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In freshwater ecosystems in the northwest United States, the distribution and movements of fish between their essential habitats are particularly impacted by the presence of hydroelectric dams. Bull Trout Salvelinus confluentus and Westslope Cutthroat Trout Oncorhynchus clarkii var. lewisi are two fish species of concern inhabiting the Pend Oreille River between Idaho and Washington states. The purpose of this study was to identify the behavior and habitat use of Bull Trout and Westslope Cutthroat Trout in the restricted area of the Pend Oreille River, downstream of Albeni Falls Dam (AFD), using a long-term radio-telemetry dataset. Between 2015 and 2018, 24 Bull Trout and 24 Westslope Cutthroat Trout were captured, tagged, and released downstream AFD. Among the fish tagged, 79% (n = 19 of 24) of Bull Trout and 67% (n = 16 of 24) of Westslope Cutthroat Trout were detected during the study period. Our results revealed movements of fish towards tributary confluences mostly in May, June, and July for both species with Bull Trout traveling longer distances than Westslope Cutthroat Trout. Although the sample size was limited, Bull Trout individual movements towards the dam suggested attempts to re-ascend the river, indicating the importance of restoring upstream connectivity.

A new genus, Mystocestus, is proposed to accommodate a new species, Mystocestus anindoi n. g., n. sp. from Mystus vittatus (Bloch) (type host) in West Bengal and Mystus cavasius (Hamilton) (Siluriformes: Bagridae) in Maharashtra, India. The new genus is most similar to Lucknowia Gupta, 1961 in the shape of the body, which is elongate, slightly tapering towards the anterior end, and scolex, which is digitiform, but differs in the shape of the ovary, which is H-shaped (vs. inverted A-shaped in Lucknowia), the absence of a seminal receptacle (present in Lucknowia) and exclusively cortical vitelline follicles (vs. some follicles in the medulla in the latter genus). Molecular data support the erection of the new genus and place it close to Bovienia Fuhrmann, 1931, species of which can be easily distinguished by exclusively lateral vitelline follicles (lateral and median in the new genus), the presence of a seminal receptacle (absent in Mystocestus) and scolex shape (digitiform, with blunt or slightly concave anterior edge in the new genus vs. small, unspecialized or spatulate in Bovienia). The convoluted taxonomy of tapeworms placed in Mystoides Mathur, 1992 is critically reviewed to clean up taxonomic chaos in Indo-Malayan caryophyllideans. Mystoides was erected in an unpublished PhD thesis and thus its generic name becomes unavailable and also, its type species is conspecific with Lucknowia fossilisi Gupta, 1961 from the stinging catfish, Heteropneustes fossilis (Bloch). Other species of this genus are also conspecific with L. fossilisi. In addition, specific names of most of these taxa are unavailable because they were described in unpublished theses or conference abstracts. Based on recent revisions of Indo-Malayan caryophyllideans, the following nine genera with 15 species are considered valid (numbers of species of individual genera are provided in parentheses): Bovienia (3), Djombangia (1), Lucknowia (2), Lytocestus (2), Mystocestus (1), Pseudocaryophyllaeus (2) (all family Lytocestidae); Adenoscolex (1), Lobulovarium (2), Paracaryophyllaeus (1) (all family Caryophyllaeidae).

Cosmetocleithrum Kritsky, Thatcher & Boeger, 1986 (Dactylogyridae) represents one of the most species-rich groups (22 species currently recognized as valid) of all dactylogyrid parasites infecting Neotropical catfishes. Species of Cosmetocleithrum exhibit a remarkable affinity towards catfishes of the Doradidae and the Auchenipteridae. However, phylogenetic relationships between members of this genus have not been yet analysed. This study analysed newly obtained partial sequences of the 28S ribosomal RNA gene of seven species of Cosmetocleithrum, including its type species C. gussevi Kritsky, Thatcher & Boeger, 1986, along with several other dactylogyrids infecting siluriform, gymnotiform, perciform and characiform fishes. Cosmetocleithrum appeared as an evolutionary recent group, composed of two well-defined lineages: lineage 1 includes parasites of doradids – namely, C. bulbocirrus, C. confusum, C. parvum and C. bifurcum – whereas lineage 2 is composed of species from doradids – that is, C. rarum, C. gussevi, C. gigas, C. trachydorasi and C. falsunilatum – together with parasites of auchenipterids – namely, C. laciniatum and C. baculum. The search for synapomorphies to characterize taxonomic groups within Cosmetocleithrum appears challenging, since the morphology of their haptoral elements is quite conservative, and that of the copulatory complex is highly variable between species. The results of the present study support the recent synonymization of Paracosmetocleithrum Acosta, Scholz, Blasco-Costa, Alves & Silva, 2018 with Cosmetocleithrum. Whereas the 28S ribosomal DNA data resolved Cosmetocleithrum as monophyletic, the statistical support for the lineage was low, rendering its phylogenetic position between other Neotropical dactylogyrids yet undefined.

The incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33%. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008-2013), we implemented peri- and postoperative preventive measures and compared the results with the recent patient cohort (2014-2016).The records of 356 patients (712 mastectomies) were retrospectively reviewed. We compared the first cohort (C1, 01/2008 - 12/2013, 346 mastectomies; peri- and postoperative standard procedure and implementation of an algorithmic care path in our institution) with the recent cohort (C2, 01/2014 - 01/2016, 366 mastectomies) and introduced in C2 the following preventive measures: perioperative administration of tranexamic acid, intraoperative elevation of blood pressure to at least 120 mmHg before wound closure, bedrest and consequent wearing of compression bandage without removal 12 hours postoperatively. Comparison of complication rate, patient satisfaction and secondary revision rate was obtained in both cohorts.The mean operation time could be reduced from 103.6 minutes to 72.5 minutes (p 0.05). The overall complication rate could be diminished from 11.8% to 5.5% (p 0.05), the acute hematoma revision rate from 9.2% to 4.1% (p 0.05). Secondary revisions were similar in both patient cohorts. Patient satisfaction rate was ameliorated from 88% to 93.5% "very satisfied" to "satisfied" patients.Hematoma is the most common reason for reoperation in FTMTS patients. By implementation of peri- and postoperative preventive measures and additional application of an algorithmic care path we could achieve a significant reduction of complications, particularly of the hematoma evacuation rate. During 8 years clinical and operative treatment in FTMTS we could furthermore achieve a decrease in operative time and an ameliorated patient satisfaction with the aesthetic results.

