings on spatial patterns of herbivory are not well understood.In this study, we used forest inventory data obtained from the federal state of Baden-Württemberg (Southern Germany) between 2001 and 2009 (grid size: 100 × 200 m) and thus, after hurricane Lothar struck Southern Germany in 1999. We investigated whether the browsing level of trees (height ≤ 130 cm) in one location is independent of that of the neighborhood.Our analyses of 1,758,622 saplings (187.632 sampling units) of oak (Quercus), fir (Abies), spruce (Picea), and beech (Fagus) revealed that the browsing level is characterized by a short distance spatial auto-correlation.The application of indicator variables based on browsed saplings should account for the spatial pattern as the latter may affect the results and therefore also the conclusions of the analysis.

Development of a smartphone app for neuromuscular facial training

BACKGROUND

Several studies have demonstrated a significant benefit of neuromuscular facial training in the rehabilitation of patients with facial palsy. However, printed instructions for home training are often not of optimum quality and associated with low adherence to therapy. Professional guidance, e.g., by occupational therapists, is regarded as being of high quality, but is associated with a high cost burden, particularly in chronic forms of disease.

OBJECTIVE

The idea to develop a smartphone app for facial training arose from the above-described situation. The aim was to provide structured exercises for the mimic muscles in the sense of neuromuscular training with visual feedback via the front camera of the device.

MATERIALS AND METHODS

A native app architecture in iOS was chosen to implement the graphical and content-related concept. In the Apple Xcode (Apple, Cupertino, CA, US) development environment, the app's code was written in the Swift programming language (Apple) and the graphical user interface was created.

RESULTS

An app prototype was implemented that provides step-by-step instructions on selected mimic exercises via animated smileys. The duration and speed of the exercise can be varied within a limited range. In the development environment, the correct functionality of both physical and virtual devices was successfully tested.

CONCLUSION

App-based facial training offers attractive opportunities to motivate patients for improved adherence to treatment, which could hypothetically lead to a better outcome. Evaluation of this question is planned in a clinical trial after completion of the development.

[Development of a smartphone app for neuromuscular facial training. German Version]

BACKGROUND

Several studies have demonstrated a significant benefit of neuromuscular facial training in the rehabilitation of patients with facial palsy. However, printed instructions for home training are often not of optimum quality and associated with low adherence to therapy. Professional guidance, e.g., by occupational therapists, is regarded as being of high quality, but is associated with a high cost burden, particularly in chronic forms of disease.

OBJECTIVE

The idea to develop a smartphone app for facial training arose from the above-described situation. The aim was to provide structured exercises for the mimic muscles in the sense of neuromuscular training with visual feedback via the front camera of the device.

MATERIALS AND METHODS

A native app architecture in iOS was chosen to implement the graphical and content-related concept. In the Apple Xcode (Apple, Cupertino, California, US) development environment, the app's code was written in the Swift programming language (Apple) and the graphical user interface was created.

RESULTS

An app prototype was implemented that provides step-by-step instructions on selected mimic exercises via animated smileys. The duration and speed of the exercise can be varied within a limited range. In the development environment, the correct functionality of both physical and virtual devices was successfully tested.

CONCLUSION

App-based facial training offers attractive opportunities to motivate patients for improved adherence to treatment, which could hypothetically lead to a better outcome. Evaluation of this question is planned in a clinical trial after completion of the development.

