Search

BackgroundPatients with open fractures often experience complications during their injury. The treatments incur high costs. Interdisciplinary cooperation between different medical disciplines may improve treatment outcomes. Such cooperation has not yet been envisaged in the German health care system. ObjectiveThe aim of the study is to improve the treatment of fractures with open soft tissue damage or postoperative complications in terms of duration and sustainability in a region in northwest Germany. Largely standardized diagnostics and therapy are intended to optimize processes in hospitals. In addition, a reduction in the duration of treatment and treatment costs is to be achieved. MethodsUsing a digital platform, physicians from 31 hospitals present patient cases to an interdisciplinary group of experts from the fields of plastic surgery, infectiology, hygiene, and others. The group of experts from the environment of the University Hospital Münster promptly makes a joint treatment recommendation for the individual case. The plan is to examine 3300 patients with open fractures or surgical complications. As consortium partners, there are also 3 statutory health insurance companies. The extent to which the therapy recommendations are effective and contribute to cost reduction in the health care system will be empirically investigated in a stepped-wedge cluster-randomized design. In addition, medical and nonmedical professional groups involved in the project will be asked about their work in the project (in total, 248 clinic employees). The primary outcome is the complication rate of open fractures or the occurrence of postoperative complications. As secondary outcomes, the number of antibiotics administered, limb function, and quality of life will be assessed. The health economic evaluation refers to the costs of health services and absenteeism. For the work-related evaluation, workload, work engagement, work-related resources, readiness for technology, and ergonomic aspects of the new telemedical technology will be collected. In addition, clinic employees will give their assessments of the success of the project in a structured telephone interview based on scaled and open-ended questions. ResultsThe project started in June 2022; data collection started in April 2023. As of mid-June 2024, data from 425 patients had been included. In total, 146 members of staff had taken part in the questionnaire survey and 15 had taken part in the interviews. ConclusionsStandardized treatment pathways in the standard care of patients with open fractures and postoperative infections will be established to reduce complications, improve chances of recovery, and reduce costs. Unnecessary and redundant treatment steps will be avoided through standardized diagnostics and therapy. The interdisciplinary treatment perspective allows for a more individualized therapy. In the medium term, outpatient or inpatient treatment centers specialized in the patient group could be set up where the new diagnostic and therapeutic pathways could be competently applied. Trial RegistrationGerman Clinical Trials Register DRKS00031308; https://drks.de/search/de/trial/DRKS00031308 International Registered Report Identifier (IRRID)DERR1-10.2196/57820

Background:. Recent advancements in the development of robotic devices increasingly draw the attention toward the concept of robotic microsurgery, as several systems tailored to open microsurgery are being introduced. This study describes the combined application of a novel microsurgical robot, the Symani, with a novel robotic microscope, the RoboticScope, for the performance of microvascular anastomoses in a two-center preclinical trial. Methods:. Six novices, residents, and experienced microsurgeons (n = 18) performed five anastomoses on 1.0-mm-diameter silicone vessels with a conventional versus combined robotic approach, resulting in 180 anastomoses. Microsurgical performance was evaluated, analyzing surgical time, subjective satisfaction with the anastomosis and robotic setup, anastomosis quality using the anastomosis lapse index score, microsurgical skills using the Structured Assessment of Microsurgery Skills score, and surgical ergonomics using the Rapid Entire Body Assessment score. Results:. All participants significantly improved their performance during the trial and quickly adapted to the novel systems. Surgical time significantly decreased, whereas satisfaction with the anastomosis and setup improved over time. The use of robotic systems was associated with fewer microsurgical errors and enhanced anastomosis quality. Especially novices demonstrated accelerated skill acquisition upon robotic assistance compared with conventional microsurgery. Moreover, upper extremity positioning was significantly improved. Overall, the robotic approach was subjectively preferred by participants. Conclusions:. The concept of robotic microsurgery holds great potential to improve precision and ergonomics in microsurgery. This two-center trial provides promising evidence for a steep learning curve upon introduction of robotic microsurgery systems, suggesting further pursuit of their clinical integration.