Zusammenfassung Hintergrund Eine Mastopexie nach massivem Gewichtsverlust stellt eine besondere Herausforderung in der Mammachirurgie dar. Der Brusthügel ist oft stark abgeflacht mit reduzierter Hautqualität. Die chirurgische Vorgehensweise basiert in erster Linie auf einer Umformung des Drüsengewebes statt auf einer Straffung des Hautmantels. Publizierte Techniken beinhalten eine Plikation, Suspension und Autoaugmentation. Das vorhandene ortsständige Gewebe (Brustdrüse, Fettgewebe, Dermofettlappen) wird vollumfänglich verwendet mit dem Ziel, eine Brust mit stabiler Projektion nachhaltig zu formen. Die Entwicklung einer solchen Technik wird präsentiert. Patienten und Methoden Es handelt sich um eine retrospektive Analyse von 68 Patientinnen (136 Brüste), bei denen eine modifizierte Ribeiro-Technik mit superomedialer Mamillenstielung durch eine Suspension mit einem inferioren dermoglandulären Lappen durchgeführt wurde. Darüberhinaus beinhaltet die vorgestellte Technik eine Einbeziehung der lateralen Interkostalarterien-Perforatorlappenplastik (LICAP flap) sowie des medialen Brustpfeilers als zusätzliche Volumengewinnung zum Ribeiro-Lappen. Dies trägt wesentlich zur Autoaugmentation des oberen Brustpols bei, führt zur Verschmälerung der verbreiterten Brust, bildet einen internen BH und redefiniert die Inframammärfalte. Die Ergebnisse zur Komplikationsrate, Patientenzufriedenheit, Brustwarzensensibilität und Korrekturrate wurden überprüft. Ergebnisse Von 01/2011–12/2016 führten wir 136 Auto-Augmentationsmastopexien durch. Das Durchschnittsalter betrug 41,2 Jahre, der durchschnittliche Body-Mass-Index (BMI) war 27,1 kg/m2, der durchschnittliche Gewichtsverlust war 54,3 kg, der durchschnittliche Mamillen-Jugulum-Abstand war 32,3 cm, die durchschnittliche OP-Dauer betrug 109 Minuten. Bei 12 Brüsten erfolgte eine freie Brustwarzentransplantation. Die Komplikationsrate lag bei insgesamt 5,1 %, die Korrekturrate bei 17,6 %. 95 % der Patientinnen waren „sehr zufrieden“ bis „zufrieden“ mit dem ästhetischen Ergebnis bei in 85 % „sehr gut“ bis „gut“ erhaltener Brustwarzensensibilität. Fazit Die Modifikation der Ribeiro-Technik mit zusätzlicher Anwendung der medialen und lateralen Brustanteile (LICAP flap) erlaubt eine Autoaugmentation des oberen Brustpols bei Patientinnen nach massivem Gewichtsverlust. Die Brustumformung durch Raffung und Suspension des residualen Brustgewebes soll die Langzeitformstabilität der Brust verbessern und die Inzidenz einer erneuten Ptosis verringern. Die präsentierte Vorgehensweise stellt eine reproduzierbare, verlässliche Methode mit geringer Komplikationsrate dar.

Zusammenfassung Hintergrund Eine Mammareduktionplastik bei Gigantomastie stellt eine Herausforderung in der Mammachirurgie selbst bei sehr erfahrenen plastischen Chirurgen dar. Extrem lange Mamillenstiele beeinträchtigen die Blutversorgung des Mamillenareolenkomplexes. Der massiv gedehnte Hautmantel erschwert die Brustformung und effektive Reduktion. Die Ribeiro-Technik stellt einen etablierten Standard zur Mammareduktion in unserer Klinik dar. Ziel der Studie war ein Review unserer Vorgehensweise bei Gigantomastie im Vergleich mit der aktuellen Literatur. Patienten und Methoden Im Zeitraum von 01/2009–12/2016 erfolgten in unserer Klinik bei 760 Patientinnen 1247 Mammareduktionsplastiken. In 294 Reduktionen (23,6 %) war das Einschlusskriterium der Gigantomastie (Resektionsgewicht > 1000 g pro Brust) erfüllt. Die Technik nach Ribeiro mit superomedialer Mamillenstielung und Bildung eines inferioren dermoglandulären Lappens zur Auffüllung des oberen Brustpols und Prävention eines bottoming outs wurde als Standard implementiert. Bei Patientinnen mit einem Mamillen-Jugulum-Abstand von > 40 cm erfolgte eine freie Brustwarzentransplantation. Die Outcome-Parameter Komplikationsrate, Patientenzufriedenheit, Brustwarzensensibilität und Notwendigkeit einer Korrekturoperation wurden retrospektiv überprüft. Ergebnisse Bei 174 Patientinnen erfolgten 294 Mammareduktionsplastiken mit mehr als 1000 g pro Brust. Das Resektionsgewicht lag im Mittel bei 1389,6 g pro Brust (1000–4580 g). Das Durchschnittsalter betrug 43,5 (18–76) Jahre, der durchschnittliche Body-Mass-Index (BMI) war 29,2 (19–40) kg/m2, der durchschnittliche Mamillen-Jugulum-Abstand war 34,8 (27–52) cm, die durchschnittliche OP-Dauer betrug 117 (72–213) Minuten. Bei 30 Reduktionen erfolgte eine freie Brustwarzentransplantation. Die Komplikationsrate lag bei insgesamt 7,8 %. Korrekturoperationen erfolgten in 16 %. 93 % der Patientinnen waren „sehr zufrieden“ bis „zufrieden“ mit dem ästhetischen Ergebnis bei in 88 % „sehr gut“ bis „gut“ erhaltener Brustwarzensensibilität. Fazit Bei der Ribeiro-Technik handelt es sich um eine gut etablierte, vielseitig einsetzbare Standardtechnik zur Mammareduktion, die reproduzierbare, formstabile Ergebnisse in hoher Qualität liefert. Bei Patientinnen mit Gigantomastie stellt dieses Verfahren ebenso eine effektive komplikationsarme Methode dar, um eine Volumenreduktion mit ästhetisch sehr zufriedenstellenden Ergebnissen zu erreichen.

