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To create art means to be creative, but how creativity is gained, how we can induce and train creativity and how we can validly measure creative potential is a matter of still unsolved research. In our exploratory study, 49 participants had to create figures by using a double set of Tangram puzzles — so to say: to create something with an infinite degree of freedoms but that is still based on just a few defined and simple basic elements. In total, participants created 708 different figures. Creativity and complexity of these creations were then assessed in a subsequent study by five further raters in two randomly ordered blocks. We observed a strong correlation between the ratings of creativity and complexity on basis of average as well as individual data level. Interestingly, highly productive people, sometimes misinterpreted as ‘creatives’ due to their sheer quantitative output, actually produced simpler scenes that were also evaluated as less creative. We could also reveal that the level of creativity in the produced items remained very similar over the course of the test, pointing to relatively stable creativity traits (at least during the study phase). Our approach could lead to a deeper and more differentiated understanding of the concept of creativity and creative potential, specifically by combining it with qualitative analyses of the complexity of the created figures.

Ein 61-jähriger Patient kam mit quälendem Husten, Tachypnoe und Tachykardie in die Notaufnahme. 17 Tage zuvor war er wegen einer COVID-19-Pneumonie stationär behandelt worden. Nun zeigte sich im Röntgen ein rechtsseitiger Spannungspneumothorax. Weitere 20 Tage später wiederholte sich das Geschehen auf der linken Seite.

Neue Operationstechniken in der kolorektalen Chirurgie verfolgen das Ziel einer moglichst geringen Patientenbelastung bei mindestens aquivalenter und moglichst verbesserter Behandlungs- und Ergebnisqualitat. Hochwertige klinische Studien sind in der Evaluation sinnvoll erscheinender Innovationen notwendig und sollen die Machbarkeit, aber auch die Vorteile (oder Nachteile) neuer Operationstechniken bewerten. Die laparoskopische Kolonkarzinomchirurgie ist durch eine Reihe exzellenter prospektiv randomisierter Studien hinsichtlich Sicherheit und onkologischer Qualitat untersucht (COST-Study, COLOR-I, CLASICC). Die Patienten profitieren von den Vorteilen des geringeren Zugangstraumas, ohne Einschrankungen in der onkologischen Radikalitat hinnehmen zu mussen. Konnen diese positiven Ergebnisse auf die Rektumkarzinomchirurgie ubertragen werden? In der Rektumkarzinomchirurgie konnten aktuell die Fruhergebnisse der COLOR-II-Studie veroffentlicht werden, in der eindeutig nachgewiesen werden konnte, dass die laparoskopische Technik dem konventionellen offenen Vorgehen nicht unterlegen ist. Hinsichtlich Blutverlust, postoperativem Schmerzniveau, Krankenhausverweildauer und lateralem Sicherheitsabstand im distalen Rektumdrittel fanden sich signifikante Vorteile fur die laparoskopische Operationstechnik. Die onkologischen Langzeitergebnisse (Lokalrezidivrate als primarer Endpunkt der Studie) zeigen ebenfalls einen gunstigen Trend fur die minimal-invasive Rektumchirurgie und werden demnachst publiziert. Die Sicherheit und die onkologische Qualitat laparoskopischer Resektionsverfahren beim Rektumkarzinom sind durch klinische Studien gut belegt. In erfahrenen Zentren wird die laparoskopische Operationstechnik immer mehr zum Goldstandard in der Rektumkarzinomchirurgie.

