Search

Die Bronchoskopie stellt neben der Lungenfunktion und der radiologischen Bildgebung das wichtigste Diagnostikum bei Patienten mit Atemwegs- und Lungenerkrankungen dar. Aufgrund des kombinierten Einsatzes flexibler und starrer Bronchoskope kommt sie heutzutage aber auch zunehmend als endoskopisches Therapieverfahren bei pulmonalen Erkrankungen in Frage. Bei thorakalen Tumoren kann die interventionelle Bronchoskopie sowohl in palliativer als auch kurativer Intention zum Einsatz kommen. Neben der bronchoskopischen Tumorbehandlung rückten in den letzten Jahren zunehmend die Techniken der endoskopischen Lungenvolumenreduktion in den Fokus. Darüber hinaus bieten sich Therapiemöglichkeiten für Asthma und chronische Bronchitis sowie bei Atemwegsstenosen und -fisteln.

The SARS-CoV-19 pandemic continues to be globally related with significant morbidity and mortality, making protective measures to prevent transmission of the virus still necessary. Healthcare employees are exposed to a higher risk of infection and this is particularly true when performing aerosol-generating procedures such as bronchoscopy.Since the publication of recommendations for performing a bronchoscopy in the times of COVID-19 more than six months ago, the risk situation has not changed significantly, but due to the considerable gain in knowledge in the meantime, an update of the recommendations was necessary.The updated recommendations include the reduction of aerosol formation, the personal protection of the people involved in the procedure, as well as measures to better organize the processes in the endoscopy suite in order to perform bronchoscopic procedures securely even in times of COVID-19.Die Pandemie ausgelöst durch SARS-CoV-19 geht weltweit unverändert mit einer bedeutsamen Morbidität und Mortalität einher, sodass Schutzmaßnahmen zur Verhinderung der Transmission des Virus weiterhin notwendig sind. Mitarbeiter im Gesundheitswesen sind einem höheren Risiko ausgesetzt, und dies gilt insbesondere im Rahmen sog. Aerosol-generierender Verfahren wie der Bronchoskopie. Seit der Veröffentlichung konsentierter Empfehlungen zur Durchführung einer Bronchoskopie unter diesen Bedingungen vor mehr als einem halben Jahr hat sich die Gefahrenlage nicht wesentlich verändert, aber aufgrund des erheblichen Erkenntnisgewinns in der Zwischenzeit war ein Update der Empfehlungen notwendig. Die erneuerten Empfehlungen umfassen u. a. die Verminderung der Aerosolentstehung, den persönlichen Schutz der beteiligten Personen sowie Maßnahmen zur besseren Organisation der Abläufe in der Endoskopie, um eine sichere Durchführung auch in Zeiten von COVID-19 zu gewährleisten.

Background Asymptomatic carotid artery stenosis (ACS) has a low risk of stroke. To achieve an advantage over noninterventional best medical treatment (BMT), carotid endarterectomy (CEA) or carotid artery stenting (CAS) must be performed with the lowest possible risk of stroke. Therefore, an analysis of risk-elevating factors is essential. Grade of ipsilateral and contralateral stenosis as well as plaque morphology are known risk factors in ACS. Methods The randomized, controlled, multicenter SPACE-2 trial had to be stopped prematurely after recruiting 513 patients. 203 patients were randomized to CEA, 197 to CAS, and 113 to BMT. Within one year, risk factors such as grade of stenosis and plaque morphology were analyzed. Results Grade of contralateral stenosis (GCS) was higher in patients with any stroke (50%ECST vs. 20%ECST; p=0.012). Echolucent plaque morphology was associated with any stroke on the day of intervention (OR 5.23; p=0.041). In the periprocedural period, any stroke was correlated with GCS in the CEA group (70%ECST vs. 20%ECST; p=0.026) and with echolucent plaque morphology in the CAS group (6% vs. 1%; p=0.048). In multivariate analysis, occlusion of the contralateral carotid artery (CCO) was associated with risk of any stroke (OR 7.00; p=0.006), without heterogeneity between CEA and CAS. Conclusion In patients with asymptomatic carotid artery stenosis, GCS, CCO, as well as echolucent plaque morphology were associated with a higher risk of cerebrovascular events. The risk of stroke in the periprocedural period was increased by GCS in CEA and by echolucent plaque in CAS. Due to small sample size, results must be interpreted carefully.

