[The contribution of health conferences and health regions to regional planning and management in health care: an overview at the federal states level]

Demands for increased health care coordination and cooperation have been raised for a long time in Germany. Over the past years, the public health services in the federal states have initiated networks at the regional level dealing with health-related topics, namely health conferences and health regions. In the areas of health promotion and prevention, health care services and nursing care sector, these networks make an important contribution to regional planning and management by setting up networks among relevant municipal players and developing a more comprehensive approach. This narrative review, worked out in collaboration with experts from the German federal states, aims to present an overview of the characteristics, key topics and results of health conferences and health regions. Furthermore, we describe differences and similarities between the approaches in the federal states as well as the respective supporting measures in the context of funding programmes and the legal basis. The results show that health conferences and health regions are established in a great number of administrative districts in the federal states. There have been many health conferences and health regions since years and, according to the evaluations, show positive impacts on regional cooperation across departmental, sectoral and professional boundaries. They deal with a wide range of topics related to local needs and problems aiming to use synergies and meet challenges in the regional provision of healthcare and prevention measures. Besides building network capacities, the assessment of local needs and the development of strategies, health conferences and health regions also initiate numerous local cooperation projects to improve the health of the population. Against the background of expected future challenges that will have to be faced by the public health services, we finally discuss the significance of regional planning and management functions of the public health services. We also we provide some recommendations related to the conditions for setting up health conferences and health regions and discuss their future development.

Gene-rich plastid genomes of two parasitic red algal species, Laurencia australis and L. verruciformis (Rhodomelaceae, Ceramiales), and a taxonomic revision of Janczewskia

Parasitic red algae are an interesting system for investigating the genetic changes that occur in parasites. These parasites have evolved independently multiple times within the red algae. The functional loss of plastid genomes can be investigated in these multiple independent examples, and fine-scale patterns may be discerned. The only plastid genomes from red algal parasites known so far are highly reduced and missing almost all photosynthetic genes. Our study assembled and annotated plastid genomes from the parasites Janczewskia tasmanica and its two Laurencia host species (Laurencia elata and one unidentified Laurencia sp. A25) from Australia and Janczewskia verruciformis, its host species (Laurencia catarinensis), and the closest known free-living relative (Laurencia obtusa) from the Canary Islands (Spain). For the first time we show parasitic red algal plastid genomes that are similar in size and gene content to free-living host species without any gene loss or genome reduction. The only exception was two pseudogenes (moeB and ycf46) found in the plastid genome of both isolates of J. tasmanica, indicating potential for future loss of these genes. Further comparative analyses with the three highly reduced plastid genomes showed possible gene loss patterns, in which photosynthetic gene categories were lost followed by other gene categories. Phylogenetic analyses did not confirm monophyly of Janczewskia, and the genus was subsumed into Laurencia. Further investigations will determine if any convergent small-scale patterns of gene loss exist in parasitic red algae and how these are applicable to other parasitic systems.

Divergence times and plastid phylogenomics within the intron-rich order Erythropeltales (Compsopogonophyceae, Rhodophyta)

The advent of high-throughput sequencing (HTS) has allowed for the use of large numbers of coding regions to produce robust phylogenies. These phylogenies have been used to highlight relationships at ancient diversifications (subphyla, class) and highlight the evolution of plastid genome structure. The Erythropeltales are an order in the Compsopogonophyceae, a group with unusual plastid genomes but with low taxon sampling. We use HTS to produce near complete plastid genomes of all genera, and multiple species within some genera, to produce robust phylogenies to investigate character evolution, dating of divergence in the group, and plastid organization, including intron patterns. Our results produce a fully supported phylogeny of the genera in the Erythropeltales and suggest that morphologies (upright versus crustose) have evolved multiple times. Our dated phylogeny also indicates that the order is very old (~800 Ma), with diversification occurring after the ice ages of the Cryogenian period (750-635 Ma). Plastid gene order is congruent with phylogenetic relationships and suggests that genome architecture does not change often. Our data also highlight the abundance of introns in the plastid genomes of this order. We also produce a nearly complete plastid genome of Tsunamia transpacifica (Stylonematophyceae) to add to the taxon sampling of genomes of this class. The use of plastid genomes clearly produces robust phylogenetic relationships that can be used to infer evolutionary events, and increased taxon sampling, especially in less well-known red algal groups, will provide additional insights into their evolution.

