Search

Primary sclerosing cholangitis (PSC), often associated with inflammatory bowel disease (IBD), presents a multifactorial etiology involving genetic, immunologic, and environmental factors. Gut dysbiosis and bacterial translocation have been implicated in PSC-IBD, yet the precise mechanisms underlying their pathogenesis remain elusive. Here, we describe the role of gut pathobionts in promoting liver inflammation and fibrosis due to the release of bacterial outer membrane vesicles (OMVs). Preclinical mouse models in addition to ductal organoids were used to acquire mechanistic data. A proof-of-concept study including serum and liver biopsies of a patient cohort of PSC (n = 22), PSC-IBD (n = 45), and control individuals (n = 27) was performed to detect OMVs in the systemic circulation and liver. In both preclinical model systems and in patients with PSC-IBD, the translocation of OMVs to the liver correlated with enhanced bacterial sensing and accumulation of the NLRP3 inflammasome. Using ductal organoids, we were able to precisely attribute the pro-inflammatory and pro-fibrogenic properties of OMVs to signaling pathways dependent on Toll-like receptor 4 and NLRP3–gasdermin-D. The immunostimulatory potential of OMVs could be confirmed in macrophages and hepatic stellate cells. Furthermore, when we administered gut pathobiont–derived OMVs to Mdr2 –/– mice, we observed a significant enhancement in liver inflammation and fibrosis. In a translational approach, we substantiated the presence of OMVs in the systemic circulation and hepatic regions of severe fibrosis using a PSC-IBD patient cohort. This study demonstrates the contribution of gut pathobionts in releasing OMVs that traverse the mucosal barrier and, thus, promote liver inflammation and fibrosis in PSC-IBD. OMVs might represent a critical new environmental factor that interacts with other disease factors to cause inflammation and thus define potential new targets for fibrosis therapy. [Display omitted] The study reveals that gut pathobiont-derived outer membrane vesicles might play a crucial role in promoting liver inflammation and fibrosis in primary sclerosing cholangitis–associated inflammatory bowel disease, highlighting outer membrane vesicles as a novel environmental factor with potential diagnostic and therapeutic implications for fibrosis. [ABSTRACT FROM AUTHOR]

The decline in nuclear medicine (NM) residencies in the United States has led to a shortage of NM physicians. To help address this, a 16-month NM pathway for diagnostic radiology (DR) residents was developed in 2010. At the University of Arkansas for Medical Sciences, we matched our first resident into the NuRad (NM + DR) pathway in 2013. Despite our success, we remain one of only five programs in the United States that offers a combined training pathway through the National Resident Matching Program. Review our 10-year experience with the NuRad pathway at UAMS and highlight the key components and significance of the 16-month NM pathway. Retrospective review of NRMP applicants to the DR and NuRad pathway from 2013 and 2023 at UAMS. Literature and website review of the educational structure of the 16-month NM pathway. We have seen significant increase in the number of applicants to the NuRad pathway at UAMS over the last 10 years with 184 applicants for 1 position in 2023, up from 18 applicants in 2013. Furthermore, we have seen an increase in the USMLE step scores for applicants during this time. There is a growing need for NM trained physicians in the United States. Over the last 10 years, we have seen increasing interest in the NM 16-month pathway as a part of DR residency. A wider implementation of this combined training pathway is needed, if we are to realize its full potential. [ABSTRACT FROM AUTHOR]

Using a case study design, the study focuses on identifying the institutional configuration that determines land take by low-density residential areas. Methodologically, it combines geospatial approaches and new institutionalism to capture and understand residential development, taking into account the interests, constraints and agency of local planning authorities, developers and households. The geospatial analysis shows that land take in the case study regions is primarily the result of low-density residential areas. We find that the combination of rural housing ideals, municipal policy objectives, municipalities' disengagement from spatial development and private sector interests are the main drivers for this kind of residential development. As the interests and constraints apply to all case study regions, the identified institutional configuration has high power in explaining low-density residential development. Our study thus uncovers a close link between the interests and constraints of actors, which on the one hand explains the limited impact of existing and new planning instruments on reducing land take, and on the other hand fosters path dependency in the development of low-density residential areas. Although there is some potential for change, breaking path dependency requires significant behavioural change among local planning authorities, developers and households. • Applying new institutionalism as a conceptual framework for understanding development of low-density residential areas. • Measuring low-density housing at sub-municipal level through building-based spatial analysis. • Structuring the housing construction process, taking into account local planning authorities, developers and households. • Understanding actors' interests, constraints and agency through expert and household interviews. • Study covers five case study regions and a period of 10 years (2009–2019). [ABSTRACT FROM AUTHOR]

Heart rate (HR) is often elevated in cats with cardiomyopathies (CMPs). Pharmacologic modulation of HR may reduce cardiac morbidity and mortality. To investigate the effects of cilobradine vs. placebo, regarding time to cardiac mortality or morbidity in cats with first episode of congestive heart failure (CHF) due to primary CMP. Three hundred and sixty-seven client-owned cats with primary CMP that had presented with a first episode of CHF at 50 centers in Europe. Per-protocol population comprised 193 cats (n = 89 cilobradine, n = 104 placebo). An interim analysis for futility was planned. Prospective, randomized, placebo-controlled, double-blinded, multicenter clinical trial. Primary outcome variable was the time to a composite of cardiac mortality or cardiac morbidity. Median time to primary outcome was 84 days (95% confidence interval [CI]: 63–219 days) in the cilobradine group (CG) and 203 days in the placebo group (95% CI: 145–377 days) with observed hazard ratio of 1.44, indicating a higher hazard for the CG (P = 0.057). Mean HR was 28 beats per minute (bpm) lower at Day 7 (P < 0.0001) and remained 29 bpm lower at Day 360 (P = 0.026) in the CG than that in the placebo group. Although the number of adverse events did not differ, there were more serious adverse events in the CG. Heart rate reduction by cilobradine in cats with a first episode of CHF due to primary CMP did not reduce cardiac mortality and morbidity. [ABSTRACT FROM AUTHOR]

The agri-environment-climate measures of the European Union Common Agricultural Policy are incentives aiming to reduce negative environmental impacts and increase positive effects generated from agriculture. Several criticisms have been addressed to their efficiency and effectiveness and thus, the design of innovative contract solutions is currently suggested. Among the novel contractual solutions, there are result-based payments, collective implementation of measures, the engagement of private and business actors in value chains, and new forms of land tenure systems coupled with environmental clauses. Little is known about the factors at interplay influencing farmers' decision to uptake such contracts. The present paper investigates the acceptability determinants of the above-mentioned novel contractual solutions concerning a sample of nearly 1900 farmers from 10 European Union countries. The analysis is based on a questionnaire built through a common research framework. We apply ordered logistic regressions: both proportional and partial proportional odds models are used. Farmers' preferences are interpreted by splitting the innovative contractual solutions into 13 individual contractual features which are then modeled in combination with the structural characteristics of the farms and the sociodemographic and behavioral characteristics of the farmers. We estimate farmers' willingness to enroll in result-based, collective, value-chain, and land tenure contracts and highlight the positive and negative factors potentially influencing farmers' acceptability of each type of contract. • Acceptability of result-based, collective, value chain, and land tenure contracts • Through ordered logistic regressions on 1866 farmers from 10 EU countries • Contractual design features matter (implementation details more than contract type) • Farmers have a good level of interest, but trade-offs in design and implementation • Managerial aspects/contractual design features matter vs. farms' structural characteristics [ABSTRACT FROM AUTHOR]