© 2019 American Physical Society. Reducing the size of a superconductor below its characteristic length scales can either enhance or suppress its critical temperature (Tc). Depending on the bulk value of the electron-phonon coupling strength, electronic and phonon confinement effects will play different roles in the modification of Tc. Experimentally disentangling each contribution has remained a challenge. We have measured both the phonon density of states and Tc of Sn nanowires with diameters of 18, 35, and 100 nm in order to quantify the effects of phonon confinement on superconductivity. We observe a shift of the phonon frequency towards the low-energy region and an increase in the electron-phonon coupling constant that can account for the measured increase in Tc. ispartof: PHYSICAL REVIEW B vol:99 issue:6 status: published

We used lithographically fabricated nanoconstrictions made of Ag–Co granular thin films to achieve current densities above 10 A/cm during magnetotransport measurements. Systematically measured variations of the resistance with current under high applied magnetic fields did not reveal any dramatically large magnetoresistance effect, in contrast to the previous observations using mechanical point contact based techniques. Our experimental results on resistance switching by current injection in the Ag–Co nanoconstrictions reveal spin torque effects. The switching amplitudes are considerably smaller when compared to the results obtained for pillar shaped trilayers due to the large number of Co grains in the nanoconstrictions. We demonstrate that the use of point contact patterns with nanometer dimensions, where effects resulting from current induced mechanical distortions at high magnetic fields are negligible, has obvious advantages over the mechanical point contact technique for studying spin injection effects.

Composite multiferroics are a new class of material where magneto-electric coupling is achieved by creating an interface between a ferromagnetic and a ferroelectric compound. The challenge of understanding the chemical and magnetic properties of such interface is a key to achieve good magneto-electric coupling. The unique possibilities offered by isotope sensitive techniques are used to selectively investigate the interface's chemistry and magnetism in Fe/BaTiO3 and Fe/LiNbO3 systems during the application of an electric field. With a large enough electric field, a strong oxidation of Fe is triggered, which creates a magnetically dead interface. This leads to an irreversible decrease of the magneto-electric coupling properties. Material parameters are identified that determine under which electric field the interface may be modified. The results are confirmed on the two systems and are expected to be widespread in this new class of hybrid material.

et al., The combination of lithography and ion implantation is demonstrated to be a suitable method to prepare lateral multilayers. A laterally, compositionally, and magnetically modulated microscale pattern consisting of alternating Co (1.6 µm wide) and Co-CoO (2.4 µm wide) lines has been obtained by oxygen ion implantation into a lithographically masked Au-sandwiched Co thin film. Magnetoresistance along the lines (i.e., current and applied magnetic field are parallel to the lines) reveals an effective positive giant magnetoresistance (GMR) behavior at room temperature. Conversely, anisotropic magnetoresistance and GMR contributions are distinguished at low temperature (i.e., 10 K) since the O-implanted areas become exchange coupled. This planar GMR is principally ascribed to the spatial modulation of coercivity in a spring-magnet-type configuration, which results in 180° Néel extrinsic domain walls at the Co/Co-CoO interfaces. The versatility, in terms of pattern size, morphology, and composition adjustment, of this method offers a unique route to fabricate planar systems for, among others, spintronic research and applications., This work was financed by the Research Foundation-Flanders (FWO), the Concerted Research ActionGOA/14/007, the 2014-SGR-1015 project of the Generalitat de Catalunya, and the European Commission under the 7th Framework Programme through the “Research Infrastructure” action of the “Capacities” Programme, NMI3-II Grant No. 283883. This work is based upon experiments (Proposal Nos. 5928 and 9384) performed at the MARIA instrument operated by JCNS at Heinz Maier-Leibnitz Zentrum (MLZ), Garching, Germany. The authors would like to thank IMEC for access to its lithography facilities as well as J. Moonens and J. Loo for technical support. ICN2 acknowledges support from the Severo Ochoa Program (MINECO, Grant SEV-2013-0295).