Abstract Objective This study investigates whether psychological well‐being in post‐bariatric patients seeking body contouring procedures differs from those who do not seek body contouring procedures, those who have already undergone body contouring procedures, and those who are unsure about body contouring procedures. Methods An anonymous, nonrandomized, cross‐sectional survey study was designed. Psychological well‐being of four groups of post‐bariatric‐patients (undergone body contouring procedures, seeking body contouring procedures, not seeking body contouring procedures, unsure about body contouring procedures) were compared. Results A total of 345 patients were included in this study. No significant difference between patients seeking body contouring procedures and those not seeking body contouring procedures was found with regard to depressive symptoms, self‐esteem, and body image. Patients who had already undergone body contouring procedures scored lower on depressive symptoms (p = 0.035) and reported feeling more attractive (p

Concentrated solar power (CSP)—photovoltaic (PV) hybrid power plants allow for the generation of cheap electrical energy with a high capacity factor (CF). A deep integration of both technologies offers synergies, using parts of the PV generated electricity for heating the thermal storage tank of the CSP unit. Such configurations have been previously studied for systems coupled by an electric resistance heater (ERH). In this work, the coupling of a CSP and a PV plant using a heat pump (HP) was analyzed due to the higher efficiency of heat pumps. The heat pump is used as a booster to lift the salt temperature in the storage system from 383 to 565 °C in order to reach higher turbine efficiency. A techno-economic analysis of the system was performed using the levelized cost of electricity (LCOE), the capacity factor and nighttime electricity fraction as variables for the representation. The CSP–PV hybrid with a booster heat pump was compared with other technologies such as a CSP–PV hybrid plant coupled by an electric heater, a standalone parabolic trough plant (PT), a photovoltaic system with battery storage (PV–BESS), and a PV thermal power plant (PVTP) consisting of a PV plant with an electric heater, thermal energy storage (TES) and a power block (PB).

Background The concept of robotic microsurgery is becoming increasingly known as several robotic systems tailored to the specific needs of microsurgery are being introduced. Training with these devices is essential to draw conclusions about their potential clinical utility. This study describes the training and learning curve of experienced microsurgeons and complete novices using such a robotic surgical system in combination with an exoscope.

BackgroundAutologous breast reconstruction is highly regarded in reconstructive surgery after mastectomy. DIEP flap reconstruction represents the gold standard for autologous breast reconstruction. The major advantages of DIEP flap reconstruction are its adequate volume, large vascular caliber and pedicle length. Despite reliable anatomy, there are procedures where the plastic surgeon's creativity is required, not only to shape the new breast, but also to overcome microsurgical challenges. An important tool in these cases is the superficial epigastric vein (SIEV).Methods150 DIEP flap procedures performed between 2018 and 2021 were retrospectively evaluated for SIEV use. Intraoperative and postoperative data were analyzed. Rate of anastomosis revision, total and partial flap loss, fat necrosis and donor site complications were evaluated.ResultsIn a total of 150 breast reconstructions with a DIEP flap performed in our clinic, the SIEV was used in 5 cases. The indication for using the SIEV was to improve the venous drainage of the flap or as a graft to reconstruct the main artery perforator. Among the 5 cases, no flap loss occurred.ConclusionsUse of the SIEV is an excellent method to expand the microsurgical options in breast reconstruction with DIEP flap surgery. It provides a safe and reliable procedure to improve venous outflow in cases of inadequate outflow from the deep venous system. The SIEV could also provide a very good option for fast and reliable application as an interposition device in case of arterial complications.