This study aimed to evaluate the implementation of a joystick-controlled camera holder (Soloassist; Actormed, Barbing, Germany) in laparoscopic cholecystectomy as so-called solo-surgery compared with the standard operation. Of the 123 patients included in this study, 63 underwent laparoscopic cholecystectomy using the Soloassist system and were compared with 60 patients who underwent laparoscopic cholecystectomy with human assistance. The two groups did not differ significantly in terms of age, sex, body mass index, or American Society of Anesthesiology classification. The surgeons were divided into those highly experienced and those experienced with the new camera holder. The operation times were measured, including setup and dismantling of the system. The assessment also included complications, postoperative hospital stay, measurement of human resources in terms of personnel/minutes/operation, and subjective evaluation of the camera-guiding device by the surgeons. The hospital stay and operation-related complications were not enhanced in the Soloassist group. The differences in core operation time (p = 0.008) and total operating time (p = 0.001) significantly favored the human assistant. Whereas the absolute duration of surgery was longer, the relative operating time (in personnel/minutes/operation) was significantly shorter (p

There is a number of reports on varicella outbreaks in populations where a one dose varicella immunization program has been implemented. We performed a metaanalysis to provide a summary vaccine effectiveness (VE) estimate and to assess the possible impact of waning immunity by means of a subgroup analysis by time since immunization. We found a VE of 72.5% (95% CI 68.5-76.0) derived from 3157 children in 14 publications. Immunization coverage of the respective population was unrelated to VE. All studies (n=4) that allowed the computation of VE over time since immunization showed a substantial decrease. In total, waning immunity was assessed by nine studies. Two reported no relation between VE and time since immunization without specifying how this had been assessed. Seven studies calculated relative risks for contracting varicella after prolonged as compared to a shorter period since immunization and reported an increased relative risk for prolonged periods. In conclusion, this metaanalysis confirms a limited effectiveness of one dose of varicella vaccine and points to waning immunity as an important causal factor. Waning might also be an issue with the newly recommended two dose vaccination schedule. Sustained surveillance for varicella outbreaks in populations with varicella immunization programs therefore is mandatory.

In recent decades, self-written documents have become established in early modern historical research as a useful and serious resource. For a long time researchers were concerned only with a few known self-written texts (e.g., Thomas and Felix Platter, Josua Mahler, Johann Kaspar Lavater). When, in the middle of the 1990s, Kaspar von Greyerz proposed a Swiss archival project, it first required a one-year pilot study just to prove that the Swiss archives and libraries held a large number of unknown self-written documents from the early modern period. The archival project involved reading through an extensive range of resources, not only the 870 self-written documents which found their way into the database but also many other resources - perhaps two or three times as many - which were not included. The diary, family book and autobiography are the major forms of self-narrative in the data-bank of Swiss-German self-narratives. Keywords: autobiography; diary; family book; Kaspar von Greyerz; self-narratives; Swiss archival project; Swiss archives

Innovative surgical techniques in colorectal surgery aim to provide diminished surgical injury and at least equivalent or even improved quality of treatment and oncological results. High level clinical studies are mandatory to examine the feasibility and advantages (or disadvantages) of new operative techniques.Laparoscopic colonic resection for cancer has been investigated with respect to safety and oncological quality in various prospective randomized studies (COST study, COLOR-I and CLASICC). The minimally invasive procedure is feasible and safe which was demonstrated in many studies but can these results be extrapolated to laparoscopic rectal cancer surgery?The short term outcomes of the COLOR-II trial were published recently and laparoscopic resection for rectal cancer was not found to be inferior compared to open resection. Recovery after laparoscopic surgery was better than after open surgery. Laparoscopic surgery was found to have significant advantages with respect to blood loss, operating time, use of pain medication, early restoration of bowel function and reduction of hospital stay as well as the lateral safety margins in the distal third of the rectum. The long-term results focussing on local recurrence showed a positive trend in favor of laparoscopic rectal surgery and will be published shortly.Laparoscopic total mesorectal excision (TME) appears to have clinically measurable short-term advantages in patients with primary rectal cancer based on the evidence of randomized studies. Laparoscopic rectal cancer resection may become the gold standard in the future.