Comparative phylogeography of two Agarophyton species in the New Zealand archipelago

Molecular studies have reported the coexistence of two species of Agarophyton in New Zealand: the newly described A.transtasmanicum with an apparently restricted distribution to some sites in the North Island, and the more widespread A.chilense. Here, we compared the distribution, genetic diversity, and structure of both Agarophyton species throughout the archipelago using sequences of the nuclear Internal Transcribed Spacer 2 (ITS2) marker. Agarophyton chilense's distribution was continuous and extensive along the North and South Islands, Stewart Island, and Chatham Island, and the genetic clusters were mostly concordant with boundaries between biogeographic regions. In contrast, specimens of A.transtasmanicum were collected in four sites broadly distributed in both the North and South Islands, with no clear spatial structure of the genetic diversity. Populations, where the species co-occurred, tended to display similar levels in genetic diversity for the two species. Demographic inferences supported a postglacial demographic expansion for two A.chilense genetic clusters, one present in the South Island and the eastern coast of the North Island, and the other present in northern South Island. A third genetic cluster located on the western coast of the North Island had a signature of long-term demographic stability. For A.transtasmanicum, the skyline plot also suggested a postglacial demographic expansion. Last, we developed a new molecular tool to quickly and easily distinguish between the two Agarophyton species, which could be used to ease future fine-scale population studies, especially in areas where the two species coexist.

The Organelle Genomes in the Photosynthetic Red Algal Parasite Pterocladiophila hemisphaerica (Florideophyceae, Rhodophyta) Have Elevated Substitution Rates and Extreme Gene Loss in the Plastid Genome

Comparative organelle genome studies of parasites can highlight genetic changes that occur during the transition from a free-living to a parasitic state. Our study focuses on a poorly studied group of red algal parasites, which are often closely related to their red algal hosts and from which they presumably evolved. Most of these parasites are pigmented and some show photosynthetic capacity. Here, we assembled and annotated the complete organelle genomes of the photosynthetic red algal parasite, Pterocladiophila hemisphaerica. The plastid genome is the smallest known red algal plastid genome at 68,701 bp. The plastid genome has many genes missing, including all photosynthesis-related genes. In contrast, the mitochondrial genome is similar in architecture to that of other free-living red algae. Both organelle genomes show elevated mutation rates and significant changes in patterns of selection, measured as dN/dS ratios. This caused phylogenetic analyses, even of multiple aligned proteins, to be unresolved or give contradictory relationships. Full plastid datasets interfered by selected best gene evolution models showed the supported relationship of P. hemisphaerica within the Ceramiales, but the parasite was grouped with support as sister to the Gracilariales when interfered under the GHOST model. Nuclear rDNA showed a supported grouping of the parasite within a clade containing several red algal orders including the Gelidiales. This photosynthetic parasite, which is unable to photosynthesize with its own plastid due to the total loss of all photosynthesis genes, raises intriguing questions on parasite-host organelle genome capabilities and interactions.

A Comment on Salomaki and Lane 2019 "Molecular Phylogenetics Supports a Clade of Red Algal Parasites Retaining Native Plastids: Taxonomy and Terminology Revised"1

Salomaki and Lane (2019) proposed a new terminology to group red algal parasites either as parasites containing their own (native) reduced plastid: "archaeplastic" (allied to the old designation "alloparasite") or parasites that contain only a host plastid: "neoplastic" (similar to the older term "adelphoparasite"). We believe this is premature. There are examples that contradict their proposed grouping, and their proposal was based on work from the mid-1990s that should be re-evaluated. We also believe that grouping red algal parasites into two groups obscures both our lack of knowledge of these organisms and the diversity that is already seen in the few intensively studied parasites. Instead of making generalizations based on limited knowledge, further in-depth study should be encouraged and will be useful in understanding these intriguing organisms.

The scientist's summer reading list Robert Macfarlane, Norton, 2019. 496 pp. Sarah Parcak, Henry Holt, 2019. 288 pp. Finn Brunton, Princeton University Press, 2019. 266 pp. Ruth Kassinger, Houghton Mifflin Harcourt, 2019. 318 pp. Gretchen McCulloch, Riverhead Books, 2019. 336 pp. Jonathan Fetter-Vorm, Hill and Wang, 2019. 256 pp. Amanda Little, Harmony, 2019. 350 pp. Neal Stephenson, William Morrow, 2019. 890 pp

How will we eat in a warming world? What makes money real? Are we being good ancestors? From a graphic celebration of the semicentennial of the Apollo 11 mission to a dystopian foray into the digital afterlife, this year's summer reading picks—reviewed by an enthusiastic group of early-career scholars—aim to unpack where we came from and where we're headed. Focus on the big picture with an engaging exploration of space archaeology, dig into the details with a thought-provoking ode to algae, or sit back and LOL at an entertaining introduction to internet linguistics.