This article studies factors affecting how policy actors perceive the effectiveness of political institutions involved in complex water governance systems. The ecology of games framework argues that participants are more likely to perceive institutions as effective when the benefits of solving collective action problems outweigh the transaction costs of developing political contracts within these institutions. The authors hypothesize that transaction costs are a function of conflict, type of participation, political knowledge, scientific knowledge, and actor resources. Survey results suggest that the importance of these different sources of transaction costs varies across study sites in the Tampa Bay watershed in Florida, the Sacramento–San Joaquin River delta in California, and the Parana River delta in Argentina. Based on the observed differences, some initial ideas are sketched about the evolution of complex governance systems from fairly simple and informal rules and networks to well-established tapestries of many formal institutions.

Methods for observing policy networks have not kept up with the development of new network analytic techniques required to understand governance in complex settings. We compare three unobtrusive methods for observing policy networks based on hyperlinks between policy actor web sites, on media reports, and on public policy partnerships. Observations of one complex local water policy arena with all three methods provide a comparison of the general as well as actor-specific network characteristics in the three observed networks. The core network of actors observed by all methods has similar network level statistics, highly correlated relationships measured by Quadratic Assignment Procedures models, and the same significant network microstructures as measured by Exponential Random Graph Models. The full networks including actors observed by any method also exhibit similar actor-level characteristics, although the correlations across networks are stronger for bridging capital measures than for bonding capital measures, and each method has different apparent biases. Once biases are accounted for, similarities suggest that these methods may provide useful proxies for each other and for other relationships that are more difficult or impossible to measure, particularly when combined to offset each method's biases. If so, they can extend the range of policy networks observable with limited resources across space and time.

The interaction between the vapor plume and the incident laser radiation affects remote laser welding. Relating to laser systems with an emitted wavelength around 1 μm, a significant loss mechanism can be traced back to the extinction by laser-induced particle formation. Due to the tight coupling between the particle formation and the evaporation rate inside the keyhole, the particle formation shows a strong dependence on the keyhole geometry and thus on process parameters (e.g. feed rate and laser beam power). In order to verify the relationship between particle formation and process parameters, the beam of a broadband LED was guided through the vapor plume during the welding processes with a fiber laser. The attenuated probe beam was analyzed in dependence on the wavelength. In addition, the propagation of the vapor plume was investigated by using high speed imaging.

Die Gynakomastie ist definiert als uni- oder bilaterale persistierende Brustdrusenvergroserung des Mannes, die von einer nur palpatorisch vergroserten Brustdruse bis hin zu einem weiblichen Thoraxerscheinungsbild reichen kann. In dieser Arbeit wird ein Algorithmus vorgestellt, der die Auswahl des geeigneten chi­rurgischen Verfahrens in Abhangigkeit von den morphologischen Aspekten des vorliegenden Befundes erleichtern soll. Es handelt sich um eine retrospektive Analyse von 118 Patienten (217 mannliche Mammae), die im Zeitraum von 01/2009 bis 08/2012 operiert wurden. Hierbei wurden die Ergebnisse von drei unterschiedlichen chirurgischen Therapieverfahren in Abhangigkeit von vier Schweregraden hinsichtlich der Outcome-Parameter Komplikationsrate, Patientenzufriedenheit, Brustwarzensensibilitat und Notwendigkeit einer Korrekturoperation uberpruft. Bei einem geringen bis moderaten Ausgangsbefund ohne Hautuberschuss (Grad I–IIa nach Simon) erfolgt die subkutane Mastektomie uber eine semizirkulare periareolare Inzi­sion sowie eine angleichende wasserstrahlassistierte Liposuktion. Bei vorhandenem Hautuberschuss und gut tastbarer Brustdruse (Grad IIb) erfolgt zusatzlich eine periareolare konzentrische Straffung. Bei den seltenen einer weiblichen Brust entsprechenden Befunden (Grad III) wird ein inframammarer Zugang mit kaudaler Stielung des Mamillen-Areolen-Komplexes verwendet. 167 Mammae (77%) konnten uber einen periareolaren Zugang operiert werden, 40 Mammae (18%) mit zusatzlicher periareolarer Straffung und zehn (5%) uber einen inframammaren Zugang mit kaudaler Mamillenstielung. Die Komplikationsrate lag bei 4,1%. Korrekturoperationen waren bei 17 Mammae (7,8%) erforderlich. Eine Patientenbefragung ergab eine hohe Zufriedenheit: 88% der Patienten waren „sehr zufrieden“ bis „zufrieden“, die Sensibilitat der Brustwarzen wurde von 83% der Patienten als „sehr gut“ bis „gut“ bewertet. Die operative Behandlung der Gynakomastie sollte moglichst narbensparend unter Respektierung der asthetischen Einheit erfolgen. Hierbei ist die Wahl des operativen Verfahrens abhangig vom Schweregrad, dem Vorhandensein eines Hautuberschusses, sowie vom Volumen des zu resezierenden Brustdrusengewebes. Der vorgestellte Algorithmus ist komplikationsarm, im Klinikalltag leicht anzuwenden und zeigt eine gute ­Bewahrung der Brustwarzensensibilitat bei hoher Patientenzufriedenheit mit dem asthetischen Ergebnis.

Rhinophyma is considered the end stage in the development of rosacea, accompanied by hypertrophy of the sebaceous glands, which causes an enlargement of the nose. It is an uncommon condition that often results in both functional and cosmetic impairment. A large variety of surgical and nonsurgical treatments have been published to treat it. Closure is usually obtained by wound granulating in by secondary intention, skin grafting or local flaps. Rarely these lesions can attain a giant size and pose a challenge in surgical treatment. We present a 63-year-old male with the necessity for tracheostomy at the ICU due to total nasal obstruction and recurrent episodes of pneumonia caused by a huge giant rhinophyma, which had undergone extreme growth in the last five years. The tumor was removed under general anesthesia by decortication with an electrosurgical wire loop to recreate the aesthetic units of the nose preserving the alar cartilage as well as the pilosebaceous appendages. The wounds healed in by secondary intention with a very pleasant cosmetic and improved functional result. The relevant literature is discussed. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

New developments and characteristics of high brilliant laser sources have led to new applications in the field of laser remote processing. Due to high particle formation rates within the vapor plume, a significant influence of the interaction between laser radiation and nanoparticles on the process may occur. The presented work shows results of the investigation of the dynamical formation of nanoparticles within the vapor plume during the welding of stainless steel with a 2 kW Multi-Mode fiber laser under laser remote conditions. The particle size distribution is measured by the evaluation of TEM-images, whereas, the plasma temperature and particle density are analyzed in dependence of the irradiation time.