Surgery of the lateral skull base: a 50-year endeavour

Disregarding the widely used division of skull base into anterior and lateral, since the skull base should be conceived as a single anatomic structure, it was to our convenience to group all those approaches that run from the antero-lateral, pure lateral and postero-lateral side of the skull base as “Surgery of the lateral skull base”. “50 years of endeavour” points to the great effort which has been made over the last decades, when more and more difficult surgeries were performed by reducing morbidity. The principle of lateral skull base surgery, “remove skull base bone to approach the base itself and the adjacent sites of the endo-esocranium”, was then combined with function preservation and with tailoring surgery to the pathology. The concept that histology dictates the extent of resection, balancing the intrinsic morbidity of each approach was the object of the first section of the present report. The main surgical approaches were described in the second section and were conceived not as a step-by-step description of technique, but as the highlighthening of the surgical principles. The third section was centered on open issues related to the tumor and its treatment. The topic of vestibular schwannoma was investigated with the current debate on observation, hearing preservation surgery, hearing rehabilitation, radiotherapy and the recent efforts to detect biological markers able to predict tumor growth. Jugular foramen paragangliomas were treated in the frame of radical or partial surgery, radiotherapy, partial “tailored” surgery and observation. Surgery on meningioma was debated from the point of view of the neurosurgeon and of the otologist. Endolymphatic sac tumors and malignant tumors of the external auditory canal were also treated, as well as chordomas, chondrosarcomas and petrous bone cholesteatomas. Finally, the fourth section focused on free-choice topics which were assigned to aknowledged experts. The aim of this work was attempting to report the state of the art of the lateral skull base surgery after 50 years of hard work and, above all, to raise questions on those issues which still need an answer, as to allow progress in knowledge through sharing of various experiences. At the end of the reading, if more doubts remain rather than certainties, the aim of this work will probably be achieved.

Induction chemotherapy (IC) followed by radiotherapy (RT) versus cetuximab plus IC and RT in advanced laryngeal/hypopharyngeal cancer resectable only by total laryngectomy-final results of the larynx organ preservation trial DeLOS-II

Background

The German multicenter randomized phase II larynx organ preservation (LOP) trial DeLOS-II was carried out to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC).

Patients and methods

Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF [docetaxel (T) and cisplatin (P) 75 mg/m2/day 1, 5-FU (F) 750 mg/m2/day days 1-5] followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24 months LFS above 35% in arm B.

Results

Of 180 patients randomized (July 2007 to September 2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24 months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). One hundred and twenty-three early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A versus 80%/86.0% in B. The 24 months overall survival (OS) rates were 68.2% and 69.3%.

Conclusions

Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24 months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS.

Clinical trial information

NCT00508664.

[Recurrent infections of the upper aerodigestive tract in patients with primary immunodeficiency]

BACKGROUND

Primary immunodeficiency is a rare disease of humoral and cellular immune defense, which can lead to severe and recurrent infections of different organs. The diagnosis of this disease is often difficult, and its early identification is necessary for adequate treatment and control.

OBJECTIVE

This study aimed to analyze ear, nose, and throat (ENT) infections in adults and children with a primary immunodeficiency. We attempted to characterize possible warning signs that should trigger an immunologic diagnostic workup.

MATERIALS AND METHODS

The current study comprised a retrospective case series of patients with primary immunodeficiencies. The type of immunodeficiency and the number of ENT infections were recorded.

RESULTS

A total of 85 Patients were included in the study. 56 patients (66%) had an acute exacerbation of chronic rhinosinusitis (n = 28), cervical lymphadenitis (n = 16), acute tonsillitis (n = 14), and acute otitis media (n = 6). Reporting detailed information about the frequencies and dates of infections was not possible, due to the retrospective nature of the analysis.

CONCLUSION

The prevalence of ENT infections in patients with a primary immunodeficiency is increased compared to the normal population. For the ENT specialist, these findings underline the necessity of including primary immunodeficiency in the differential diagnosis and initiating targeted diagnostic methods where indicated. Interdisciplinary collaboration with rheumatologists and immunologists is highly recommended, particularly for pediatric patients.