Objective. The aim of this study was to investigate whether the growth of soft tissue and bone in children with traumatic tooth loss or agenesis of teeth can be developed reliably, using a new technique of autogenous primary canine transplant. Study Design. A total of 10 patients (age range, 7-13 years) were treated either for trauma or for agenesis (n ¼ 14 primary canine transplants). In addition to the clinical examination, patients were subjected to radiologic examinations with regard to root resorption, bone height, and soft tissue level. Results. With an average survival rate of 87%, the average survival time of the transplants using the Kaplan-Meier estimator was 5.2 years. In all cases, soft tissue and bone growth was effectively developed. Conclusions. Autogenous primary canine transplant is a reliable surgical method for rehabilitating children in the early mixed dentition after traumatic tooth loss, enabling adequate soft tissue and bone growth. (Oral Surg Oral Med Oral Pathol Oral Radiol 2015;119:158-169) The lack of a permanent upper incisor, either due to traumatic loss in the early mixed dentition (ages 6 to 10 years) or due to congenital tooth agenesis, always presents the dentist with the difficult task of satisfactorily rehabilitating the affected patients in terms of both aesthetics and function. Epidemiologic studies have found that in Europe, every second child experiences a tooth trauma before the age of 16 years 1,2 ;8 % to 10% of all dental injuries are injuries with loss of permanent teeth. 3 In contrast to traumatic tooth loss, multiple aplasia of teeth is rather rare in the maxillary anterior region. Nevertheless, it presents the dentist with a difficult task, as natural bite raising with alveolar process growth does not occur, owing to the absence of tooth development. The incidence of aplasia in adolescent dentition is found to be approximately 8%. 4 The loss of a permanent tooth in adolescent dentition, and also agenesis of the corresponding tooth, is always accompanied by an inhibition of the vertical and horizontal alveolar process growth. 5 Especially between the ages of 6 and 10 (in the so-called early mixed dentition), a fixed restoration of existing primary or traumatically incurred tooth gaps is not possible because during this time, neither orthodontic gap closure nor endosseous implantation are available as treatment options. Endosseous implants placed before the completion

Background Laparoscopic total mesorectal excision (TME) for rectal cancer has been proved in various studies. The minimal invasive procedure is feasible and safe which was demonstrated in many studies. However, the results of prospective, randomized studies providing valuable evidence are still not available. Compared to conventional surgery, the laparoscopic technique has short-term advantages including less pain, shorter duration of postoperative ileus, less fatigue, better pulmonary function, and less blood loss (Leung et al., Lancet 363:1187–1192, 2004; Braga et al., Dis Colon Rectum 48:217–223, 2005; Jayne et al., J Clin Oncol 25:3061–3068, 2007; Agha et al., Surg Endosc 22:2229–2237, 2008). Methods The autonomic nerve sparing TME technique is the gold standard in rectal cancer resection even in conventional or laparoscopic procedure. With regard of the oncological dimension, the laparoscopic TME technique is not different compared to the open procedure. However, a standardized laparoscopic step-by-step procedure may simplify the operation and can reduce operation time. Results There are no studies available which compare different types of TME procedures. Most surgeons start the operation left laterally mobilizing the sigmoid colon first. In the laparoscopic technique, we recommend the medial to lateral approach starting the operation at the right side of the rectum and sigmoid colon. A nerve sparing TME technique can be performed easier, and the identification of the left ureter may be simplified. After multiple workshops and extensive discussion with national and international experts, we developed a standardized laparoscopic “10 step TME procedure.” Reviewing the results of laparoscopic TME the studies do not allow firm conclusions as to the questions of whether the safety and efficacy of laparoscopic TME is equal or superior to open TME (Breukink et al. 2006). Actually, we are waiting for large prospective randomized studies comparing laparoscopic TME with the traditional open procedure (Bonjer et al., Dan Med Bull 56:89–91, 2009). Conclusion Laparoscopic TME appears to have clinically measurable short-term advantages in patients with primary resectable rectal cancer based on evidence mainly from nonrandomized studies (Breukink et al. 5). In nearly all published studies, the efficacy and technical feasibility of laparoscopic surgery for rectal cancer could be demonstrated regarding perioperative morbidity and oncological outcome. A standardized laparoscopic TME technique can be strongly recommended. Electronic supplementary material The online version of this article (doi:10.1007/s00423-009-0556-y) contains supplementary material, which is available to authorized users.