This paper presents a conceptual framework for clarifying the network hypotheses embedded in policy theories and how they relate to macro-level political outcomes and micro-level political behavior. We then describe the role of statistical models of networks for testing these hypotheses, including the problem of operationalizing theoretical concepts with the parameters of statistical models. Examples from existing policy research are provided and potential extensions are discussed. This paper is forthcoming as the introduction to a special issue of the Policy Studies Journal on statistical models of policy networks. Paper Prepared for Political Networks Conference, 2011. Ann Arbor Note to PolNet 2011 Readers: Believe with Caution! This paper is in midstream so there are many missing references and sections that need additional work. We would welcome any comments that would help clarify the ideas in the paper, and especially persuade readers about the value of applying statistical models of networks to policy theory. Also, the references to the PSJ special issue might be confusing so feel free to ignore.

A characteristic of the laser ablation process of metals with high brilliant radiation is a significant formation of nanoparticles within the vapour plume. Due to the interaction between the incoming radiation and the particles, the intensity is attenuated at the workpiece. This leads to a decrease of the ablation rate and the related ablation velocity. In order to verify the influence of the interaction between nanoparticles and high brilliant radiation on the ablation process, experimental and theoretical results of the laser ablation process of stainless steel with a single mode fiber laser are presented. For an ablation process with an intensity of 1.9×10 8 W/cm², it is shown that the average particle size is 9 nm. Within a further time-dependent analysis of the correlation between particle formation and ablation velocity, the beam of a test laser is directed through the vapour plume and the angle-dependent scattered radiation is detected. The results point out that a decrease of the ablation velocity corresponds with an increasing of the particle density within the ablation plume.

Cob is an earthen building material comprised of sand, clay, straw, and water used for millennia to construct dwellings. Although cob construction largely died out during the nineteenth century, it is experiencing a revival in England and the Pacific Northwest of the United States. Little scientific research has investigated the engineering properties of cob, knowledge of which is important for modern-day design practices and code requirements. Researchers at Oregon State University investigated six different Oregon cob mixtures using a series of standard soils and concrete tests adapted for this material. The objectives were to characterize the constituents, to establish estimates for the magnitude of, and degree of variability in, the mixture properties, and to develop correlations between the engineering properties and mixture composition. Results indicated low to moderate variation in basic mixture properties (i.e., unit weight, moisture content, and sand equivalent), moderate variation in strength properties, and high variation in the elastic modulus. Several reasonable correlations were found between shrinkage, compressive strength, elastic modulus, and sand equivalent and between flexural strength and fiber tensile strength.

Policy actors seek network contacts to improve individual payoffs in the institutional collective action dilemmas endemic to fragmented policy arenas. The risk hypothesis argues that actors seek bridging relationships (well-connected, popular partners that maximize their access to information) when cooperation involves low risks, but seek bonding relationships (transitive, reciprocal relationships that maximize credibility) when risks of defection increase. We test this hypothesis in newly developing policy arenas expected to favor relationships that resolve low-risk dilemmas. A stochastic actor-based model for network evolution estimated with survey data from 1999 and 2001 in 10 U.S. estuaries finds that actors do tend to select popular actors as partners, which presumably creates a centralized bridging structure capable of efficient information transmission for coordinating policies even without any government mandate. Actors also seek reciprocal bonding relationships supportive of small joint projects and quickly learn whether or not to trust their partners.

High-speed laser micro-perforation (“on-the-fly” technique) represents a processing technique for the time-efficient and cost-effective production of microsieves. In order to increase the perforation rate this process is researched with use of a brilliant laser source. These laser sources combine ample output power with an excellent beam quality. The high perforation rate [

Aim: Neurodevelopmental impairment in very preterm infants can be reasonably diagnosed by 18–24 months corrected age, whereas the predictive value of earlier assessments is debated. We hypothesized that neurological findings at 6 and 12 months indicative of subsequent cerebral palsy predict 18–24 months’ neurodevelopmental impairment. Methods: Neurodevelopmental examinations (Griffiths scales) at 20 months of age in 561 preterm infants (birth weight

Nanometer sized particles are formed within the vapor plume during the ablation of metal with laser radiation. Thereby, the particle formation rate depends strongly on the used intensity of the laser source. High brilliant laser sources have the ability to generate intensities higher than 1 ⋅ 108 W / cm 2 during cw operation. Due to the widespread use of high brilliant laser sources in research and industrial applications, it is important to investigate the influence of particle formation on the ablation process. Therefore, the presented work is focused on the particle formation during the ablation process of stainless steel with a single-mode fiber laser. Results of experimental work are shown and analyzed. In the experimental work a probe laser beam is directed through the ablation plume and the scattered intensity is analyzed. TEM images of particles show an average particle size of 9 nm at an intensity of 1.92 ⋅ 108 W cm 2 .

Background Organ shortage has resulted in an increased use of expanded criteria donors for transplantation, in particular kidneys from older donors. There is limited data on the impact of donor age more than 75 years on kidney transplant outcome. Methods A retrospective single-center analysis on deceased donors more than 75 years and kidney transplant outcome in an old for old setting was performed. Histologic findings (global kidney score) in graft biopsies and deceased-donor scores were evaluated to observe if this information could be helpful in predicting outcome. Results Evaluation of data from 54 single kidney transplantations from 29 donors more than 75 years (median 77.5, range 75.2-86.1) were assessed. Ninety-three percent of the donors died of intracranial bleeding, and 69% had a history of hypertension or cardiovascular event(s). Median recipient age was 70.1 (range 50.6-82.4). Fifty-two grafts (96%) had posttransplant function. Death censored graft survival at 1, 3, and 5 years were 87%, 83%, and 83%, respectively. Patient survival was 81%, 75%, and 59% at the same time points. At follow-up at median 23 months (range 6-144 months), thirty-five recipients were alive with a median serum creatinine of 163 micromol/ L (range 103-348). Global kidney score and deceased donor score did not predict graft outcome. Conclusion Kidney transplants from deceased donors more than 75 years perform acceptable as single transplants and should be considered for use in older recipients.