Risk factors for children requiring adenotonsillectomy and their impact on postoperative complications: a retrospective analysis of 2000 patients

Adenotonsillectomies are commonly performed procedures and sleep-disordered breathing is becoming increasingly important as an indication for surgery. Because of the higher risks in patients with obstructive sleep apnoea, the required level of postoperative care for these patients is currently under discussion, and better identification of patients at risk may reduce unnecessary postoperative monitoring. To evaluate the influence of obstructive sleep apnoea, and other risk factors, on peri-operative complications in children requiring adenotonsillectomy, we performed a retrospective case-control study that included 1995 patients treated between January 2009 and June 2017. In our analysis, young age (OR 3.8, 95%CI 2.1-7.1), low body weight (OR 2.6, 95%CI 1.5-4.4), obstructive sleep apnoea (OR 2.4, 95%CI 1.5-3.8), pre-existing craniofacial or syndromal disorders (OR 2.3, 95%CI 1.4-3.8) and adenotonsillectomy, compared with adenoidectomy alone, (OR 7.9, 95%CI 4.7-13.1) were identified as risk factors for complications during or after surgery, p < 0.001. All 13 patients suffering from complications more than 3 h postoperatively had obstructive sleep apnoea plus at least one more of these risk factors. Patients at risk of postoperative complications can therefore be identified by several criteria pre-operatively, and should be monitored postoperatively using pulse oximetry overnight. For all other patients, postoperative observation on a surgical ward without extra monitoring is sufficient. Admission to paediatric intensive care should be reserved for patients suffering serious intra-operative complications.

Klinische Anwendung der Computertomographie beim Rind

Die Computertomographie liefert mithilfe von Röntgenstrahlen Schnittbilder von Körperregionen. Diese zeigen eine überlagerungsfreie, zweidimensionale Darstellung aller gewünschten Ebenen und ermöglichen auch eine dreidimensionale Rekonstruktion interessierender Körperregionen. Berichte über die Computertomographie beim Rind finden sich nur vereinzelt. Hohe Kosten, medikamentöse Restriktionen und die notwendige Allgemeinanästhesie limitieren die Anwendungen. Indikationen beim Rind sind vor allem Erkrankungen des Kopfes – wie Zahnerkrankungen oder Otitis media – sowie neurologische Erkrankungen, weniger oft Erkrankungen der Wirbelsäule und Gliedmaßen. Bei wertvollen Rindern, bei denen eine operative Therapie geplant ist, kann die Computertomographie Befunde liefern, die für die Durchführung des Eingriffs entscheidend sind. Die computertomographischen Befunde können andererseits auch dazu beitragen, eine ungünstige Prognose zu erkennen und so unnötige Operationen zu vermeiden.

Metacognitive beliefs mediate the effect of emotional abuse on depressive and psychotic symptoms in severe mental disorders

BACKGROUND

Early trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms.

METHOD

Patients (N = 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety.

RESULTS

Metacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R 2 = 0.21-0.29).

CONCLUSION

Our results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.

Temporal patterns in road crossing behaviour in roe deer (Capreolus capreolus) at sites with wildlife warning reflectors

Every year, there are millions of documented vehicle collisions involving cervids across Europe and North America. While temporal patterns in collision occurrence are relatively well described, few studies have targeted deer behaviour as a critical component of collision prevention. In this study, we investigated weekly and daily patterns in road crossing behaviour in roe deer. Using road crossing events and movement data obtained from GPS telemetry, we employed mixed-effect models to explain frequency and timing of crossings at five road segments by a number of predictors including traffic volume, deer movement activity and the presence of wildlife warning reflectors. We analysed 13,689 road crossing events by 32 study animals. Individual variation in crossing frequency was high but daily patterns in crossing events were highly consistent among animals. Variation in the intensity of movement activity on a daily and seasonal scale was the main driver of road crossing behaviour. The seasonal variation in crossing frequency reflected differences in movement activity throughout the reproductive cycle, while daily variation in the probability to cross exhibited a clear nocturnal emphasis and reflected crepuscular activity peaks. The frequency of road crossings increased as a function of road density in the home-range, while traffic volume only exerted marginal effects. Movement activity of roe deer in our study coincided with commuter traffic mainly in the early morning and late afternoon during winter and during periods of high spatial activity such as the rut. Both timing and frequency of crossing events remained unchanged in the presence of reflectors. Our results emphasise the importance of behavioural studies for understanding roe deer vehicle-collision patterns and thus provide important information for collision prevention. We suggest that mitigation of collision risk should focus on strategic seasonal measures and animal warning systems targeting drivers.

