Search

This study employs qualitative methodology to assess surgeons' perspective on decision making in management of recurrent diverticulitis to improve patient-centered decision making.The decision to pursue colectomy for patients with recurrent diverticulitis is nuanced. Strategies to enact broad acceptance of guidelines for surgery are hindered because of a knowledge gap in understanding surgeons' current attitudes and opinions.We performed semi-structured interviews with board-certified North American general and colorectal surgeons who manage recurrent diverticulitis. We purposely sampled specialists by both surgeon and practice factors. An iterative inductive/deductive strategy was used to code and analyze the interviews and create a conceptual framework.25 surgeons were enrolled over a nine-month period. There was diversity in surgeons' gender, age, experience, training, specialty (colorectal vs general surgery) and geography. Surgeons described the difficult process to determine who receives an operation. We identified seven major themes as well as twenty subthemes of the decision-making process. These were organized into a conceptual model. Across the spectrum of interviews, it was notable that there was a move over time from decisions based on counting episodes of diverticulitis to a focus on improving quality of life. Surgeons also felt that quality of life was more dependent on psychosocial factors than the degree of physiological dysfunction. [What about what surprised you/].Surgeons mostly have discarded older dogma in recommending colectomy for recurrent diverticulitis based on number and severity of episodes. Instead, decision making in recurrent diverticulitis is complex, involving multiple surgeon and patient factors and evolving over time. Surgeons struggle with this decision and education- or communication-based interventions that focus on shared decision making warrant development.

AimsThis study assessed gender differences in a debilitating urologic pain condition, interstitial cystitis/bladder pain syndrome (IC/BPS). We aimed to (1) evaluate how pain, symptom, and distress profiles of IC/BPS may differ between genders and (2) obtain in-depth firsthand accounts from patients to provide additional insight into their experiences that may explain potential gender differences.MethodsA mixed methods approach combined validated patient-reported outcome measures with a single timepoint 90-min focus group. Tests of summary score group differences between men and women were assessed across questionnaires measuring urologic symptoms, pain, emotional functioning, and diagnostic timeline. Qualitative analysis applied an inductive-deductive approach to evaluate and compare experiences of living with IC/BPS Group narratives were coded and evaluated thematically by gender using the biopsychosocial model, providing insight into the different context of biopsychosocial domains characterizing the male and female experience of IC/BPS.ResultsThirty-seven participants [women (n = 27) and men (n = 10)] completed measures and structured focus group interviews across eight group cohorts conducted from 8/2017 to 3/2019. Women reported greater pain intensity (p = 0.043) and extent (p = 0.018), but not significantly greater impairment from pain (p = 0.160). Levels of psychological distress were significantly elevated across both genders. Further, the duration between time of pain symptom onset and time to diagnosis was significantly greater for women than men (p = 0.012). Qualitative findings demonstrated key distinctions in experiences between genders. Men appeared not to recognize or to deter emotional distress while women felt overwhelmed by it. Men emphasized needing more physiological treatment options whilst women emphasized needing more social and emotional support. Interactions with medical providers and the healthcare system differed substantially between genders. While men reported feeling supported and involved in treatment decisions, women reported feeling dismissed and disbelieved.ConclusionThe findings indicate different pain experiences and treatment needs between genders in persons experiencing urologic pain and urinary symptoms, with potential intervention implications. Results suggest gender health inequality in medical interactions in this urologic population needing further investigation.

Research confirms the heterogeneous nature of patient challenges during recovery from the ICU and supports the need for modifying care experiences, but few data are available to guide clinicians seeking to support patients' individual recovery trajectories.What is the content of patient-provider dialogues in a telemedicine multidisciplinary ICU recovery clinic (ICU-RC)?We conducted a qualitative descriptive study in a telemedicine multidisciplinary ICU-RC at a tertiary academic medical center in the southeastern United States. The sample included 19 patients and 13 caregivers (≥ 18 years of age) attending a telemedicine ICU-RC visit after critical illness resulting from septic shock or ARDS. Patients and caregivers met with an ICU pharmacist, ICU physician, and a psychologist via a secure web-conferencing platform for 33 ICU-RC visits within 12 weeks of hospital discharge. Telemedicine ICU-RC visits were audio-recorded and transcribed verbatim for analysis. A coding system was developed using iterative inductive and deductive approaches.Two themes were identified from the patient-provider dialogue: (1) problem identification and (2) problem-solving strategies. We identified five subthemes that capture the types of problems identified: health status, mental health and cognition, medication management, health-care access and navigation, and quality of life. Problem-solving subthemes included facilitating care coordination and transitions, providing education, and giving constructive feedback and guidance.Patients surviving a critical illness experience a complexity of problems that may be addressed best by a multidisciplinary ICU-RC. Through analysis of our telemedicine ICU-RC dialogues, we were able to identify problems and solutions to address challenges during a critical transitional phase of ICU recovery.ClinicalTrials.gov; No.: NCT03926533; URL: www.gov.