Bei hartnackiger Obstipationsneigung sollte in der Anamnese auch an das Kopfschmerzmittel Ergotamin gedacht werden, das im Ausland teilweise noch frei erhaltlich ist und vasokonstriktorische Nebenwirkungen aufweisen kann. Unser Fall handelt von einem 64-jahrigen Piloten, bei dem es nach Ergotamineinnahme unter anderem zu Defakationbeschwerden mit krampfartigen Unterbauchschmerzen kam.

Our experimental study compares the effectiveness of three reputation mechanisms believed to enhance cooperation. Groups of 14 subjects repeatedly select partners, play two-person prisoner's dilemmas, and rely only on individual experience to find trustworthy exchange partners in the baseline condition. The local condition represents emergent, bottom-up networks that allow partners to voluntarily share recommendations. The central condition represents designed, top-down institutions that allow wide dissemination of recommendations provided voluntarily. Surprisingly, the greater provision and use of information in the local condition supports the highest level of cooperation, suggesting an unrecognized advantage of exchange networks over centralized institutions in credibility and information provision.

Two competing theories suggest different ways in which networks resolve collective action problems: small, dense networks enhance credible commitments supportive of cooperative solutions, while large boundary-spanning networks enhance search and information exchange supportive of coordinated solutions. Our empirical study develops and tests the competing credibility and search hypotheses in 22 estuary policy arenas, where fragmentation of authority creates collective problems and opportunities for joint gains through collaboration. The results indicate that search rather than credibility appears to pose the greater obstacle to collaboration; well-connected centrally located organizations engage in more collaborative activities than those embedded in small, dense networks.

Periodontitis is the primary clinical indication for enamel matrix derivative (EMD). Recent investigations, showing that EMD inhibits the production of tumor necrosis factor-alpha (TNF-alpha) when added to human whole blood, indicate a novel role for EMD as a modulator of systemic inflammation. In the present study, we investigated the systemic effects of EMD in lipopolysaccharide (LPS)-challenged pigs.In a preparatory study, seven pigs received a prophylactic EMD bolus injection (5 mg/kg), followed by a continuous infusion (50 mg/kg/min). Thirty minutes later, a continuous infusion of LPS (1.7 mcg/kg/h) was started. An additional 12 pigs were randomized into two groups. Six of these animals were given the same treatment, except that EMD was administered 30 min after LPS. The remainder served as controls. The groups were compared according to organ injury and function, hemodynamics, and systemic markers of inflammation.Prophylactic administration of EMD triggered transient hemodynamic instability in two of seven pigs. In the randomized pigs, no or only nonspecific changes were observed in biopsies from vital organs, independent of treatment. Enamel matrix derivative did not modify systemic TNF-alpha, interleukin (IL)-1 beta, or IL-6 concentrations.In the formulation and dosages used, EMD did not modulate the inflammatory response. No true allergic or immunotoxic reactions were seen. To be usable for systemic application, a new formulation should be developed, or the active part of the protein(s) should be identified and produced in a soluble form designed for infusion. The potential of EMD as a systemic immune modulator is still unsettled.

Liposuction is one of the most common aesthetic procedure used in plastic surgery. Reports are available on the results, the probable complications, and the feedback of patients. However, systematic studies dealing with these aspects using reliable large-enough data are still needed. The data comprised 116 procedures during a 6-year period up to 2005. The data were processed and categories of results were formed. Furthermore, a follow-up examination and a survey on the feedback of patients were carried out. Significant differences were identified in indications, results, and complications. The follow-up examinations and the survey showed satisfying results. In the majority of cases, surgeons were satisfied with the operations. In conclusion, if conducted by qualified surgeons in appropriate surgical conditions and postoperative care possibilities, liposuction may be considered as a reliable surgical procedure. The success of this procedure depends, however, on suitable infrastructure and operative competence.

Minimally invasive procedures in recent years have gained widespread acceptance. Within the field of transplantation, laparoscopic living donor nephrectomy (LLDN), requiring a 6- to 10-cm incision, is now considered the optimal procedure. According to recent MEDLINE searches, no minimally invasive technique has been reported for kidney transplantation. Considering the rapid evolution of minimally invasive surgery during the last decade, there is little reason to believe that kidney transplantation in future will be excluded from this development. A novel minimally invasive technique for kidney transplantation (MIKT) is presented, restricted to a 7- to 9-cm incision and minimal dissection/tissue trauma. The kidney is meticulously prepared on the back table and placed in a fitted lateral, retroperitoneal pouch. All three anastomoses are performed with the kidney in its final "in situ" position, and ureter reimplantation is done by extravesical technique. Twenty-one patients have been transplanted by MIKT and followed in a prospective manner, along with a matched control group subjected to conventional kidney transplantation. Our results indicate that MIKT may be executed safely and quickly. Beneficial effects on postoperative pain/analgesia, recovery, and complications are suggested by this first MIKT experience. The technical solutions of MIKT are per se not unique. However, the incision is minimal and not larger than the one required for LLDN. Minimally invasive surgery seems particularly attractive in the immunosuppressed population, and even more so with the recent introduction of potent antiproliferative drugs.

Background. Very few randomized studies on laparoscopic (L) versus open (O) living-donor nephrectomy (LDN) have been presented. The largest randomized series reported so far included 80 donors. In 2000, an Australian safety group concluded that the evidence base for L-LDN is inadequate to make recommendations regarding safety and efficacy. Methods. With this background, at our single national center, 122 donors were randomized to left-sided L-LDN (n=63) or O-LDN (n=59), from February 2001 to May 2004. This article summarizes our experiences, in particular regarding complications and safety. Results. There were significant differences in favor of O-LDN regarding operative time, warm ischemia time, and vessel lengths, whereas the analgesic requirements and pain data were significantly in favor of the laparoscopic procedure. In the L-LDN group, there were five major postoperative complications resulting in reoperations (8%), including two intestinal perforations. No major complications occurred in the O-LDN group. Conclusions. These results from our randomized study do suggest that conventional O-LDN is a very secure procedure, superior to L-LDN regarding donor safety. There has been an unacceptably high rate of reoperations in our L-LDN series but without mortality or significant sequelae. A careful look at some other L-LDN series also suggests increased morbidity/mortality. Our data do, however, support the view that a perfect, uncomplicated L-LDN appears to be the superior procedure, and the laparoscopic procedure is still evolving. Donor safety may be improved by avoiding obese donors, stapling of the renal artery (not clipping), and perhaps by hand assistance. Furthermore, we will consider the retroperitoneal approach.

