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Background: Autologous breast reconstruction is a reliable solution for many patients after mastectomy. While this technique represents a standardized approach in many patients, patients with ptotic breasts may require a combination of procedures to achieve an aesthetically pleasing result. Methods: We reviewed the mastectomy and free-flap breast reconstruction procedures performed at our institution from 2018 to 2022 in patients with ptotic breasts. The technique used to address the ptosis was put in focus as we present the four strategies used by our reconstructive surgeons. We performed two different one-stage and two different two-stage procedures. The difference between the two-stage procedures was the way the nipple areola complex was treated (inferior dermal pedicle or free skin graft). The difference between the one-stage procedures was the time of execution of the mastopexy/breast reduction (before or after the mastectomy and autologous breast reconstruction). Results: The one-stage procedure was performed with a free NAC in three patients and with a pedicled NAC in five patients. The two-stage procedure was performed in seven patients, with six of them undergoing mastopexy before and one patient undergoing mastopexy after the bilateral mastectomy and autologous reconstruction. No flap loss or total loss of the nipple areola complex occurred. Partial NAC loss was observed in five breasts in the single-stage group without any occurrence in the double-stage group. Conclusions: While both one- and two-stage procedures were performed in a safe fashion with satisfactory results at our institution, larger trials are required to determine which procedure may yield the best possible outcomes. These outcomes should also include oncological safety and patient-reported outcomes.

Background: In an era where textured devices are being phased out due to concerns about BIA-ALCL, the Motiva SilkSurface breast implants intend to alleviate historical prosthesis-related complications. However, its safety and feasibility remain unelucidated. Methods: An analysis of Pubmed, Web of Science, Ovid, and Embase databases was performed. A total of 114 studies were identified initially, and 13 of these met the inclusion criteria and were assessed regarding postoperative parameters such as complication rate or follow-up period. Results: In 4784 patients who underwent breast augmentation with Motiva SilkSurface breast implants, a total of 250 (5.2%) complications were observed. Short- and medium-term complication rates ranged from 2.8–14.4% and 0.32–16.67%, respectively. The most common complication was early seroma (n = 52, overall incidence = 1.08%), followed by early hematoma (n = 28, overall incidence = 0.54%). The incidence of capsule contracture was 0.54% and breast implant-associated-anaplastic large cell lymphoma was not observed. Discussion: Although the majority of the studies in the current literature suggest the distinction of the Motiva SilkSurface breast implants in terms of postoperative complications and capsular contracture, its safety and feasibility need to be further elucidated with well-designed, large-scale, multicenter, prospective case-control studies. Other: No funding was received.

(1) Background: Postoperative pain is a frequently underestimated complication significantly influencing surgical outcome and patient satisfaction. While abdominoplasty is one of the most commonly performed plastic surgery procedures, studies investigating postoperative pain are limited in current literature. (2) Methods: In this prospective study, 55 subjects who underwent horizontal abdominoplasty were included. Pain assessment was performed by using the standardized questionnaire of the Benchmark Quality Assurance in Postoperative Pain Management (QUIPS). Surgical, process and outcome parameters were then used for subgroup analysis. (3) Results: We found a significantly decreased minimal pain level in patients with high resection weight compared to the low resection weight group (p = 0.01 *). Additionally, Spearman correlation shows significant negative correlation between resection weight and the parameter “Minimal pain since surgery” (rs = −0.332; p = 0.013). Furthermore, average mood is impaired in the low weight resection group, indicating a statistical tendency (p = 0.06 and a Χ2 = 3.56). We found statistically significant higher maximum reported pain scores (rs = 0.271; p = 0.045) in elderly patients. Patients with shorter surgery showed a statistically significant (Χ2 = 4.61, p = 0.03) increased claim for painkillers. Moreover, “mood impairment after surgery” shows a dramatic trend to be enhanced in the group with shorter OP duration (Χ2 = 3.56, p = 0.06). (4) Conclusions: While QUIPS has proven to be a useful tool for the evaluation of postoperative pain therapy after abdominoplasty, only continuous re-evaluation of pain therapy is a prerequisite for constant improvement of postoperative pain management and may be the first approach to develop a procedure-specific pain guideline for abdominoplasty. Despite a high satisfaction score, we detected a subpopulation with inadequate pain management in elderly patients, patients with low resection weight and a short duration of surgery.

