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Purpose The aim of this study was to demonstrate the value of DCE MRI with high spatiotemporal resolution (GRASP) for differentiating paragangliomas and schwannomas in the head and neck. Methods In a retrospective PACS search of in total 410 patients who had undergone head & neck GRASP-MRI, we identified 6 patients with biopsy proven cervical paragangliomas (n = 3) and schwannomas (n = 3). Conventional MRI features were evaluated, lesion size was determined. Postprocessing in 4D-GRASP datasets was performed (1) based on reconstructions with a temporal resolution (Tres) of 4.1 s, qualitative time-intensity curve classification and semiquantitative parameter (Tpeak, PH, ERmax and Slopemax) analysis, and (2) voxel-based mapping and qualitative and semiquantitative perfusion modeling based on reconstructions with a Tres of 1.6 s. Additionally, GRASP perfusion analysis was performed in another set of 5 patients with presumed cervical paragangliomas (n = 3) and schwannomas (n = 2) based on conventional imaging criteria and was correlated with conventional imaging findings. Due to the small sample size, both groups were compared qualitatively. Results In the time intensity curve classification of 4D GRASP reconstructions (Tres 4.1 s), biopsy proven paragangliomas were consistently characterized by a type-III rapid inflow wash-out pattern, compared to a type-I inflow pattern in the schwannoma group. In both temporal resolutions, semiquantitative analysis of time intensity curves demonstrated rapid wash-in, wash-out, and higher peak signal intensities in paragangliomas compared to schwannomas. In 5 presumed (non-biopsy-proven) paragangliomas and schwannomas, time intensity curves improved diagnostic certainty. Conclusions Visual time intensity curve classification and semi-quantitative analysis of GRASP-MRI were, in this small retrospective series, sufficient to differentiate cervical paragangliomas from schwannomas. Utilization of this technique may further improve diagnostic confidence in lesions lacking conventional imaging features.

PurposeThe current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications.Materials and methodsThis is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis.ResultsSeventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred.ConclusionExclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

Contains fulltext : 208201.pdf (Publisher’s version ) (Closed access) BACKGROUND: Diffuse-type tenosynovial giant-cell tumour is a rare, locally aggressive, and difficult-to-treat soft tissue tumour. Clinical and surgical outcomes depend on multiple factors, including preoperative diagnostic assessment, the localisation and extent of disease, and possibly the choice of treatment modalities by orthopaedic surgeons. We did a retrospective cohort study to characterise global surgical treatment protocols, and assess surgical outcomes, complications, and functional results in patients with diffuse-type tenosynovial giant-cell tumours. METHODS: In this international, multicentre, retrospective cohort study, we included consecutive patients treated in 31 sarcoma reference centres between Jan 1, 1990, and Dec 31, 2017. Eligible patients were of any age and had histologically proven diffuse-type tenosynovial giant-cell tumour of large joints. Patient data were retrieved from the local databases of participating centres. Patients with localised-type tenosynovial giant-cell tumour were excluded. In the analysis, we only included patients with complete core criteria data regarding admission status, date of treatment, type of treatment at participating centre, and first local recurrence after treatment. We used a non-parametric method to estimate recurrence-free survival at 3, 5, and 10 years after initial surgical resection in a tertiary centre. We used a multivariate Cox regression model to estimate the effect of risk factors. We also present subgroup analyses of disease status at presentation (primary vs recurrent disease) and recurrence-free survival by surgery type (open surgery vs arthroscopic synovectomy), and prespecified risk factors were tested in a univariate and multivariable analyses, with an endpoint of first local recurrence after treatment in a tertiary centre. FINDINGS: Data collection for these analyses occurred between January, 2016, and May, 2018. We received the records of 1192 patients, of which 966 (81%) were surgically treated and had complete information on core criteria. 445 patients were admitted with therapy-naive disease of the knee and were primarily treated in a tertiary centre. Since patients with wait and see treatment do not have a starting date of treatment, these patients were excluded in the calculation of median follow-up time for all patients. For this calculation we used time of surgery as a starting date. 758 (64%) of 1192 patients had knee involvement and 628 (54%) of 1163 patients with complete data on type of surgery had one-staged open synovectomy. At a median follow-up of 54 months (IQR 27-97), recurrent disease developed in 425 (44%) of all 966 surgically treated cases, and recurrence-free survival was 62% (95% CI 59-65) at 3 years, 55% (51-58) at 5 years, and 40% (35-45) at 10 years. Surgical complications were reported in 105 (12%) of 906 patients who had complete data on surgical complications. Pain improved after surgical treatment in 255 (59%) of 434 patients and swelling improved in 328 (72%) of 453 patients who had complete data. INTERPRETATION: This study of patients with diffuse-type tenosynovial giant-cell tumour provides a comprehensive and up-to-date disease overview, assessing the clinical profile and management of the disease in multiple specialised referral centres. Surgical treatment of diffuse-type tenosynovial giant cell tumours is not a definitive treatment for every patient because it involves a high risk for local recurrent disease and a relatively high risk for postoperative complications. After surgical treatment in treatment-naive patients, risk factors for recurrent disease in individual patients were not identified in what we believe is the largest cohort to date. FUNDING: Daiichi Sankyo.

