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We report an outbreak with SARS-CoV-2 breakthrough infections related to a festive event in Northern Bavaria, Germany in October 2021, with 24 of 95 participants infected. Correlation analyses among 15 interrogated variables revealed that duration at the event and conversation with the supposed index person were significant risk factors. Article Summary LineThe risk of infection with SARS-CoV-2 in a vaccinated cohort associated with a private festive event was significantly increased upon conversation with the putative index person and positively correlated to the duration of stay at the event.

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Methods@#Prospective questionnaire-based assessment was performed for 1,000 participants. Questionnaires consisted of validated generic and disease-specific queries and specific questions. The survey included patients without pathologies of cervical spine/shoulders/upper extremities. @*Results@#Mean age of participants was 39 years. The average neck VAS score was 1.2, NDI% was 7.3, arm VAS score was 0.8, QuickDASH was 6.2, mConstant score was 70.7, HADS-A score was 4.9, and HADS-D score was 3.2. The psychological scores showed a significant correlation with neck- and shoulder-disability (p35 kg/m2 influenced shoulder-disability (p<0.005) and psychological distress (HADS-D score, p<0.00001). Limited neck rotation was present in those with higher age, psychological distress, neck and shoulder disability (p<0.001). @*Conclusions@#Normative scores for neck and shoulder disability were established. The outcomes of cervical spine surgery can be normalized to these results. A better understanding of the interdependencies of neck and shoulder disability and psychological distress would enable superior decision-making and patient counseling.

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Methods@#Prospective questionnaire-based assessment was performed for 1,000 participants. Questionnaires consisted of validated generic and disease-specific queries and specific questions. The survey included patients without pathologies of cervical spine/shoulders/upper extremities. @*Results@#Mean age of participants was 39 years. The average neck VAS score was 1.2, NDI% was 7.3, arm VAS score was 0.8, QuickDASH was 6.2, mConstant score was 70.7, HADS-A score was 4.9, and HADS-D score was 3.2. The psychological scores showed a significant correlation with neck- and shoulder-disability (p35 kg/m2 influenced shoulder-disability (p<0.005) and psychological distress (HADS-D score, p<0.00001). Limited neck rotation was present in those with higher age, psychological distress, neck and shoulder disability (p<0.001). @*Conclusions@#Normative scores for neck and shoulder disability were established. The outcomes of cervical spine surgery can be normalized to these results. A better understanding of the interdependencies of neck and shoulder disability and psychological distress would enable superior decision-making and patient counseling.

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BACKGROUND AND PURPOSE: This study analyzed the number of patients with ischemic strokes recorded in the Austrian Stroke-Unit Registry with the aim of projecting this number from 2012 to 2075 and to highlight that the Austrian health system will face a dramatic increase in older patients within the next few decades. METHODS: Current demographic information was obtained from EUROSTAT, and information on age- and sex-stratified 1-year incidence rates of ischemic stroke were obtained from the Austrian Stroke-Unit Registry. Sensitivity analysis was performed by analyzing the projections based on predicted ageing, main, and growth population scenarios, and with stratification by age and gender. RESULTS: The total number of ischemic strokes recorded in the Austrian Stroke-Unit Registry was 8,690 in 2012 and is expected to increase to 15,826, 15,626, or 18,134 in 2075 according to the ageing, main, and growth scenarios, respectively. The corresponding numbers of patients are projected to increase or decrease within different age strata as follows (100%=number of registered ischemic strokes in 2012): 0–40 years, 100%/99% (males/females); 40–50 years, 83%/83%; 50–60 years, 98%/97%; 60–70 years, 126%/119%; 70–80 years, 159%/139%; 80–90 years, 307%/199%; and 90+ years, 894%/413%. CONCLUSIONS: The ageing population in Austria will result in the number of patients increasing considerably from 2012 to 2075, to 182%, 180%, or 208% (relative to 100% in 2012) according to the ageing, main, and growth scenarios, respectively; the corresponding value among those aged 80+ years is 315%, 290%, or 347%. These figures demonstrated the importance of improving primary preventive measures. The results of this study should provide a basis for discussions among health-care professionals and economists to face the future large financial burden of ischemic stroke on the Austrian health system.

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STUDY DESIGN: This was a prospective randomized comparative study. PURPOSE: The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain. OVERVIEW OF LITERATURE: Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported. METHODS: Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7-10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented. RESULTS: Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56+/-7.6 years, whereas the average age of patients in group B was 52.6+/-10.4 years. Group A had an average of 0.6+/-0.7 previous surgeries per patient, whereas group B had an average of 0.8+/-1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6+/-0.7, whereas the average number of levels fused in group B was 3.7+/-0.9 (all p>0.05). In group A, the mean ropivacaine volume administered was 8.4+/-1.5 mL. No patient complaints regarding chronic pain, were reported six months postoperatively. No complications were encountered from the harvest site, and all patients underwent successful 3-level and 4-level ACDFP. Statistical analysis showed significant differences for VAS on postoperative day 1 (p=0.004) and day 2 (p=0.005). CONCLUSIONS: VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.