Objectives: To investigate the efficacy of heat acclimation (HA) in the young (YEX) and elderly (EEX) following exercise-HA, and the elderly utilising post-exercise hot water immersion HA (EHWI).Design: Cross-sectional study.Method: Twenty-six participants (YEX: n = 11 aged 22 ± 2 years, EEX:n = 8 aged 68 ± 3 years, EHWI: n = 7 aged 73 ± 3 years) completed two pre-/post-tests, separated by five intervention days. YEX and EEX exercised in hot conditions to raise rectal temperature (Trec) ≥38.5 °C within 60 min, with this increase maintained for a further 60 min. EHWI completed 30 min of cycling in temperate conditions, then 30 min of HWI (40 °C), followed by 30 min seated blanket wrap. Pre- and post-testing comprised 30 min rest, followed by 30 min of cycling exercise (3.5 W·kg-1 Ḣprod), and a six-minute walk test (6MWT), all in 35 °C, 50% RH.Results: The HA protocols did not elicit different mean heart rate (HR), Trec, and duration Trec ≥ 38.5 °C (p > 0.05) between YEX, EEX, and EHWI groups. Resting Trec, peak skin temperature, systolic and mean arterial pressure, perceived exertion and thermal sensation decreased, and 6MWT distance increased pre- to post-HA (p < 0.05), with no difference between groups. YEX also demonstrated a reduction in resting HR (p < 0.05). No change was observed in peak Trec or HR, vascular conductance, sweat rate, or thermal comfort in any group (p > 0.05).Conclusions: Irrespective of age or intervention, HA induced thermoregulatory, perceptual and exercise performance improvements. Both exercise-HA (EEX), and post-exercise HWI (EHWI) are considered viable interventions to prepare the elderly for heat stress. [ABSTRACT FROM AUTHOR]

Bronchoscopic valve placement constitutes an effective endoscopic lung volume reduction (ELVR) therapy in patients with severe emphysema and low collateral ventilation. After the most destroyed lobe is occluded with valves, significant target lobe volume reduction leads to improvements in lung function, exercise capacity, and quality of life. The effects are not consistent in some patients, leading to long-term therapy failure. We hypothesized that surgical lung volume reduction (LVRS) would reestablish ELVR short-term clinical improvements after ELVR long-term failure. This retrospective single-center analysis included all patients who underwent consolidating LVRS by lobectomy after long-term failure of valve therapy between 2010 and 2015. Changes in forced expiratory volume in 1 second, residual volume, 6-minute walking distance, and Modified Medical Research Council dyspnea score 90 days after ELVR and LVRS were analyzed, and the outcomes of both procedures were compared. LVRS was performed in 20 patients after ELVR failure. A lower lobectomy was performed in 90%. The 30-day mortality of the cohort was 0% and 90-day mortality was 5% (1 of 20). The remaining 19 patients showed a significant increase in forced expiratory volume in 1 second (+27.5% ± 19.4%) and a reduction in residual volume (−21.0% ± 17.4%) and total lung capacity (−11.1% ± 11.1%). This resulted in significant improvements in exercise tolerance (6-minute walking distance: +56 ± 60 m) and relief of dyspnea (ΔModified Medical Research Council: −1.8 ± 1.4 points.). Consolidating LVRS by lobectomy after failure of a previously successful ELVR is feasible and results in significant symptom relief and improvement of lung function. [ABSTRACT FROM AUTHOR]

Quantification of mastery is the first step in using objective metrics for teaching. We hypothesized that during orotracheal intubation, top tier performers have less idle time compared to lower tier performers. At the Anesthesiology 2018 Annual Meeting, 82 participants intubated a normal airway simulator and a burnt airway simulator. The movements of the participant's laryngoscope were quantified using electromagnetic motion sensors. Top tier performers were defined as participants who intubated both simulators successfully in less than the median time for each simulator. Idle time was defined as the duration of time when the laryngoscope was not moving. Top performers showed less Idle Time when intubating the normal airway compared to lower tier performers (14.5 ± 9.8 seconds vs 34.0 ± 52.0 seconds, respectively P <.01). Likewise, top performers showed less Idle Time when intubating the burnt airway compared to lower tier performers (18.6 ± 15.2 seconds vs 63.4 ± 59.11 seconds; P <.01). Comparing performance on the burnt airway to the normal airway, there was a difference for lower tier performers (63.4 ± 59.1 seconds vs 34.0 ± 52.0 seconds; P <.01) but not for top tier performers (18.6 ± 15.2 seconds vs 14.5 ± 9.8 seconds; P =.07). Similar to our previous findings with other procedures, Idle Time was shown to have known group validity evidence when comparing top performers with lower tier performers. Further, Idle Time was correlated with procedure difficulty in our prior work. We observed statistically significant differences in Idle Times for lower tier performers when comparing the normal airway to the burnt airway but not for top tier performers. Our findings support the continued exploration of Idle Time for development of objective assessment and curricula. [ABSTRACT FROM AUTHOR]

Presentation of myocarditis in athletes is heterogeneous and establishing the diagnosis is challenging with no current uniform clinical gold standard. The combined information from symptoms, electrocardiography, laboratory testing, echocardiography, cardiac magnetic resonance imaging, and in certain cases endomyocardial biopsy helps to establish the diagnosis. Most patients with myocarditis recover spontaneously; however, athletes may be at higher risk of adverse cardiac events. Based on scarce evidence and mainly autopsy studies and expert's opinions, current recommendations generally advise abstinence from competitive sports ranging from a minimum of 3 to 6 months. However, the dilemma poses that (un)necessary prolonged disqualification of athletes to avoid adverse cardiac events can cause considerable disruption to training schedules and tournament preparation and lead to a decline in performance and ability to compete. Therefore, better risk stratification tools are imperatively needed. Using latest available data, this review contrasts existing recommendations and presents a new proposed diagnostic flowchart putting a greater focus on the use of cardiac magnetic resonance imaging in athletes with suspected myocarditis. This may enable cardiac caregivers to counsel athletes with suspected myocarditis more systematically and furthermore allow for pooling of more unified data. To modify recommendations regarding sports behavior in athletes with myocarditis, evidence, based on large multicenter registries including cardiac magnetic resonance imaging and endomyocardial biopsy, is needed. In the future, physicians might rely on combined novel risk stratification methods, by implementing both noninvasive and invasive tissue characterization methods. • Myocarditis is a leading cause of SCD in athletes but diagnosis and risk stratification is challenging. • Using latest data and existing recommendations, we present a new proposed diagnostic flowchart. • Cardiac magnetic resonance imaging can diagnose but may also risk stratify athletes with suspected myocarditis. • Sports behavior counseling may be guided by combining novel noninvasive and invasive tissue characterization methods [ABSTRACT FROM AUTHOR]