Telehealth is the use of electronic information and technology for long-distance clinical care. In direct-to-patient (DTP) telehealth, the patient initiates care from a personal computer or mobile device to a medical provider. While information on standard clinic-to-clinic telehealth exists, less is known about DTP telehealth in pediatric populations. Using quantitative and qualitative data, we examined DTP telehealth for low-income pediatric patient-families and compared the experience of English and non-English speakers.Telehealth visits for acute and preventive care took place from April 2020 to May 2020 at a pediatric primary care clinic (80% Medicaid-insured, 40% non-English-speaking). Patients and primary care providers conducted the visit through the clinic's portal or other platforms (WhatsApp, FaceTime, Zoom). Providers completed an electronic survey with patient feedback about the telehealth experience and their own observations. An iterative inductive/deductive approach informed a coding scheme for free-text survey responses consisting of five domains.REDCap surveys were completed for 258 (52%) of telehealth visits. There was an overrepresentation of English visits compared to the overall clinic population and the majority of visits were via mobile phone. Visits with English speakers utilized the patient portal and had positive process ease ratings more often than those with non-English speakers. Providers rated most telehealth visits as satisfactory, with contributing elements including family call environment, technology process and experience, value added, and barriers.Expanding telehealth in pediatrics without worsening health disparities requires building digital health that is user-friendly on mobile technology, facilitating patient preferred language, and simplifying logistical processes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Tissue specimens are valuable materials for microbiological diagnosis. The method of tissue processing can have a significant effect on sensitivity. This study aimed to compare different biopsy processing methods in terms of efficacy and standardization. Pork tissue artificially inoculated with Staphylococcus aureus and Escherichia coli, and samples of infected human tissue were processed by different methods before culture, and the results compared. Bacterial recovery from artificially inoculated pork tissue was significantly higher by homogenization with GentleMacs Dissociator than with sonication. No significant difference was observed between the GentleMacs Dissociator and manual treatment with a scalpel and vortexing. The microbial yield from homogenized human tissues was significantly higher after homogenization with GentleMacs Dissociator than with the conventional method. Homogenization with the GentleMacs Dissociator retrieves bacteria from tissue effectively. Tissue homogenization with the Dissociator is easy and fast to perform and allows for a high degree of standardization.

Antibiotics are frequently prescribed for children in the outpatient setting. Although sometimes necessary, antibiotic use is associated with important downstream effects including the development of antimicrobial resistance among human and environmental microorganisms. Current outpatient stewardship efforts focus on guiding appropriate antibiotic prescribing practices among providers, but little is known about parents’ understanding of antibiotics and appropriate disposal of leftover antibiotics. To help bridge this gap, we conducted a qualitative study to assess parental understanding of their children’s antibiotics, their adherence to antibiotic instructions, and their disposal practices. We conducted a semi-structured interview with parents of 13 children diagnosed with acute respiratory illnesses and prescribed antibiotics in an urban outpatient clinic. We found that parents had limited understanding of how antibiotics work. Although they received instructions about antibiotic use during the healthcare visit, adherence to the prescription and appropriate disposal of antibiotics was suboptimal. Limited baseline understanding of antibiotics, their prior experiences with antibiotics, perceptions about their social networks’ antibiotic use, and information provided to them by healthcare providers may influence these behaviors. Our findings can inform educational efforts of outpatient stewardship programs to help optimize parental understanding of how to use and dispose of their children’s antibiotics.

Purpose: Lung cancer is the leading cause of cancer death in the U.S. Lung cancer screening significantly reduces lung cancer mortality, but national uptake is low ( Citation Format: Jennifer Richmond, Jessica R. Fernandez, Kemberlee R. Bonnet, Maria A. Pena, Allana T. Forde, David G. Schlundt, Consuelo H. Wilkins, Melinda C. Aldrich. Evaluating medical mistrust in efforts to promote equity in lung cancer screening implementation [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A116.

In 2016, the Patient-Centered Outcomes Research Institute funded the National Patient Centered Clinical Research Network (PCORnet) Bariatric Study (PBS). Understanding the experience of postoperative patients was a key component of this study. Nine focus groups were conducted in Southern California, Louisiana, Pennsylvania, and Ohio and in a national advocacy conference for patients with obesity. Participants were identified and recruited in both clinical and community settings. Focus group transcripts were analyzed using an iterative inductive-deductive approach to identify global overarching themes. There were 76 focus group participants. Participants were mostly women (81.4%), had primarily undergone gastric sleeve (47.0%), were non-Hispanic white (51.4%), had some college education (44.3%), and made $100,000 annual income or less (65.7%). Qualitative findings included negative reactions patients received from friends, family, and co-workers once they disclosed that they had bariatric surgery to lose weight; and barriers to follow-up care included insurance coverage, emotional and situational challenges, and physical pain limiting mobility. These findings confirm the other qualitative findings in this area. The approach to bariatric surgery should be expanded to provide long-term comprehensive care that includes in-depth postoperative lifetime monitoring of emotional and physical health.

The growth kinetics of ferrite during intercritical annealing of steel has been investigated using in situ high energy X-ray diffraction with a specially designed furnace allowing highly quantitative measurements of phase volume fractions. Kinetics have been obtained at 730 ∘ C, 750 ∘ C and 775 ∘ C in different ternary Fe-C-X (where X : Mn, Ni, Mo and Cr) alloys and in a quaternary Fe-C-1Mn-1Cr (wt.%) alloy. The obtained results were compared with the predictions of classical Local Equilibrium and Para-Equilibrium models as well as an improved version of a three-jump solute drag model, where the interactions between the solute elements and the moving interface are described comprehensively. Good agreement was obtained between the measured ferrite growth kinetics and the predictions of the solute drag model for the different Fe-C-X systems using only one fitting parameter, namely the Fe-X interaction parameter at the interface. The interactions found here qualitatively match those reported in literature for all solutes except for Ni, which displayed an attractive interaction with the interface. For the quaternary Fe-C-Mn-Cr system, the solute drag model succeeded in predicting ferrite growth kinetics using the same interaction values as used for the ternary Fe-C-Mn and Fe-C-Cr systems.

Objectives The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. Methods A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. Results Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed ( Discussion Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.

A ferritic steel composite with titanium diboride (TiB2) particles produced by in-situ precipitation was studied by means of synchrotron X-ray diffraction. Samples were subjected to an in-situ heat treatment which allowed to study the mismatch in the coefficient of thermal expansion between the matrix and the reinforcement. In addition, in-situ tensile tests enable the observation of the load partitioning in the composite. A transfer of load from the ferritic matrix to the TiB2 particles was seen at the beginning of the plastic regimen of the matrix.