[20 Years of Bilateral Cochlear Implantation - an Analysis of the Implanted Patients]

Binaural hearing is essential for localization abilities and improves the speech perception in noise. Since 20 years, bilateral cochlear implantation is routinely performed to restore binaural hearing. In this cross-sectional study, we evaluated speech perception in quiet (Freiburger monosyllables, Hochmair-Schulz-Moser (HSM) sentence test, each at 70 dB) and in noise (HSM test, signal-to-noise ratio 10 dB) in 103 out of 165 adult patients who were bilaterally implanted in Würzburg between 1995 and June 2014. In almost half the patients, the second implanted side showed the better speech perception. Compared to the first implanted side, the average monosyllable scores with bilateral implants were improved from 54 to 63% and the HSM scores from 86 to 96%. In noise the speech perception improved from 47 to 65%. The speech perception of the second implanted side was independent of the time interval between the implantation of both sides in this cohort of postlingually deafened patients. This cross-sectional data underline the importance of bilateral cochlear implantation for speech understanding in quiet and even more in noise and thus, for the everyday life. For this, bilateral cochlear implantation should be the generally accepted standard in the treatment of deaf patients.

Effectiveness of light-reflecting devices: A systematic reanalysis of animal-vehicle collision data

Every year, approximately 500 human fatalities occur due to animal-vehicle collisions in the United States and Europe. Especially heavy-bodied animals affect road safety. For more than 50 years, light-reflecting devices such as wildlife warning reflectors have been employed to alert animals to traffic when crossing roads during twilight and night. Numerous studies addressed the effectiveness of light-reflecting devices in reducing collisions with animals in past decades, but yielded contradictory results. In this study, we conducted a systematic literature review to investigate whether light-reflecting devices contribute to an effective prevention of animal-vehicle collisions. We reviewed 53 references and reanalyzed original data of animal-vehicle collisions with meta-analytical methods. We calculated an effect size based on the annual number of animal-vehicle collisions per kilometer of road to compare segments with and without the installation of light-reflecting devices for 185 roads in Europe and North America. Our results indicate that light-reflecting devices did not significantly reduce the number of animal-vehicle collisions. However, we observed considerable differences of effect sizes with respect to study duration, study design, and country. Our results suggest that length of the road segment studied, study duration, study design and public attitude (preconception) to the functioning of devices may affect whether the documented number of animal-vehicle collisions in- or decrease and might in turn influence whether results obtained were published.

[Direct Drive Simulation - Sound-Simulation of the Vibrant Soundbridge®]

BACKGROUND

The Direct-Drive-Simulation (DDS) tends to simulate the sound quality of hearing with the active middle ear implant Vibrant Soundbridge(®) (VSB). Up to now a scientific evaluation of the validity is missing. Furthermore, the test procedure has not been described yet. Aim of this study was to evaluate the test validity and to describe the test realization in detail.

MATERIAL AND METHODS

10 patients evaluated their sound impression on scales from 1 to 10 concerning sound quality during DDS, postoperative free field testing at least 3 month after the first fitting of the VSB and in the everyday life situation. 3 patients were implanted bilaterally. Together, 36 data sets could be analyzed.

RESULTS

Coupling of the Floating Mass Transducer (FMT), which was placed inside of a silicone probe during DDS was successful in all cases. In 11 out of 13 cases the coupling quality was judged as "good" an only in 2 cases as "medium". None of the patients needed local anesthesia. Comparing the evaluation of the sound impression during DDS preoperatively, and with the implanted VSB in free field testing and in everyday life no significant differences were found.

CONCLUSION

The DDS offers the possibility of a realistic preoperative sound simulation of the "VSB-hearing" in case of sensorineural hearing loss. Thus, the test is supposed to facilitate the patient's decision towards possible treatment options. The specialist gets additional information regarding the indication especially when audiologic indication criteria are critical. The DDS should be a basic part of the preoperative diagnostic prior to VSB-implantation.