In this manuscript we report about the realization and testing of a high-voltage electrochemical double layer capacitor (EDLC) prototype (IES prototype), which has been assembled using innovative electrode and electrolyte components. The IES prototype displays a nominal capacitance of 4 F, a maximum voltage of 3.2 V and its maximal energy and power are in the order of 37 Wh kg −1 and 65 kW kg −1 , respectively. Furthermore, it also displays good cycling stability, high capacitance retention after 80 h float test and acceptable self-discharge. Taking into account substantial improvements of the cell design and assembly procedure, the performance of the IES prototype indicates that the components utilized in this device might be suitable alternatives to the state-of-the-art materials used in high energy EDLCs.

Zielsetzung: Das Ziel der vorliegenden Studie ist die Evaluation eines Versorgungsmanagementprogramms innerhalb der mhplus Betriebskrankenkasse (mhplus BKK) fur psychische und Verhaltensstorungen, das mittels eines telefonbasierten Ansatzes durchgefuhrt wurde. Methodik: Randomisierte kontrollierte Studie im Rahmen einer gesundheitsokonomischen Kosteneffektivitatsevaluation. Ergebnisse: 424 Teilnehmer und 114 Kontrollpersonen wurden in der Auswertung berucksichtigt. In der Interventionsgruppe (IG) konnte verglichen mit der Kontrollgruppe (KG) die Chance, innerhalb eines Jahres rehospitalisiert zu werden, statistisch signifikant nahezu halbiert werden (Odds Ratio 0,52; 95 % KI: 0,27 – 0,99). Die Zufriedenheit mit der mhplus BKK war in der IG statistisch signifikant hoher. Die durchschnittlichen Kosten pro Versichertem waren in der IG mit 3703 Euro niedriger als in der Kontrollgruppe (4057 Euro). Dieser Unterschied war statistisch nicht signifikant (p = 0,56). Schlussfolgerung: Die Studie belegt die Wirksamkeit eines Versorgungsmanagementprogramms fur psychische Erkrankungen innerhalb einer Krankenkasse. Aufgrund erster Kostenersparnisse ist das Programm als dauerhafte Mehrleistung der mhplus BKK eingefuhrt worden.