Search Dynamics on Multimodal Multiobjective Problems

We continue recent work on the definition of multimodality in multiobjective optimization (MO) and the introduction of a test bed for multimodal MO problems. This goes beyond well-known diversity maintenance approaches but instead focuses on the landscape topology induced by the objective functions. More general multimodal MO problems are considered by allowing ellipsoid contours for single-objective subproblems. An experimental analysis compares two MO algorithms, one that explicitly relies on hypervolume gradient approximation, and one that is based on local search, both on a selection of generated example problems. We do not focus on performance but on the interaction induced by the problems and algorithms, which can be described by means of specific characteristics explicitly designed for the multimodal MO setting. Furthermore, we widen the scope of our analysis by additionally applying visualization techniques in the decision space. This strengthens and extends the foundations for Exploratory Landscape Analysis (ELA) in MO.

A clickable NHC-Au(i)-complex for the preparation of stimulus-responsive metallopeptide amphiphiles

We report the synthesis of an alkyne functionalised NHC-Au(i)-complex which is conjugated with amphiphilic oligopeptides using a copper(i) catalysed cycloaddition. The resulting Au(i)-metalloamphiphiles are shown to self-assemble into charge-regulated stimulus-responsive supramolecular polymers in water via a weakly cooperative polymerisation mechanism.

A high-strength silicide phase in a stainless steel alloy designed for wear-resistant applications

Hardfacing alloys provide strong, wear-resistant and corrosion-resistant coatings for extreme environments such as those within nuclear reactors. Here, we report an ultra-high-strength Fe-Cr-Ni silicide phase, named π-ferrosilicide, within a hardfacing Fe-based alloy. Electron diffraction tomography has allowed the determination of the atomic structure of this phase. Nanohardness testing indicates that the π-ferrosilicide phase is up to 2.5 times harder than the surrounding austenite and ferrite phases. The compressive strength of the π-ferrosilicide phase is exceptionally high and does not yield despite loading in excess of 1.6 GPa. Such a high-strength silicide phase could not only provide a new type of strong, wear-resistant and corrosion-resistant Fe-based coating, replacing more costly and hazardous Co-based alloys for nuclear applications, but also lead to the development of a new class of high-performance silicide-strengthened stainless steels, no longer reliant on carbon for strengthening.

Analyzing the BBOB results by means of benchmarking concepts

We present methods to answer two basic questions that arise when benchmarking optimization algorithms. The first one is: which algorithm is the "best" one? and the second one is: which algorithm should I use for my real-world problem? Both are connected and neither is easy to answer. We present a theoretical framework for designing and analyzing the raw data of such benchmark experiments. This represents a first step in answering the aforementioned questions. The 2009 and 2010 BBOB benchmark results are analyzed by means of this framework and we derive insight regarding the answers to the two questions. Furthermore, we discuss how to properly aggregate rankings from algorithm evaluations on individual problems into a consensus, its theoretical background and which common pitfalls should be avoided. Finally, we address the grouping of test problems into sets with similar optimizer rankings and investigate whether these are reflected by already proposed test problem characteristics, finding that this is not always the case.

Effectiveness of bevacizumab for radiation-induced cerebral necrosis in children

INTRODUCTION

Bevacizumab has been reported to effectively reduce cerebral edema caused by radiation therapy. However, only limited data with a short follow-up in tumor patients are available so far.

PATIENTS AND METHODS

Two children suffering from hemorrhage from arteriovenous malformation (AVM) have been treated with stereotactic radiotherapy and developed radiation-induced cerebral edema with deteriorating neurological status despite maximized steroid therapy. Bevacizumab administration at 5 mg/kg body weight was initiated every 2 weeks.

RESULTS

Bevacizumab treatment rapidly ameliorated the neurological deficits, malignant edema and prevented catastrophic complications. Corticoid therapy could be reduced and discontinued. However, after 18 months, both patients showed identical or worse neurological status than before bevacizumab therapy. AVM radiation therapy had been successful to completely obliterate AVMs.