Solar energy 259, 257-276 (2023). doi:10.1016/j.solener.2023.05.008, Published by Elsevier Science, Amsterdam [u.a.]

Lipedema patients suffer not only from visual stigma but also reduction in their quality of life through pain and performance loss in daily life. In clinical practice, it is still difficult to reliably diagnose the disease. This study aims to provide further insights into the characteristics of lipedema patients of all stages and provide a baseline prior to surgery for a surgical treatment evaluation by means of patient-reported outcome measures. Methods: Patients completed a lipedema-specific questionnaire containing 50 items, the World Health Organization Quality of Life BREF (WHOQOL-BREF) and the Patient Health Questionnaire 9 (PHQ-9). The data were analyzed using SPSS statistics 27. Patients who had already received liposuction were excluded. Results: Five hundred and eleven patients were included, of whom 337 completed the PHQ9 and 333 completed the WHOQOL-BREF questionnaires. The general characteristics of lipedema patients, especially the daily symptoms, are described. Previous observations, such as the frequent occurrence of hypothyroidism and the low rate of type 2 diabetes, were confirmed. Over 49% suffer from severe impairments in their jobs, whereby the disease shows a familial accumulation. The results of the WHOQOL-BREF and the PHQ-9 suggest a high level of mental stress. Discussion: As surgical intervention in lipedema patients is gaining traction, its effects should be well-documented. Therefore, a comprehensive baseline needs to be established prior to surgical treatment. The psychological components are just as important as the inclusion of daily impairments.

The four previous articles in this series addressed the myths and facts surrounding lipoedema. We have shown that there is no scientific evidence at all for the key statements made about lipoedema – which are published time and time again. The main result of this “misunderstanding” of lipoedema is a therapeutic concept that misses the mark. The patient’s real problems are overlooked.The national and especially the international response to the series, which can be read in both German and English, has been immense and has exceeded all our expectations. The numerous reactions to our articles make it clear that in other countries, too, the fallacies regarding lipoedema have led to an increasing discrepancy between the experience of healthcare workers and the perspective of patients and self-help groups, based on misinformation mostly generated by the medical profession.Parts 1 to 4 in this series of articles on the myths surrounding lipoedema have made it clear that we have to radically change the view of lipoedema that has been held for decades. Changing our perspective means getting away from the idea of “oedema in lipoedema” – and hence away from the dogma that decongestion is absolutely necessary – and towards the actual problems faced by our patients with lipoedema. Such a paradigm shift in a disease that has been described in the same way for decades cannot be left to individuals but must be put on a much broader footing. For this reason, the lead author of this series of articles invited renowned lipoedema experts from various European countries to discussions on the subject. Experts from seven different countries took part in the two European Lipoedema Forums, with the goal of establishing a consensus. The consensus reflects the experts’ shared view on the disease, having scrutinized the available literature, and having taken into account the many years of clinical practice with this particular patient group. Appropriate to the clinical complexity of lipoedema, participants from different specialties provided an interdisciplinary approach. Nearly all of the participants in the European Lipoedema Forum had already published work on lipoedema, had been involved in drawing up their national lipoedema guidelines, or were on the executive board of their respective specialty society.In this fifth and final part of our series on lipoedema, we will summarise the relevant findings of this consensus, emphasising the treatment of lipoedema as we now recommend it. As the next step, the actual consensus paper “European Best Practice of Lipoedema” will be issued as an international publication.Instead of looking at the treatment of oedema, the consensus paper will focus on treatment of the soft tissue pain, as well as the psychological vulnerability of patients with lipoedema. The relationship between pain perception and the patient’s mental health is recognised and dealt with specifically. The consensus also addresses the problem of self-acceptance, and this plays a prominent role in the new therapeutic concept. The treatment of obesity provides a further pillar of treatment. Obesity is recognised as being the most common comorbid condition by far and an important trigger of lipoedema. Bariatric surgery should therefore also be considered for patients with lipoedema who are morbidly obese. The expert group upgraded the importance of compression therapy and appropriate physical activity, as the demonstrated anti-inflammatory effects directly improve the patients’ symptoms. Patients will be provided with tools for personalised self-management in order to sustain sucessful treatment. Should conservative therapy fail to improve the symptoms, liposuction may be considered in strictly defined circumstances.The change in the view of lipoedema that we describe here brings the patients’ actual symptoms to the forefront. This approach allows us to focus on more comprehensive treatment that is not only more effective but also more sustainable than focusing on the removal of non-existent oedema.