Background Granulomatous inflammation on transbronchial needle aspirates from mediastinal lymph nodes is an infrequent yet important finding. We determined associations between cytomorphological features and underlying aetiology in an area of high prevalence of HIV-infection and tuberculosis. Methods We identified cases with granulomatous inflammation on mediastinal aspirates from January 2003 to July 2010. Cytomorphological features were evaluated and graded according to a simple and reproducible system including the presence, quality (discrete or vague), and number (≤5 or more) of granulomas as well as the presence of necrosis, lymphocytes, multinucleated giant cells, and neutrophils. Results In 81 patients (36 male, 9 HIV-positive) the final diagnosis was tuberculosis in 37 (46%), sarcoidosis in 40 (49%), fibrosing mediastinitis in 1 (1%), and unknown in 3 (4%). The presence of necrosis (P

Entscheidend fur den Erfolg der Strahlentherapie ist die zeitgerechte Applikation ohne toxizitatsbedingte Pausen; eine effektive Supportivtherapie ist obligat. Es werden Prophylaxe und Therapie akuter/subakuter Strahlenfolgen beschrieben. Von 1995 bis 2011 publizierte Studien wurden systematisch analysiert und die Leitlinie „Supportive Masnahmen der Radioonkologie“ der Deutschen Gesellschaft fur Radioonkologie erstellt. Prophylaxe und Therapie der (sub)akuten Strahlenreaktion werden fur Bestrahlungen des Zerebrums, im Kopf-Hals-Bereich, der Lunge und der Haut dargestellt. Strahlentherapiepausen konnen durch leitliniengerechte Supportivtherapie vermieden werden. Bei Verdacht auf Nebenwirkungen sollten die Patienten in der Radioonkologie vorgestellt werden.

In this paper an innovative hydrostatic micro actuator system for controlling the rotational degree of freedom of microsurgery instruments is presented. From the possible hydrostatic motor designs, an annular gear motor in orbit configuration has been chosen based on its suitability for micro manufacturing. The innovative actuator design includes a rotor-integrated control mechanism for connecting the actuator’s individual positive-displacement chambers. First a macro-model of the new actuator was fabricated and tested. The obtained test results already confirm the functionality and show the actuator’s exciting potential. The important design parameters were identified and a mathematical model was developed and is presented in this paper. Thereby optimized design parameters enable a further miniaturization and the use within minimal invasive surgery tools. A potential application of this novel device is discussed in the context of endovascular and interventional resection treatment. Combined with a shape memory alloy actuator a tool for the resection of calcified aortic valves was developed. Because of its small size it is possible to integrate it into a trocar channel.

Targeted mass spectrometry comprises a set of methods able to quantify protein analytes in complex mixtures with high accuracy and sensitivity. These methods, e.g., Selected Reaction Monitoring (SRM) and SWATH MS, use specific mass spectrometric coordinates (assays) for reproducible detection and quantification of proteins. In this protocol, we describe how to analyze, in a targeted manner, data from a SWATH MS experiment aimed at monitoring thousands of proteins reproducibly over many samples. We present a standard SWATH MS analysis workflow, including manual data analysis for quality control (based on Skyline) as well as automated data analysis with appropriate control of error rates (based on the OpenSWATH workflow). We also discuss considerations to ensure maximal coverage, reproducibility, and quantitative accuracy.

In this Perspective, we discuss developments in mass-spectrometry-based proteomic technology over the past decade from the viewpoint of our laboratory. We also reflect on existing challenges and limitations, and explore the current and future roles of quantitative proteomics in molecular systems biology, clinical research and personalized medicine. ISSN:1750-2799 ISSN:1754-2189