Objective: Due to the natural aging and the loosened CI-implantation criteria more formerly operated Meniere's patients will be supplied with a cochlear implant. However, it raises the question whether an implantation in a previously treated ear is promising. Material and Methods: Based on 2 cases in which we have carried out a CI-implantation, one of them 10 years after transmastoidal labyrinthectomy, and based on the current literature we draw attention to problems and prospects of success. Discussion: Histological studies show only a small ossification of the cochlea after labyrinthectomy. Implanted Meniere's patients have a better speech intelligibility than other CI users. Attacks of rotatory vertigo with tinnitus and fluctuations of hearing after cochlear implantation in Meniere's patients are rare or they are too little described. Conclusion: There is a trend to perform a simultaneous labyrinthectomy and cochlea implantation in Meniere's patients with desabling vertigo which have not responded to drug treatment. A formerly performed transmastoidal labyrinthectomy is not a contraindication for a cochlear implantation.

International audience; ObjectivesWe previously described extended-spectrum oxacillinase OXA-145 from Pseudomonas aeruginosa, which differs from narrow-spectrum OXA-35 by loss of Leu-155. The deletion results in loss of benzylpenicillin hydrolysis and acquisition of activity against ceftazidime. We report the crystal structure of OXA-145 and provide the basis of its switch in substrate specificity.MethodsOXA-145 variants were generated by site-directed mutagenesis and purified to homogeneity. The crystal structure of OXA-145 was determined and molecular dynamics simulations were performed. Kinetic parameters were investigated in the absence and in the presence of sodium hydrogen carbonate (NaHCO3) for representative substrates.ResultsThe structure of OXA-145 was obtained at a resolution of 2.3 Å and its superposition with that of OXA-10 showed that Trp-154 was shifted by 1.8 Å away from the catalytic Lys-70, which was not N-carboxylated. Addition of NaHCO3 significantly increased the catalytic efficiency against penicillins, but not against ceftazidime. The active-site cavity of OXA-145 was larger than that of OXA-10, which may favour the accommodation of large molecules such as ceftazidime. Molecular dynamics simulations of OXA-145 in complex with ceftazidime revealed two highly coordinated water molecules on the α- or β-face of the acyl ester bond, between Ser-67 and ceftazidime, which could be involved in the catalytic process.ConclusionsDeletion of Leu-155 resulted in inefficient positioning of Trp-154, leading to a non-carboxylated Lys-70 and thus to loss of hydrolysis of the penicillins. Ceftazidime hydrolysis could be attributed to enlargement of the active site and to a catalytic mechanism independent of the carboxylated Lys-70.

Steel-based composites reinforced with titanium diborides (TiB 2 ) and produced by eutectic solidification display a significant increase in specific stiffness ( E / ρ ) in comparison with usual steels. A significant lightening can be achieved in parts designed for stiffness with a high Young’s modulus and a low density. They can be produced through the use of industrial continuous casting devices and can be hot rolled without any damage. This production route guarantees a good cohesion of the steel/reinforcement interface and the control of the main parameters that determine the final properties of the product (size, shape, clustering of reinforcements). In order to get a better understanding of the composite properties, its microstructural features after hot rolling are investigated through transmission electron microscopy at microscopic and atomic levels. TiB 2 reinforcements are homogeneously distributed in the ferritic iron matrix. Interfaces between Fe and TiB 2 particles are mainly parallel to dense planes of the diboride, with a preferential growth of prismatic planes { 1 0 1 ¯ 0 } . Interfacial misfit dislocations occur at interfaces parallel to the prismatic planes. The TiB 2 basal plane is covered by a TiC layer three atomic planes in width. The hot rolling operation induces a significant plastic deformation in the TiB 2 particles, with the activation of basal and prism plane slip systems. All these characteristics may account for the good behaviour of the composite in terms of hot rolling capability.

Background Chromosomal class A β-lactamases have been characterized in Raoultella ornithinolytica and Raoultella planticola. The purpose of this study was to characterize that of Raoultella terrigena. Materials and methods The blaTER-1 gene of R. terrigena strain ATCC33257T was cloned (pACter-1) and sequenced. It was then used to detect the bla gene of strains BM 85 01 095 and SB2796. The hypermutable Escherichia coli strain AB1157 mutS::Tn10 was transformed with pACter-1 and mutants growing on plates containing > 2 mg/L ceftazidime were studied. Notably, the impact of mutations only observed in the promoter region on β-lactam resistance was assessed by site-directed mutagenesis experiments. Results R. terrigena strains ATCC33257T and BM 85 01 095 had the same bla gene and deduced protein (TER-1) whereas there were 3 substitutions in those of strain SB2796 (TER-2). Class A β-lactamases TER showed 78%, 69.9% and 38.7% identity with PLA or ORN, TEM-1 and KOXY, respectively. Compared with TEM-1, TER-1 and TER-2 showed 2 particular substitutions, Leu75Pro and Glu240Asn demonstrated to be involved in the inherent β-lactam resistance profile of R. terrigena. TER-1 (pI of 7.6) had a high activity against penicillin G and a significantly low one against amoxicillin. Substitution G/T observed in the -35 region of the blaTER gene harbored by strains growing in the presence of ≥ 2 mg/L ceftazidime was shown to be responsible for this growth. Conclusion TER is a new class A β-lactamase belonging to functional group 2b.

Cephalosporinases, which are naturally present in some enterobacterial species, can be mobilized by transposons, migrate to plasmids, and spread into other species such as Escherichia coli. The aim of this study was to characterize genes responsible for the production of extended-spectrum β-lactamases (ESBL) in E. coli isolates from urinary origin isolated in two hospitals in Senegal. Thus, a fortuitous discovery of plasmidic cephalosporinase in two isolates was noted. One of the isolates produced dha-1 associated with ESBL CTX-M-14, the other produced cmy-2, ESBL CTXM-15, tem-1 penicillinase, and oxa-1. This confirms the circulation of multidrug-resistant bacteria producing plasmidic cephalosporinase in Senegal. However, a large study is needed to better understand the prevalence and the nature of the genes involved.