Solar fields of parabolic troughs are extensive complex thermal hydraulic facilities. Intra-hour and intra-minute variabilities of the DNI, mainly caused by passing clouds, pose an operational challenge for parabolic trough power plants. Under perfect circumstances a solar field controller would adjusts the mass flow in such a way, that the design temperature is always maintained constant with a maximized focus rate. However, heterogeneous irradiance conditions or flow distribution may cause some solar field sections to temporarily overheat while others may not reach the set point temperature, which in turn leads to an economic loss. State of the art solar field controllers have only access to incomplete information on spatial DNI variability, from DNI measurements of few pyrheliometers. Solar field controllers could be optimized with access to highly resolved DNI informations both in space and time. Such DNI information can be provided by all sky imager (ASI) based irradiance monitoring systems. In a previous study we developed and benchmarked new solar field controllers with access to spatial DNI information from an ASI system for a 50 MWe plant close to Cordoba (Spain). Significant improvements in revenue were observed. Yet, this previous study was limited to 22 days only. In this study, we estimate the potential benefit of these new solar field controllers over a 2 year period on the basis of the simulation results over 22 days. The upscaling method makes use of DNI variability classes. Using the ASI data we obtain a significant improvement in revenue up to 2% for the 2 year period.

This study focuses on the techno-economic optimization of direct molten salt parabolic trough solar thermal power plants (STPPs) equipped with thermocline filler (TCF) thermal energy storage (TES). On one hand, this technology allows for cost reductions compared with state of the art two-tank (2T) TES. On the other hand, however, it leads to a performance decrease of the power block (PB) due to partial part load operation. To evaluate the dominating effect, annual simulations on a system level are performed for the TCF direct molten salt storage concept and, as a reference, for the two-tank direct molten salt storage concept. The levelized cost of electricity (LCOE) serves as a global measure to compare the two systems and to optimally size the TCF storage and the solar field (SF). The result of this study is that LCOE can theoretically be reduced by up to 8% by using a TCF instead of 2T storage system. The influence of temperature deviations from the nominal value at the end of charge or discharge, porosity and particle diameter of the TCF on LCOE, and system behavior is investigated in detail. This study further presents alternative operation strategies with improved system behavior and reveals determining factors for the integration of TCF storage into a system.

The continuously growing penetration of intermittent electricity sources will increase the future demand for dispatchable power plants, which balance out fluctuations within the electrical grids. Parabolic trough power plants with thermal energy storages could be one renewable solution for regions with a high yearly direct normal irradiance (DNI) sum, but in order to compete against other renewable as well as non-renewable technologies, the economic competitiveness must be ensured. Price reductions can be achieved for example by optimizing the plant operation. One shortcoming of state of the art plant controllers is that they only use the DNI measured at one or a few positions in the solar field. Due to the spatial variability of the DNI throughout the solar field this DNI information can be misleading. In this paper, we investigate the optimization potential of solar field control strategies with access to spatially resolved DNI information from all sky imagers (ASI). Uncertainties of the ASI system are considered by introducing additional independent spatial DNI information from a shadow camera system. The spatial and temporal DNI variability of the DNI seen by the controller is classified in distinct DNI variability classes. Two new control strategies are developed, with optimized control parameters for distinct combinations of the spatial and temporal DNI variability classes. These new variability class dependent control strategies are benchmarked in a simulation environment. A relative increase in revenue in excess of 1.9% is observed over a test period with 22 days, compared to a state of the art reference controller.