• First quantitative nation-wide assessment of infilling in Germany. • Quantitative assessment of infilling based on small-scale 100 × 100 m grid cells. • Study covers 4389 municipalities and a period of more than 30 years (1979–2011). • In-depth analyses based on building types, Local Moran's I and OLS regressions. • Robust and well-suited methodology for evaluations at regional or national level. To achieve the German government's 30-hectare land take per day target, infilling is considered a key planning guideline. However, there are hardly any valid empirical results on the extent of residential construction activity realised as infilling. This is due, on the one hand, to the fuzziness of what constitutes an inner urban area as a spatial construct in German law and planning practice and, on the other hand, to the lack of small-scale data on construction activity. This paper presents a methodology – based on the open data of the Global Human Settlement Layer (GHSL) and the 2011 German Census – to determine and assess for the first time the relevance of infilling at a nationwide level over a period of more than 30 years. The methodology is applied to the 9.409.547 new housing units built in Germany between 1979 and 2011. The result shows a positive trend, indicating that German cities have succeeded over the course of time in boosting infilling. At the same time, major differences between urban and rural areas become apparent, with urban and more central regions being more successful in directing residential construction activity towards existing settlements and already-developed areas. Therefore, a key recommendation is to encourage and support especially smaller municipalities in their infilling efforts. [ABSTRACT FROM AUTHOR]

Capacitive deionization (CDI) is a promising electrochemical technique for the removal and recycling of ions from micro-polluted wastewater but is still hindered by the co-ion expulsion effect and anode oxidation. In this study, these issues are addressed through optimization of both materials and electrochemical systems. A diverse set of porous carbons are prepared using biomass as a precursor and KOH as the activation agent. It is found that direct carbonization and/or KOH activation induce a negative surface charge, whereas intense nitrogen-doping results in an inverse surface charge for all biomass-derived carbons, characterized by the potential of zero charge (E pzc). Density functional theory calculations suggest that the carboxyl group and quaternary N contribute most among other functional groups to the negative and positive charges, respectively. A E pzc -matching asymmetric CDI system is constructed employing negatively charged and positively charged carbons as the cathode and anode, respectively. This configuration, coupled with precise optimization of the cathode-to-anode mass ratio (m -/ m +), unlocks a high adsorption capacity of 17.2 mg g−1 for NaCl, surpassing the symmetric system by 84.7 %. Further fine tuning of the m -/ m + ratio results in a removal capacity of 167.4 mg g−1 for Cu2+ ions, which is the highest reported for carbonaceous materials to date. [Display omitted] • Direct carbonization and post KOH activation result in negative surface charge for all biomass-derived carbons. • Nitrogen doping into the lignin-derived carbon shifted its surface from negative to positive charges. • Origins of both negative and positive charges were revealed through DFT calculation. • Optimization of the mass ratio of the cathode to anode led to high adsorption capacities for both NaCl and Cu2+. [ABSTRACT FROM AUTHOR]

Abstract Purpose Benzalkonium chloride is the most widely used preservative in ophthalmic topical solutions. The aim of this study was to investigate the influence of BAC as a single substance or as a component of several commercially available ophthalmic solutions on meibomian gland epithelial cells in vitro. Materials and methods An immortalized human meibomian gland epithelial cell line (HMGEC) was used and cells were cultured in the absence or presence of fetal bovine serum to assess cell morphology, cell proliferation, cell viability (MTS assay) and impedance sensing (ECIS) after stimulation with BAC. Further, the viability of HMGECs stimulated with BAC-containing and BAC-free bimatoprost, travoprost and latanoprost was evaluated using the MTS assay. Real-time PCR analysis for hyperkeratinization associated genes (cornulin, involucrin) was performed. Results In the absence of serum, the proliferation rate of HMGECs decreased starting with 0.1 μg/ml BAC. At concentrations of 50 μg/ml BAC and higher, cell viability was reduced after 10 min exposure with a corresponding change in cell morphology. Toxicity of BAC-containing ophthalmic solutions was greater than that of BAC alone, whereas BAC-free alternative products did not significantly influence cell viability. Confluence, cell-cell contacts and serum-containing medium appeared to facilitate HMGECs survival. Expression rate of involucrin and cornulin declined after exposure to preserved bimatoprost and BAC. Conclusions BAC showed cytotoxic effects on HMGECs starting with a concentration of 0.1 μg/ml. The combination of BAC and prostaglandin-analogs might have a synergistic effect which results in higher toxicity than BAC alone. Unpreserved eye drops and eye drops preserved with Polyquaternium-1 are less damaging to HMGECs. [ABSTRACT FROM AUTHOR]

Highlights • A microevolutionary model of the most-important non-O157 EHEC serotypes was developed based on whole genome sequencing. • aEPEC were identified as the common ancestor of closely related EHEC lineages of O-serogroups O26 and O111. • Human and bovine EHEC and aEPEC are closely related, envisioning a bidirectional conversion with Stx-converting phages. • EHEC and aEPEC are bona fide zoonotic agents that constitute a risk of transmission between both hosts. Abstract Enterohemorrhagic Escherichia coli (EHEC) are a cause of bloody diarrhea, hemorrhagic colitis (HC) and the potentially fatal hemolytic uremic syndrome (HUS). While O157:H7 is the dominant EHEC serotype, non-O157 EHEC have emerged as serious causes of disease. In Germany, the most important non-O157 O-serogroups causing one third of EHEC infections, including diarrhea as well as HUS, are O26, O103, O111 and O145. Interestingly, we identified EHEC O-serogroups O26 and O111 in one single sequence type complex, STC29, that also harbours atypical enteropathogenic E. coli (aEPEC). aEPEC differ from typical EHEC merely in the absence of stx -genes. These findings inspired us to unravel a putative microevolutionary scenario of these non-O157 EHEC by whole genome analyses. Analysis of single nucleotide polymorphisms (SNPs) of the maximum common genome (MCG) of 20 aEPEC (11 human/ 9 bovine) and 79 EHEC (42 human/ 36 bovine/ 1 food source) of STC29 identified three distinct clusters: Cluster 1 harboured strains of O-serogroup O111, the central Cluster 2 harboured only O26 aEPEC strains, while the more heterogeneous Cluster 3 contained both EHEC and aEPEC strains of O-serogroup O26. Further combined analyses of accessory virulence associated genes (VAGs) and insertion sites for mobile genetic elements suggested a parallel evolution of the MCG and the acquisition of virulence genes. The resulting microevolutionary model suggests the development of two distinct EHEC lineages from one common aEPEC ancestor of ST29 by lysogenic conversion with stx -converting bacteriophages, independent of the host species the strains had been isolated from. In conclusion, our cumulative data indicate that EHEC of O-serogroups O26 and O111 of STC29 originate from a common aEPEC ancestor and are bona fide zoonotic agents. The role of aEPEC in the emergence of O26 and O111 EHEC should be considered for infection control measures to prevent possible lysogenic conversion with stx -converting bacteriophages as major vehicle driving the emergence of EHEC lineages with direct Public Health consequences. [ABSTRACT FROM AUTHOR]

