[Resection of recurrent rectal cancer]

A curative treatment of locally recurrent rectal cancer (LRRC) can only be achieved with a complete resection and microscopically tumor-free surgical margins (R0). Imaging techniques are the most important investigations for the preoperative staging of local and systemic diseases. Due to substantial improvements in surgical strategies and techniques, previously unresectable tumors can now be excised. Several publications have demonstrated the oncological benefits of high sacral resection for LRRC. High subcortical sacrectomy (HiSS), extended lateral resection and extended lateral pelvic sidewall excision (ELSiE) belong to the newer surgical options. Biological meshes, various myocutaneous flaps, titanium and bone allografts can be used for reconstruction. Specialized centers provide an efficient management of complications and postoperative treatment.

Dynamical Disentangling and Cooling of Atoms in Bilayer Optical Lattices

We show how experimentally available bilayer lattice systems can be used to prepare quantum many-body states with exceptionally low entropy in one layer, by dynamically disentangling the two layers. This disentangling operation moves one layer-subsystem A-into a regime where excitations in A develop a single-particle gap. As a result, this operation maps directly to cooling for subsystem A, with entropy being shuttled to the other layer. For both bosonic and fermionic atoms, we study the corresponding dynamics showing that disentangling can be realized cleanly in ongoing experiments. The corresponding entanglement entropies are directly measurable with quantum gas microscopes, and, as a tool for producing lower-entropy states, this technique opens a range of applications beginning with simplifying production of magnetically ordered states of bosons and fermions.

Validation of an updated Associative Transcriptomics platform for the polyploid crop species Brassica napus by dissection of the genetic architecture of erucic acid and tocopherol isoform variation in seeds

An updated platform was developed to underpin association genetics studies in the polyploid crop species Brassica napus (oilseed rape). Based on 1.92 × 10¹² bases of leaf mRNAseq data, functional genotypes, comprising 355 536 single-nucleotide polymorphism markers and transcript abundance were scored across a genetic diversity panel of 383 accessions using a transcriptome reference comprising 116 098 ordered coding DNA sequence (CDS) gene models. The use of the platform for Associative Transcriptomics was first tested by analysing the genetic architecture of variation in seed erucic acid content, as high-erucic rapeseed oil is highly valued for a variety of applications in industry. Known loci were identified, along with a previously undetected minor-effect locus. The platform was then used to analyse variation for the relative proportions of tocopherol (vitamin E) forms in seeds, and the validity of the most significant markers was assessed using a take-one-out approach. Furthermore, the analysis implicated expression variation of the gene Bo2g050970.1, an orthologue of VTE4 (which encodes a γ-tocopherol methyl transferase converting γ-tocopherol into α-tocopherol) associated with the observed trait variation. The establishment of the first full-scale Associative Transcriptomics platform for B. napus enables rapid progress to be made towards an understanding of the genetic architecture of trait variation in this important species, and provides an exemplar for other crops.

Perceived indoor air quality and its relationship to air pollutants in French dwellings

Perception of indoor air quality (PIAQ) was evaluated in a nationwide survey of 567 French dwellings, and this survey was combined with measurements of gaseous and particulate matter (PM₁₀ and PM_2.5 ) indoor air pollutants and indoor climate parameters. The perception was assessed on a nine-grade scale by both the occupants of the dwellings and the inspectors who performed the measurements. The occupants perceived the air quality in their homes as more pleasant than the inspectors. The inspectors perceived the air quality as more unpleasant in dwellings in which the residents smoked indoors. Significant associations between PIAQ and indoor air pollutant concentrations were observed for both the inspectors and, to a lesser extent, the occupants. Introducing confounding parameters, such as building and personal characteristics, into a multivariate model suppressed most of the observed bivariate correlations and identified the tenure status of the occupants and their occupation as the parameters that most influenced their PIAQ. For the inspectors, perceived air quality was affected by the presence of smokers, the season, the type of ventilation, retrofitting, and the concentrations of acetaldehyde and acrolein.

Fractions from Commercial Collagenase Preparations: Use in Enzymic Isolation of the Islets of Langerhans from Porcine Pancreas

Transplantation of isolated islets of Langerhans is an intriguing possibility for the treatment of diabetes mellitus. The isolation of islets from pancreata requires the specific dissociation of the tissue. Commercial collagenases from Clostridium histolyticum are widely used for this purpose. Unfortunately, the effectiveness of these commercial enzymes is not predictable and differs considerably between suppliers and even from lot to lot. This is due mainly to differences in their specific collagenase activity and to the presence of other lytic enzymes, as well as to other contaminants. Free flow zone electrophoresis (FFZE) was used to separate the effective protein components from undesired compounds and to prepare a digestive enzyme mixture with controlled composition of lytic activities. Fractionation of crude collagenases by FFZE resulted in partially purified protein fractions that were enriched for collagenase and tryptic activities, and contained only trace amounts of neutral protease. These preparations proved to be highly effective in an in vitro assay for the liberation of viable islets from porcine pancreas. To scale up the production of these collagenases with defined enzyme composition, we fractionated two different lots of a commercial collagenase from C. histolyticum (one lot effective in islet isolation, the other not) by using fast protein liquid chromatography (FPLC) on hydroxyapatite. Again, high efficacy of islet release from pancreatic tissue was correlated to high specific tryptic and collagenase activities and low levels of neutral protease. The chromatographic protocol developed in this study converted a non-effective collagenase lot into a preparation that allowed successful islet isolation.