Chronic pelvic pain (CPP) is often diagnosed by gynecologists. In recent years, the realization that venous insufficiency in the pelvic or retroperitoneal area can also cause CPP has led to the involvement of vascular physicians in the diagnosis and treatment. Differentiating pelvic venous disease (PeVD) from gynecological, internal or even orthopedic complaints poses a challenge. A comprehensive study of the patient's medical history and a detailed description of symptoms are of paramount importance. The symptoms of PeVD depend on the veins involved. Whereas pelvic pain is mainly an expression of an insufficiency of the ovarian vein and/or the internal iliac vein, left flank pain and hematuria are caused by an obstruction of the renal vein. Symptoms may also be associated with atypical varicose veins in the vulva, perineum, or legs. Anatomical gaps, pelvic escape points, allow them to communicate with the branches of the insufficient internal iliac veins and with the ovarian. As an effective tool for reporting PeVD patient populations the symptoms-varicespathophysiology (SVP) classification was published in 2021. It is thought to be the initial point of both the treatment standard and identifying homogenous patient populations for clinical trials. [Turk J Vasc Surg 2021; 30(1.100): 1-7]

Pelvic venous disease (PeVD) are one of the most important causes of chronic pelvic pain in women resulting from the pathological venous flow in ovarian and pelvic veins. Pelvic vein embolization is the method of choice for treatment of PeVD caused by primary reflux in ovarian and internal iliac veins. In this review, we discuss possible complications and side effects after embolization therapy. [Turk J Vasc Surg 2021; 30(1.100): 44-48]

The presented review gives reliable information about the currently used measurement instrumentation in parabolic trough fields and recent monitoring approaches. The usually built-in measurement equipment in the solar field, clamp-on systems for flexible measurements of temperature and flow, solar irradiance measurements, standard meteorological equipment, laboratory devices for heat transfer fluid analyses and instruments related to the tracking of solar collector assemblies are presented in detail. The measurement systems are reported with their measurement uncertainty, approximate costs and usual installation location for the built-in instrumentation. Specific findings related to the installation and operation of the measurement devices are presented. The usually installed instrumentation delivers a lot of measurements all over the field at the expense of measurement accuracy, compared to special test facility equipment. Recently introduced measurement approaches can improve the standard instrumentation in terms of accuracy, frequency, spatial distribution or can even extend the amount of measurands. The information about available measurands is the basis for future operation and maintenance solutions based on data-driven approaches.

BackgroundChronic rejection remains the Achilles heel in vascularized composite allotransplantation. Animal models to specifically study chronic rejection in vascularized composite allotransplantation do not exist so far. However, there are established rat models to study chronic rejection in solid organ transplantation such as allogeneic transplantation between the rat strains Lewis and Fischer344. Thus, we initiated this study to investigate the applicability of hindlimb transplantation between these strains to imitate chronic rejection in vascularized composite allotransplantation and identify potential markers.MethodsAllogeneic hindlimb transplantation were performed between Lewis (recipient) and Fischer344 (donor) rats with either constant immunosuppression or a high dose immunosuppressive bolus only in case of acute skin rejections. Histology, immunohistochemistry, microarray and qPCR analysis were used to detect changes in skin and muscle at postoperative day 100.ResultsWe were able to demonstrate significant intimal proliferation, infiltration of CD68 and CD4 positive cells, up-regulation of inflammatory cytokines and initiation of muscular fibrosis in the chronic rejection group. Microarray analysis and subsequent qPCR identified CXC ligands 9-11 as potential markers of chronic rejection.ConclusionsThe Fischer344 to Lewis hindlimb transplantation model may represent a new option to study chronic rejection in vascularized composite allotransplantation in an experimental setting. CXC ligands 9-11 deserve further research to investigate their role as chronic rejection markers.