The treatment of aggressive fibromatosis poses a therapeutic challenge in an interdisciplinary setting. The extent of surgical resection is still discussed controversially. The present retrospective analysis aimed to determine prognostic factors leading to recurrence. Between 2000 and 2014, 114 patients with aggressive fibromatosis were treated surgically at BG-University Hospital Bergmannsheil (Bochum, Germany). Univariate and multivariate analyses were restricted to 90 participants with information available on surgical margins at the initial procedure. The median follow-up time was 7.7 years. A total of 45 patients (50%) developed recurrence during follow-up. Primary tumors were resected with negative margins (R0) in 50 patients (68%) and with microscopically positive margins (R1) in 28 patients (25%). In addition, tumors in 12 patients (7%) were resected with macroscopically positive margins at the initial surgical procedure. The rates of recurrence-free survival (RFS) after 5 years were 68.8% [95% confidence interval (CI), 53.5-79.9%] in patients with R0-resected primary tumors and 34.1% (95% CI, 19.9-48.9%) in patients with R1/R2-status (P=0.001). Narrow and wide clear margins within the R0-group were not associated with significantly different outcomes. Adjuvant radiation, tumor site and patient age were not associated with a significant alteration of RFS. The current results suggest that the attainment of microscopically negative surgical margins at the initial surgical treatment is associated with a significantly improved prognosis. A conservative surgical approach involving the attainment of narrow negative margins while preserving function should be sought in patients in whom tumor resection is indicated. The decision for resection should be made interdisciplinary in each case based on tumor progression, available treatment alternatives and the decision of the informed patient.

The yield of solar thermal power plants is strongly affected by disturbances in the irradiation condition through passing clouds. This effect is even more prominent when the clouds shade the solar field only partially as the irradiance situation cannot be fully measured by few measurement points in the field. In this paper, the benefit of using nowcasting systems to produce highly resolved irradiance maps on the field during start-up is studied. A simulation tool is used to dynamically model all the loops and piping in a reference commercial solar field. Automatic solar field controllers allow the model to operate during different situations. The performance of the field under a reference state-of-the-art controller is compared against a controller using the irradiance maps from nowcasting systems. The benefit during start-up processes is found to be significantly lower than the benefit the system makes during normal solar field operation. However, there is more potential shown for more advanced controllers, like model-predictive control.

Operators of a solar-thermal power plant bear a high responsibility as they are in charge of the plant integrity, the safety of staff and optimal performance. At the same time, the complexity of such plants is very high. Thus, skilled operators are needed to understand what they do and, especially, how to react in non-standard plant conditions. Training the operators for these situations is very important for trouble-free operation. Those items become particularly crucial for testing of parabolic trough plants with molten salt as working fluid, as they inherit the danger of HTF freezing at normal ambient conditions. DLR developed a training simulation software as a platform to train the operators in dealing with various scenarios and test automation concepts for plant control for the test facility in the HPS2 project. The simulator software features a detailed model for transient simulation of the solar field based on DLR’s Virtual Solar Field (VSF), a simulator management system and a human-machine interface (HMI). VSF communicates via a standard TCP/IP interface with the simulator management. The plant model features detailed modelling of the hydraulic network and storage system, alarm functions and control logics derived from the functionality of the test plant. The HMI is designed according to the real process control software. Simulations with measured weather data validated the correct behavior of the physical models. To understand the behavior of the plant, the plant model can be completely manually operated. Various weather scenarios can be loaded to show difficulties of transient situations, like a sudden direct normal irradiation (DNI) rise or drop. This enables the trainer to show real operation scenarios of the molten salt plant during the training course without endangering the test facility.