Neuroendokrine Neoplasien der Lunge leiten sich von diffus im Korper verteilten enterochromaffinen Zellen her. Die Inzidenz der neuroendokrinen Neoplasien der Lunge ist in den letzten Jahrzehnten aufgrund der zur Verfugung stehenden Diagnostik deutlich angestiegen, sie machen etwa 1 – 2 % aller Lungentumoren und ca. 20 – 30 % aller neuroendokrinen Neoplasien aus. Die aktuelle WHO-Klassifikation ist aus dem Jahre 2004 und unterteilt typische Karzinoide (TC), atypische Karzinoide (AC), groszellige Lungenkarzinome (LCNEC) und kleinzellige Lungenkarzinome (SCLC). Die wichtigsten neuroendokrinen Biomarker sind Chromogranin A, CD56 und Synaptophysin. TC haben eine geringe Mitoserate von Die steigende Zahl der therapeutischen Moglichkeiten und diagnostische Verfahren erfordert ein multidisziplinares Vorgehen und eine Entscheidungsfindung in multidisziplinaren Tumorkonferenzen, um eine „masgeschneiderte“ Therapie zu gewahrleisten, weshalb Patienten mit einer neuroendokrinen Neoplasie der Lunge in spezialisierten Zentren behandelt werden sollten.

Since the last decade, lightening of automotive structure was mainly achieved by gauge reduction using ultrahigh strength steels such as dual phase and transformation induced plasticity grades. However, gauge reduction can significantly reduce the stiffness. Limits are today reached for some applications such as chassis/suspension part. Development of steel with improved specific stiffness becomes more and more relevant to go further in weight reduction. Development of steel matrix composites (SMCs) with ceramic reinforcements is a promising solution. With an appropriate selection of the ceramic, eutectic solidification can be achieved. This natural production route guarantees a good cohesion of the steel/reinforcement interface and the control of the main parameters, which provide final properties of the product (size, shape, clustering of reinforcement). Significant fraction of ceramic can be obtained (10–25 vol.-%). Eutectic SMC can be produced with conventional industrial process such as conti...

Resume Introduction Le syndrome de Churg-Strauss est une vascularite systemique rare. Cette maladie est responsable d’un infiltrat eosinophile des tissus dont les manifestations les plus frequentes sont l’asthme cortico-dependant, une mono- ou multinevrite, une polypose des sinus de la face, des atteintes digestive et renale. L’atteinte des glandes salivaires est exceptionnelle. Observation Nous decrivons les caracteristiques d’une atteinte salivaire parotidienne bilaterale chez une patiente porteuse de ce syndrome. Le bilan morphologique detaille des glandes salivaires a mis en evidence un epaississement inhabituel des parois des canaux salivaires. Discussion Generalement au second plan du tableau clinique, et source d’errements diagnostiques, l’atteinte salivaire du syndrome de Churg et Strauss peut etre delicate a demontrer histologiquement. Il est recommande de realiser un prelevement tissulaire dans la glande responsable de la symptomatologie, en dehors de tout traitement corticoide.

Bei der hereditaren hamorrhagischen Teleangiektasie (HHT, Morbus Osler-Weber-Rendu) kann es zur Ausbildung von pulmonalen arteriovenosen Malformationen (pAVM) kommen. Zur Vermeidung von Komplikationen und zum Verschluss relevanter AV-Shunts sollte eine Embolisation der Malformationen vorgenommen werden. Im vorliegenden Fallbeispiel kam es zum Abhusten von Embolisationsspiralen 15 Jahre nach Intervention. Bei Hamoptysen nach Interventionen mit Embolisationsspiralen sollte auch Jahre nach deren Implantation neben dem Verdacht auf neue AV-Malformationen an durchwanderte Spiralen gedacht und eine entsprechende Diagnostik durch Einsatz von Thorax-CT mit Kontrastmittel und Bronchoskopie durchgefuhrt werden.

Anlasslich des 50. Geburtstags der Wissenschaftlichen Arbeitsgemeinschaft fur die Therapie von Lungenkrankheiten (WATL) wird ihre Geschichte von der Grundung bis zur heutigen Situation dargestellt. Es werden die Forschungsthemen der WATL uber diese lange Zeit hinweg benannt und wesentliche Studien der WATL kurz charakterisiert. Fruh vor allem mit Studien zur Tuberkulose beschaftigt, hat sich das Spektrum der WATL dann erheblich verbreitert und Krankheiten wie die Sarkoidose, die pulmonale Langerhans-Zell-Histiozytose, das Lungenemphysem beim α1-Antitrypsin-Mangel, die chronisch-obstruktive Bronchitis und das Asthma bronchiale sowie die nichttuberkulosen Mykobakteriosen ins Visier genommen. Schlieslich in der Erkenntnis, dass die methodischen Moglichkeiten fur grose Studien bei den klassischen Lungenkrankheiten unter aktuellen Anforderungen nicht ausreichen, hat die WATL begonnen, sich eine Kompetenz auf dem Sektor der seltenen Lungenkrankheiten wie Lymphangioleiomyomatose und Alveolarproteinose zu erwerben. Zusatzlich hat sich die WATL mit ihren nun zum dritten Mal durchgefuhrten Kongressen in Berlin ein edukatives Ziel im Bereich der nicht zum Mainstream gehorenden Fragen in der Pneumologie auf die Fahnen geschrieben.

