Resin-based Composite Light-cured Properties Assessed by Laboratory Standards and Simulated Clinical Conditions

The following parameters were varied: 1) irradiation technique: top and bottom polymerization according to the ISO standard, and polymerization from only the top, simulating clinical situations; 2) polymerization time: 5, 10, 20, and 40 seconds; 3) storage conditions: 24 hours in distilled water, thermocycling followed by storage for four weeks in artificial saliva or alcohol. Flexural strength (FS), flexural modulus (Eflexural), indentation modulus (E), Vickers hardness (HV), and degree of conversion (DC) were measured.

The laboratory results were similar to those measured by mimicking clinical conditions only at high polymerization times and mild storage conditions (20 seconds and 40 seconds and storage for 24 hours in water, and 40 seconds with aging and storing in saliva). Significantly higher DC values were measured on the top than on the bottom of a 2-mm layer for all polymerization times. Overall, 5-second and 10-second irradiation times induced significantly lower DC values compared to the currently recommended polymerization times of 20 and 40 seconds at both the top and bottom of the samples.

The initial DC differences as a function of irradiation time are leveled at 24 hours of storage but seem to do well in predicting long-term material behavior. A minimum irradiation time of 20 seconds is necessary clinically to achieve the best mechanical properties with modern high-intensity light emitting diode (LED) units.

[Surgical competence in the treatment of thoracic and abdominal injuries in rural hospitals]

The German S3 Guideline on Treatment of Polytrauma/Severely Injured Patients characterizes key recommendations on the current diagnostic and therapeutic approach in concomitant thoracic and abdominal trauma based on the available scientific data. The special requirements for appropriate basic treatment can be derived for rural hospitals, even though the particular grade of recommendation often is low because evidence-based studies are still lacking.The options for adequate basic treatment of thoracic and abdominal trauma in patients with multiple injuries treated in rural hospitals substantially depend on the dedication, the level of experience and training, and the willingness of the locally responsible team to cooperate.

[Perioperative nutrition - a nationwide web-based survey of German surgery departments]

BACKGROUND

Insufficient nutrition in surgical patients increases perioperative morbidity, mortality, length of stay and therapy costs. Therefore, guidelines declare the integration of nutrition into the overall management as one of the key aspects of perioperative care. This study was conducted to evaluate the current clinical practice of clinical nutrition in surgical departments in Germany.

METHODS

In 2009 German Surgical Society (DGCH) members in leading positions were surveyed with a standardised online questionnaire concerning their perioperative nutritional routines in elective surgery.

RESULTS

From the addressed physicians n = 156 (6.24 %) answered. Of those, 86.9 % consider the nutritional status of their patients. Only 6 % use standardised nutritional screening tools. Short preoperative fasting for solid and liquid food is practiced by 65 % and 40 %, respectively. After the operation, 65 % allow intake of clear fluids on the day of surgery and 78 % initiate solid food on the day of surgery or the first postoperative day. Oral nutritional supplements are given only "sometimes" or "rarely" by 53.9 % of the respondents.

CONCLUSION

The low response rate may imply the dilemma that the evidence-based benefit of perioperative nutrition does not meet sufficient interest. Even in case of a positive selection of "pro-nutrition respondents", standardised preoperative malnutrition screening is also rare. Aspects such as shorter perioperative fasting are already practiced more progressively. However, still greater efforts are needed to promote guideline-based clinical nutrition in surgical care in Germany.

[Quality of life of German surgeons: results of a survey of 3,652 attendees of the annual meetings of the German Surgical Societies ]

BACKGROUND AND OBJECTIVE

Quality of life is of vital importance for patients undergoing surgery. However, little is known about the quality of life of surgeons who are facing a stressful and dramatically changing working environment. For this reason, this large scale study investigated the quality of life (QL) of surgeons in Germany in the context of occupational, private, and system-related risk factors with a standardized QL measurement instrument.

METHODS

The study population consisted of attendees (surgeons, non-surgical physicians, medical students) of the nine major annual conferences of the German Society of Surgery between 2008 and 2009. Participants filled in a single questionnaire including study-specific questions (demographic variables, professional position, and occupational situation) and a standardized quality of life instrument. Surgeons' responses with regard to their professional situation and their quality of life were contrasted with those of the two controls (non-surgical physicians, i. e. orthopedics, pediatrics, gastroenterologists and medical students). Furthermore, QL scores were compared with German population reference data and with reference data of several patient groups.