Highlights • Pan-European ICP Forests evaluation of weather cues for mast years in five species. • In beech and spruce summer conditions are the main weather cues for mast years. • Spring temperatures in the mast year is the main weather cue for oak species. • Weather cues are consistent on different spatial scales for beech and spruce. • Resource depletion is not present in beech, the oak species, and pine. Abstract Mast seeding, the synchronised occurrence of large amounts of fruits and seeds at irregular intervals, is a reproductive strategy in many wind-pollinated species. Although a series of studies have investigated mast year (MY) patterns in European forest tree species at the regional scale, there are few recent evaluations at a European scale on the impact of weather variables (weather cues) and resource dynamics on mast behaviour. Thus the main objective of this study is to investigate the impact of specific weather conditions, as environmental drivers for MYs, on resources in Fagus sylvatica L., Quercus petraea (Matt.) Liebl. , Quercus robur L., Picea abies (L.) Karst. and Pinus sylvestris L. at a European level and to explore the robustness of the relationships in smaller regions within Europe. Data on seed production originating from the International Co-operative Programme on Assessment and Monitoring of Air Pollution Effects on Forests (ICP Forests) were analysed. Three beta regression models were applied to investigate the impact of seasonal weather variables on MY occurrence, as well as the influence of fruiting intensity levels in the years prior to MYs. Resource dynamics are analysed at three different spatial scales (continent, countries and ecoregions). At a European scale, important weather cues for beech MYs were a cold and wet summer two years before a MY, a dry and warm summer one year before a MY and a warm spring in the MY. For spruce, a cold and dry summer two years prior to a MY and a warm and dry summer in the year before the MY showed the strongest associations with the MY. For oak, high spring temperature in the MY was the most important weather cue. For beech and spruce, and to some extent also for oak species, the best fitting models at European scale were well reflected by those found at smaller scales. For pine, best fitting models were highly diverse concerning weather cues. Fruiting levels were high in all species two years before the MY and also high one year before the MY in the oak species and in pine. In beech, fruiting levels one year before the MY were not important and in spruce, they were inconsistent depending on the region. As a consequence, evidence of resource depletion could only be seen in some regions for spruce. [ABSTRACT FROM AUTHOR]

Highlights • Synanthropic rodents and shrews shed atypical EPEC (aEPEC), but not EHEC strains. • aEPEC strains of diverse origin can be lysogenized with a stx -depleted bacteriophage yielding stable, yet prophage-inducible lysogens. • Sequence comparison of two highly related murine and human aEPEC strains and their respective lysogens showed sequence identities of >90%. • Whole genome analysis revealed prophage integration into the highly variable tRNA integration site argW in all three lysogens. • aEPEC are progenitors of typical EHEC. Abstract Bacteriophages play an important role in the evolution of bacterial pathogens. A phage-mediated transfer of stx -genes to atypical enteropathogenic E. coli (aEPEC) which are prevalent in different hosts, would convert them to enterohemorrhagic E. coli (EHEC). We decided to confirm this hypothesis experimentally to provide conclusive evidence that aEPEC isolated from different mammalian hosts are indeed progenitors of typical EHEC which gain the ability to produce Shiga-Toxin by lysogeny with stx -converting bacteriophages, utilizing the model phage Φ3538 Δ stx 2 ::cat. We applied a modified in vitro plaque-assay, using a high titer of a bacteriophage carrying a deletion in the stx 2 gene (Φ3538 Δ stx 2 ::cat) to increase the detection of lysogenic conversion events. Three wild-type aEPEC strains were chosen as acceptor strains: the murine aEPEC-strain IMT14505 (sequence type (ST)28, serotype Ont:H6), isolated from a striped field mouse (Apodemus agrarius) in the surrounding of a cattle shed, and the human aEPEC-strain 910#00 (ST28, Ont:H6). The close genomic relationship of both strains implies a high zoonotic potential. A third strain, the bovine aEPEC IMT19981, was of serotype O26:H11 and ST21 (STC29). All three aEPEC were successfully lysogenized with phage Φ3538 Δ stx 2 ::cat. Integration of the bacteriophage DNA into the aEPEC host genomes was confirmed by amplification of chloramphenicol transferase (cat) marker gene and by Southern-Blot hybridization. Analysis of the whole genome sequence of each of the three lysogens showed that the bacteriophage was integrated into the known tRNA integration site argW , which is highly variable among E. coli. In conclusion, the successful lysogenic conversion of aEPEC with a stx -phage in vitro underlines the important role of aEPEC as progenitors of EHEC. Given the high prevalence and the wide host range of aEPEC acceptors, their high risk of zoonotic transmission should be recognized in infection control measures. [ABSTRACT FROM AUTHOR]

Introduction Whereas hadron therapy of static targets is clinically established, treatment of moving organs remains a challenge. One strategy is to minimize motion of surrounding tissue mechanically and to mitigate residual motion with an appropriate irradiation technique. In this technical note, we present and characterize such an immobilization technique for a novel noncancerous application: the irradiation of small targets in hearts with scanned carbon ion beams in a porcine model for elimination of arrhythmias. Material and methods A device for immobilization was custom-built. Both for the treatment planning 4D-CT scan and for irradiation, breath-hold at end-exhale was enforced using a remotely-controlled respirator. Target motion was thus reduced to heartbeat only. Positioning was verified by orthogonal X-rays followed by couch shift if necessary. Reproducibility of bony anatomy, diaphragm, and heart position after repositioning and between repeated breath-hold maneuvers was evaluated on X-rays and cardiac-gated 4D-CTs. Treatment was post hoc simulated on sequential 4D-CTs for a subset of animals, after immediate repositioning and after a delay of one week, similar to the delay between imaging and irradiation. Results Breath-hold without repositioning was highly reproducible with an RMS deviation of at most one millimeter. 4D-CTs showed larger deformations in soft tissue, but treatment simulation on sequential images resulted in full target coverage (V95 >95%). Conclusion The method of immobilization permitted reproducible positioning of mobile, thoracic targets for range-sensitive particle therapy. The presented immobilization strategy could be a reasonable approach for future animal investigations with the ultimate goal of translation to therapy in men. [ABSTRACT FROM AUTHOR]

The crystallization behavior of perovskite films has a profound influence on the resulting defect densities, charge carrier dynamics and photovoltaic performance. Herein, we introduce ionic liquids into the perovskite component to tailor the crystal growth of perovskite films from a disordered to a preferential corner-up orientation and accordingly increase the charge carrier mobility to accelerate electron transport and extraction. Using time-resolved measurements, we probe the charge carrier generation, transport and recombination behavior in these films and related devices. We find the ionic liquid-containing samples exhibit lower defects, faster charge carrier transport and suppressed non-radiative recombination, contributing to higher efficiency and fill factor. Via operando grazing-incidence small- and wide-angle X-ray scattering measurements, we observe a light-induced lattice compression and grain fragmentation in the control devices, whereas the ionic liquid-containing devices exhibit a slight light-induced crystal reconstitution and stronger tolerance against illumination. Under ambient conditions, the non-encapsulated device with the pyrrolidinium-based ionic compound (Pyr 14 BF 4) maintains 97% of its initial efficiency after 4368 h. [Display omitted] • Perovskite crystal growth is tailored by ionic liquid addition. • Ionic liquid addition suppressed non-radiative recombination. • Operando studies reveal insights in light-induced lattice compression and grain fragmentation. • Performance is improved with ionic liquid addition. • Stability is improved with ionic liquid addition. [ABSTRACT FROM AUTHOR]