International audience; Highly spatially and temporally resolved solar irradiance maps are of special interest for predicting ramp rates and for optimizing operations in solar power plants. Irradiance maps with lead times between 0 and up to 30 min can be generated using all-sky imager based nowcasting systems or with shadow camera systems. Shadow cameras provide photos of the ground taken from an elevated position below the clouds. In this publication, we present a shadow camera system, which provides spatially resolved Direct Normal Irradiance (DNI), Global Horizontal Irradiance (GHI) and Global Tilted Irradiance (GTI) maps. To the best of our knowledge, this is the first time a shadow camera system is achieved. Its generated irradiance maps have two purposes: (1) The shadow camera system is already used to derive spatial averages to benchmark all-sky imager based nowcasting systems. (2) Shadow camera systems can potentially provide spatial irradiance maps for plant operations and may act as nowcasting systems. The presented shadow camera system consists of six cameras taking photos from the top of an 87 m tower and is located at the Plataforma Solar de Almería in southern Spain. Out of six photos, an ortho-normalized image (orthoimage) is calculated. The orthoimage under evaluation is compared with two reference orthoimages. Out of the three orthoimages and one additional pyranometer and pyrheliometer, spatially resolved irradiance maps (DNI, GHI, GTI) are derived. In contrast to satellites, the shadow camera system uses shadows to obtain irradiance maps and achieves higher spatial and temporal resolutions. he preliminary validation of the shadow camera system, conducted in detail on two example days (2015-09-18, 2015-09-19) with 911 one-minute averages, shows deviations between 4.2% and 16.7% root mean squared errors (RMSE), 1.6% and 7.5% mean absolute errors (MAE) and standard deviations between 4.2% and 15.4% for DNI maps calculated with the derived approach. The GHI maps show deviations below 10% RMSE, between 2.1% and 7.1% MAE and standard deviations between 3.2% and 7.9%. Three more days (2016-05-11, 2016-09-01, 2016-12-09) are evaluated, briefly presented and show similar deviations. These deviations are similar or below all-sky imager based nowcasts for lead time zero minutes. The deviations are small for photometrically uncalibrated, low-cost and off-the-shelf surveillance cameras, which is achieved by a segmentation approach.

International audience; Mainly due to clouds, Direct Normal Irradiance (DNI) displays short-term local variabilities affecting the efficiency of concentrating solar power (CSP) plants. To enable efficient plant operation, DNI nowcasts in high spatial and temporal resolutions for 15 to 30 minutes ahead are required. Ground-based All Sky Imagers (ASI) can be used to detect, track and predict 3D positions of clouds possibly shading the plant. The accuracy and reliability of these ASI-derived DNI nowcasts must be known to allow its application in solar power plants. Within the framework of the European project DNICast, an ASI-based nowcasting system was developed and implemented at the Plataforma Solar de Almería (PSA). Its validation methodology and validation results are presented in this work. The nowcasting system outperforms persistence forecasts for volatile irradiance situations.

This paper investigates cost reduction potential for thermocline filler (TCF) storage in a direct molten salt parabolic through plant based on system-level simulations in response to weather data for a reference week and corresponding plant control. In a first step the theoretical potential for investment cost reduction of TCF tanks filled with nitrate salts and natural stone as filler material operating in a range of 290°C and 550°C is represented. The effective potential on system-level though is reduced due to a temperature drop at the end of the discharge cycle. Therefor the electricity cost for selected reference days is chosen as a measure for the economic potential of TCF systems over two tank (2T) storage systems. As a base case a 100 MWel direct two tank parabolic trough power plant with 13 hours storage capacity using molten salt as heat transfer fluid and storage medium was chosen. This setup is modelled and simulated as a function of TES capacity and solar field size using the commercial software EBSILON Professional©. Based on best and worst case assumptions for the financial parameters, a total TES investment cost reduction of 30 to 42% can be achieved and a first estimate for the levelized cost of electricity (LCOE) results in 5 to 9% improvement as well as an increased capacity factor and a higher storage capacity.

