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Ideal agents for the topical treatment of skin wounds should have antimicrobial efficacy without negative influence on wound healing. Octenidine (OCT) has become a widely used antiseptic in professional wound care, but its influence on several components of the wound healing process remains unclear. In the present study, we have used a superficial wound model using tape stripping on human full-thickness skin ex vivo to investigate the influence of OCT on epidermal Langerhans cells (LCs) and cytokine secretion pattern of skin cells during wound healing in a model without disruption of the normal skin structure. Histological and immunofluorescence studies showed that OCT neither altered human skin architecture nor the viability of skin cells upon 48 hours of culture in unwounded or wounded skin. The epidermis of explants and LCs remained morphologically intact throughout the whole culture period upon OCT treatment. OCT inhibited the upregulation of the maturation marker CD83 on LCs and prevented their emigration in wounded skin. Furthermore, OCT reduced both pro- and anti-inflammatory mediators (IL-8, IL-33, and IL-10), while angiogenesis and growth factor mediators (VEGF and TGF-β1) remained unchanged in skin explant cultures. Our data provide novel insights into the host response to OCT in the biologically relevant environment of viable human (wounded) skin.

Summary Background Various measures are considered to reduce the risk of surgical site infection (SSI), including preoperative decolonization. Details of preoperative decolonization practices in surgical departments have not been investigated in Austria. Aim To analyse the current situation of pre-surgical patient decolonization in national hospitals and to assess the current knowledge on this procedure among surgeons of different surgical disciplines. Methods A 12-point structured questionnaire was distributed to all Austrian hospitals with at least one surgical department. Findings Two-thirds (103/158; 65%) of responding surgeons stated that any type of preoperative decolonization is implemented in their surgical department. There was heterogeneity of different protocols, ranging from decolonization of only known S. aureus carriers, of a subgroup of patients, or universal decolonization of all patients before elective surgery. Octenidine was the most frequently used antimicrobial compound (60.2%), followed by mupirocin (38.8%), triclosan (14.6%), polyhexanide (12.6%), chlorhexidine (11.7%), and didecyldimonium chloride (7.8%). Conclusion Preoperative decolonization seems to be performed in Austrian hospitals on a routine basis. However, this measure is implemented using a variety of modalities, antimicrobial compounds, and staff. Since our survey also demonstrated that those who are better informed about preoperative decolonization are also those who are more convinced of the usefulness of the preventive measure, future activities should not only focus on generating more comparable studies in this field, but should also include targeted education.

Blepharoplasty is the third most common plastic surgical procedure in the USA. Due to the emergence of multiresistant bacteria, optimising the antiseptic procedure is crucial. Choice of antiseptics plays an important role as they may cause skin irritation and colouring of disinfected areas. In this study, the use of the aqueous antiseptic octenisept® (octenidine) was evaluated in the outcome of blepharoplasties: incidence of wound dehiscence; haematoma; and infection in correlation with gender, medication, smoking habits and time of year. This retrospective surveillance study included 352 patients (median age 58·3 years). Skin disinfection was performed thrice prior to blepharoplasty. Sutures were removed on day 6. None of the patients suffered from wound infection. The total rate of wound dehiscence was 6·3%, with a higher ratio among male patients. Smokers and patients on anticoagulant medication showed a significantly higher incidence of wound dehiscence. Throughout the year, rates of wound dehiscence were highest in summer. Aseptic surgical preparation for blepharoplasty via full-face scrub with octenisept® without oral antibiotic prophylaxis is well tolerated, with no report of wound infection, which may improve antibiotic stewardship as well as patient comfort. Elective upper eyelid blepharoplasty may ideally be performed in winter.