Parametric multicategorical models are an established tool in statistical data analysis. Alternative semi-parametric models are introduced where part of the explanatory variables is linearly parametrized and part is given as a sum of unspecified functions of the explanatory variables. An important feature of the modelling approach is that it distinguishes between global and category specific variables. In contrast to global variables the effect of the latter may vary across the categories of the response. Continuous variables of both types, global and category specific ones, are modelled nonparametrically. Estimation procedures are derived which make use of an expansion in basis functions which are localized on a grid of values of the explanatory variables. Regularization of the estimates is obtained by penalization. †E-mail: scholz@stat.uni-muenchen.de

The authors of the aforementioned manuscript have recently claimed the synthesis of the ternary nitrides ZnNFe3 (=ZnFe3N) and AlNFe3 (=AlFe3N), ordered substituted variants of the binary phase γ‘-Fe4N [1]. While soft ferromagnets of such kind are presently attracting lots of attention, their history dates back for more than half a century. In particular, Al-substituted γ‘-Fe4N has already been mentioned in 1961 [2], and the existence of AlFe3N has also been claimed in 2009 [3] from a two-step ammonolysis reaction combining a high-temperature sintering step and a low-temperature nitriding reaction [4]. Nonetheless, one of us had to withdraw the latter claim after finding out, by means of scanning-electron microscopy and elemental mapping, that all samples of “AlFe3N” consisted of an intimate solid mixture of γ‘-Fe4N and amorphous Al2O3 [5]. From what follows, we have strong reasons to believe that the authors of Ref. [1] overlooked our findings [5] and also did not synthesize ZnFe3N and AlFe3N.

We studied the effects of bypass circuit surface heparinization on kallikrein-kinin, coagulation, fibrinolytic and complement activation in a closed model system for simulating veno-venous bypass (VVBP) in orthotopic liver transplantation (OLT). The circuits were identical to those in routine use during clinical OLT in our institution. Fresh whole human blood diluted 1: 2 with Ringer’s acetate was circulated at a non-pulsatile flow (2 l/min) and at a constant temperature (37.5°C) for 12 h. In 10 experiments, the entire inner surface of the circuits was coated with end-point attached heparin (HC). In the remaining 10, non-treated PVC tubing was used (NC). Components of the plasma kallikrein-kinin, coagulation, fibrinolytic and complement systems were analyzed using functional techniques (chromogenic peptide substrate assays) and enzyme immunoassays at baseline, 3 and 12 h. Significant activation of the initial (C3bc) and terminal (TCC) components of the complement system were found in both the NC and HC groups after 3 and 12 h: C3bc: NC: baseline =4 (3.5-7.7), 3 h=17.3* (12.5-27), 12 h=31* (17.7-63.6), HC: baseline=4.9 (3.2-6.8), 3 h=9* (6-14.4), 12 h=13.7* (7.4-18.1). TCC: NC: baseline=0.4 (0.2-0.6), 3 h=5* (0.8-11.9), 12 h: 13.1* (4.2-25.7). HC: baseline=0.5 (0.1-0.6), 3 h=0.6* (0.1-0.8), 12 h=1.2* (0.3-2) AU/ml; median and range (*: p2-antiplasmin complexes ( p=0.016) were found in the non-coated group, but not in the heparin-coated group during the observation period, showing that the coagulation and fibrinolytic systems were activated in the non-coated circuits. We conclude that heparin-coating of the internal surface of the extracorporeal perfusion circuit used for VVBP reduces activation of the plasma cascade systems in a closed venous system in vitro.

Current immunosuppressive strategies are aimed at abrogating the allospecific T-cell response against donor tissues or organs. However, little information is yet available on the potential influences of these drugs on innate immune responses. In order to address this, we have employed a whole blood model. Human whole blood was pretreated with sirolimus, cyclosporine A or tacrolimus in therapeutic as well as supra therapeutic doses, and subsequently stimulated with lipopolysaccharide (LPS), peptidoglycan (PepG) or lipoteichoic acid (LTA). Plasma cytokine analyses revealed a potent inhibitory effect of sirolimus on interleukin(IL)-10 production induced by all bacterial products tested. In contrast, cyclosporine A and tacrolimus inhibited the tumour necrosis factor (TNF)-α production in response to LPS, but not to PepG and LTA. Using a quantitative mRNA analyses, we also observed that sirolimus significantly decreased the IL-10 mRNA accumulation to sub-basal levels in peripheral blood mononuclear cells (PBMC). This suggests that the sirolimus inhibits IL-10 production by interfering with the IL-10 gene transcription. However, the molecular mechanism of this inhibition remains unclear. Based on the present study and observations by others, we postulate that the clinical use of the sirolimus may be associated with a dysregulated innate immune response to bacterial infection and thus an increased risk of hyperinflammation and sepsis.

The equilibrium pressure obtained during simultaneous occlusion of hepatic vascular inflow and outflow was taken as the reference estimate of hepatic vascular distending pressure (Phd). Phdat baseline was 1.1 ± 0.2 (mean ± SE) mmHg higher than hepatic vein pressure (Phv) and 0.7 ± 0.3 mmHg lower than portal vein pressure (Ppv). Norepinephrine (NE) infusion increased Phdby 1.5 ± 0.5 mmHg and Ppvby 3.7 ± 0.6 mmHg but did not significantly increase Phv. Hepatic lobar vein pressure (Phlv) measured by a micromanometer tipped 2-Fr catheter closely resembled Phdboth at baseline and during NE-infusion. Dynamic pressure-volume (PV) curves were constructed from continuous measurements of Phvand hepatic blood volume increases (estimated by sonomicrometry) during brief occlusions of hepatic vascular outflow and compared with static PV curves constructed from Phddeterminations at five different hepatic volumes. Estimates of hepatic vascular compliance and changes in unstressed blood volume from the two methods were in close agreement with hepatic compliance averaging 32 ± 2 ml · mmHg−1· kg liver−1. NE infusion reduced unstressed blood volume by 110 ± 38 ml/kg liver but did not alter compliance. In conclusion, Phlvreflects hepatic distending pressure, and the construction of dynamic PV curves is a fast and valid method for assessing hepatic compliance and changes in unstressed blood volume.