Introduction: CT alone cannot provide sufficient information referring to response after neoadjuvant therapy in a timely manner. To evaluate the role of 18F-FDG-PET after neoadjuvant chemoradiation as a valid, non-invasive predictor for early therapy response and its effect on survival as compared to histopathologic tumor response, data of 32 of 210 randomized patients with NSCLC stage IIIA/IIIB, who were treated in a prospective randomized controlled multicenter trial (LUCAS- MD), were re-evaluated. Material and Methods: For 32 patients with NSCLC stage IIIA (44%) IIIB (56%) neoadjuvant treatment consisted of two to three cycles of chemotherapy (225 mg/m2 paclitaxel and carboplatin AUC 6 d1q22) and concomitant chemoradiation (50 mg/m2 paclitaxel and carboplatin AUC 2 d1, d8, d15; 1.5 Gy b.i.d. up to 45 Gy). Documentation of involved lymph node stations as detected by 18F-FDG-PET/CT and lymph node sampling during surgery according to the IASLC lymph node mapping (2009). Evaluation of histological regression grade (RG) according to Junker et al. (2001) and correlation with 18F-FDG-PET/CT for primary tumor and each lymph node station. Calculation of disease free survival using Kaplan-Meier estimates and log rank tests. Results: Actuarial tumor specific survival for the 32 patients with concomitant chemoradiation plus chemotherapy: complete vs. incomplete metabolic remission prior to surgery after 60 months: 40% vs. 24% (p = 0.018). RG III/IIb (no/less than 10% of vital tumor cells) vs. RG IIa/I (more than 10% vital tumor cells) after 60 months: 46% vs. 15% (p = 0.006). 18/32 (56%) patients had RG III/IIb, 8/32 (25%) patients had regression grade III. 1/8 pts. with RG III were in the 18F-FDG- PET/CT false positive, 10 pts. with RG IIb (i.e. all pts. with RG IIb) were in the 18F-FDG-PET/CT false negative. One patient with RG IIa was in the 18F-FDG-PET/CT false negative. Hence, the cut-off level in detecting vital tumor cells by 18F-FDG-PET/CT after neoadjuvant chemoradiation for NSCLC is about 10%. Conclusion: Histological regression grading correlates well with metabolic remission as detected by 18F-FDG-PET. Thus, 18F-FDG-PET precedes CT in measuring the tumor response and may predict long-term therapeutic outcome in patients with stage III NSCLC. Invasive staging procedures may be avoided and patients who will not profit from resection due to insufficient downstaging after neoadjuvant treatment will be easily detected by using 18F-FDG-PET as standard imaging in workup and evaluation of treatment response.

Cementite composition in a ferrite-pearlite steel dedicated to the industrial production of Dual-Phase steels has been investigated after hot-rolling and during annealing. By coupling TEM investigations and local field composition modeling using THERMOCALC and DICTRA softwares, its progressive enrichment in manganese is explained. This enrichment begins during hot-rolling when austenite first decomposes into ferrite and pearlite. Measured enrichments are consistent with a pearlite transformation process governed by two simultaneous local equilibria at the growing fronts between ferrite, cementite and austenite. During subsequent coiling operation and annealing, cementite enrichment in manganese continues. Observed composition profiles can be reproduced considering diffusion simulations with local equilibrium at ferrite/cementite interface. Nevertheless, the known diffusion coefficient of manganese in cementite has been reassessed to explain observed composition gradients. Both thermodynamic approach of pearlite phase transformation and diffusion simulation must be coupled to follow seamlessly manganese composition gradients in cementite all along the manufacturing process. Such calculation is the key to understand the inheritance effects of hot-rolling on final properties on Dual-Phase steels.

We discuss the performances of (001) and (110) oriented gate-all-around silicon nanowire (Si NW) transistors within a nonequilibrium Green's functions framework, taking surface roughness and phonon scatterings into account. We show, in agreement with previous studies, that uniaxial tensile (respectively, compressive) strains can significantly improve the mobility of electrons (respectively, holes) in the channel. This does not, however, necessarily result in a comparable enhancement of the device performances. Indeed, the current in short channels is limited by both the scattering and the number of sub-bands available for carrier transport in quantum confined systems (intrinsic “ballistic” resistance). The dependence of the mobility and ballistic resistance on strains can be different, which calls for a careful design of the devices. We show, in this respect, that (110) Si NWs provide the best opportunities for strain engineering in ultimate short channel transistors.

International audience; Plasmid-mediated quinolone resistance mechanisms have become increasingly prevalent among Enterobacteriaceae strains since the 1990s. Among these mechanisms, AAC(6')-Ib-cr is the most difficult to detect. Different detection methods have been developed, but they require expensive procedures such as Sanger sequencing, pyrosequencing, polymerase chain reaction (PCR) restriction, or the time-consuming phenotypic method of Wachino. In this study, we describe a simple matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) method which can be easily implemented in clinical laboratories that use the MALDI-TOF technique for bacterial identification. We tested 113 strains of Enterobacteriaceae, of which 64 harbored the aac(6')-Ib-cr gene. We compared two MALDI-TOF strategies, which differed by their norfloxacin concentration (0.03 vs. 0.5 g/L), and the method of Wachino with the PCR and sequencing strategy used as the reference. The MALDI-TOF strategy, performed with 0.03 g/L norfloxacin, and the method of Wachino yielded the same high performances (Se = 98 %, Sp = 100 %), but the turnaround time of the MALDI-TOF strategy was faster (< 5 h), simpler, and inexpensive (< 1 Euro). Our study shows that the MALDI-TOF strategy has the potential to become a major method for the detection of many different enzymatic resistance mechanisms.