DISCUSSION

In our limited experience, bevacizumab may be an effective and safe option for rescue therapy for malignant cerebral edema on the basis of radiation-induced necrosis especially in patients who experience rapid deterioration despite corticoid therapy and/or intolerable steroid side effects. Despite the fact that functional improvement could not be achieved in long-term outcome patients significantly stabilized and improved during periods of acute deterioration. In order to determine the long-term effectiveness of bevacizumab further investigation in placebo-controlled studies with a higher number of patients are required.

A synchrotron tomographic energy-dispersive diffraction imaging study of the aerospace alloy Ti 6246

A titanium alloy sample (#6246) containing a linear friction weld has been imaged nondestructively using tomographic energy-dispersive diffraction imaging (TEDDI). The diffraction patterns measured at each point of the TEDDI image permitted identification of the material and phases present (±5%). The image also showed the preferred orientation and size–strain distribution present within the sample without the need for any further sample preparation. The preferred orientation was observed in clusters with average dimensions very similar to the experimental spatial resolution (400 µm). The length scales and preferred orientation distributions were consistent with orientation imaging microscopy measurements made by Szczepanski, Jha, Larsen & Jones [Metall. Mater. Trans. A(2008),39, 2841–2851] where the microstructure development was linked to the grain growth of the parent material. The use of a high-energy X-ray distribution (30–80 keV) in the incident beam reduced systematic errors due to the source profile, sample and air absorption. The TEDDI data from each voxel were reduced to an angle-dispersive form and Rietveld refined to a mean χ2of 1.4. The mean lattice parameter error (δd/d) ranged from ∼10−4for the highly crystalline regions to ∼10−3for regions of very strong preferred orientation and internal strain. The March–Dollase preferred orientation errors refined to an average value of ±2%. A 100% correlation between observed fluorescence and diffraction peak broadening was observed, providing further evidence for vicinal strain broadening.

Brainstem abscess caused by Haemophilus influenza and Peptostreptococcus species

We present a patient with a solitary brainstem abscess caused by Haemophilus influenza type b (Hib) and Peptostreptococcus species. This is the first report of a Hib brainstem abscess in the English literature. Hib has been mainly associated with respiratory or nasal infections, and a few cases of intracerebral abscesses, but no brainstem abscesses have been described. The literature on solitary brainstem abscesses was reviewed and an overview of the literature between January 1984 and May 2009 is presented.

Accuracy of three-dimensional photogrammetric images in non-synostotic cranial deformities

OBJECTIVE

Given the increasing incidence of deformational plagiocephaly due to infants' supine sleeping position to prevent sudden infant death syndrome, reliable anthropometric diagnostics are needed. Besides the traditional method of measuring landmarks with callipers, three-dimensional (3D) photography has great potential. In this investigation the accuracy of 3D photogrammetry is studied.

METHODS

The study included 100 randomly chosen children between the ages of 4 and 20 months with a non-synostotic cranial deformity in a retrospective analysis. Measurements of diagonals A and B on the infant's head were obtained once using callipers. 3D photographs of these children were measured 5 times by 5 clinicians separately.

RESULTS

The inter- and intra-rater agreements of the 3D measurements had low variability in the variance component analysis. The standard deviations for reproducibility and repeatability were 0.117-0.283 cm for diagonals A and B. The intra-class correlation coefficients for the inter-rater reliability resulted in excellent agreement (0.97 for plagiocephaly, 0.98 for brachycephaly, 0.96 for combined deformity). The comparison of the 3D photographic and callipers measurements showed that 3D photography resulted in a slight over-estimation.

CONCLUSION

3D photogrammetry is potentially a reliable tool for treatment planning and follow-up of abnormal head shapes in infancy.

Progressive biological behavior of a dysembryoplastic neuroepithelial tumor

We present the case of a 13-month-old girl with a right occipital cortical alteration on MRI that proved to be a growing lesion. Tumor growth had been observed over a period of 15 months before total resection was performed, revealing a dysembryoplastic neuroepithelial tumor WHO grade I. This case shows that dysembryoplastic neuroepithelial tumors can present as growing neoplasias. It underlines the importance of obtaining histologic diagnosis and close follow-up examinations using MRI, even in so-called stable lesions that are only unveiling through epileptic seizures.