Species of Ascocotyle Looss, 1899 (subgenus Phagicola Faust, 1920) (Digenea: Heterophyidae) related to A. (P.) longa Ransom, 1920, i.e. those with a bipartite gonotyl and a single crown of 16 circumoral spines, were revised on the basis of examination of type and voucher specimens. The species A. (P.) arnaldoi Travassos, 1929, A. (P.) byrdi (Robinson, 1956) and A. (P.) longicollis (KuntzChandler, 1956), all possessing 16 circumoral spines, are synonymised with A. (P.) longa. A. (P.) ascolonga Witenberg, 1929, the types of which were not available, is provisionally retained as a valid species despite its close similarity to A. (P.) longa (identical number of circumoral spines and morphology of the ventrogenital sac). It differs from A. (P.) longa in the presence of uterine loops posterior to the testes and intestinal caeca ending anterior to the ovary (versus the pretesticular uterus and intestinal caeca reaching to the posterior margin of the ovary in A. (P.) longa). A. (P.) inglei (HuttonSogandares-Bernal, 1959), found only once in a single specimen, is also tentatively considered a valid species because it differs in number of circumoral spines (19), slightly larger eggs (23-26 x 13-16 microns) and the distribution of refractile bodies of the gonotyl arranged in four separate groups from A. (P.) longa and A. (P.) ascolonga (16 circumoral spines; eggs 15-20 x 8-12 microns; refractile bodies in two groups).

In this study, we evaluated the role of proteolytic enzymes belonging to the coagulation, fibrinolytic, and plasma contact systems in the early postoperative phase after orthotopic liver transplantation (OLT). Twenty-nine patients were studied at the time of OLT and during the first 2 postoperative weeks. Blood samples were collected daily after OLT and analyzed for kallikrein-like activity (KK), functional kallikrein inhibition (KKI), plasmin-like activity (PL), and alpha2-antiplasmin (AP). In addition, prekallikrein (PKK), prothrombin (PTH), antithrombin III (AT III), plasminogen (PLG), prothrombin/antithrombin III complexes (TAT), prothrombin fragment 1 + 2 (F1 + 2), and plasmin/alpha2-antiplasmin complexes (PAP) were measured. Nineteen patients experienced biopsy-verified acute rejections (AR) and ten patients had uneventful courses and served as controls. Plasma analyses showed that the contact, coagulation, and fibrinolytic systems were activated during OLT. Following OLT, continuous thrombin and plasmin generation was observed, and these effects were more pronounced in the group having an uneventful course than in patients with AR. Factors that could possibly affect plasma proteolytic activity, such as blood product usage during and after OLT and cold ischemia time of the liver graft, did not differ between the groups, nor did the routine liver function tests, alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

The morphology of the scolex of the tapeworm Silurotaenica siluri (Batsch, 1786) (Proteocephalidae: Gangesiinae), a specific parasite of European wels (Silurus glanis L.), was studied using light, scanning (SEM), and transmission electron (TEM) microscopy. The scolex of S. siluri is rather uniform in shape and size; it is globular, and has four prominent, anteriorly directed suckers and a spherical, muscular apical organ corresponding to the rostellum of cyclophyllidean cestodes. The rostellum-like apical organ is armed with five to six irregular rows of small hooklets with a wide, oval basal plate and a short, posteriorly curved blade. The excretory system of the scolex is formed by sinuous secondary canals ending blindly beneath the distal layer of the tegument, not opening outside. The surface of the scolex is covered with filiform microtriches; giant spine-like and blade-like microtriches, incorrectly interpreted as spines or hooklets in previous descriptions of S. siluri, are present on the neck region and posterior margins and internal cavities of the suckers. It is assumed that tegumental spines reported in the scolices of other proteocephalideans (subfamilies Acanthotaeniinae and Gangesiinae, genera Spasskyellina and Nomimoscolex) could indeed be spiniform microtriches.

The suitability of several metallization schemes for high temperature sensors and devices based on silicon carbide was investigated. Auger electron spectroscopy (AES) depth profiling was used for the detection of possible interface reactions and thermal induced diffusion processes. Changes in the structure of the films under the influence of high temperature were observed by transmission electron microscopy (TEM). The maximum operation temperature for the metallization with aluminum as coverlayer was found at 450 °C. The ability of gold with underlying tungsten nitride as diffusion barrier to work at temperatures above 450 °C was shown.

We used an in vitro model for venovenous bypass in a prospective, randomized study to analyze the effect on leukocytes cell activation after coating the total blood contact surface with covalently bound heparin. In ten experiments heparin-coated circuits were used, and in ten other experiments noncoated circuits were used. Monocyte cytokine production and neutrophil myeloperoxidase release were analyzed. Monocytes were isolated using anti-CD14 paramagnetic beads, and oligo (dT)25 beads were used to isolate mRNA before subsequent reverse transcription and semiquantitative amplification of various cytokines in order to determine time-related changes in expression during bypass. After 2 h, mRNAs for IL-1 beta and IL-6 were highly upregulated in noncoated compared to heparin-coated circuits. Little or no change was seen in the expression of other cytokines. IL-1 beta and IL-6 were measured in plasma after 12 h and reflected the upregulated mRNAs in noncoated circuits. A significantly reduced release of myeloperoxidase was observed in coated versus noncoated circuits. This indicates that heparin-coated surfaces reduce cellular activation and the release of inflammatory mediators.