Abstract: In a total of 171 surgical procedures for lesions in the head and neck region in patients in whom phenprocoumon therapy was not stopped, 16 (9%) postoperative bleeding events were observed over a follow-up period of two weeks. Local measures were sufficient in all cases except one severe case where blood transfusion was needed and anticoagulant treatment was stopped for 7 days. The bleeding risk was significantly higher for the surgical procedures of the nose than those in other areas (21% versus 6%, P = 0.014), but was not influenced by the international normalized ratio (INR) of blood coagulation, size, site and type of the lesion, surgical procedure, and sex and age of the patients. The bleeding rate in patients not on any anticoagulation therapy was significantly lower (6/211 = 3%). Across both groups, just over 80% of the bleeding episodes were within the first two days (55% on the same day and 32% on the next day) of the surgery. No bleeding was recorded after 5 days. Our data suggest that cutaneous surgery in the head and neck region can be safely performed with continued phenprocoumon therapy in most cases in an INR range of 1.3–3.4, but rarely severe bleeding does occur and can be managed with a close-contact follow-up and with 24-h on call services during the first two days postoperatively. [Copyright &y& Elsevier]

A performance model of a radio frequency plasma bridge neutralizer was developed to calculate the electrical parameters and optimize the neutralizer design. Minimization of power losses and gas consumption, and a maximization of the neutralizer lifetime and the reliability of the system are requirements of all electric propulsion concepts and strongly determine their future application. The requirements of the neutralizer depend on mission profiles. [ABSTRACT FROM AUTHOR]

Recently, we have set up an Advanced Electric Propulsion Diagnostic (AEPD) platform [1] , which allows for the in-situ measurement of a comprehensive set of thruster performance parameters. The platform utilizes a five-axis-movement system for precise positioning of the thruster with respect to the diagnostic heads. In the first setup (AEPD1) an energy-selective mass spectrometer (ESMS) and a miniaturized Faraday probe for ion beam characterization, a telemicroscope and a triangular laser head for measuring the erosion of mechanical parts, and a pyrometer for surface temperature measurements were integrated. The capabilities of the AEPD1 platform were demonstrated with two electric propulsion thrusters, a gridded ion thruster RIT 22 (Airbus Defence & Space, Germany, [13]) and a Hall effect thruster SPT 100D EM1 (EDB Fakel, Russia, [1,4] ), in two different vacuum facilities. [ABSTRACT FROM AUTHOR]

An important complication during insertion of implants in atrophic mandibles is the fracture that can be induced by preparation of the cavity. We designed this study to identify which configuration of cavities in the interforaminal region was the least likely to fracture. An electromechanical testing machine was used to measure breaking loads of specifically-designed synthetic models of atrophic mandibles. The implant cavities correlated with the common clinical patterns. Intact atrophied synthetic mandibles broke at a mean (SD) load of 729.48 (59.94) N (control group). Models with four different configurations of cavities fractured as follows: two short, wide cavities (8 x 4.2 mm) at a mean (SD) load of 569.17 (67.7) N; two long, thin cavities (15 x2.8 mm) at a load of 563.40 (62.0) N; four short, wide cavities (8 x 4.2 mm) at a load of 667.01 (71.89) N; and four long, thin cavities (15 x 2.8 mm) at a load of 409.50 (43.61) N. Biomechanical findings showed that there was a greater risk of fracture of atrophic mandibular models in long, thin implant cavities with more preparation sites. Each cavity prepared for an implant increased the risk of fracture in an atrophic mandible. The risk of fracture is greatest with long, thin cavities. [ABSTRACT FROM AUTHOR]

Summary Background Augmentation mammaplasty is one of the most common surgical procedures performed by plastic surgeons. The aim of this study was to estimate the cost of the initial procedure and its subsequent complications, as well as project the cost of Food and Drug Administration (FDA)-recommended surveillance imaging. Methods The potential costs to the individual patient and society were calculated. Local plastic surgeons provided billing data for the initial primary silicone augmentation and reoperative procedures. Complication rates used for the cost analysis were obtained from the Allergen Core study on silicone implants. Imaging surveillance costs were considered in the estimations. Results The average baseline initial cost of silicone augmentation mammaplasty was calculated at $6335. The average total cost of primary breast augmentation over the first decade for an individual patient, including complications requiring reoperation and other ancillary costs, was calculated at $8226. Each decade thereafter cost an additional $1891. Costs may exceed $15,000 over an averaged lifetime, and the recommended implant surveillance could cost an additional $33,750. Discussion The potential cost of a breast augmentation, which includes the costs of complications and imaging, is significantly higher than the initial cost of the procedure. Level of evidence Level III, economic and decision analysis study. [ABSTRACT FROM AUTHOR]

OCF-networks provide the possibility to combine qualitative information expressed by rankings of (conditional) formulas with the strong structural information of a network, in this respect being a qualitative variant of the better known Bayesian networks. Like for Bayesian networks, a global ranking function can be calculated quickly and efficiently from the locally distributed information, whereas the latter significantly reduces the exponentially high complexity of the semantical ranking approach. This qualifies OCF-networks for applications. However, in practical applications the provided ranking information may not be in the format needed to be represented by an OCF-network, or some values may be simply missing. In this paper, we present techniques for filling in the missing values using methods of inductive reasoning and we elaborate on formal properties of OCF-networks. [ABSTRACT FROM AUTHOR]

Objective Dental osteotomy, the removal of an impacted, ankylosed, or severely destroyed tooth requiring an osteotomy, is more invasive than other minor dental procedures and therefore also has a higher bleeding risk. A considerable number of patients under antiplatelet therapy interrupt their therapy perioperatively, which, however, increases the risk of thromboembolism. Study Design This retrospective study assessed postoperative bleeding incidence for a total of 297 dental osteotomies with continued aspirin therapy, compared with that of 179 similar procedures on patients who were not on any anticoagulation or anti-platelet therapy. All procedures were carried out on an outpatient basis. Results Postoperative bleeding event was rare in both groups, 5 (1.7%) and 2 (1.1%), respectively, and the difference was not significant ( P = .7). Conclusions Continued aspirin therapy in patients undergoing dental osteotomies has no effect on the incidence of postoperative bleeding and should not be interrupted. [ABSTRACT FROM AUTHOR]