Two cases of Walker-Warburg syndrome complicated by hydrocephalus

Walker-Warburg syndrome is a very rare autosomal recessive disorder with congenital muscular dystrophy, brain malformations on the basis of a neuronal migration defect and ocular abnormalities. We report our experience in treating two cases of Walker-Warburg syndrome complicated by hydrocephalus with shunting and endoscopic techniques.

Statistical methods for convergence detection of multi-objective evolutionary algorithms

In this paper, two approaches for estimating the generation in which a multi-objective evolutionary algorithm (MOEA) shows statistically significant signs of convergence are introduced. A set-based perspective is taken where convergence is measured by performance indicators. The proposed techniques fulfill the requirements of proper statistical assessment on the one hand and efficient optimisation for real-world problems on the other hand. The first approach accounts for the stochastic nature of the MOEA by repeating the optimisation runs for increasing generation numbers and analysing the performance indicators using statistical tools. This technique results in a very robust offline procedure. Moreover, an online convergence detection method is introduced as well. This method automatically stops the MOEA when either the variance of the performance indicators falls below a specified threshold or a stagnation of their overall trend is detected. Both methods are analysed and compared for two MOEA and on different classes of benchmark functions. It is shown that the methods successfully operate on all stated problems needing less function evaluations while preserving good approximation quality at the same time.

Metastatic tumours mimicking vestibular schwannoma

In this review of the literature we discuss the rare occurrence of metastatic tumours mimicking bilateral vestibular schwannoma and present an own case with pancreatic signet-ring cell carcinoma as primary tumour.

Methods for obtaining the strain-free lattice parameter when using diffraction to determine residual stress

The determination of residual stress by diffraction depends on the correct measurement of the strain-free lattice spacing d_{hkl}^0, or alternatively the enforcement of some assumption about the state of strain or stress within the body. It often represents the largest uncertainty in residual stress measurements since there are many ways in which the strain-free lattice spacing can vary in ways that are unrelated to stress. Since reducing this uncertainty is critical to improving the reliability of stress measurements, this aspect needs to be addressed, but it is often inadequately considered by experimenters. Many different practical strategies for the determining of d_{hkl}^0 ordrefhave been developed, some well known, others less so. These are brought together here and are critically reviewed. In practice, the best method will vary depending on the particular application under consideration. Consequently, situations for which each method are appropriate are identified with reference to practical examples.

Types of indwelling urinary catheters for long-term bladder drainage in adults

BACKGROUND

Prolonged urinary catheterisation is common amongst people in long-term care settings and this carries a high risk of developing a catheter-related urinary tract infection and associated complications. A variety of different kinds of urethral catheters are available. Some have been developed specifically to lower the risk of catheter-associated infection, for example antiseptic or antibiotic impregnated catheters. Ease of use, comfort and handling for the caregivers and patients, and cost-effectiveness are also important factors influencing choice.

OBJECTIVES

The primary objective was to determine which type of in-dwelling urinary catheter is best to use for long-term bladder drainage in adults.

SEARCH STRATEGY

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 15 December 2004), MEDLINE (January 1950 to February 2005) and CINAHL (January 1982 to February 2005). We also handsearched 28 relevant journals and conference proceedings. We examined the bibliographies of relevant articles and contacted catheter manufacturers, scientific societies and experts for trials.

SELECTION CRITERIA

All randomised trials comparing types of indwelling urinary catheters for long-term catheterisation in adults. Long-term catheterisation was defined as more than 30 days.

DATA COLLECTION AND ANALYSIS

Data extraction has been undertaken by two review authors independently and simultaneously. Any disagreement has been resolved by a third review author. The included trial data were handled according to the description of the Cochrane Collaboration Reviewers' Handbook.

MAIN RESULTS

Three trials were included involving 102 adults in various settings. Two trials had a parallel group design and one was a randomised cross-over trial. Only two of the six targeted comparisons were assessed by these trials: antiseptic impregnated catheters versus standard catheters (one trial) and one type of standard catheter versus another standard catheter (two trials). The single small cross-over trial was inadequate to assess the value of silver alloy (antiseptic) impregnated catheters. In the two trials comparing different types of standard catheters, estimates of differences were all imprecise because the trials also had small sample sizes: confidence intervals were too wide to rule out clinically important differences. One trial did suggest, however, that the use of a hydrogel coated latex catheter rather than a silicone catheter may be better tolerated (RR for need for early removal 0.41, 95% CI 0.22 to 0.77).