Fragment-based design was used to guide derivatization of a lead series of β-lactamase inhibitors that had heretofore resisted optimization for in vivo activity. X-ray structures of fragments overlaid with the lead suggested new, unanticipated functionality and points of attachment. Synthesis of three derivatives improved affinity over 20-fold and improved efficacy in cell culture. Crystal structures were consistent with the fragment-based design, enabling further optimization to a K i of 50 pM, a 500-fold improvement that required the synthesis of only six derivatives. One of these, compound 5 , was tested in mice. Whereas cefotaxime alone failed to cure mice infected with β-lactamase-expressing Escherichia coli , 65% were cleared of infection when treated with a cefotaxime: 5 combination. Fragment complexes offer a path around design hurdles, even for advanced molecules; the series described here may provide leads to overcome β-lactamase-based resistance, a key clinical challenge.

Hintergrund: Neuroendokrine Tumore der Lunge weisen eine deutlich ansteigende Inzidenz auf. Uber Diagnose und Therapie dieser Tumoren existieren jedoch nur wenig gesicherte Informationen. Demgegenuber liegen deutlich mehr Daten fur die neuroendokrinen Tumore des gastroenteropankreatischen Systems vor. Methode: Dialog mit Fachexperten fur neuroendokrine Tumore (NET) des gastroenteropankreatischen Systems und der Lunge am 25. und 26. Februar 2011 in Weimar, um Gemeinsamkeiten und Unterschiede zwischen den neuroendokrinen Tumoren der Lunge und des gastroenteropankreatischen Systems herauszustellen. Ergebnisse: Die neuroendokrinen Tumoren der Lunge weisen viele Gemeinsamkeiten, aber auch einige Unterschiede mit den gastroenteropankreatischen NETgastroenteropankreatischen Tumoren auf. Gemeinsamkeiten bestehen vor allem in der Pathologie, der Diagnosestellung und der Therapie. Unterschiede bestehen in den Empfehlungen zur systemischen Therapie und der deutlich geringeren Inzidenz paraneoplastischer Syndrome. Das Somatostatinrezeptor-PET/CT mit Gallium-68 konjugierten Somatostatinanaloga und die Peptid-Rezeptor vermittelte Radiorezeptortherapie sind innovative Verfahren fur die neuroendokrinen Tumore der Lunge. An erster Stelle der Therapie steht jedoch die komplette kurative Resektion. Erste Ergebnisse von Studien mit molekularen Wirkstoffen wie Everolimus (Afinitor®) zeigen eine Wirksamkeit an. Schlussfolgerungen: Es existieren deutliche Schnittmengen in der Diagnose und Therapie der neuroendokrinen Tumore der Lunge und des gastroenteropankreatischen Systems. Weitere Studien sind geplant und notwendig, um die Datenlage zu verbessern. Ein Register zur Erfassung der neuroendokrinen Tumore der Lunge ware sinnvoll.

Deformation behavior and damage evaluation of a new composite steel has been investigated by means of in situ three-point bend tests in the scanning electron microscope. The titanium diboride (TiB2)-reinforced steel composite is produced by in situ precipitation of the TiB2 particles during eutectic solidification. This production process developed by ArcelorMittal leads to a steel composite with a significant increase in specific stiffness (>20%), and good strength/ductility compromise. The microstructures obtained consist of primary TiB2 crystals surrounded by a eutectic mixture of ferrite and TiB2 particles. The primary mode of damage is particle fracture and inhomogeneous plastic deformation in the matrix. In contrast with other production process, particle fracture was more common than interfacial debonding indicating that interfacial strength is not the limiting factor in damage accumulation and fracture in this composite. Crack growth occurred by particle fracture ahead of the crack tip, producing large microvoids, which then link up to the growing crack by ductile failure of the remaining matrix ligaments. The results suggest also that the cracks tended to avoid direct particle interactions.

Resume Introduction L’os spongieux est le materiau de comblement de choix dans la reconstruction de la fente alveolaire (alveoloplastie secondaire). Le prelevement iliaque est le plus classique mais sa morbidite est importante. Parmi les autres sites proposes, le prelevement tibial semble plus sur avec une morbidite moindre. Nous avons evalue les consequences du prelevement tibial medioproximal sur 55 enfants operes d’une alveoloplastie secondaire. Patients et methode Un questionnaire individuel a evalue retrospectivement l’intensite et la duree de la douleur postoperatoire, l’impotence fonctionnelle, d’eventuelles complications tardives et la longueur de la cicatrice. Des radiographies tibiales postoperatoires de face et de profil ont permis de mesurer le diametre de la corticotomie, sa distance avec l’espace articulaire et avec le cartilage de croissance, et de rechercher des complications locales. Resultats L’âge moyen etait de neuf ans. Aucune complication n’a ete relevee. Soixante-neuf pour cent des patients se sont plaints de douleur postoperatoire cotee 4/10 pendant une duree de 17 jours en moyenne. Soixante-cinq pour cent ont eu une gene a la marche pendant 12 jours en moyenne. La longueur de la cicatrice etait de 10 mm en moyenne. Deux patients (3,6 %) presentaient des sequelles deux ans apres l’intervention : une douleur residuelle sur la cicatrice et une ossification ectopique indolore en regard du site de prelevement. Discussion La morbidite du prelevement tibial medioproximal est faible. La technique est simple, rapide et sure. L’os spongieux recueilli est suffisant pour greffer deux sites alveolaires simultanement. Ce site nous semble particulierement adapte a l’alveoloplastie secondaire chez l’enfant.

It is commonly known in economics that markets follow both positive and/or negative trends, crashes and bubble effects. In general a strong positive trend is followed by a crash. Famous examples of these effects were seen in the recent crash on the NASDAQ (April 2000) and prior to the crash on the Hong Kong market, which was associated with the Asian crisis in the early 1994. In this paper we use real market data input into a minority game with a variable payoff function and a nonlinear super exponential model for bubbles, to explore financial bubbles. By changing the payoff function in the minority game we study how one can get the price function to follow the dynamics of a real market.