The performance assessment of an Integrated Gasification Combined Cycle (IGCC) integrated with the Sorption Enhanced Water Gas Shift (SEWGS) technology for pre-combustion CO 2 capture at full-load and part-load modes of operation is investigated. Syngas from a coal gasifier is sent to the SEWGS system after going through solids and H 2 S removal units. A H 2 -rich stream is produced by the SEWGS system and used in a gas turbine (GT) for combustion. A control strategy including a buffer tank followed by a control valve, between the SEWGS system and the GT is implemented to smooth out the fluctuations in the H 2 -rich fuel flow rate, resulted from the cyclic operation of the PSA-based SEWGS system. Simulation of the IGCC integrated with the SEWGS system is first performed at full-load operation of the GT. For evaluating part-load performances, four different cases, introducing various load change strategies for the GT and gasifier are studied. Step/ramp changes of the GT and gasifier, unplanned/planned GT load changes and same/different GT and gasifier load change occurrence time are all addressed through these four cases. Simulation results indicate that the designed control strategy is able to minimize the H 2 -rich fuel flow rate fluctuations and dampen the fuel composition variations, while keeping the buffer tank pressure within the desired range. Dynamic characteristics of the SEWGS system are revealed and compared with those of the gasifier and the GT. Using the buffer tank between the SEWGS and the GT, improves part-load operation flexibility of the GT. Smooth operation and load following capability of the IGCC integrated with the SEWGS system are achievable, depending on the GT part-load level and load change strategy, taking into account the limited load gradient of the gasifier and the SEWGS units compared to the GT. [ABSTRACT FROM AUTHOR]

Summary Background Tissue expander based reconstruction is the most common restorative procedure used following mastectomy. Infection is a common complication in the post-operative period and may lead to failure of the reconstruction. Various previous studies have investigated the potential sources of infection during these procedures. The purpose of this study was to examine the fluid within the saline-filled tissue expander at time of implant exchange for the presence of microbial growth. Methods Twenty-five patients (39 breasts) were enrolled in the study. Fluid samples were sent for Gram stain, aerobic, anaerobic, fungal, and acid-fast bacilli (AFB) cultures. Average age was 53.1. Mean time to exchange was 7.7 months. Average follow-up was 25 months. Results None of the samples were positive for microbial growth at final culture (0/39). Discussion These results show the tissue expander fluid maintains a microbial-free environment during the expansion process, and is unlikely a significant source of contamination in cases of infection. Level of evidence Level II, prospective cohort, therapeutic study. [ABSTRACT FROM AUTHOR]

Background Large cell neuroendocrine carcinoma (LCNEC) represents a rare entity in non-small cell lung cancer, with only partially understood biology and poor survival. A diagnosis is difficult to obtain on the basis of small biopsy specimens, but surgical procedures may be indicated in only a small fraction of patients. The aim of this study was to assess the clinical and immunohistochemical features of patients with LCNEC to identify predictors of outcome and long-term survival. Methods The clinical and pathologic data of 57 surgical patients with LCNEC between March 2003 and December 2012 were retrospectively reviewed. The tumor specimens were examined for expression of neuronal specific enolase, synaptophysin, CD 56, chromogranin-A, and the somatostatin receptor by immunohistochemistry. Statistical analysis was performed to determine significant predictors for overall survival and recurrence-free survival. Results Fifty-seven patients (41 men, 16 women) underwent thoracic operations with curative intent. Complete resection was achieved in 91% of cases. The results of staining for CD56, synaptophysin, neuronal specific enolase, chromogranin-A, and somatostatin were positive in 86%, 81%, 68%, 61%, and 21%, respectively. Recurrence occurred in 28 patients (49%). Overall survival and recurrence-free survival were 50% and 45%, respectively, after 3 years. Advanced nodal status (N1, p < 0.025; N2, p < 0.02) and simultaneous expression of CD56 and chromogranin-A ( p < 0.04) were significantly associated with poorer outcome. Conclusions LCNEC is a rare neuroendocrine pulmonary malignancy that is associated with poor prognosis and high recurrence rates. Surgical treatment can achieve satisfactory results in selected cases. Neuroendocrine marker profiles may predict prognosis and may influence the decision for adjuvant therapy or follow-up intervals. [ABSTRACT FROM AUTHOR]

PreQ 1 riboswitches help regulate the biosynthesis and transport of preQ 1 (7-aminomethyl-7-deazaguanine), a precursor of the hypermodified guanine nucleotide queuosine (Q), in a number of Firmicutes, Proteobacteria, and Fusobacteria. Queuosine is almost universally found at the wobble position of the anticodon in asparaginyl, tyrosyl, histidyl and aspartyl tRNAs, where it contributes to translational fidelity. Two classes of preQ 1 riboswitches have been identified (preQ 1 -I and preQ 1 -II), and structures of examples from both classes have been determined. Both classes form H-type pseudoknots upon preQ 1 binding, each of which has distinct unusual features and modes of preQ 1 recognition. These features include an unusually long loop 2 in preQ 1 -I pseudoknots and an embedded hairpin in loop 3 in preQ 1 -II pseudoknots. PreQ 1 -I riboswitches are also notable for their unusually small aptamer domain, which has been extensively investigated by NMR, X-ray crystallography, FRET, and other biophysical methods. Here we review the discovery, structural biology, ligand specificity, cation interactions, folding, dynamics, and applications to biotechnology of preQ 1 riboswitches. This article is part of a Special Issue entitled: Riboswitches. [ABSTRACT FROM AUTHOR]

Purpose Microvascular free tissue transfer allows major ablative defects following oncologic surgical and traumatic reasons to be reliably reconstructed in the head and neck region. A retrospective analysis of the microvascular flap procedures which were performed within one year in a high volume training centre was performed. Patients and methods The microvascular free flap procedures of the year 2011 were reviewed and followed up until the 31st December 2012. The type and indication of the reconstructive procedure, operation time, operating team, experience and level of training of the surgeons involved, postoperative IMC (intermediate care unit) and/or ICU (intensive care unit) time, inpatient time, flap revisions, further postoperative complications, preoperative and postoperative radiation of the patients, the placement of dental implants were studied. Results From 1st of January 2011 to 31st of December, 2011, the data of 101 patients with 103 microvascular free flap procedures were analysed of which 72% (84 flaps) were harvested by residents. The patients ranged in age from 14 to 89 years (mean age 59 years, 71 males and 40 females). The mean operation time was 591 min with the longest operation times for scapular flaps (744 min) and the shortest operation times for ALT flaps (455 min). Mean inpatient time was 34.2 days with a minimal time for the fibular flaps of 27.2 days and a maximum of 45.7 days for the latissimus dorsi flaps. 24 flaps (23.3%) in total had to be revised with bleeding being the main cause of immediate revisions (41.7% of all revisions). 5 flaps (4.85% of all flaps) were lost despite a revision procedure meaning a successful revision rate in 79.2% of all revisions. Conclusion Microvascular reconstruction procedures are safe and should be considered as standard procedures for reconstruction of large defects especially in high volume training centres. Intensive flap monitoring and early revisions maximize the flap outcome. [ABSTRACT FROM AUTHOR]