Summary: Laminin 332-deficient junctional epidermolysis bullosa (JEB) is a severe genetic skin disease. JEB is marked by epidermal stem cell depletion, the origin of which is unknown. We show that dysregulation of the YAP and TAZ pathway underpins such stem cell depletion. Laminin 332-mediated YAP activity sustains human epidermal stem cells, detected as holoclones. Ablation of YAP selectively depletes holoclones, while enforced YAP blocks conversion of stem cells into progenitors and indefinitely extends the keratinocyte lifespan. YAP is dramatically decreased in JEB keratinocytes, which contain only phosphorylated, inactive YAP. In normal keratinocytes, laminin 332 and α6β4 ablation abolish YAP activity and recapitulate the JEB phenotype. In JEB keratinocytes, laminin 332-gene therapy rescues YAP activity and epidermal stem cells in vitro and in vivo. In JEB cells, enforced YAP recapitulates laminin 332-gene therapy, thus uncoupling adhesion from proliferation in epidermal stem cells. This work has important clinical implication for ex vivo gene therapy of JEB. : Gene therapy of junctional epidermolysis bullosa is hampered by the epidermal stem cell loss marking this disease. De Rosa et al. find that YAP dysregulation underpins such loss, which is recapitulated by laminin 332 and α6β4 integrin ablation. Combined cell and gene therapy rescues adhesion, YAP function, and stem cells. Keywords: epidermal stem cells, epidermolysis bullosa, YAP, cell and gene therapy

Solar field developers include innovative solutions to optimize the energy production of their plants. Simulation tools play a significant role in the design and testing phases as they provide estimations of this yield in different conditions. Transient processes, like passing clouds and solar field start-up, are specifically challenging to optimize and estimate using such simulation tools. Solar fields are subject to high degree of both temporal and spatial variability in the energy input and a detailed estimation can be achieved by simulating subsystems within acceptable time and computational power. Hence, such simulation tools cannot be utilized for tests under realistic operation conditions. The Virtual Solar Field is a computationally efficient simulation tool that allows a detailed transient simulation of parabolic trough solar fields based on single-phase fluids. Using this tool, developers could reproduce a transient test case with exactly the same disturbances to provide fair comparisons between different configurations. In this paper, an evaluation process based on numerical simulations using the Virtual Solar Field is presented. The economic benefit of novel innovative control concepts can be assessed according to the presented scheme. This is demonstrated by evaluating the potential benefit of availability of spatial DNI nowcasts on the control of parabolic trough solar fields. Results show that nowcasting can increase the economic revenue of commercial power plants by up to 2.5% per day. This proves the feasibility of installing such systems.

Environmental and economic needs drive the increased penetration of intermittent renewable energy in electricity grids, enhancing uncertainty in the prediction of market conditions and network constraints. Thereafter, the importance of energy systems with flexible dispatch is reinforced, ensuring energy storage as an essential asset for these systems to be able to balance production and demand. In order to do so, such systems should participate in wholesale energy markets, enabling competition among all players, including conventional power plants. Consequently, an effective dispatch schedule considering market and resource uncertainties is crucial. In this context, an innovative dispatch optimization strategy for schedule planning of renewable systems with storage is presented. Based on an optimization algorithm combined with a machine-learning approach, the proposed method develops a financial optimal schedule with the incorporation of uncertainty information. Simulations performed with a concentrated solar power plant model following the proposed optimization strategy demonstrate promising financial improvement with a dynamic and intuitive dispatch planning method (up to 4% of improvement in comparison to an approach that does not consider uncertainties), emphasizing the importance of uncertainty treatment on the enhanced quality of renewable systems scheduling.

Weather forecast uncertainty is a key element for energy market volatility. By intelligently considering uncertainties on the schedule development, renewable energy systems with storage could improve dispatching accuracy, and therefore, effectively participate in electricity wholesale markets. Deterministic forecasts have been traditionally used to support dispatch planning, representing reduced or no uncertainty information about the future weather. Aiming at better representing the uncertainties involved, probabilistic forecasts have been developed to increase forecasting accuracy. For the dispatch planning, this can highly influence the development of a more precise schedule. This work extends a dispatch planning method to the use of probabilistic weather forecasts. The underlying method used a schedule optimizer coupled to a post-processing machine learning algorithm. This machine learning algorithm was adapted to include probabilistic forecasts, considering their additional information on uncertainties. This post-processing applied a calibration of the planned schedule considering the knowledge about uncertainties obtained from similar past situations. Simulations performed with a concentrated solar power plant model following the proposed strategy demonstrated promising financial improvement and relevant potential in dealing with uncertainties. Results especially show that information included in probabilistic forecasts can increase financial revenues up to 15% (in comparison to a persistence solar driven approach) if processed in a suitable way.