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BACKGROUND: Changes in the treatment of rectal cancer during the past decades have led to an increase in sphincter preservation with a consecutive decline in abdominoperineal resection rates. OBJECTIVE: The aim of this study was to analyze the cumulative incidence of permanent stoma in patients undergoing sphincter-preserving resection of mid and low rectal cancer. DESIGN: This study is a retrospective analysis of prospectively collected data. SETTINGS: This study was conducted at a tertiary referral cancer hospital. PATIENTS: From 2003 to 2010, 125 patients with primary mid and low rectal cancer who underwent sphincter-preserving low anterior resection were included. MAIN OUTCOME MEASURES: The occurrence of a permanent stoma over time was investigated by using a Cox proportional hazards regression model and competing-risk models, with death as a competing risk. The risk factors were assessed by computing HRs and a Cox proportional hazards regression. RESULTS: After a median follow-up time of 61 months (range, 22-113), 15 of 125 patients ended up with a permanent stoma, accounting for a 5-year cumulative incidence of 6% (95% CI, 4%-11%). The reasons for obtaining a permanent stoma were anastomotic leakage (60%, 9/15), intractable fecal incontinence (27%, 4/15), and local recurrence (13%, 2/15). The Cox proportional hazards regression identified anastomotic leakage (HR, 6.10; 95% CI, 2.23-16.71; p = 0.0004) and coloanal anastomosis (HR, 4.31; 95% CI, 1.49-12.47; p = 0.007) as statistically significant risk factors. LIMITATIONS: Because of the small number of events in this sample, further investigations with a larger number of patients are required. Fecal incontinence was assessed by patient self-reported data without the use of a validated score. CONCLUSION: The 5-year cumulative incidence of a permanent stoma was 6%. Anastomotic leakage and coloanal anastomosis were identified as risk factors. These details should be considered before sphincter-preserving surgery.

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<p><b>OBJECTIVE</b>The present study aimed to test whether exposure to radiofrequency electromagnetic fields (RF-EMF) emitted by mobile phone base stations may have effects on salivary alpha-amylase, immunoglobulin A (IgA), and cortisol levels.</p><p><b>METHODS</b>Fifty seven participants were randomly allocated to one of three different experimental scenarios (22 participants to scenario 1, 26 to scenario 2, and 9 to scenario 3). Each participant went through five 50-minute exposure sessions. The main RF-EMF source was a GSM-900-MHz antenna located at the outer wall of the building. In scenarios 1 and 2, the first, third, and fifth sessions were "low" (median power flux density 5.2 microW/m(2)) exposure. The second session was "high" (2126.8 microW/m(2)), and the fourth session was "medium" (153.6 microW/m(2)) in scenario 1, and vice versa in scenario 2. Scenario 3 had four "low" exposure conditions, followed by a "high" exposure condition. Biomedical parameters were collected by saliva samples three times a session. Exposure levels were created by shielding curtains.</p><p><b>RESULTS</b>In scenario 3 from session 4 to session 5 (from "low" to "high" exposure), an increase of cortisol was detected, while in scenarios 1 and 2, a higher concentration of alpha-amylase related to the baseline was identified as compared to that in scenario 3. IgA concentration was not significantly related to the exposure.</p><p><b>CONCLUSIONS</b>RF-EMF in considerably lower field densities than ICNIRP-guidelines may influence certain psychobiological stress markers.</p>

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AIMS: We want to provide new qualitative and quantitative data on the long-term impact of cochlear implantation (CI) on educational placement, vocational outcomes and employment status of hearing-impaired adolescents and young adults. METHODS: 52 cochlear implant users (age: 12-21 years) and a control group of 155 normal-hearing peers participated in structured interviews on their educational level, achievement, satisfaction with their vocational placement and correspondence between career aspiration and actual occupation. RESULTS: The educational level of CI-using pupils did not differ from the Austrian population. More than 80% of school-aged children attended mainstream schools. The educational level was positively correlated to the educational level of the father and performance on numbers in an auditory speech test. Nevertheless, parents of pupils with cochlear implants rated the future career chances of their children significantly less optimistic than parents of normal-hearing peers. More than 60% of secondary post-graduates (alumni) completed their education in mainstream schools, two studied at university. 12 out of 13 participants, who required work, were employed, 75% of them with regular contracts. Although all CI-users reported high satisfaction with their work, the correspondence between career aspiration and actual occupation was significantly lower for CI-users compared to normal-hearing peers. CONCLUSION: The majority of CI-users in our study group was well integrated into the hearing world, concerning their schooling and post-graduate development. However their career perspectives are still not satisfying.

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