The development of pressure sores is still not only an enormous economical but also a medical burden. Especially in the ischial region, the local defect coverage remains demanding as it is the main weight-bearing area in wheelchair-mobilised patients and is prone to high mobility. The purpose of our study was to report our long-time experience with the reconstruction of ischial pressure ulcers with the medially based posterior thigh flap. A retrospective analysis of all primary pressure sores grade III-IV in the ischial area, which were covered with a medially based posterior thigh flap between January 2008 and December 2014, at our department was conducted. A total of 28 patients underwent defect coverage of an ischial pressure sore with the aforementioned flap. The subgroup with complications showed a statistically significant longer hospital stay. A statistically significant correlation between age and the coincidence of comorbidities could be seen. Older patients showed significantly higher grades of pressure sores. The medially based posterior thigh flap is a safe and reliable flap design. Complication rates are comparable to other flaps. Nevertheless, in case of complications, a significantly longer duration of hospitalisation has to be taken into account.

Objective: The aim of this study was to investigate the bacterial bioburden in experimental in vitro wounds during the application of conventional negative pressure wound therapy (NPWT), with and without antimicrobial dressings (polyhexanide, silver), against NPWT instillation of octenidine. Method: Experimental wounds produced in an in vitro porcine wound model were homogenously contaminated with bacterial suspension and treated with NPWT and different options. Group A: non-antimicrobial polyurethane foam dressing; group B: antimicrobial polyurethane foam dressing containing silver; group C: antimicrobial gauze dressing containing polyhexanide; group D: non-antimicrobial polyurethane foam dressing intermittently irrigated with octenidine; group E: negative control (non-antimicrobial polyurethane foam dressing without NPWT). Standard biopsies were harvested after 24 and 28 hours. Results: This study demonstrated that the use of NPWT with intermitted instillation of octenidine (group D) or application of silver-based polyurethane foam dressings (group B) is significantly superior against Staphylococcus aureus colonisation in experimental wounds compared with non-antimicrobial polyurethane foam dressing (group A) after 48 hours. Surprisingly, the polyhexanide-based dressing (group C) used in this model showed no statistical significant effect compared with the control group (group E) after 24 or 48 hours of treatment. Conclusion: Both intermitted instillation of octenidine and silver-based dressings in standard NPWT were significantly superior compared with non-antimicrobial polyurethane foam dressings or PHMB coated gauze dressing after 48 hours.

Soft tissue defects in the genito-perineal region are predominantly because of trauma, infections, neoplasms or iatrogenic causes. As a result of the region's urological, reproductive and gastrointestinal function, defects in this area may cause devastating physical and psychological consequences as well as diminished sexual functioning. The purpose of this study was to examine the efficacy of implementing a medial thigh lift for defect coverage in the perineal region. A retrospective analysis of all medial thigh lift procedures for defect coverage in the genito-perineal region between November 2010 and March 2015 was conducted at three institutions. Ten consecutive patients underwent a medial thigh lift for defect coverage in the genito-perineal region. Nine patients were male, and one was female. The causative factors were Fournier's gangrene in eight patients, one patient had a straddle injury, and one suffered from extramammary Paget's disease. The mean follow-up time was 19·8 months. The average total defect size was 11·1 × 11 cm (length × width). The medial thigh lift procedure is a safe, technically easy and reliable technique with discrete scars. Outstanding aesthetic and functional outcomes result in a high rate of patient satisfaction. Through immediate wound closure, a reduction of recovery time can be achieved.

After debridement and before dressing a wound with maggots of calliphorid flies, one frequently performed step is the application of antiseptics to the prepared wound bed. However, the concomitant application of antiseptic agents during maggot therapy is regarded controversial as antiseptics may interfere with maggots' viability. In this experimental in vitro study, the viability of fly maggots was investigated after exposure to various antiseptics frequently used in wound care. Here, we show that Lucilia sericata fly maggots can survive up to an hour's exposure to wound antiseptics such as octenidine, povidone-iodine or polihexanide. Concomitant short-term application of wound antiseptics together with maggots on wound beds is tolerated by larvae and does not impair their viability.