Pronounced room temperature vertical shifts in the magnetic hysteresis loops of granular, highly polycrystalline and ferromagnetic-like BiFeO3 thin films are observed upon field-cooling from a temperature above the Neel temperature of bulk BiFeO3. This is ascribed to the interplay between the preferential alignment, established by the field-cooling process, of the net magnetic moment, which arises from uncompensated antiferromagnetic spins, and the pinning of a fraction of these spins at the particle boundaries. Conversely, field-cooling of an epitaxially grown BiFeO3 film results in no vertical shift, confirming the effective role played by the particle boundaries (i.e., morphology) of the granular-like BiFeO3 films in the process of spin frustration.

This report describes development of an augmentation kit that will give users of the sustainment pavement repair (SuPR) kit the capability for in-place asphalt recycling. This type of repair has the potential for reducing not only logistics associated with airfield pavement repair, but also the airfield downtime during the repairs. The specific technologies evaluated were infrared heaters, rejuvenator products, and cement stabilization. Different variations of these technologies were combined and evaluated in the laboratory to study the best combination that would produce quality sustainment repairs in asphalt concrete pavement yielding good performance with limited construction periods. The researchers also performed a series of pavement repairs to evaluate the equipment, materials and procedures required for in-place asphalt recycling in terms of the efficiency of the components to reduce repair logistics, equipment footprint, and airfield downtime during repairs. The performance of the repairs was evaluated under simulated F-15 aircraft traffic. Data collected from this study were used to develop guidance for the use of in-place asphalt recycling for sustainment repairs on military airfield pavements.

Two Bolivian Aspidosperma species were investigated. The seed and stem bark of Aspidosperma macrocarpon Mart. contain six known alkaloids : (-)-vincadifformine, ervinceine, kopsanone, kopsinine, kopsanol in the seed, and kopsanone, kopsinine, kopsanol, 18-epikopsanol in the stem bark. The stem bark of Aspidosperma pyrifolium Mart. contains eleven known alkaloids: (-)-vincadifformine, O-demethylpalosine, haplocine, N-formylaspidospermidine, vallesine, demethoxyaspidospermine, palosine, (-)-aspidospermine, aspidospermidine, akuammicine, tubotaiwine, beside the two new bases dehydroxyhaplocidine and 10-methoxyaspidospermidine.

We investigate the link between superconductivity and atomic vibrations in Nb3Sn films with a thickness ranging from 10 to 50 nm. The challenge of measuring the phonon density of states (PDOS) of these films has been tackled by employing the technique of nuclear inelastic scattering by 119Sn isotopes to reveal the Sn-partial phonon density of states. With the support of ab initio calculations, we evaluate the effect of reduced film thickness on the PDOS. This approach allows us to estimate the changes in superconducting critical temperature Tc induced by phonon confinement, which turned out to be limited to a few tenths of K. The presented method is successful for the Nb3Sn system and paves the way for more systematic studies of the role of phonon confinement in Sn-containing superconductors. ispartof: Physical Review B, Condensed Matter and Materials Physics vol:88 issue:4 status: published

Four separate detergents were tested to determine their effectiveness in airfield rubber removal to restore friction. Each detergent is applied to the pavement surface in controlled 50' x 30' patches. There were three patches placed for each detergent with increasing levels of mechanical effort and agitation duration ranging from 2 to 4 hours. Upon completion of agitation, a water trailer and spray bar was employed to sufficiently rinse the airfield surface and neutralize the detergent agents. Friction measurements were conducted prior to and after cleaning with a GripTester device towed at a constant velocity of 40 mph.