[Partial Fasciectomy and Options of Reconstruction Using Local Flaps in Cases of Dupuytren's Disease]

Aim: Partial fasciectomy in cases of grade III-IV Dupuytren's contracture and coverage of the defect with local flaps. Indication: Dupuytren's contracture is a progressive disease of the hand associated with the formation of fascial cords, which may result in flexion and adduction contractures of the fingers leading up to complete dysfunction of the hands. Method: If several fingers are affected, partial fasciectomy is the gold standard in the treatment of Dupuytren's contracture. Ideally, the fingers reach the neutral position after the fibres causing the contracture are resected and arthrolysis is performed as needed. The skin deficits resulting from restored extension have to be covered by the use of Z-plasties, local or pedicled flaps of the hand. Conclusion: The resection of contracting cords in advanced cases of Dupuytren's contracture leads to large soft tissue defects. The microsurgical preparation of nerve and vascular structures is often difficult because of the fascial cords surrounding them. Exact preoperative planning of the extent of resection, as well as reconstruction options are essential and determine how incisions are made. To prevent a relapse, it is essential to reverse skin fibre direction using flaps and to insert intact skin with preserved subdermal adipose tissue.

[Registry Research Funding of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRÄC) and Research Funding Report 2015/2016]

In addition to the impact factor, research funding also plays a central role in evaluating the academic performance and quality of a researcher, a clinic or a surgical specialty. The scope and quality of research in Plastic Surgery are usually very little known, so that even large funding institutions do not get a full view of research funding in our specialty. Therefore, sometimes traditional structures are not adapted to new needs by the developing younger surgical fields. In peer review sometimes peers are not chosen from the same surgical specialty, but from a different surgical fields being peers in large field of surgery. By this a bias can easily be generated which would not be advantageous for subspecialties such Plastic Surgery. The goal of this paper is to establish an overview in the form of a registry of the German Society of Plastic Reconstructive and Aesthetic Surgeons (DGPRÄC) in order to make the joint academic achievements more visible in the future. At the same time, a research funding report is to be published for the years 2015 and 2016.

Plastische Rekonstruktion nach Sternumosteomyelitis mittels gefäßgestielter Latissimus-dorsi-Lappenplastik

Zielsetzung: Durchführung eines sternalen Knochen- und Weichteil-Débridements nach abgelaufener Sternumosteomyelitis mit simultaner Defektdeckung mittels gefäßgestielten Latissimus-dorsi-Lappens.

Indikation: Tiefe sternale Wundheilungsstörungen können mittels verschiedener Lappenplastiken gedeckt werden. Der Latissimus-dorsi-Lappen bildet eine schnelle, suffiziente und zuverlässige Deckungsoption für sternale Defekte. Des Weiteren kann bei ausgeprägter Radikalität des Weichteil- und Knochen-Débridements eine einzeitige Deckung erfolgen.

Methode: Aufzeigen einzelner OP-Schritte zur Durchführung eines sternalen Débridements mit simultaner Defektdeckung mittels gefäßgestielter Latissimus-dorsi-Lappenplastik.

Schlussfolgerung: Die Radikalität des Débridements ist entscheidend für den weiteren Therapieerfolg und erlaubt es, Débridement sowie simultan die lappenplastische Deckung durchzuführen. Das gleichzeitige Arbeiten von 2 Operateuren verkürzt dabei die Operationszeit für den Patienten deutlich.

[Perspectives on advance directives among German intensive care physicians in leading positions]

INTRODUCTION

Six years after introduction of a law for advance directives (AD) in 2009, AD are still discussed controversially. For the first time in Germany, this study investigates intensive care physicians' perspectives on implementation of AD, and corresponding experience of ethical issues.

METHODS

A standardized questionnaire was sent to German hospitals with > 300 beds and anesthesiologist-led intensive care units. The questionnaire was based on results of a previous qualitative study and was intended to be answered by one leading intensive care physician per hospital.