RESULTS

3652 individuals (2991 surgeons, 561 non-surgical physicians, 100 medical students) participated in this study. 68 % of the surgeons but only 39 % of the non-surgeons worked more than 60 hours per week on average. Surgeons reported restrictions on their private and family life due to work overload, more so than non-surgeons (74 % vs. 59 %). Responses to the PLC quality of life questionnaire confirmed these results, showing score values lower than those of the German population reference data and of several patient groups.

CONCLUSION

The time has come for surgeons to consider their own quality of life, as this is a main issue in their scientific and clinical work with patients.

[Organizational forms of emergency medicine from the perspective of DGCH and BDC. Discipline-specific or interdisciplinary?]

Due to logistic, organizational and economic advantages, interdisciplinary emergency centers are gaining more and more acceptance compared to established, discipline-specific and independent emergency rooms. Organizational concepts for interdisciplinary emergency centers need to consider the mandate for comprehensive patient care and the consequential performance spectrum. Thus, the implementation of generally accepted guidelines and specifications is demanding.Currently developed concepts of the accordant interdisciplinary working groups try to fulfill these premises. Further fundamental criteria to be met are the quality and education of medical and nursing staff, which are predominantly doing their jobs within the interdisciplinary emergency centers. The concept of the German surgical societies and connected organizations is not the implementation of a new definition of the role of emergency specialized physicians but rather a substantial advancement of the existing and established regulations for further education. Therefore, a further advanced-training program for clinical emergency medicine has to be implemented in addition to the existing emergency education within the common trunk, which every physician has to pass through during discipline-specific education. Furthermore, this program should complement the existing pre-clinical emergency education, which can be acquired after specialization.The accordant criteria to be developed and the coordination with the German Medical Association (Bundesärztekammer) are currently prioritized on the agenda of the interdisciplinary working group. Due to reasons of compatibility with the regulations for further education, specific management skills for future heads and directors of such interdisciplinary emergency centers should not be stipulated within the advanced-training program for clinical emergency medicine but should be gained through specific course concepts beyond this program.

TISSUE MAST CELLS AND ACUTE INFLAMMATION IN EXPERIMENTAL CUTANEOUS MUCORMYCOSIS OF NORMAL, 48/80-TREATED, AND DIABETIC RATS

The role of the tissue mast cells in relation to the acute inflammatory reaction to experimental cutaneous mucormycosis was studied histologically in normal rats, in animals whose tissue mast cells had been depleted of their cytoplasmic granules prior to infection by the administration of compound 48/80 and in others in whom acute alloxan diabetes with acidosis had been produced before injection of the fungus. The discharge of the tissue mast cell granules in normal rats occurred within minutes at the site of infection and appeared to initiate the rapid onset of acute inflammation. The degranulation of the tissue mast cells subsided in a short time and the cells reassumed a normal histologic appearance while inflammation progressed with the formation of circumscribed lesions. In animals pretreated with compound 48/80 in which the tissue mast cells contained no granules, the onset of inflammation was briefly delayed, the intensity of the process was somewhat decreased, fibroblastic proliferation was retarded, and the fungus growth in the early lesions was increased. However, the infection did not spread and the lesions were well localized. The tissue mast cells in the diabetic and acidotic rats completely failed to discharge their cytoplasmic granules, the onset and intensity of the acute inflammatory response were markedly delayed and decreased and the infection progressed rapidly with massive fungus growth invading adjacent tissues. A relationship between the discharged tissue mast cell granules and eosinophilic granulocytes was noted since the latter were numerous among the inflammatory cell exudate in normal rats and scarce in the lesions of the diabetic animals. It is concluded that a function of the tissue mast cells in the normal rat is the rapid initiation of acute inflammation at the site of injury and that degranulation of these cells prior to infection somewhat delays the inflammatory response and therefore slightly diminishes host resistance. Furthermore, a severe metabolic disorder such as acute alloxan diabetes with acidosis, inhibits the normal function of the tissue mast cells, delays and decreases inflammation, and in this manner contributes to the greatly increased susceptibility of the host to infection.