["Giant" fibrovascular esophageal polyp]

Fibrovascular polyps are rare mesenchymal tumors that arise mainly in the cricopharyngeal portion of the esophagus. They may protrude distally to become "giant" pedunculated lesions filling almost the entire esophageal lumen. Histologically they contain varying amounts of adipose, fibrous and vascular tissues and belong to spindle cell lipomas according to the classification of soft tissue tumors. Immediate resection of these benign lesions is warranted as they may be regurgitated and cause asphyxia. These lesions are usually treated by open surgery (left cervicotomy) or, less invasively, by peroral endoscopic surgery. Polyp removal by flexible endoscopy has been described but may be hazardous if its stalk is broad-based. In this report the case of a 73-year-old male with dysphagia is described in whom a "giant" fibrovascular polyp was diagnosed endoscopically and promptly removed surgically by the peroral route. At control endoscopy 14 months later, the asymptomatic patient was free of polyp recurrence.

Comparative Study between the Surgeon's Intraoperative Evaluation and Histopathology for Diagnosis of Laryngeal Lesions

Objective. To compare the surgeon's evaluation and histopathology for diagnosis of laryngeal lesions. Material. A clinical survey was distributed to laryngeal surgeons, ENT clinicians, and students in 2013 at the Department of Otorhinolaryngology in Rostock. Participants were asked to anonymously identify laryngeal pathologies and to assess the severity of the lesion starting from hyperplasia and inflammation over moderate dysplasia to early laryngeal cancer. Images of similar clinical laryngeal lesions were demonstrated in a multiple-choice modus to assess the surgeon's intraoperative evaluation. The questionnaires were digitally processed and evaluated. The results were correlated with histopathology and compared between experienced laryngeal surgeons, clinicians inexperienced in laryngeal surgery, and medical students from the Medical Faculty of the University of Rostock. Results. Sensitivity and specificity varied among the various groups, being highest in experienced laryngeal surgeons. In this group, sensitivity, specificity, positive and negative predictive value, and accuracy were 85%, 56%, 44%, 90%, and 65%, respectively. In 4% and 31%, laryngeal disease was underdiagnosed and overdiagnosed, respectively. In this group, Kappa statistics resulted in Kappa 0.32 (P < 0.001). Conclusion. This clinical survey clearly demonstrates that conformity between histopathology and evaluation of the laryngeal lesion depends on the surgeon's experience.

[Adipose-derived stromal cells (ASC) - basics and therapeutic approaches in otorhinolaryngology]

Adipose-derived Stromal Cells (ASC) - Basics and Therapeutic Approaches in Otorhinolaryngology Mesenchymal stem cells from adipose tissue can be easily harvested with less discomfort, low donor-site morbidity and high amount compared to bone marrow-derived stem cells. Due to their multilineage differentiation potential in various cell types, immunmodulatory properties and their capability to enhance wound healing, ASC are a promising cell source for tissue engineering approaches and regenerative medicine. They are characterized by the expression of specific surface marker proteins and their differentiation potential into the mesenchymal lineages. Whereas only preclinical studies are published for otorhinolaryngology-related therapeutic options using ASC, various diseases, for instance graft-versus-host disease, have already been treated with ASC in single cases or clinical trials. Safety and genomic stability of ASC as well as the risk of spontaneous malignant transformation are still disputed. This review summarizes the current literature on characterization and anatomic localization of ASC. In addition, beside the presentation of preclinical studies concerning therapeutic approaches in otorhinolaryngology as well as of current clinical applications, the issue of safety of ASC in human stem cell therapy is discussed.

[Evaluation of the Freiburg monosyllabic speech test in background noise]

BACKGROUND

The Freiburg speech test has been the gold standard in speech audiometry in Germany for many years. Previously, however, this test had not been evaluated in assessing the effectiveness of a hearing aid in background noise. Furthermore, the validity of particular word lists used in the test has been questioned repeatedly in the past, due to a suspected higher variation within these lists as compared to the other word list used.