The objective of this research was to evaluate rapid-set materials for use in deep spall repair. The evaluation process considered the following thermal and mechanical properties: elasticity, modulus of elasticity, creep, bond strength, compressive strength, tensile strength, modulus of rupture, and the coefficient of thermal expansion.

Information presented in this report is organized along specific issues such as the advantages and disadvantages of using geopolymer concrete for industrial applications, the benefits and risks associated with binder variables (alkaline concentration, pozzolan ratios, curing methodologies), mechanical variance resulting from differences in microstructural evolution and performance in harsh environments (extreme temperatures and chemical attack).

We are presenting the outcome of the development of an external frequency doubled, pulsed thin disk Yb:YAG laser for use in the GLAS (Ground-layer Laser Adaptive-optics System) project. The special goal was a very high robustness and reliability needed for the operation at the William Herschel Telescope on La Palma. For the green output at l = 515nm we report pulse lengths down to 250ns and an average power of 23W at 3kHz repetition rate and up to 32W average power and minimum pulselengths of 350ns at 5kHz. At all power levels the beam is nearly diffraction limited with M 2 l 1.1.

Considering the increasing demands on manufacturer to take responsibility for their products in all phases of life, companies are going forward to integrate environmental aspects into production and products. In the context of the coming EU-directives (WEEE, RoHS and EuE) companies have to furnish information about the constituent substances in their products. Project undertaken: Rohde & Schwarz (R&S), Munich, Germany, an internationally active company in the fields of test and measurement, information technology and radiocommunication, started a project in cooperation with Fraunhofer IZM, to integrate material data information into the construction process. The cognition of environmental product assessment should be integrated in the product development as early as possible. Data processing tools may assist the designer in finding environmental adequate solutions. The conception of the integration of environmental assessment tools into the design process shows how to exert influence on design decisions in various stages of development. In the first step the assessment of existing products or modules helps to identify weak points of the realized construction and shows the main origin of environmental impacts. This may serve as a starting point for an effective new approach of construction. During the realization phase the selection of parts can be directed by an assessment of components. Components with higher-than-average environmental impact can be exchanged for others with lower impact. The created material portfolio and the results of product assessment can be taken as a basis for product documentation.

In the great majority of cases of long-standing intrathoracic foreign bodies, patients are asymptomatic. However, symptoms may occur years later from the migration of the foreign body. We report on a 70-year-old patient who developed relapsing pneumonia due to obstruction of a bronchial branch of the left apical group by a migrating infantry bullet impacting 53 years ago. This was not diagnosed until the second attack of pneumonia in 1998. The bullet remains were removed bronchoscopically and the pneumonia resolved completely without further complications.

In the era of routinely used ultrasound techniques intrasplenic tumors are diagnosed more frequently. Usually these findings are not combined with specific symptoms. However, large cysts can lead to malfunctions of nearly located organs by displacing. Etiopathogenetic findings in our region are mainly non parasitic, epithelial and traumatic cysts or tumors of the spleen. We describe a large splenic mass of a 44 years old female patient. Pathological dignity remained unclear after using sonographic, radiological and clinical techniques. After uncomplicated total splenectomy the histopathological diagnosis revealed a benign, pseudoinflammatory tumor of the spleen. Inflammatory pseudotumors are a benign response to an unknown cause. It must be a main objective of preoperative diagnostics to distinguish them from malignant processes.