RESULTS

N = 222/299 (74.2 % response) physicians answered the survey. Despite a number of reported problems regarding the implementation of AD, 70.6 % (n = 154/218) rated AD generally as helpful. 86.5 % (n = 185/214) would prefer a more goal-oriented approach to an intervention-oriented approach to formulate AD. Furthermore 95.9 % (n = 207/216) plead for qualified professional counseling for intensive care topics in AD. Acceptance for interventions that equal termination of treatment can be perceived. Terminal extubation in correspondence with the patient's will is done in 79.4 % (n = 173/218) of hospitals, however 54.8 % (n = 113/206) of the physicians experience terminal extubations as burdening.

DISCUSSION

Supporting concepts and measures will be necessary in order to prepare valid AD and to effectively improve implementation in intensive care practice.

Dynamical Quasicondensation of Hard-Core Bosons at Finite Momenta

Long-range order in quantum many-body systems is usually associated with equilibrium situations. Here, we experimentally investigate the quasicondensation of strongly interacting bosons at finite momenta in a far-from-equilibrium case. We prepare an inhomogeneous initial state consisting of one-dimensional Mott insulators in the center of otherwise empty one-dimensional chains in an optical lattice with a lattice constant d. After suddenly quenching the trapping potential to zero, we observe the onset of coherence in spontaneously forming quasicondensates in the lattice. Remarkably, the emerging phase order differs from the ground-state order and is characterized by peaks at finite momenta ±(π/2)(ℏ/d) in the momentum distribution function.

Ventilation strategies and indoor particulate matter in a classroom

Particle mass and number concentrations were measured in a mechanically ventilated classroom as part of a study of ventilation strategies for energy conservation. The ventilation system was operated either continuously, intermittently, or shut down during nights while it was on during workdays. It appears that the nighttime ventilation scheme is not important for indoor particle concentrations the following day if fans are operated to give five air exchanges in advance of the workday. The highest concentrations of PM10 were found during and after workdays and were due to human activity in the classroom. The average workday PM10 concentration was 14 μg/m(3) , well below the WHO guideline values. The number concentration of particles with diameter <0.750 μm was typically between 0.5 × 10(3) and 3.5 × 10(3)  particle/cm(3) . These concentrations were largely independent of the occupants. Transient formation of small particles was observed when ventilation was shut down. Then remaining ozone reacted with terpenes emitted by indoor sources and gave up to 8 × 10(3)  particle/cm(3) before formation stopped due to lack of ozone. The intermittent ventilation regime was found least favorable for the indoor air quality in the classroom.

[Complication management after interventions on thoracic organs : deep sternal wound infections]

With an incidence rate of 0.5-4 % and a mortality of up to 50 %, deep sternal wound infections are a rare but devastating complication after median sternotomy for cardiac surgery. Currently, no standard operating procedures exist. Long-term drainage with continuous lavage or negative pressure wound therapy should be used to condition the wound. After restabilization of the sternum and primary closure, the infection often reoccurs presenting deep cavities with an open, unstable thorax and an uncovered mediastinum. This article gives an overview of the different options for deep sternal wound infections in plastic reconstructive surgery. The key point for successful treatment is still the extent of debridement. Primary coverage with a pedicled flap can be made only if the wound debridement was performed radically enough. In the clinic of the author, in which over 120 patients with deep sternal wound infections were treated in 2.5 years, latissimus dorsi muscle flaps have been established as the gold standard.

Optimizing the pharmacotherapy of vascular surgery patients by medication reconciliation

AIM

Medication errors may occur at any stage during the medication process and can lead to preventable adverse drug events and patients' harm. Pharmacists' support for reconcilable medication has been shown to be effective, rectifying errors and inaccuracies of the drug treatment and in the increase of medication safety. However, none of the previous studies focused on vascular patients. We investigated the nature and frequency of drug-related problems (DRPs) including the amount of potentially inappropriate medication (PIM) prescribed for elderly patients suffering from vascular diseases and the influence of pharmacists in the improvement of cardiovascular medication.

METHODS

After the patients' routine admission process, medication reconciliation was performed. Therefore, a pharmacist obtained an accurate medication use history. The patients' drug therapy was critically screened for DRPs and referring to this, intervention was made by the pharmacist and communicated to the physician if necessary. Potentially inappropriate medication in the elderly was reviewed through a retrospective analysis using the Priscus-List. DRPs were documented anonymously and classified.

RESULTS

We identified 138 DRPs among 105 patients. Sixty-five patients experienced at least 1 DRP, accordingly 1.3 DRPs per patient. In total, 43 unintended discrepancies between current medication and admission medication were detected with an overall rate of 0.41 per patient; 100 interventions were made of which 56 resulted in explicit recommendations for prescription changes. Drug classes frequently affected by DRPs were antihypertensive in 23.9%, antithrombotic agents in 19.3% and lipid lowering agents in 12.1%. In a retrospective analysis of the home medication, 12 definite PIM were identified in 49 elderly patients.

CONCLUSION

DRPs are common in the medication of vascular surgery patients and may be improved by pharmacists.