Inadequate supplies of human organs for transplantation have evoked an escalating interest in human xenotransplantation. Hyperacute rejection precludes use of discordant organs. We have developed an ex vivo perfusion model in order to evaluate hyperacute rejection in a pig-to-human combination. Pig kidneys (n = 6) perfused with human blood deteriorated rapidly and rejection was seen after 70 (60–87) min (median, 95% confidence interval). Kidneys perfused with pig blood survived 300 (216–360) min, corresponding to the upper time limit of the model. Increases in prostaglandin E2 and 6-keto-prostaglandin F1α indicated endothelial activation. Sequential blood samples revealed a strong progressive inflammatory response with reduced leukocyte and platelet counts, granulocyte activation indicated by increased myeloperoxidase, and complement activation, shown by an increase in C3 activation products and the terminal SC5b-9 complement complex. A significant role for classical pathway activation was indicated by formation of C1rs-C1 inhibitor complexes and activation of C4, whereas factor B was not significantly activated. Biopsies at rejection demonstrated hyperacute rejection with inflammatory changes involving the vessels as well as the nephrons. Where the inflammatory markers could be studied in pig blood, activation was less than in human blood. The present discordant xenotransplant model is a valuable adjunct for evaluation of changes occurring in the human blood perfusate as well as in the pig kidney during hyperacute rejection.

We have introduced and evaluated several modifications of the conventional venovenous bypass (VVBP) in 29 adult patients undergoing liver transplantation (OLT). A percutaneous technique for insertion of a jugular venous return cannula and a femoral vein cannula was applied. The inferior mesenteric vein (IMV) was used for splanchnic decompression, which facilitated dissection of the recipient liver and allowed portal anastomosis to be performed without disconnecting the portal bypass. A heat exchanger was introduced into the bypass circuit to prevent heat loss. The percutaneous technique prevented complications related to dissection in the axilla and groin. Hemodynamic characteristics corresponded to those found using the traditional technique. Complications related to the VVBP were seen in only one patient in whom the femoral catheter was accidentally introduced into the femoral artery. We conclude that percutaneous cannulas, use of the IMV for splanchnic decompression and the introduction of a heat exchanger offer significant benefits and that they are safe and reliable.

Mechanisms of circulatory effects induced by nitric oxide synthase inhibition in endotoxemia were investigated in 36 pigs randomized to 1) endotoxin infusion (1.7 micrograms.kg-1.h-1 iv) for 7 h and bolus NG-nitro-L-arginine methyl ester (L-NAME; 25 mg/kg iv) after 3 h; 2) endotoxin infusion for 7 h; 3) saline infusion for 7 h and L-NAME after 3 h; and 4) saline infusion for 7 h. Fifteen minutes after L-NAME injection during endotoxemia, reductions in cardiac output (41%, P < 0.05), portal venous flow (51%, P < 0.05), and hepatic artery flow (50%, P < 0.05) were observed. Systemic vascular resistance increased by 82% (P < 0.05), and the portocaval vascular resistance increased by 101% (P < 0.05). Despite marked vasoconstriction after L-NAME, left ventricular intracavitary filling pressure, central venous pressure, and arterial pressure remained unchanged. During endotoxemia, hematocrit increased from 38.4 +/- 1.4 to 41.9 +/- 1.2 after L-NAME, and blood volume (n = 3) was reduced by an average of 8.3 ml/kg body wt. These changes probably reflect transcapillary fluid loss as urine output was unchanged. In conclusion, L-NAME decreased intravascular blood volume and increased splanchnic venous resistance. These effects will tend to reduce venous return. Combined with a marked increase in left ventricular after-load, L-NAME may thus compromise cardiovascular function in endotoxemia.

Indentation tests with loads between 0.5 and 10 mN were performed on fused quartz, (0001) oriented sapphire and (001) oriented barium titanate. The resulting submicron cracks were used to determine the fracture toughness KIC of the tested samples. The indentation crack length method was applicable, but a c/a dependency of the constant of proportionality was found. In addition, a very effective and simple approach—using the extra penetration of the indenter, due to the formation of cracks, so called pop-in—was used to determine KIC.

Post-pneumonectomy bronchopleural fistula (BPF) remains a rare but often life-threatening complication and therapeutic challenge. Traditional surgical procedures include chronic open drainage, attempts at direct stump closure, thoracoplasty with or without chest wall muscle transposition and trans-sternal bronchial closure. We describe a case with successful closure of a chronic BPF after pneumonectomy by intrathoracic transposition of a pedicled latissimus dorsi muscle flap circumferentially fixed on the surrounding pleural tissue under continuous video-assisted thoracoscopic overview. The postoperative course was without complications; no tumour, empyema or fistula re-occurred. In this article we want to present the potential advantages of video-assisted thoracoscopic support and interdisciplinary teamwork to improve the outcome of patients with BPFs after pneumonectomy.

Microvascular endothelial cells play an important part in inflammation as well as in organ specific leucocyte traffic, and may be functionally different from large vessel endothelium in this respect. This study therefore established a method for isolation and longterm culture of human intestinal microvascular endothelial cells (HIMEC). After dissociation by collagenase/dispase/DNase of mucosal and submucosal tissue obtained from normal adult jejunum, cells were plated and cultured to subconfluence in endothelial serum free medium containing 2.5% fetal calf serum, hydrocortisone, and N6, O2-dibutyryladenosine cyclic monophosphate. Primary cultures were trypsinised and endothelial cells were isolated by paramagnetic beads armed with monoclonal antibody to CD31. Optimal growth conditions for HIMEC cultures were established, allowing up to nine passages (three months in vitro). The cells contained Weibel-Palade bodies, expressed von Willebrand factor, CD31, and VE-cadherin; and bound Ulex Europaeus lectin I. A method to establish longterm cell cultures of HIMEC will facilitate further investigation of the function of intestinal endothelial cells and their participation in physiological and pathological events in the gut.

A new technique is presented which allows the use of a front-end sensor head for in situ and on-line characterization of cell concentration and cell size during fermentation. An epifluorescence microscope is mounted in a port of a bioreactor viewing directly into the agitated broth. Still images from cells are generated using pulsed illumination. They are directly visualized on a monitor and used for automatic image analysis. The cell concentration and morphological information are determined by counting and evaluating the cell images with respect to their depth from focus characteristic. An in situ microscope was successfully tested during yeast fermentations and yielded results which correlated well with results from a hemocytometer. (c) 1995 John Wiley & Sons, Inc.