Die Tuberkulose ist mit geschatzt 9 Mio. betroffenen Menschen im Jahre 2013 eine weltweit verbreitete Infektionskrankheit. In den haufigsten Fallen liegt eine Infektion mit Mycobacterium (M.) tuberculosis zugrunde [3]. Etwa 1 % der humanen Tuberkulosefalle ist durch M. bovis verursacht und manifestiert sich meist extrapulmonal [2]. Unterschieden werden die beiden Subspezies M. bovis subsp. bovis (intrinsische Pyrazinamidresistenz) und subsp. caprae (in der Regel pyrazinamidempfindlich). Wichtigster Wirt von M. bovis subsp. caprae sind Ziegen. Infektionen mit M. bovis kommen auch bei Rindern, Hirschen und Wildschweinen vor [2]. M. bovis subsp. caprae ist hauptsachlich auf europaische Lander beschrankt [4]. Die Ubertragung erfolgt von Tier zum Menschen. Meist handelt es sich um Menschen, die in der Landwirtschaft tatig sind oder Kontakt zu Rotwild haben. Auch die Ubertragung von Mensch zu Mensch ist moglich [1]. Eine Infliximabtherapie birgt ein erhohtes Risiko fur die Reaktivierung einer Tuberkulose. In einer Follow-up-Studie mit Morbus-Crohn-Patienten (n = 500) wurde bei einem Probanden (0,2 %) M. avium nachgewiesen [5].

Transbronchial needle aspiration (TBNA) via flexible bronchoscopy is a well-established sampling modality for lung masses. The procedure is useful in the diagnosis of neoplastic and non-neoplastic lesions as well as for staging of bronchogenic carcinoma. Rapid on-site evaluation (ROSE) adds value as it has the advantage of triaging material during the procedure so avoiding a battery of investigations. Frequently used rapid stains are the modified Wright-Giemsa water-based stain (WG-ROSE) and the alcohol-based modified Papanicolaou stain (Pap-ROSE). Final review of laboratory-based Giemsa and Pap stains supplemented by ancillary investigations is essential for quality assurance. To investigate whether and how ROSE influenced the quantity and quality of the material submitted to the laboratory we randomized 126 patients to WG-ROSE, requiring only one pathologist on-site, or combined WG- and Pap-ROSE, requiring an additional person on-site to assist with staining. In those patients with positive TBNA we graded the laboratory-based slides of the first pass containing diagnostic material into insufficient, suspicious, adequate and excellent. The first diagnostic pass was found after 3.06 ± 1.94 (SD) passes and 3.13 ± 2.16 passes with WG-ROSE and combined ROSE (P = 0.87), respectively. Following WG-ROSE and combined ROSE 69% and 71.1% (P = 0.509) of slides were diagnostic (adequate or excellent) on laboratory-based Giemsa stains, and 93.3% and 100% (P = 0.134) were scored adequate or excellent on laboratory-based Pap stains. We concluded that the less costly and labour intensive WG-ROSE procedure is adequate for TBNA. This has cost implications especially in resource poor settings.

Due to the late onset of symptoms, retroperitoneal liposarcoma are often diagnosed in advanced stages when adjacent organs have been infiltrated and the tumours have reached extensive sizes. Surgery remains the first choice of therapy. We report on the primary resection of a 45-kg liposarcoma that was removed en-bloc including the left kidney and descending colon with -tumour-free margins. Nine months later, the follow-up revealed a right-sided recurrence of the tumour, which was surgically removed including the right ureter. Since then, the patient has been without any signs of tumour recurrence or metastases. This report demonstrates that even extreme-ly large tumours can be removed safely and that the size is not a contraindication for primary surgical treatment. Local recurrence is common as seen in our case, and occurs even after R0 resection up to 10 years after the first operation. Recurrences should be surgically removed as this is the only treatment which has been shown to increase survival in even R1 and R2 situations.

Background: Staphylococcus is the leading cause of microbial keratitis. Staphylococcus aureus isolated from ocular infections with resistance to a wide range of antibiotics, including the commonly prescribed fluoroquinolones, is emerging. The aim of this study was to determine the current antibiotic susceptibilities of ocular S. aureus isolates and also determine whether isolates from different adverse events or those with similar antimicrobial susceptibilities are related. Methods: A collection of 55 S. aureus strains from ocular adverse events were analysed for antibiotic susceptibility using disc diffusion (CDS method) and typed using PCR-ribotyping and pulsed-field gel electrophoresis (PFGE). Results: S. aureus isolated from symptomatic ocular adverse events in the USA exhibited greater resistance to antibiotics than did those isolated from symptomatic ocular adverse events in Australia or India (p