The direct normal irradiance (DNI) is of utmost importance for concentrated solar power (CSP) plants. For annual yield prediction, a steady-state heat balance is made for each hour of the year or for a smaller time period such as 15 min with the corresponding average DNI value. However, short term DNI variations by clouds are ignored by this approach. In consequence, there is no information on the transient behavior of the plant and the question remains how the plant is influenced by the DNI disturbance. The paper intends to start a discussion on DNI characterization and its application to CSP. An approach to categorize the DNI behavior from a transient system point of view is presented by using purpose- and system-specific filters. Resulting DNI disturbance classes are proposed to directly compare different sites and technologies. They can be useful for better yield analysis and better commercial project selection in the future. An example on a once-through direct steam generation plant is provided.

Background: Free tissue transfer has become a safe and reliable procedure and is routinely used in a variety of settings. However, it is associated with lengthy operating times and a high potential for blood loss and consecutive red blood cell transfusions (RBCT). Methods: To assess the risk for [for full text, please go to the a.m. URL], 47. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 21. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)

Fibrosarcomas are rare malignant soft tissue tumours that exhibit a poor response to current therapeutic regimens. Previously, tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) and taurolidine were observed to induce apoptosis synergistically in HT1080 human fibrosarcoma cells in vitro. Consequently, the present study aimed to assess the safety and efficacy of TRAIL in combination with taurolidine on the local growth of fibrosarcoma xenografts in vivo. HT1080 fibrosarcoma cells were inoculated subcutaneously into both flanks of 49 athymic nude mice in order to establish tumour xenografts. TRAIL and taurolidine were applied intraperitoneally at various single and cumulative treatment doses. After 12 days, the experiment was terminated and surviving animals were euthanised. Tumour progression was determined during and following treatment. To assess the potential toxic effects of the two compounds, the organs (lung, liver, kidney and heart) of all animals were examined histologically. The results revealed that combined treatment with TRAIL and taurolidine significantly inhibited the growth of HT1080 xenografts, whereas untreated animals had steadily increasing tumours. The most effective combination was TRAIL at 2 µg per application (cumulative dose, 16 µg) and taurolidine at 30/15 mg per application (cumulative dose, 180 mg), reducing the mean size of implanted xenografts to 10.9 mm2 following treatment (vs. 48.9 mm2 in the control group; P=0.0100). Despite distinct tumour mass reduction, the rate of mortality was significantly increased in animals treated with TRAIL and taurolidine in a taurolidine dose-dependent manner; however, histological examinations of relevant organs revealed no evidence of systemic toxicity (mean survival time, 7.9 days in the treated groups vs. 12 days in the control group; P

This paper provides an overview on an important step towards a SolarPACES guideline for CSP yield calculation. With the increasing number of CSP installations, standardization becomes more and more important for further reduction of costs and increase in quality. Yield calculation is a key issue throughout all phases of project development and throughout most of the involved players. Due to the need for more complex process models for CSP compared to other renewables like PV or wind, the yield calculation procedure is more demanding. Uncertainties in the process are covered by additional but partially unnecessary risk surcharges since systematic approaches for avoiding expensive redundancies in risk buffers are not available. It is the main motivation of the mentioned CSP yield calculation guideline to overcome this situation by providing a detailed methodology for yield calculation. A first comprehensive draft version has been compiled and will be subject of discussion in the SolarPACES working group guiSmo. The following sections illustrate the motivation for the guideline, the contents at a glance, as well as expected benefits for selected players.