PATIENTS AND METHODS

In this prospective study, two groups of subjects [normal hearing control subjects and patients with SNHL (sensorineural hearing loss) that had been fitted with hearing aid] were examined. In a first group, 113 control subjects with normal age- and gender-related pure tone thresholds were assessed by means of the Freiburg monosyllabic test under free-field conditions at 65 dB. The second group comprised 104 patients that had been fitted with hearing aids at least 3 months previously to treat their SNHL. Members of the SNHL group were assessed by means of the Freiburg monosyllabic test both with and without hearing aids, and in the presence or absence of background noise (CCITT-noise; 65/60 dB signal-noise ratio, in accordance with the Comité Consultatif International Téléphonique et Télégraphique), under free-field conditions at 65 dB.

RESULTS

The first (control) group exhibited no gender-related differences in the Freiburg test results. In a few instances, inter-individual variability of responses was observed, although the reasons for this remain to be clarified. Within the second (patient) group, the Freiburg test results under the four different measurement conditions differed significantly from each other (p>0.05). This group exhibited a high degree of inter-individual variability between responses. In light of this, no significant differences in outcome could be assigned to the different word lists employed in the Freiburg speech test.

CONCLUSION

The Freiburg monosyllabic test is able to assess the extent of hearing loss, as well as the effectiveness of a fitted hearing aid, in the presence or absence of background-noise (CCITT-noise). The present study could not evidence statistically significant differences in outcome when using the different word lists in this test battery.

Synchrony in hunting bags: reaction on climatic and human induced changes?

Human induced land use changes negatively impact the viability of many wildlife species through habitat modifications and mortality, while some species seem to benefit from it. Roe deer (Capreolus capreolus), a wide spread ungulate increased both its abundance and range throughout Europe. This pattern is also reflected in the increasing hunting bags over the last 40 years. Such a development raises questions about the relationship between human hunting and population dynamics and, in particular, about the potential of human hunting to control related populations. We analysed and reconstructed annual hunting bags of roe deer for three federal states of northern Germany, Brandenburg, Lower Saxony and Mecklenburg West Pomerania for the years 1972 to 2011. Since 1992 the hunting bags from these three states are significantly higher than those reported for the years 1972-1991. Our reconstruction takes into consideration effects of climate variability, expressed by inter-annual changes in the North Atlantic Oscillation and impacts from rapeseed and wheat cultivation. We found that severe winters, which are indicated by negative values of the North Atlantic Oscillation during the months December-March, directly, or with a time lag of two years affect the number of deer shot. In contrast, an increase in the area used for rapeseed cultivation coincides with higher numbers of roe deer shot, with respect to the overall mean value. Consequently, we recommend that wildlife management addresses changes in large scale processes including land use pattern and climate variability.

Human mesenchymal stem cells promote cancer motility and cytokine secretion in vitro

Interactions of human mesenchymal stem cells (hMSC) with tumors are controversially discussed since there is evidence for both tumor progression as well as tumor inhibition by hMSC. The objective of the present study is to investigate whether hMSC support cell motility and cytokine secretion in a head and neck squamous cell carcinoma cell line (HLaC 78). A spheroid model was generated in which the ultrastructure of spheroids was analyzed using scanning electron microscopy (SEM). The migration capability was monitored in a monolayer as well as in a spheroid model. The variation in migration and secretion of interleukin (IL)-6, IL-8 and vascular endothelial growth factor (VEGF), as well as the expression of the multidrug resistance gene (MDR-1) was investigated. Finally, the alteration in the cell cycle was analyzed by flow cytometry. SEM showed a tight cell-cell contact with extensive secretion of extracellular matrix. The migration and invasion capability of HLaC 78 was enhanced by hMSC. Cancer cell motility was also increased by hMSC as well as secretion of the cytokines IL-6, IL-8 and VEGF. hMSC did not induce the expression of MDR-1 in HLaC 78, and there was no alteration in the cell cycle of HLaC 78 after cocultivation with hMSC. Our results confirm the important role of hMSC in cancer biology since both an enhancement of cell motility as well as cytokine secretion could be shown. However, based on these findings and those in the current literature, caution must be applied when using hMSC as a carrier for tumor therapy in cancer treatment.