AUTHORS' CONCLUSIONS

Very few trials have compared types of catheter for long-term bladder drainage. All were small and showed methodically weaknesses. Therefore, the evidence was not sufficient as a reliable basis for practical conclusions. Further, better quality trials are needed to address the current lack of evidence in this clinically important area.

Electronic excitations of glycine, alanine, and cysteine conformers from first-principles calculations

The electronic and optical properties are studied for three conformers of amino acid molecules using gradient-corrected (spin-) density functional theory within a projector-augmented wave scheme and the supercell method. We investigate single-particle excitations such as ionization energies and electron affinities as well as pair excitations. By comparing eigenvalues resulting from several local and nonlocal energy functionals, the influence of treatment of exchange and correlation is demonstrated. The excitations are described within the Delta-self-consistent field method with an occupation number constraint to obtain excitation energies and Stokes shifts. The results are used to also discuss the optical absorption properties. In contrast to the lowest single- and two-particle excitation energies, remarkable changes are found in absorption spectra in dependence on the conformation of the molecule geometry.

DFT studies using supercells and projector-augmented waves for structure, energetics, and dynamics of glycine, alanine, and cysteine

A large variety of gas phase conformations of the amino acids glycine, alanine, and cysteine is studied by numerically efficient semi-local gradient-corrected density functional theory calculations using a projector-augmented wave scheme and periodic boundary conditions. Equilibrium geometries, conformational energies, dipole moments, vibrational modes, and IR optical spectra are calculated from first principles. A comparison of our results with values obtained from quantum-chemistry methods with localized basis sets and nonlocal exchange-correlation functionals as well as with experimental data is made. For conformations containing strong intramolecular hydrogen bonds deviations in their energetic ordering occur, which are traced back to different treatments of spatial nonlocality in the exchange-correlation functional. However, even for these structures, the comparison of calculated and measured vibrational frequencies shows satisfying agreement.

Coulombic amino group-metal bonding: adsorption of adenine on Cu110

The interaction between molecular amino groups and metal surfaces is analyzed from first-principles calculations using the adsorption of adenine on Cu110 as a model case. The amino group nitrogens are found to adsorb on top of the surface copper atoms. However, the bonding clearly cannot be explained in terms of covalent interactions. Instead, we find it to be largely determined by mutual polarization and Coulomb interaction between substrate and adsorbate.

Optical absorption of water: coulomb effects versus hydrogen bonding

The optical spectrum of water is not well understood. For example, the main absorption peak shifts upwards by 1.3 eV upon condensation, which is contrary to the behavior expected from aggregation-induced broadening of molecular levels. We investigate theoretically the effects of electron-electron and electron-hole correlations, finding that condensation leads to delocalization of the exciton onto nearby hydrogen-bonded molecules. This reduces its binding energy and has a dramatic impact on the line shape. The calculated spectrum is in excellent agreement with experiment.

Ground- and excited-state properties of DNA base molecules from plane-wave calculations using ultrasoft pseudopotentials

We present equilibrium geometries, vibrational modes, dipole moments, ionization energies, electron affinities, and optical absorption spectra of the DNA base molecules adenine, thymine, guanine, and cytosine calculated from first principles. The comparison of our results with experimental data and results obtained by using quantum chemistry methods show that in specific cases gradient-corrected density-functional theory (DFT-GGA) calculations using ultrasoft pseudopotentials and a plane-wave basis may be a numerically efficient and accurate alternative to methods employing localized orbitals for the expansion of the electron wave functions.

Long-Term Outcome and Quality of Care of Patients with Staphylococcus aureus Bacteremia

To assess the long-term outcome and influence of clinical management of patients with Staphylococcus aureus bacteremia (SAB), 229 patients with blood cultures positive for Staphylococcus aureus between January 1997 and December 2000 were retrospectively identified and followed up. Risk factors, source of infection, treatment, clinical course, and outcome were recorded by chart review. For the assessment of 1-year survival, a questionnaire was sent to family doctors and government registration offices. Time of initial antibiotic therapy, duration of antibiotic treatment and performance of echocardiography were regarded as indicators of the quality of the clinical management of SAB. Among the 229 patients studied, 218 were evaluable for 1-year survival. Crude mortality after 1 year was 37.6% year. Within 30 days 43 (19.7%) patients had died, and 39 (17.9%) additional patients died thereafter. Using multivariate analysis, the following variables were associated with death: malignant disease (odds ratio [OR] 4.8; 95% confidence interval [CI], 2.6-8.9), pneumonia (OR, 3.6; 95%CI, 1.2-10.2), age >60 years (OR, 2.6; 95%CI, 1.5-4.5), and known source of infection (OR, 2.3; 95%CI, 1.3-4.1). Among 160 patients with a completely assessable treatment course 73 (46%) had received antibiotics for at least 14 days. A delay of antibiotic treatment of 1 day or more after microbiological diagnosis was observed in 28.3% of patients (i.e., 60 of 212 patients who received at least 1 dose of antibiotics). Echocardiography was performed in 101 (44.1%) cases. Overall, the findings indicate that standard guidelines for the management of SAB are followed only in part in clinical practice. In order to reduce the considerable mortality associated with SAB and to improve short- and long-term outcome, efforts should be made to increase adherence to recommendations.