Bacteria of the family Vibrionaceae naturally occur in marine and estuarine environments. Only few species of Vibrionaceae are associated with human cases of gastroenteritis, ear and wound infections, caused by ingestion of seafood or contact with Vibrio containing water. Increasing consumption of seafood (fish, fishery products and shellfish) poses a possible source of Vibrio infections in Germany. Additionally, there is a growing concern that abundances of pathogenic vibrios may increase in German coastal waters as a result of e.g. climate change resulting in probably rising surface water temperatures. According to the One Health concept the VibrioNet consortium started in 2010 to investigate the occurrence and relevance of non-cholera vibrios of human concern in Germany. Vibrios from environmental, seafood and clinical sources were analyzed with the aim to find connections between different reservoirs or sources and to identify potential ways of transmission of these pathogens to assess the risk of infections associated with them. Potentially pathogenic strains mostly belong to the species Vibrio parahaemolyticus , Vibrio vulnificus and non-O1/non-O139 Vibrio cholerae . Investigations on imported seafood and mussels from primary production areas confirmed the frequent occurrence of these species. Moreover, studies of German coastal waters and sediments showed the presence and seasonality of these marine bacteria. So far the incidence of clinical cases of vibriosis in Germany is low. Between 1994 and 2013 thirteen cases of Vibrio spp. associated wound infections and/or septicaemia have been reported. However, the high prevalence of vibrios in aquatic environments and aquatic organisms is of concern and demands continued control of food and surveillance for clinical infections with pathogenic vibrios. [ABSTRACT FROM AUTHOR]

Highlights: [•] Post-disaster destination consumption is explored through dark tourism theory. [•] The findings move beyond the common approach to destination recovery. [•] Newly formed dark attributes are of key importance to destination recovery. [•] Exploring motives and travel intentions reveals new potential tourist segments. [•] Most tourists seek joint consumption of leisure attractions and dark sites. [ABSTRACT FROM AUTHOR]

Copyright of Basic & Applied Ecology is the property of Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Highlights: [•] Identifies and analyses strategies preventing or enabling resistance of disabled people. [•] Enhances the understanding of strategies linked to individual and collective resistance. [•] Contrasts these strategies based on contextual differences. [•] Strategies enabling resistance at home rely on a collective identity. [•] Tourism offers greater possibilities for individual resistance highlighting the self. [ABSTRACT FROM AUTHOR]

Artemisinin is a drug, widely used in malaria treatment. As the binding affinity of artemisinin and its derivatives dihydroartemisinin and artesunate to blood serum proteins might influence the effectiveness of the drug, binding of artemisinin and derivatives to serum albumin was studied under near physiological conditions. Binding kinetics indicate a simple, single-step association process for all artemisinin derivatives. The determined changes in enthalpy and entropy upon drug binding clearly indicate that hydrophobic forces are most important for artemisinin and dihydroartemisinin binding, whereas binding of artesunate is governed by both hydrophilic and hydrophobic forces. Key residues, which are most likely involved in binding of the respective compounds, were identified in subsequent protein/drug docking studies. The obtained results not only explain differences in between artemisinin and derivatives but generally illustrate how slight modifications in a drug can significantly affect principles underlying drug binding to target proteins. [ABSTRACT FROM AUTHOR]

Background. Sleeve pneumonectomy is a challenging therapeutic strategy for patients with non-small cell lung cancer (NSCLC) invading the carina. The aim of this study was to illustrate common indications and individual concepts for surgery and to investigate oncologic outcomes and complications. Methods. Sixty-four consecutive sleeve pneumonectomies were performed between September 2000 and November 2011. All patients had histologically proven central NSCLC. Data were retrospectively reviewed for indications, complications, and factors influencing long-term survival. Results. Sixty-four patients underwent sleeve pneumonectomy for curative (n = 50,78%) or palliative therapy (n = 14, 22%). Complete resection was achieved in 83%. Pathologic N2 disease was found in 41%. Complications occurred in 41%, with severe anastomotic problems in 8% of cases. Thirty-day mortality was 3% (n = 2). Outcome was significantly influenced by pathologic nodal status with 5-year survival rates of 70%, 35%, and 9% for N0, N1, and N2 subgroups, respectively. Patients with multilevel N2 disease and contraindications for chemotherapy or radiotherapy had a mean survival of 13 months after palliative surgery. Conclusions. Sleeve pneumonectomy for central NSCLC invading the carina or proximal main bronchus can be performed with tolerable risk and encouraging survival rates in selected cases. Palliative sleeve pneumonectomy displays an option in the absence of alternative therapeutic strategies. [ABSTRACT FROM AUTHOR]

Abstract: Cellulose nanowhiskers (CNWs) are high-aspect-ratio rod-like nanoparticles prepared via partial hydrolysis of cellulose. For the first time, CNWs have been extracted from the marine invertebrate Ascidiella aspersa, yielding animal-derived CNWs with particularly small diameters of only a few nanometres. Oriented surfaces of adsorbed CNWs were prepared using a flexible and facile spin-coating method, allowing the modulation of CNW adsorption and relative orientation. Due to the shape and nanoscale dimensions of the CNWs, C2C12 myoblasts adopted increasingly oriented morphologies in response to more densely adsorbed and oriented CNW surfaces. In addition, the degree of myoblast fusion was greatest on the highly oriented CNW surfaces, and even low-orientation CNW surfaces promoted more extensive fusion than flat control surfaces. Highly oriented multinuclear myotubes formed on the oriented CNW surfaces and fibrillar fibronectin deposited on the surfaces was also modelled in a highly oriented arrangement after only 4days in culture. With a mean feature height of only 5–6nm, the CNW surfaces present the smallest features ever reported to induce contact guidance in skeletal muscle myoblasts, highlighting the potential for nanoscale materials for engineering oriented tissues such as skeletal muscle. [Copyright &y& Elsevier]

Abstract: The atomic force microscope (AFM) has become a standard and wide spread instrument for characterizing nanoscale devices and can be found in most of today‘s research and development areas. Within the EU-project “NanoBits”, exchangeable and customizable scanning probe tips are developed. These NanoBits offer a high level of freedom in adapting the shape and size of the tips to the surface topology of the specific application. In order to exchange the NanoBits without changing the cantilever, a special type of cantilever is developed. This cantilever combines the geometric flexibility of a silicon nitride cantilever with the advantages of a silicon connector platform. Besides the cantilever based connector platform, first results of mounting a NanoBit onto the connector platform are also presented. This mounting results in a fixed connection between NanoBit and connector platform but also allows an exchange of the NanoBit when needed. [Copyright &y& Elsevier]

Background: A laparoscopic approach to adrenalectomy has become the procedure of choice for most adrenal resections. We hypothesized that laparoscopic adrenalectomy is less likely to result in intensive care unit (ICU) level complications or death than open adrenalectomy, despite baseline comorbidity mix. Methods: Using the National Surgical Quality Improvement Program (NSQIP) participant use files for 2005–2009, all laparoscopic and open adrenalectomies were identified by current procedural terminology. Adverse outcomes tracked in NSQIP were mapped to Clavien level based on need for ICU care or death. Univariate and multivariate analysis were used to compare groups. Results: There were 1,980 laparoscopic and 592 open procedures. Clavien 4 and 5 complications occurred in 45 (7.6%) of open and 35 (1.8%) of laparoscopic operations. The univariate odds ratio showed a 4.6-fold greater likelihood that a patient would have an ICU level complication (P < .001), and 4.9 odds ratio of death (P < .001) if an open rather than laparoscopic operation was performed. Regression modeling showed persistence of the protective effect of laparoscopy after adjusting for comorbidities with a multivariate odds ratio of 3.3 (P < .001). Conclusion: The laparoscopic approach to adrenalectomy has an independent protective effect on ICU level complications and mortality when compared with open procedures. This correlation persists after correcting for multiple comorbidities. [ABSTRACT FROM AUTHOR]