In vitro–generated soft tissue could provide alternate therapies for soft tissue defects. The aim of this study was to evaluate methacrylated gelatin/hyaluronan as scaffolds for soft tissue engineering and their interaction with human adipose–derived stem cells (hASCs). ASCs were incorporated into methacrylated gelatin/hyaluronan hydrogels. The gels were photocrosslinked with a lithium phenyl-2,4,6-trimethylbenzoylphosphinate photoinitiator and analyzed for cell viability and adipogenic differentiation of ASCs over a period of 30 days. Additionally, an angiogenesis assay was performed to assess their angiogenic potential. After 24 h, ASCs showed increased viability on composite hydrogels. These results were consistent over 21 days of culture. By induction of adipogenic differentiation, the mature adipocytes were observed after 7 days of culture, their number significantly increased until day 28 as well as expression of fatty acid binding protein 4 and adiponectin. Our scaffolds are promising as building blocks for adipose tissue engineering and allowed long viability, proliferation, and differentiation of ASCs.

Although bone regeneration is typically a reliable process, type 2 diabetes is associated with impaired or delayed healing processes. In addition, angiogenesis, a crucial step in bone regeneration, is often altered in the diabetic state. In this study, different stages of bone regeneration were characterized in an unicortical bone defect model comparing transgenic type 2 diabetic (db-/db-) and wild type (WT) mice in vivo. We investigated angiogenesis, callus formation and bone remodeling at early, intermediate and late time points by means of histomorphometry as well as protein level analyses. In order to enhance bone regeneration, defects were locally treated with recombinant FGF-9 or VEGFA. Histomorphometry of aniline blue stained sections indicated that bone regeneration is significantly decreased in db-/db- as opposed to WT mice at intermediate (5 days post operation) and late stages (7 days post operation) of bone regeneration. Moreover, immunohistochemical analysis revealed significantly decreased levels of RUNX-2, PCNA, Osteocalcin and PECAM-1 in db-/db- defects. In addition, osteoclastogenesis is impaired in db-/db- indicating altered bone remodeling. These results indicate significant impairments in angiogenesis and osteogenesis in type 2 diabetic bones. Importantly, angiogenesis, osteogenesis and bone remodeling could be reconstituted by application of recombinant FGF-9 and, in part, by VEGFA application. In conclusion, our study demonstrates that type 2 diabetes affects angiogenesis, osteogenesis and subsequently bone remodeling, which in turn leads to decreased bone regeneration. These effects could be reversed by local application of FGF-9 and to a lesser degree VEGFA. These data could serve as a basis for future therapeutic applications aiming at improving bone regeneration in the type 2 diabetic patient population.

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

The paired leg and pelvic veins as well as the gonadal and renal veins flow into the unpaired inferior vena cava. The abdominal aorta splits into two iliac branches. This results in numerous crossings of the closely adjacent vessels and causes hemodynamic effects. The reason behind this lies in the embryological development. Early on in human development, primitive arteries and veins form from a capillary network. The limb, renal and testicular veins as well as the inferior vena cava develop from the cardinal vein system and are initially created in pairs. Remodelling and regression processes in the cardinal venous system during embryonic development explain the special anatomy of the retroperitoneal veins as well as the pathophysiological conditions underlying the various forms of PeVD. [Turk J Vasc Surg 2023; 32(0.000): 22-3]