Die transumbilikale laparoskopisch assistierte „one-trocar” Appendektomie - TULAA - als Alternative zu den bisher bekannten Operationsverfahren in der Behandlung der Appendizitis

INTRODUCTION

Appendectomy is one of the most commonly performed surgical procedures in general surgery and laparoscopic appendectomy represents the beginning of minimal invasive era in visceral surgery. But until yet, laparoscopic appendectomy is not the standard method for removal of the appendix and the discussion about the value and the advantages of laparoscopic appendectomy is still going on between the opponents and advocates of this method. In this article we present the transumbilical laparoscopic assisted "one-trocar" appendectomy (TULAA) as an alternative procedure for appendectomy and our experiences with this technique, which is up to now not very well known in Germany.

METHOD

From November 1, 2000 to December 31, 2002, we performed appendectomy in 350 patients. 163 patients (46.6 %) underwent TULAA in the technique of Begin. All of them were examined two weeks and three months after surgery.

RESULTS

In 94.5 % the "one-trocar" appendectomy was successful and there were no intraoperative complications. The mortality was 0 %. Conversion to the open procedure was necessary in 3 patients (1.8 %), respectively introduction of accessory trocars was necessary in 6 patients (3.7 %). In 111 from 163 patients (68.1 %) appendectomy was performed because of acute appendicitis. In 14.1 % we detected additional secondary findings during the laparoscopy. The postoperative complication rate was 3.6 %.

CONCLUSION

The transumbilical laparoscopic assisted "one-trocar" appendectomy complements the minimal invasive procedures in visceral surgery. The operating technique combines the simplicity and the safety of conventional appendectomy with the survey of laparoscopic appendectomy. It minimizes the trauma of surgery and shows a perfect cosmetic result.

Ad�quates Management von Stich- und Schussverletzungen

BACKGROUND

It is difficult to verify the treatment of stab and gunshot wounds with prospective randomized studies. That is why the results of observational studies are so important.

MATERIAL

From 1 January 1989 to 31 December 1998, we saw 74 patients because of stab (64) and gunshot (ten) wounds.

RESULTS

Most of the patients, whose injuries were caused mainly for criminal reasons (criminal 54, autoaggressive 14, accidental 4, unknown 2), came to hospital on weekends. We saw 38 abdominal, 23 thoracic, and 13 mixed injuries. On average, 3.8 h passed between the time of injury and getting first aid. Concerning abdominal injuries, we counted 21 negative intraoperative results. Two of 12 thoracic injuries showed no further damage. The patients stayed in hospital for 13.1 days on average. The morbidity was 28.38%, and mortality was 5.41%.

CONCLUSIONS

Abdominal gunshot wounds need immediate surgical treatment. Concerning stab wounds, obligatory as well as selective surgical methods are both acceptable. Because of valid diagnostic options, thoracic stab wounds allow several ways of treatment.