In a four year period (1990-93) 75 patients were treated in our hospital for acute lower gastrointestinal bleeding. In the course of diagnostic procedures an upper gastrointestinal bleeding was excluded routinely and further 126 endoscopic measures were performed. All patients underwent rectoscopy and additional partial or total coloscopy. In addition to that, 16 scintigrams and 7 angiograms were taken. The validity of the endoscopic measures was 0.73, scintigraphy and angiography were less valid with 0.53 and 0.34. Therefore endoscopic diagnostic procedures are of more value. 32 of these 75 patients underwent operative treatment. Recurrent bleeding after operative treatment was seen in 6.25%. Overall mortality was 5.33%. Because prognosis of a recurrent bleeding after operative treatment is poor, primary subtotal colectomy is indicated when the source of bleeding can not be localized.

We present an approach to probe the magnetization inside superconducting films using ultrathin Fe-57 probe layers excited by synchrotron radiation. We investigate the evolution of the Fe-57 hyperfine field orientation as a function of magnetic field above and below the superconducting transition temperature T-c for a Nb(50 nm)/Fe-57(0.6 nm)/Nb(50 nm) trilayer. It is found that significant screening of the external field in the superconductor occurs only at low field, leading to a change in the hyperfine field angle below T-c. The presented approach allows to study the influence of magnetic fields and vortex induced electron correlations in complex layered structures incorporating superconductors. (C) 2011 American Institute of Physics. [doi:10.1063/1.3625941] ispartof: Applied Physics Letters vol:99 issue:9 status: published

Drei Moderatoren demonstrierten am praparierten Schweinedarm: Oesophago-Pouch-Anastomosen, Dunndarmanastomosen, Ileotransversostomie und tiefe anteriore, Rektumresektionen, jeweils in Hand- und Staplertechnik. Ebenfalls wurden Anastomosen mit einem biodegradablen Anastomosenring gefertigt. Es wurde eine Ubersicht uber moderne Nahtmateriahen mit speziellen Indikationen gegeben. Auf Indikationen der Klammernahtgerate in der Lungenchirurgie wurde hingewiesen. Gemeinsam mit dem Auditorium wurden praktische Probleme diskutiert und Losungswege demonstriert.

Using modern methods of medical decision making (regression analysis) one can determine risk factors for rebleeding in peptic ulcer disease. Prediction of rebleeding for the individual patient is possible. Under regard of five effective risk factors and using adequate statistical methods, sensitivity and specificity reach about 80%.

A 43-year-old previously fit railway official collapsed in May, 1998, with an epileptic fit on the sidelines of a football pitch while watching his son’s match. His medical history was uneventful except for an appendicetomy a few years previously. He had smoked 30 cigarettes per day for many years, but had had a cough only for the last 3 months. Physical examination was normal except for chronic periodontitis. Laboratory examination showed the following abnormalities: white blood cell count 19·3 10/L (normal

In ten years a total of 1207 operations for gastroduodenal ulcer were performed, using a standardizing treatment scheme. The number of operations has markedly decreased since 1978, probably due to the introduction of H2-receptor blockers in the treatment of peptic ulcers. The results of operations suggest elective surgical treatment for ulcer patients at risk of complications. This is the only way of decreasing the adverse effect of emergency operations on the total surgical mortality of ulcer patients.

Since 1976 Taurolin is applied in clinical trials in several European states. The results being submitted show a very good activity of this substance against bacteria and endotoxin. Evaluating all clinical and experimental studies in our opinion the use of antibiotics postoperatively together with Taurolin seems to be an effective treatment of peritonitis. In our hospital taurolin has become an important part of the surgical management of severe forms of peritonitis. A development of resistant bacteria is not known up to now.

In a larger collective of surgical patients the behaviour of the individual thyroid parameters (T4, T3, rT3, TBG and thyroxine-binding capacity) were studied before, during and after operation and set in relation to each other. There are significant shifts in T4 metabolism towards the formation of rT3. In spite of its greatly reduced metabolic activity compared with T3, an important regulatory effect is attributed to rT3, in thyroid metabolism in stress situations.

Many problems may persist after operation of an acute abdomen. Most important are peritonitis, hemorrhage, vascular occlusion and reduced general condition. Pathophysiology, clinical symptoms and therapeutic principles are discussed.