AIM Aim of the study was to compare stability of pedicle screws and ventral implanted screws after insertion in soft or cured kyphoplasty cement. METHODS Pedicle screws were inserted in a total of 40 thoracolumbar vertebrae of 10 different formalin-fixed human specimens: each 10 pedicle screws were implanted in soft (group 1) and cured cement (group 2), each 10 ventral screws were placed in soft (group 3) and cured (group 4) cement. Pedicle screws were then evaluated for biomechanical axial pullout resistance. RESULTS Mean pull-out force was 452 N (range 60-1 125 N) in group 1, 367 N (range 112-840 N) in group 2, 364 N (range 65-875 N) in group 3 and 271 N (range 35-625 N) in group 4. CONCLUSION Implantation of pedicle screws and ventral implanted screws in soft and cured kyphoplasty cement is a sufficient method. We achieved more stability with pedicle screws compared with ventral implanted screws in soft and cured cement. No significant difference was seen.

BACKGROUND Psychosocial adjustment, relationship and self-concept in siblings of children with idiopathic epilepsy was compared with healthy controls. PATIENTS 173 persons--68 siblings, 62 mothers and 43 fathers--from the study group (children with idiopathic epilepsy) and matched controls were investigated. METHODS Child Behaviour Checklist (CBCL), Self-Description-Questionnaire I and II (SDQ) and Sibling Relationship Questionnaire (SRQ) were used. RESULTS There were more somatic complaints of the siblings reported by the mothers of the study group. They also noted more nurturance of the sibling than mothers of healthy children did. The data of the fathers showed more dominance of the sibling. Siblings of children with epilepsy showed more prosocial action towards their classmates. In families with a new diagnosed epilepsy the fathers noticed more problems in school und somatic complaints of the siblings. The number of seizures, which were seen by the sibling, not the absolute number of seizures, had an influence on the behavior of the siblings; these siblings had more social problems than siblings, who had never seen a seizure. CONCLUSIONS We suggest a close cooperation with the families and constant inclusion in the treatment as claimed by recent systemic family medicine. Resource-orientated and salutogenetic aspects should be given a greater focus in modern work with families and especially siblings.

The present study is based on the assumption of an interaction between family functioning and chronic illness. Using a systemic approach, the intra-familial situation of families with a diabetes-affected child is examined. 44 families were evaluated using a family diagnostic instrument ("Familienbogen") and compared with 31 control families with a healthy child. Furthermore, the study looked at the influence of the level of family functioning on glycemic control, as measured by HbA1c values, and vice versa. Families with a child affected by diabetes showed significantly more dysfunctional domains and higher discrepancies of the ratings in the family diagnostic instrument (p < 0.05). Unexpectedly, no significant interaction between family functioning and glycemic control was found. Poor glycemic control therefore did not have any negative effects on the family dynamics, in fact, the opposite was often the case. Also, the relationship between siblings was judged more positively when one of the siblings was chronically ill (p < 0.05). The results show that despite the fact that diabetes in children may lead to an increase in impairment of intra-familial dynamics, it may, at the same time, offer opportunities for an improvement of family relationships. However, if physiological parameters deteriorate in the child (poor glycemic control), family problems seem to become less important. Success in the treatment of diabetes patients should therefore not only be measured by the quality of glycemic control, but also by considering psychological factors and aspects of family dynamics.