Monitoring of water content and water distribution in ischemic hearts

We determined water content and water distribution by fitting dielectric spectra of ischemic canine hearts between 5 MHz and 3 GHz with a newly developed model which describes heart cells and subcellular organelles as rotational ellipsoids filled with electrolyte enclosed by an isolating membrane. The fraction of dry material is modelled by spherical particles with a small dielectric permittivity. Free model parameters were water content, cell volume fraction, and the conductivity of the electrolytes. Resulting model parameters were compared to data from tissue desiccation and to conductivity changes produced by protons and lactate ions. We investigated hearts in two states: during ischemia after interruption of blood flow (pure ischemia, PI, n=5) and during ischemia after resuscitation with Tyrode's solution (IAR, n=14). The difference between water content determined by tissue desiccation and by dielectric spectroscopy was less than 0.5%. During 360 min of ischemia, water content in IAR decreased from 85+/-1.6% to 83+/-2.2% and in PI from 80+/-0.8% to 78+/-1.5%. Cellular volume fraction in IAR increased from 0.47+/-0.045 to 0.63+/-0.031 and in PI from 0.62+/-0.014 to 0.73+/-0.013, which is consistent with published morphometric data. After 180 min of ischemia, the increase of the cytosolic conductivity was 0.14+/-0.02 S/m as calculated from the dielectric spectrum and was similar to the conductivity increase which was roughly estimated on the basis of tissue lactate concentration. In conclusion, dielectric spectroscopy combined with our model analysis facilitates the monitoring of water content and distribution by means of nondestructive surface probes.

Comparison of two in vitro dendritic cell maturation models for screening contact sensitizers using a panel of methacrylates

Allergen-induced emigration and maturation of dendritic cells (DC) are pivotal steps in sparking off allergic contact dermatitis. In vitro models, reflecting these steps, may provide tools for assessment of sensitizing capacities of putative contact allergens. Here, we evaluated the applicability of such models for a panel of methacrylate congeners, the sensitizing properties of which were established previously in clinical and experimental animal studies. First, using interleukin-4 (IL-4)/granulocyte-macrophage colony-stimulating factor (GM-CSF)-induced, blood monocyte-derived DC, hapten-induced up-regulation of maturation/ activation markers, including CD80, CD83, CD86, chemokine receptors CXCR4 and CCR5, as well as the drug resistance related molecules P-glycoprotein (Pgp) and lung resistance protein (LRP), were monitored by flow cytometry. Of note, whereas CD86 and CXCR4 were most sensitive in discriminating between the contact sensitizers and irritants included in the panel, i.e. sodium dodecyl sulphate (SDS) and croton oil (CO), assessment of CD83 and LRP expression reflected the relatively lower sensitizing capacity of methyl methacrylate. Second, using ex vivo skin explant cultures, allergen-induced LC migration from epidermal to basal membranous and dermal skin structures was most reliably monitored by CDla, as compared with Pgp, LRP, HLA-DR or CD54 staining. The extent of CD1a+ LC migration was found to closely correlate with the sensitizing capacities of the panel of test compounds. These results support the view that both in vitro models can provide valuable data on contact sensitizing properties, and add chemokine receptors and drug resistance related molecules to the list of DC membrane markers revealing allergenic signaling.

X-ray tomographic imaging of Ti/SiC composites

In this paper, high-resolution tomographic synchrotron X-ray imaging is applied to study the occurrence and evolution of damage in Ti-6Al-4V/SCS6 SiC fibre composite materials. Three composite morphologies of increasing complexity have been studied, namely single fibre, single-ply and multi-ply composites. The single fibre composite was strained to full fibre fragmentation and the progressive introduction of damage monitored. For the single-ply composite, damage was introduced deliberately by laser drilling to establish the effect of damaged fibres on their neighbours, whereas for the multi-ply composite the morphology of a fibre bridging fatigue crack was studied. In addition to traditional mode I fibre fractures, subsequent fibre wedge cracks were observed presumably nucleating from damage introduced into the fibre surface by the first fracture event. In addition to these crack morphologies, spiral defects were observed for the single ply during failure. Finally, for the multi-ply composite, the matrix crack front showed a number of characteristic features, including advancement in fibre-free regions, crack bifurcation near fibres and different crack plane heights either side of a fibre.

[Primary and secondary aortoiliac reconstructions in patients with coexistent horseshoe and pelvic kidney]

The coexistence of dystopic kidney and abdominal aortic aneurysm or aortoiliac occlusive arterial disease is uncommon (0.12-0.15 %) and constitutes a technical challenge to vascular surgeons. Between 1997 and 1999 we performed 249 aortoiliac reconstructions and encountered four patients (1.6 %) with dystopic kidneys. The aortoiliac reconstructions were performed successfully in all patients while maintaining renal blood supply. Aortoiliac reconstructions in patients with horseshoe or pelvic kidney show similar results as regular reconstructions on the condition that optimal preoperative diagnosis and operative technique are used considering atypical renal vessels. Nevertheless, pelvic kidneys can lead to serious complications as we describe in this report. On the basis of our patients anatomy, embryology and surgical management of this entity.