Abstract: The buccal fat pad (BFP) as pedicled graft was originally used in reconstructing medium sized intraoral defects. Promising results concerning the use of BFP in cleft palate surgery have been published recently. The aim of this article is to report on the use of BFP as a pedicled graft in cleft palate surgery and to discuss promising results for this reconstructive surgical concept. A retrospective evaluation of 24 patients who had BFP pedicled flaps used for the prevention and repair of Type III (Pittsburgh Fistula Classification) cleft palate fistulas, to obstruct the retromolar space of Ernst and in case of wide clefts, from 2005 to 2010, was conducted. In all cleft palate patients, the recipient area fully epithelialized within 4 weeks or less. No recurrence was seen and the donor site healed well without aesthetic or significant functional impairment. This series confirms the excellent and predictable healing of BFP intraorally and the minimal morbidity associated with the use of such grafts. The results of this study allow the authors to recommend that the BFP pedicled flap is considered as a reliable alternative procedure to expand the therapeutic options. The BFP graft provides an advantage in reconstructive cleft palate surgery. [Copyright &y& Elsevier]

Summary: Conventional continuing education in microscopic anatomy, histopathology, hematology and microbiology has hitherto been carried out using numerous sets of sectioned tissue specimens in a microscopy laboratory. In comparison, after digitalization of the sections it would be possible to access teaching specimens via virtual microscopy and the internet at any time and place. This would make it possible to put innumerable new learning scenarios into practice. The present article elucidates the advantages of virtual microscopy in histology instruction and presents a concept of how virtual microscopy could be introduced into the teaching of microscopic anatomy in several steps. Initially, the presently existing microscopic teaching specimens would be digitalized and made available on-line without restriction. In a second step, instruction would be shifted to an emphasis on virtual microscopy, utilizing all of the advantages offered by the technique. In a third step, the microscopic contents could be networked with other anatomical, radiological and clinical content on-line, thus opening new learning perspectives for students of human and dental medicine as well as those of medically related courses of study. The advantages and disadvantages of such a concept as well as some possibly arising consequences are discussed in the following. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leakage after esophagectomy is an important determinant of early and late morbidity and mortality. Control of the septic focus is essential when treating patients with anastomotic leakages. Surgical and endoscopic treatment options are limited. Methods: Between 2005 and 2009, we treated 6 patients who experienced an intrathoracic anastomotic leakage after esophageal resection. After all established therapeutic measures had failed, we explored the feasibility of an endoscopically assisted mediastinal vacuum therapy. Results: We were able to heal intrathoracic esophageal leakages in all 6 patients without any local complications and without the need for reoperation. One patient died because of a progressive pneumonia. Conclusions: Endoscopic vacuum-assisted closure of anastomotic leakages may help to overcome the limitations that are associated with intermittent endoscopic treatment and conventional drainage therapy. Our preliminary results suggest that this new concept may be suitable for those patients. [ABSTRACT FROM AUTHOR]

Malignant tumors in the oral cavity are relatively rare. About 5% of all malignant growths in the body are localized in the oral cavity. The vast majority of oral malignancies are primary tumors with squamous cell carcinoma being the most frequent and sarcomas occurring very seldom. Secondary tumors caused by hematogenous spread arising from a tumor localized elsewhere in the body are extremely rare. About 1% of all oral cancers are metastases to the jawbones and the surrounding soft tissues. Metastases to the jaws are mainly caused by malignant tumors of the breast, lung, kidney, bone, and colon. They occur in the late state of the disease and are regularly detected by staging examinations including scintigraphy. Even more rare are metastases into odontogenic cysts. Odontogenic cysts include dentigerous cysts, periapical or radicular cysts, and the keratocysts—nowadays declared as keratocystic odontogenic tumor. The incidence of odontogenic cysts is about 10% to 15% of all oral biopsies and therefore general dentists are frequently faced with these types of lesions. The aim of this study was to review the literature regarding metastasis into odontogenic cysts and to further highlight this rare entity with the help of a clinical case. [Copyright &y& Elsevier]

Abstract: In future, wind power is to contribute decisively toward achieving climate policy goals. It can accomplish this, however, only if sufficient space for erecting wind turbines (WTs) is made available. In Europe we currently observe the trend that administrative landscape protection counteracts the desired development. Especially in Germany, the country that leads the world thus far in terms of installed capacity for wind power, the planning authorities are moving toward limiting locally available sites by designating so-called priority and suitability areas. These areas give the erection of WTs priority over other types of land uses but prohibit the erection of WTs outside these areas. The scale and the placement of these areas will be of great significance in future for securing wind energy supply at the regional level and thus for accomplishing national goals in climate policy. According to the regulations in the law revising the legal status of the Renewable Energy Sources Act (Erneuerbare-Energien-Gesetz, EEG, 2009), payment for wind power feed-in to the grid is granted only if, with regard to energy production, the WT to be erected yields at least 60% of a pre-defined standard performance level. With this regulation, the EEG wishes to prevent erecting WTs at locations inefficient for energy production. At the same time, however, higher standards are placed on the allocation of VE areas (priority and suitability areas) as a result. This poses the question: Does regional planning conform to such standards? With the example of the planning region West Saxony, we will evaluate the role the designation of VE areas plays in achieving Germany''s wind energy ambitions. The case study reveals that the strategic search of VE areas by the regional planning authorities, involving local stakeholders and the public, hampers investment in state-of-the-art WTs as fostered by the EEG (2009). This leads us to the general conclusion that, even with a participatory design of strategic planning and a determined governmental policy, deployment of the wind resource is not a fast-selling item that in future may contribute decisively toward achieving the ambitious goals in energy and climate policy. [Copyright &y& Elsevier]

Purpose: The surgical approaches for the open treatment of condylar process fractures have been controversial. In our study, we evaluated the morbidity of the transparotid approach during 2 years of follow-up. Patients and Methods: A total of 48 patients with condylar process Class II and IV fractures according to classification of Spiessl and Schroll, were included in the present study. Of the 48 patients, 16 were female and 32 male. The patient age range was 16 to 79 years (average 36.52). All patients were treated using the transparotid approach, with rigid internal fixation using miniplates. Follow-up examinations were performed for a minimum of 6.5 months and a maximum of 25 months (average 12.16) after surgical treatment. At the follow-up examination, the patients completed the Mandibular Function Impairment Questionnaire, and the examiner completed the Helkimo index. X-rays taken before, directly after, and 6 months after surgery were compared. Results: None of our patients had problems with wound healing; 2 patients developed a fistula of the parotid gland; and 4 patients developed palsy of the facial nerve that was completely reversible after 6 weeks. The results of the Mandibular Function Impairment Questionnaire and the Helkimo index revealed only a few subjective and objective problems after 6 months. Conclusions: The transparotid approach to condylar process fractures is most appropriate for strongly displaced Class II fractures. Especially for very old patients with dementia, for whom maxillomandibular fixation is contraindicated, this approach is very appropriate. Another benefit to this type of patient is the short operating time, with an average of 45 minutes. [Copyright &y& Elsevier]