Skin defects of the penile shaft, caused by trauma, infection, or iatrogenically after surgery are commonly treated with skin grafts. A suboptimal postoperative outcome after the use of skin grafts is affected by the trend towards wound bed and skin graft contraction in this often-expanding region. We report on our experience using a new technique for defect coverage of the penile shaft with respect to its elasticity demands during erection and its mechanical demands during sexual intercourse. Furthermore we would like to illustrate the advantages of the application of a dermal substitute together with split-thickness skin grafts compared to the use of split-thickness skin grafts alone. At the follow-up, the patient did not report any impairment during erection or after sexual intercourse. The aesthetic outcome was natural and pleasing. The use of acellular dermal templates together with unmeshed split-thickness skin grafts has proven its superior functional and aesthetic outcome in several demanding regions. With the aid of negative-pressure wound therapy, a single procedure for penile defect coverage is possible. Our reported procedure revealed a natural and pleasing outcome, with no sexual impairment and high patient satisfaction. Level of Evidence: Level V, therapeutic study

Following my prior study of long-term results after laparoscopic gastric banding concerning operative outcome and complications involving the gastric band itself, I now focus on long-term quality-of-life improvement in the same study group after body-contouring surgery. As determined from our electronic patient data system, 72 patients from the former study group subsequently sought body-contouring surgery at our hospital after successful weight loss. Patients were enrolled in a telephone interview and asked about their expectations and body image before and after postbariatric aesthetic surgery and how it altered their well-being in addition to the weight loss achieved with the gastric band. All patients undergoing postbariatric aesthetic surgery felt extremely uneasy with the hanging skin resulting from weight reduction. Patients cannot imagine the degree of dissatisfaction they will experience from the sagging skin that comes with weight loss. Hardly any patient expected fewer scars than he ultimately had after body-contouring surgery and reported an extreme improvement in body image. Gastric banding should not be performed without informing patients about the need for postbariatric body-contouring surgery, because most patients not forewarned suffer greatly from their body image after weight loss.

Effective wound bed preparation is an essential element in the healing of chronic wounds, including pressure ulcers (PUs). Negative pressure wound therapy (NPWT) reduces oedema, stimulates the formation of granulation tissue and helps remove wound exudate. This helps prepare the wound bed for secondary healing, skin grafting or coverage with flaps. Combining NPWT with an instillation phase using an antiseptic (octenidine based) irrigation solution is a novel approach to PU management. Three patients with Category 4 gluteal PUs were treated with NPWT and instillation fluid, following surgical debridement of necrotic tissue. The aim was to achieve optimal wound bed preparation prior to wound closure by local fasciocutaneous flap. The antiseptic efficacy of octenilin wound irrigation solution in microorganism eradication was quantified by in vitro tests simulating real conditions using leg ulcer vacuum exudates. All wounds completely healed after four weeks, and no adverse incidents occurred due to instillation of octenidine. No recurrence of the PU occurred during a one year follow-up. Declaration of interest: The study was performed independently with no external financial support. The authors have no conflicts of interest to declare with regards to the article or its content.

After debridement and before dressing a wound with maggots of calliphorid flies, one frequently performed step is the application of antiseptics to the prepared wound bed. However, the concomitant application of antiseptic agents during maggot therapy is regarded controversial as antiseptics may interfere with maggots' viability. In this experimental in vitro study, the viability of fly maggots was investigated after exposure to various antiseptics frequently used in wound care. Here, we show that Lucilia sericata fly maggots can survive up to an hour's exposure to wound antiseptics such as octenidine, povidone‐iodine or polihexanide. Concomitant short‐term application of wound antiseptics together with maggots on wound beds is tolerated by larvae and does not impair their viability.