We recently observed a near fatal case of transfusion-transmitted infection with standard platelet concentrate. Streptococcus dysgalactiae subspecies equisimilis was isolated both from donor, residual component container and cultures of the patient's blood. This should question the usefulness of systematic bacterial detection in platelet concentrates, however a lethal accident has occurred recently which escaped bacterial detection. This observation calls for implementation of pathogen inactivation procedures for platelets concentrates.

We describe the characterization of a novel CTX-M β-lactamase from Salmonella enterica . Four S. enterica isolates (three of serotype Westhampton and one of serotype Senftenberg) resistant to extended-spectrum cephalosporins (cefotaxime and ceftazidime) were recovered in 2004 from living cockles in three supermarkets located in distant geographic areas in France, which got their supplies from the same fishery. The isolates were found to produce a novel extended-spectrum β-lactamase (ESBL) belonging to the CTX-M-1 phylogenetic group and named CTX-M-53. The CTX-M-53 β-lactamase harbored the substitution Asp240Gly, like the CTX-M-15 enzyme, which is specifically implicated in a higher catalytic efficiency against ceftazidime. The bla CTX-M-53 gene was located on a mobilizable 11-kb plasmid, pWES-1. The complete sequence of pWES-1 revealed the presence of a novel insertion sequence, IS Sen2 , and an IS 26 element upstream and downstream of the bla CTX-M-53 gene, respectively; however, transposition assays of the bla CTX-M-53 gene were unsuccessful. IS 26 elements may have contributed to the acquisition of the bla CTX-M-53 gene. Interestingly, the mobilization module of the pWES-1 plasmid was similar to that of quinolone resistance plasmids (carrying the qnrS2 gene) from aquatic sources. Although belonging to two serotypes differentiated on the basis of the O-antigen structure (E1 or E4 groups), the isolates were found to be genetically indistinguishable by pulsed-field gel electrophoresis. Multilocus sequence typing showed that the isolates of serotype Westhampton had a sequence type, ST14, common among isolates of serotype Senftenberg. This is the first characterization of the CTX-M-53 ESBL, which represents an additional ceftazidime-hydrolyzing CTX-M enzyme.

Because of the expected significant growth in the elderly population and respiratory diseases, the topic of "delegation of physician's duties" is of increasing importance to the German health-care system. In 2004 the German Respiratory Society (Deutsche Gesellschaft fur Pneumologie und Beatmungsmedizin e. V. (DGP)) established the new profession: respiratory therapist. A curriculum was defined which offers training for certified nurses and physiotherapists. Respiratory therapists evaluate, treat, document and care for patients with pulmonary disorders. Under appropriate supervision a licensed respiratory therapist performs some of the work previously done by physicians at the same quality of care. The first respiratory therapists have finished their professional training in Germany. Most of these respiratory therapists are now employed in hospital-based positions requiring their specific skills. Generally, the increased medical responsibility and the increased degree of decision-making possibilities associated with the new profession contribute to a better job satisfaction. However, this is not yet true for all the newly employed respiratory therapists. Only few of the new graduate respiratory therapists were awarded higher salaries. It is a strongly recommendation to the heads of medical departments and the human resources managers of hospitals that they should recognise the increased qualifications of nurses and physiotherapists who become respiratory therapists by appropriate remuneration.

The formation of carbon filaments which occurs at carbon activities ac > 1 in a range of temperatures 450-700°C is a major problem in many chemical, petrochemical and refinery processes where hydrocarbons or other strongly carburizing atmospheres are involved. An excessive carbon deposition causes deterioration of the furnace alloys, such as an important migration of carbon into the alloys. In order to better control and limit this deterioration, this work has been performed to on one side get a more accurate understanding of the mechanisms of formation of catalytic coke and on the other side to find remedies as the injection of selected additives in the feed. Thermogravimetric analyses (TGA) were performed on iron samples in simulated conditions of isobutane dehydrogenation. X ray diffraction (XRD) and scanning electron microscopy examinations were used to identify the different steps during the formation of the catalytic coke. The selection of appropriate remedies to reduce the catalytic coke deposition, requires accurate understanding on both mechanisms of the catalytic particles formation and of the growth of the graphite filaments. We have studied the first steps of the catalytic coke formation on high purity iron that has been previously reduced or oxidised. The comparison of the catalytic coke deposition kinetics indicates that the mass gain is much faster on a pre oxidised state than on a reduced one. In refinery and petrochemical processes, several methods can be selected in order to limit the deposition phenomena of catalytic coke: selection of an appropriate metallurgy, protection of the surfaces by application of coatings, injection of additives with the feed. Steric inhibitors (that block the adsorption sites and slow down the germination and diffusion steps) such as sulfur additives are currently industrially used but special care has to be taken in order to prevent consequential secondary effects such as, for catalytic refinery process, the deactivation of catalysts. Based on TGA experiments, the accurate amount of inhibitor to be injected has been selected regarding the oxidising state of the iron surface.