A large number of commercial and research line focusing solar power plants are in operation and under development. Such plants include parabolic trough collectors (PTC) or linear Fresnel using thermal oil or molten salt as the heat transfer medium (HTM). However, the continuously varying and dynamic solar condition represent a big challenge for the plant control in order to optimize its power production and to keep the operation safe. A better understanding of the behaviour of such power plants under transient conditions will help reduce defocusing instances, improve field control, and hence, increase the energy yield and confidence in this new technology. Computational methods are very powerful and cost-effective tools to gain such understanding. However, most simulation models described in literature assume equal mass flow distributions among the parallel loops in the field or totally decouple the flow and thermal conditions. In this paper, a new numerical model to simulate a whole solar field with sing...

Surgical intervention is the mainstay treatment for soft tissue sarcomas. The significance of adjuvant and neoadjuvant therapies such as chemotherapy, radiation and isolated limb perfusion remains under controversial discussion. The goal of this review is to discuss the effects of the aforementioned treatment modalities and their timing of application on plastic surgery techniques. Furthermore, options of reconstruction in cases of complications caused by adjuvant and neoadjuvant therapies are discussed. When compared with adjuvant radiation, neoadjuvant treatment can reduce negative side effects such as fibrosis and edema, because radioderma can be removed during the subsequent surgical procedure. Furthermore, there have not been any reports of negative effects of neoadjuvant radiation on microsurgical procedures. However, the dose of neoadjuvant radiation correlates with increased risks of impaired wound healing postoperatively. Thus, a patient-specific approach to decide whether radiation should be performed adjuvant or neoadjuvant is necessary. Pre-operative irradiation should be considered in cases where functional structures are exposed after tumor resection, in order to ensure the best possible functionality. Adjuvant radiation should be considered in all other cases because of its known superior wound healing. .As for chemotherapy, no negative influence of its use adjuvant or neoadjuvant to reconstructive procedures such as local or free flaps has been reported. Lastly, small sample size studies have not shown increased risks of microsurgical failure or wound complications after isolated limb perfusion. The findings of this review suggest that the chronological order of the discussed therapeutic approaches is not a decisive factor in the surgical outcome of reconstructive procedures for soft tissue sarcoma.

The direct steam generation in line focus systems such as parabolic troughs and linear Fresnel collectors is one option for providing ‘solar steam’ or heat. Commercial power plants use the recirculation concept, in which the steam generation is separated from the superheating by a steam drum. This paper analyzes the once-through mode as an advanced solar field concept. It summarizes the results of the DUKE project on loop design, a new temperature control strategy, thermo-mechanical stress analysis, and an overall cost analysis. Experimental results of the temperature control concept at the DISS test facility at Plataforma Solar de Almeria are presented.

\(\textbf {Introduction:}\) Surgical treatment of malignant thoracic wall tumors represents a formidable challenge. In particular, locally advanced tumors that have already infiltrated critical anatomic structures are associated with a high surgical morbidity and can result in full-thickness defects of the thoracic wall. Plastic surgery can reduce this surgical morbidity by reconstructing the thoracic wall through various tissue transfer techniques. Sufficient soft-tissue reconstruction of the thoracic wall improves quality of life and mitigates functional impairment after extensive resection. The aim of this article is to illustrate the various plastic surgery treatment options in the multimodal therapy of patients with malignant thoracic wall tumors. \(\textbf {Materials and methods:}\) This article is based on a review of the current literature and the evaluation of a patient database. \(\textbf {Results:}\) Several plastic surgical treatment options can be implemented in the curative and palliative therapy of patients with malignant solid tumors of the chest wall. Large soft-tissue defects after tumor resection can be covered by local, pedicled, or free flaps. In cases of large full-thickness defects, flaps can be combined with polypropylene mesh to improve chest wall stability and to maintain pulmonary function. The success of modern medicine has resulted in an increasing number of patients with prolonged survival suffering from locally advanced tumors that can be painful, malodorous, or prone to bleeding. Resection of these tumors followed by thoracic wall reconstruction with viable tissue can substantially enhance the quality of life of these patients. \(\textbf {Discussion:}\) In curative treatment regimens, chest wall reconstruction enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. In palliative disease treatment, plastic surgical techniques of thoracic wall reconstruction provide palliation of tumor-associated morbidity and can therefore improve patients’ quality of life.