Automatic speech recognition (ASR) has become a valuable tool in large document production environments like medical dictation. While manual post-processing is still needed for correcting speech recognition errors and for creating documents which adhere to various stylistic and formatting conventions, a large part of the document production process is carried out by the ASR system. For improving the quality of the system output, knowledge about the multi-layered relationship between the dictated texts and the final documents is required. Thus, typical speech-recognition errors can be avoided, and proper style and formatting can be anticipated in the ASR part of the document production process. Yet - while vast amounts of recognition results and manually edited final reports are constantly being produced - the error-free literal transcripts of the actually dictated texts are a scarce and costly resource because they have to be created by manually transcribing the audio files. To obtain large corpora of literal transcripts for medical dictation, we propose a method for automatically reconstructing them from draft speech-recognition transcripts plus the corresponding final medical reports. The main innovative aspect of our method is the combination of two independent knowledge sources: phonetic information for the identification of speech-recognition errors and semantic information for detecting post-editing concerning format and style. Speech recognition results and final reports are first aligned, then properly matched based on semantic and phonetic similarity, and finally categorised and selectively combined into a reconstruction hypothesis. This method can be used for various applications in language technology, e.g., adaptation for ASR, document production, or generally for the development of parallel text corpora of non-literal text resources. In an experimental evaluation, which also includes an assessment of the quality of the reconstructed transcripts compared to manual transcriptions, the described method results in a relative word error rate reduction of 7.74% after retraining the standard language model with reconstructed transcripts.

The impaired compliance of large and medium-sized muscular arteries has been shown to correlate with the risk of adverse cardiovascular events. We assessed coronary artery distensibility using simultaneous intracoronary ultrasound and pressure wire measurements in porcine coronary arteries after implantation of paclitaxel-eluting (PES) and bare metal stents (BMS) and compared this with the histopathology of the arterial wall injury.PES and BMS were implanted into porcine left coronary arteries under general anesthesia. At 1-month follow-up (FUP) the endothelium-dependent and endothelium-independent vascular compliances were measured after intracoronary infusion of 10(-6)M acetylcholine for 2.5min, and intracoronary bolus of 100microg nitroglycerine, respectively. The arterial stiffness index, distensibility and reflexion index were calculated in stented arteries (n=25 PES and n=25 BMS), and correlated with histopathologic and histomorphometric changes of the vessel wall.In spite of smaller neointimal area, the fibrin deposition, medial thickening, vascular wall inflammation scores and arterial remodeling index were elevated and endothelialization was impaired in arteries with PES. Arteries with PES exhibited significantly worse endothelium-dependent vascular compliance: the stiffness (p0.001) and reflexion index (p0.001) were significantly higher and the distensibility index (p0.001) lower as compared with the arteries with BMS. The endothelium-independent vascular reaction was similarly impaired in arteries with PES, as the stiffness index (p0.001) and the distensibility index (p0.001) differed significantly between the PES and BMS groups. Incomplete endothelialization (r=0.617, p0.001) was significantly associated with the endothelium-dependent increased vascular stiffness. The increased fibrin score (r=0.646, p0.001), vessel wall inflammation (r=0.657, p0.001) and medial thickening (r=0.672, p0.001) correlated significantly with the endothelium-independent stiffness index.Implantation of PES impairs the coronary artery wall structure and the endothelium-dependent and independent vessel wall dynamics more than does the implantation of BMS.

Skin transplantation is a commonly used surgical technique; however, the complication rate, including postoperative infection and delayed wound healing due to inefficient perfusion, is significantly higher in patients suffering from comorbidities. Hence, a subsequent repeat procedure is often necessary. In this report, two case studies are presented in which an octenidine-based antiseptic is used with a tie-over dressing (TOD) instead of povidone iodine (PVP-iodine), following a split-thickness skin graft. The two patients selected were deemed to be at high risk of impaired wound healing due to comorbidities. The first patient, a confirmed smoker with diabetes, presented with a nodular melanoma that was resected and covered with a split-thickness skin graft. After 5 days of negative pressure wound therapy as a TOD, in combination with PVP-iodine, the graft became necrotic. A second split-thickness skin graft was performed and an antiseptic regimen with octenidine in combination with the same TOD resulted in a completely healed transplant. The second patient, also a confirmed smoker with diabetes and receiving oral corticosteroid treatment, was diagnosed with a skin necrosis on her leg. Following the split-thickness skin graft, octenidine and TOD were applied. The patient's skin graft completely healed without any adverse events. These two case studies indicate that the combination of octenidine and TOD following split-thickness skin transplantation is safe, well-tolerated and appears to have positive benefits in the reconstruction of defects in patients with impaired wound healing.