Die anteriore oder tiefe anteriore Rektumresektion in Kombination mit einer partiellen (PME) oder totalen mesorektalen Exzision (TME) sind die derzeitigen Standardverfahren in der Chirurgie der Rektumkarzinome. Diese Operationen werden laparoskopisch oder in konventioneller Technik durchgefuhrt. Die wesentlichen Phasen der Operation sind: 1. Mobilisierung von Sigma und Colon descendens; 2. Durchtrennung der A. und V. mesenterica inferior; 3. Durchtrennung des Colon descendens; 4. Mobilisierung des Rektums in PME- oder TME-Technik; 5. Absetzen des Rektums; 6. Anastomosierung; 7. Anlage eines protektiven Stomas (optional). Technische Probleme und schwierige Entscheidungssituationen entstehen meistens bei der ventralen Praparation im kleinen Becken, beim Absetzen des Rektums und bei der Anastomosierung.

Einleitung: Ziel einer aktuellen Studie war es, die Durchführung einer standardisierten laparoskopischen Cholezystektomie mithilfe eines Joystickgesteuerten Kameranachführungssystems SOLOASSIST (Fa. Actormed) als sogenannte Solo-Chirurgie mit der Durchführung derselben Operation mithilfe[for full text, please go to the a.m. URL], 130. Kongress der Deutschen Gesellschaft für Chirurgie

Pancreatic cancer is the fourth leading cause of cancer-related death in Western countries with a poor prognosis (5-year survival rates, 25% in patients after tumor resection with adjuvant treatment; overall, the 5-year survival rate is about 4%; Jemal et al., CA Cancer J Clin, 55:10–30, 2005). Many patients develop a cachectic status during the progression of the disease, and this syndrome accounts for up to 80% of deaths in patients with advanced pancreatic cancer. Remarkably, there are only a few data available on the impact of cachexia in patients with pancreatic cancer scheduled for tumor resection. Therefore, in this study, 227 consecutive patients with ductal adenocarcinoma of the pancreas were documented over an 18-month period regarding the prevalence of cachexia and its influence on perioperative morbidity and mortality with a special interest to postoperative weight gain and survival in a prospectively designed database and followed up. In 40.5% of the patients, cachexia was already present at the time of operation. The cachectic patients did present in a worse nutritional status, represented by lower protein, albumins, and hemoglobin levels. Despite no significant differences in tumor size, lymph node status, and CA19-9 levels, the resection rate in patients with cachexia was reduced (77.8% vs. 48.9%) due to a higher rate of metastatic disease in patients with cachexia. The morbidity and in-hospital mortality revealed no significant difference. However, patients with and without cachexia lost weight after operation, and the weight gain started not until 6 months after operation. The survival in patients with cachexia was significantly reduced in patients undergoing tumor resection as well as in palliative treated patients. Cachexia has a significant impact on survival and performance status in palliative patients as well as in patients operated for pancreatic cancer. But tumor-related cachexia is not necessarily dependent on tumor size or load and that metastatic dedifferentiation of the tumor might be a critical step in the development of tumor-associated cachexia.

Summary Asplenia and other conditions of immunodeficiency are established risk factors for invasive pneumococcal disease (IPD). There are no current data available on the risk of IPD in children with acute lymphoblatic leukaemia (ALL), the most common type of childhood malignancy. This study combined data from a nation-wide surveillance for IPD and the German childhood cancer registry, and showed that children with ALL carry a more than 10-fold higher risk for IPD than the general paediatric population. As a substantial proportion of IPD occurs during maintenance chemotherapy, children with ALL may represent candidates for the evaluation of prophylactic interventions including vaccination.