Summary Purpose Aim of this study was to measure the outcome of hamstring transfer for quadriceps reconstruction after soft tissue sarcoma resection and to identify risk factors influencing postoperative results. Methods 43 patients underwent hamstring transfer after sarcoma resection. Medical records were reviewed for surgical technique and complications. Physical examination included assessment of range of motion and muscle strength as well as plantar pressure distribution by computerized dynamometer and podometry, respectively. Additionally, patients' satisfaction, quality of life and karnofsky index were assessed. Results Sole biceps transfer was performed in 31 (74%) and combined biceps/semitendinosus or gracilis transfer in 12 patients (26%). In 91%of cases 3/4 or more of the quadriceps muscle had to be removed. Postoperative complications occurred in 16 patients (37%). 17 patients (40%) were available for physical examination. Mean follow-up was 61 months (22–107). Average knee flexion was 74° (35–110°). All patients had full knee extension. Average extension force was 44% (19–79%) and flexion-force 74% (55–100%) of the unaffected leg. Mean plantar pressure distribution was 119% (44–200%) on the forefoot and 107% (60–169%) on the heel. Average patient satisfaction score was 16 (9–25), quality of life assessment was 78 (54–92) and Karnofsky Index was 82% (70–90%). Besides patient's age and the extent of resection, the surgical technique had statistically significant influence on functional outcome and postoperative complications (p Conclusion Hamstring transfer is feasible for quadriceps reconstruction after massive tumor resection from the thigh. In contrast to biceps alone, combined semitendinosus or gracilis transfer revealed comparable outcome but higher complication rates.

Complete surgical resection with clear margins remains the mainstay of therapy for localised fibrosarcomas. Nevertheless, metastatic fibrosarcomas still represent a therapeutic dilemma. Commonly used chemotherapeutic agents like doxorubicin have proven to be effective in

Innate defense regulators (IDRs) are synthetic immunomodulatory versions of natural host defense peptides (HDP). IDRs mediate protection against bacterial challenge in the absence of direct antimicrobial activity, representing a novel approach to anti-infective and anti-inflammatory therapy. Previously, we reported that IDR-1018 selectively induced chemokine responses and suppressed pro-inflammatory responses. As there has been an increasing appreciation for the ability of HDPs to modulate complex immune processes, including wound healing, we characterized the wound healing activities of IDR-1018 \(\textit {in vitro}\). Further, we investigated the efficacy of IDR-1018 in diabetic and non-diabetic wound healing models. In all experiments, IDR-1018 was compared to the human HDP LL-37 and HDP-derived wound healing peptide HB-107. IDR-1018 was significantly less cytotoxic \(\textit {in vitro}\) as compared to either LL-37 or HB-107. Furthermore, administration of IDR-1018 resulted in a dose-dependent increase in fibroblast cellular respiration. \(\textit {In vivo}\), IDR-1018 demonstrated significantly accelerated wound healing in \(\textit {S. aureus}\) infected porcine and non-diabetic but not in diabetic murine wounds. However, no significant differences in bacterial colonization were observed. Our investigation demonstrates that in addition to previously reported immunomodulatory activities IDR-1018 promotes wound healing independent of direct antibacterial activity. Interestingly, these effects were not observed in diabetic wounds. It is anticipated that the wound healing activities of IDR-1018 can be attributed to modulation of host immune pathways that are suppressed in diabetic wounds and provide further evidence of the multiple immunomodulatory activities of IDR-1018.