To evaluate the development of neointimal hyperplasia after implantation of drug-eluting stents (paclitaxel) compared to bare metal stents in porcine internal carotid arteries (ICAs).While drug-eluting stents have effectively reduced neointimal proliferation in porcine external carotid arteries, the porcine internal carotid artery (ICA) is more sensitive to shear stress and altered flow conditions. Thus, a study was conducted to evaluate bare vs. drug-eluting stents in porcine ICAs. Under general anesthesia, 18 domestic pigs were implanted with paclitaxel-eluting (n = 18) and bare (n = 18) stents in the left and right ICAs, respectively. After 1 and 3 months, control carotid angiography was performed, followed by histopathological and histomorphometric analyses of the stented ICA.Histopathological results (fibrin deposition, necrosis, inflammation) were similar in the groups at 1 and 3 months. Moreover, the injury score and rate of endothelialization did not differ between the groups. Histomorphometric analysis after 1 month revealed significantly (p0.05) less neointimal hyperplasia after implantation of paclitaxel-eluting stents. The antiproliferative effect of paclitaxel-eluting stents were maintained during the 3-month follow-up: the neointimal area was 0.7 ± 0.5 vs. 1.2 ± 0.6 mm(2) (p0.01), the area stenosis was 23.5% ± 13.9% vs. 37.8% ± 14.4% (p0.01), the maximal neointimal thickness was 0.2 ± 0.1 vs. 0.2 ± 0.9 mm (p0.05) in paclitaxel-eluting vs. bare stents, respectively. Implantation of paclitaxel-eluting and bare stents did not lead to edge restenosis or vessel remodeling in porcine ICAs at 1 or 3 months.Compared to bare metal stents, drug-eluting stents implanted in the porcine ICA produced significantly less neointimal hyperplasia.

In this paper, we describe the use of lexical and semantic features for topic classification in dictated medical reports. First, we employ SVM classification to assign whole reports to coarse work-type categories. Afterwards, text segments and their topic are identified in the output of automatic speech recognition. This is done by assigning work-type-specific topic labels to each word based on features extracted from a sliding context window, again using SVM classification utilizing semantic features. Classifier stacking is then used for a posteriori error correction, yielding a further improvement in classification accuracy.

Automatic processing of medical dictations poses a significant challenge. We approach the problem by introducing a statistical framework capable of identifying types and boundaries of sections, lists and other structures occurring in a dictation, thereby gaining explicit knowledge about the function of such elements. Training data is created semi-automatically by aligning a parallel corpus of corrected medical reports and corresponding transcripts generated via automatic speech recognition. We highlight the properties of our statistical framework, which is based on conditional random fields (CRFs) and implemented as an efficient, publicly available toolkit. Finally, we show that our approach is effective both under ideal conditions and for real-life dictation involving speech recognition errors and speech-related phenomena such as hesitation and repetitions.

Hand hygiene is acknowledged as the single most important measure to prevent nosocomial infections in the healthcare setting. Similarly, in non-clinical settings, hand hygiene is recognised as a key element in helping prevent the spread of infectious diseases. The aim of this study was to evaluate the efficacy of three different disinfectant hand sanitizers in reducing the burden of bacterial hand contamination in 60 healthy volunteers in a community setting, both before and after education about the correct use of hand sanitizers. The study is the first to evaluate the efficacy and ease of use of different formulations of hand rubs used by the general population. The products tested were: Sterillium (perfumed, liquid), desderman pure gel (odorless, gel) and Lavit (perfumed, spray). Sterillium and desderman are EN1500 (hygienic hand rub) certified products (available in pharmacy) and Lavit is non EN1500 certified and available in supermarkets. The two EN1500 certified products were found to be significantly superior in terms of reducing bacterial load. desderman pure gel, Sterillium and Lavit reduced the bacterial count to 6.4%, 8.2% and 28.0% respectively. After education in the correct use of each hand rub, the bacterial load was reduced even further, demonstrating the value of education in improving hand hygiene. Information about the testers' perceptions of the three sanitizers, together with their expectations of a hand sanitizer was obtained through a questionnaire. Efficacy, followed by skin compatibility were found to be the two most important attributes of a hand disinfectant in our target group.