Die CT ist nach neoadjuvanter Radio-Chemo-Therapie zur Charakterisierung der Tumorregression nur begrenzt einsetzbar. Daher sollte die Wertigkeit der 18F-FDG-PET als molekulares, nichtinvasives bildgebendes Verfahren analysiert werden. Bislang 32/100 Patienten mit NSCLC Stadium IIIA/IIIB wurden in einer multizentrischen, randomisierten Therapiestudie (LUCAS-MD) untersucht. Pratherapeutisch erfolgten eine 18F-FDG-PET und eine Spiral-CT. Der neoadjuvante Therapieblock bestand aus 2–3 Zyklen Paclitaxel und Carboplatin sowie einer simultanen Radio-Chemo-Therapie. Es folgte eine zweite PET direkt vor der Operation mit Bestimmung des Glukosemetabolismus fur Primartumor und Lymphknotenmetastasen sowie eine PET-CT-Bildfusion. Der am OP-Praparat bestimmte Regressionsgrad wurde mit den PET-Befunden und dem Uberleben der Patienten korreliert. In Lymphknoten von 10 Patienten mit kompletter Remission in der FDG-PET zeigte sich ein Regressionsgrad/RG III im OP-Praparat (Sensitivitat 100%). Zu 94% wiesen die 16/32 Patienten mit kompletter Remission im Primartumor RG IIb oder III auf, ein Patient RG IIa (falsch-negativ). Die Zweijahresuberlebenswahrscheinlichkeit bei kompletter Remission war nach 24 Monaten signifikant erhoht (76 vs. 20%, p=0,0079). Patienten mit RG III bzw. IIb lebten signikant langer als Patienten mit RG IIa bzw. I (63 vs. 36%, p=0,0123). Der RG korreliert mit der in der FDG-PET bestimmten metabolischen Remission. Die PET eilt metabolisch dem durch die CT bestimmten Tumoransprechen nach neoadjuvanter Behandlung deutlich voraus und ermoglicht wahrscheinlich eine prospektive Aussage uber den Langzeittherapieerfolg von Patienten mit NSCLC im Stadium III.

The extreme anisotropic limit of Euclidean SU(3) lattice gauge theory is examined to extract the Hamiltonian limit, using standard path integral Monte Carlo (PIMC) methods. We examine the mean plaquette and string tension and compare them to results obtained within the Hamiltonian framework of Kogut and Susskind. The results are a significant improvement upon previous Hamiltonian estimates, despite the extrapolation procedure necessary to extract observables. We conclude that the PIMC method is a reliable method of obtaining results for the Hamiltonian version of the theory. Our results also clearly demonstrate the universality between the Hamiltonian and Euclidean formulations of lattice gauge theory.

Respiratory therapists are healthcare professionals taking care of patients with pulmonary disorders. They are an allied health specialty, practicing under medical direction. The professionalism of nurses and therapists must grow up to act successfully in new fields of medicine, where evidence-based independent action is necessary. Specialized therapists can help us coordinate separated processes (diagnoses, therapy and nursing). The profession "Respiratory Therapist" was created in the United States 50 years ago. We intend to introduce this profession also in Germany. We follow many other countries who have already taken this step. We hope that we can reach yet a higher quality of patient care.

The production of β-lactamases is the predominant cause of resistance to β-lactam antibiotics in gram-negative bacteria. These enzymes cleave the amide bond in the β-lactam ring, rendering β-lactam antibiotics harmless to bacteria. They are classified according to the scheme of Ambler et al. (2) into four classes, designated classes A to D, on the basis of their amino acid sequences, with classes A and C being the most frequently occurring among bacteria. Oxyimino-cephalosporins such as cefotaxime and ceftazidime, which are inherently less susceptible to β-lactamases, were introduced in the early 1980s to treat infections caused by gram-negative bacilli that were resistant to established β-lactams and that produced class A, C, and D β-lactamases. Their repetitive and increased use induced the appearance of resistant strains, which overproduced class C enzymes (42, 72) and/or which produced extended-spectrum β-lactamases (ESBLs), mainly those of class A but also those of class D (19, 61). Class A ESBLs hydrolyze oxyimino-cephalosporins and aztreonam but not 7-α-substituted β-lactams. They are generally susceptible to β-lactamase inhibitors (clavulanate, sulbactam, tazobactam). According to the functional classification scheme of Bush et al. (23), class A ESBLs are therefore clustered in group 2be, which can be subdivided on the basis of their activities against ceftazidime and cefotaxime as ceftazidimases (higher levels of hydrolytic activity against ceftazidime than against cefotaxime) and cefotaximases (higher levels of hydrolytic activity against cefotaxime than against ceftazidime), respectively (48). However, class A ESBLs form a heterogeneous molecular cluster comprising β-lactamases sharing 20 to >99% identity. The earliest class A ESBLs, which were reported from 1985 to 1987, differed from widespread plasmid-mediated TEM-1/2 and SHV-1 penicillinases by one to four point mutations, which extend their hydrolytic spectra (51, 90, 91). TEM and SVH ESBLs now comprise at least 130 members and have a worldwide distribution. Most of them are ceftazidimases, and only a few are cefotaximases. More recently, non-TEM and non-SHV plasmid-mediated class A ESBLs have been reported: ceftazidimases of the PER, VEB, TLA-1, and GES/IBC types and cefotaximases of the SFO-1, BES-1, and CTX-M types (8, 12, 13, 16, 31, 58, 62, 75, 76, 79, 81, 88, 96). The CTX-M β-lactamases are the most widespread enzymes. They were initially reported in the second half of the 1980s, and their rate of dissemination among bacteria and in most parts of the world has increased dramatically since 1995. This review focuses on the origin, epidemiology, clinical impact, enzymatic properties, and structural relationships of the CTX-M-type ESBLs.

Iron and copper powders were co-milled in a planetary mill in order to obtain nanometric products. The mechanical characteristics of hot compacted nanocrystalline Fe–Cu alloys with various compositions have been determined based on the measurement of the longitudinal, transverse and Rayleigh wave velocities by acoustic echography and interferometry.

We investigate topological charge and the index theorem on finite lattices numerically. Using mean field improved gauge field configurations we calculate the topological charge Q using the gluon field definition with improved cooling and an improved field strength tensor Fμν. We also calculate the index of the massless overlap fermion operator by directly measuring the differences of the numbers of zero modes with left- and right-handed chiralities. For sufficiently fine lattices and/or sufficiently smooth field configurations we find that the gluon field definition of the topological charge is integer to better than 1% and furthermore that this agrees with the index of the overlap Dirac operator, i.e., the Atiyah-Singer index theorem is satisfied. This establishes a benchmark for reliability when calculating lattice quantities which are very sensitive to topology.