In this paper, we report about some preliminary experiments in which we tried to improve the performance of a state-of-the-art Predictive Typing system for the German language by adding a collocation-based prediction component. This component tries to exploit the fact that texts have a topic and are semantically coherent. Thus, the appearance in a text of a certain word can be a cue that other, semantically related words are likely to appear soon. The collocation-based module exploits this kind of topical/semantic relatedness by relying on statistics about the co-occurrence of words within a large window of text in the training corpus. Our current experimental results indicate that using the collocation-based prediction module has a small but consistent positive effect on the performance of the system.

We present an algorithm that takes an unannotated corpus as its input, and returns a ranked list of probable morphologically related pairs as its output. The algorithm tries to discover morphologically related pairs by looking for pairs that are both orthographically and semantically similar, where orthographic similarity is measured in terms of minimum edit distance, and semantic similarity is measured in terms of mutual information. The procedure does not rely on a morpheme concatenation model, nor on distributional properties of word substrings (such as affix frequency). Experiments with German and English input give encouraging results, both in terms of precision (proportion of good pairs found at various cutoff points of the ranked list), and in terms of a qualitative analysis of the types of morphological patterns discovered by the algorithm., Comment: 10 pages, to appear in the Proceedings of the Morphology/Phonology Learning Workshop of ACL-02

In word prediction systems for augmentative and alternative communication (AAC), productive word-formation processes such as compounding pose a serious problem. We present a model that predicts German nominal compounds by splitting them into their modifier and head components, instead of trying to predict them as a whole. The model is improved further by the use of class-based modifier-head bigrams constructed using semantic classes automatically extracted from a corpus. The evaluation shows that the split compound model with class bigrams leads to an improvement in keystroke savings of more than 15% over a no split compound baseline model. We also present preliminary results obtained with a word prediction model integrating compound and simple word prediction.

Communication and information exchange is a vital factor in human society. Communication disorders severely influence the quality of life. Whereas experienced typists will produce some 300 keystrokes per minute, persons with motor impairments achieve only much lower rates. Predictive typing systems for English speaking areas have proven useful andefficien t, but for all other European languages there exist no predictive typing programs powerful enough to substantially improve the communication rate andthe IT access for disabledp ersons. FASTY aims at offering a communication support system significantly increasing typing speed, adaptable to users with different language and strongly varying needs. In this way the large group of non-English-speaking disabled citizens will be supported in living a more independent and self determined life.

We describe the development of a generator for German built by reusing and adapting existing linguistic data and software. Reusability is crucial for the successful application of NLP techniques to real-life problems since it helps to cut down on both development and adaptation effort. However, combining resources not designed to work together is not trivial. We describe the problems arising when integrating three preexisting resources (FUF, a unification-based generator, an HPSG Grammar for German, and X2MorF, a two-level morphology component) and the adaptations necessary to come up with a wide coverage tactical generator for German.

Datenbank-DIALOG is a German language interface for relational databases. Its goal is to provide easy and efficient access to the contents of such a database for casual users. The user has only to type in his or her question in plain German and the system will respond properly. This is much easier than using a formal query language and more flexible than a menu-type or graphic interaction. Datenbank-DIALOG was designed to be as portable as possible, in particular with regard to the application domains as well as the database management system and the operating system of the supporting computer. Equally important was good coverage of the subset of German relevant for database retrieval. German was chosen because we feel that at present it is not feasible to design a parser adaptable to different natural languages, at least not in a satisfying manner. As a result of this specialization Datenbank-DIALOG imposes almost no syntactic restrictions on the user, and care has been taken to make the semanti...

One main task of a natural language interface to a relational database is to map the semantic structures created by the parser onto database relations by translating them into statements of the query language. In this paper we present a method which employs an intermediate logical representation based on the theory of Generalized Quantifiers. These theoretical foundations provide the framework for an effective and straightforward implementation.