Summary We report the case of a 78-year-old woman who suffered from a severe soft tissue and bone infection of her left knee 3 years after a total knee-joint replacement without loosening of her endoprosthesis. Cultures from joint aspiration and tissue specimen identified Staphylococcus aureus and Candida albicans. Direct microscopic examination of vital spongy bone and fibrous tissue revealed microabscesses and seeds of yeasts inside the fatty marrow and interface. After removal of the prosthesis several soft tissue and bone specimens were taken during planned re-operations. The histological examination showed no morphological changing, no reduction or extinction of the yeast cells under fluconazole therapy with a dosage of 6 mg kg−1 body weight (400 mg daily). Curing of the fungal infection with eradication of the yeasts in the bony specimens was achieved with higher doses of 12 mg kg−1 body weight (800 mg day−1) over a 2 month regimen in combination with repeated surgical debridements. Zusammenfassung Wir berichten uber eine 78-jahrige Frau mit einer schweren Weichteil- und Knocheninfektion im Bereich des linken Kniegelenkes drei Jahre nach einem totalen Kniegelenksersatz ohne Lockerung der Endoprothese. Die kulturelle Untersuchung erbrachte den Nachweis von Staphylococcus aureus und Candida albicans. Die mikroskopische Untersuchung von vitalem spongiosem Knochen und fibrosem Gewebe bestatigte Mikroabszesse und Hefezellinseln im Fettmark und in der Interface. Nach Entfernen der Prothese wurden wahrend mehrerer geplanter Reoperationen Weichteil und Knochenproben gewonnen. Die histologische Untersuchung zeigte keine morphologische Veranderung, Reduktion oder Verschwinden der Pilzzellen unter Fluconazol-Therapie in einer Dosierung von 6 mg pro kg Korpergewicht (400 mg taglich). Die Heilung der Pilzinfektion mit Eradikation der Hefepilze aus dem Knochen wurde erreicht mit einer hoheren Dosis von 12 mg pro kg Korpergewicht (800 mg taglich) uber einen Zeitraum von 2 Monaten in Kombination mit chirurgischem Debridement.

Obwohl das klinische Bild einer frischen Achillessehnenruptur eindeutig ist, wird diese Sehnenverletzung in bis zu 10% der Falle nicht erkannt oder fehlinterpretiert. Ohne operative Versorgung oder adaquate Ruhigstellung besteht die Gefahr der Ausbildung einer instabilen Defektstrecke, deren Therapie und Nachbehandlung von der einer frischen Verletzung erheblich abweicht. Zwischen 6/2000 und 3/2002 wurden 11 Patienten (Durchschnittsalter 53 Jahre, mannlich:weiblich = 9:2) mit einer veralteten Achillessehnenruptur prospektiv erfasst, bei denen eine instabile Narbenzone operativ uberbruckt wurde. Kraftlosigkeit und Belastungsschmerzen waren die praoperativen Kardinalsymptome. Die Defektstrecke lag im Mittel bei 3,5 (2,0–6,0) cm. Nach Resektion der Narbe wurde die Sehnenkontinuitat 9-mal durch eine Umkehrplastik mit breitem zentralen Sehnenstreifen und 2-mal mit einer Griffelschachtelplastik wiederhergestellt. Durch die operative Sehnenrekonstruktion wurde bei der Abschlussuntersuchung ein mittlerer Kraftzuwachs von 40% festgestellt bei geringeren Beschwerden und gleichem Bewegungsumfang. Als Komplikationen lagen 2-mal eine oberflachliche Wundrandnekrose und einmal eine temporare Wundsekretion vor. Klinischer Befund, ein seitliches Rontgenbild und die Sonographie als praoperative bildgebende Diagnostik reichen fur die Indikationsstellung und Planung der Operation aus. Am besten hat sich in unserem Patientengut die Umkehrplastik mit breiten zentralen Faszienstreifen bewahrt. Bei einem kurzen distalen Stumpf ist die Griffelschachtelplastik mit zentralem Sehnenanteil indiziert. Sehnendefekte bis 6 cm Lange konnen mit einem ortsstandigen autologen Gewebe uberbruckt werden.

Sulfurcell (SC) has been running a pilot production for thin-film solar modules using CuInS2-chalcopyrite (CIS) as absorber material since 2004. Since then production technology has been constantly improved with module power values exceeding 64 W, corresponding to an aperture area efficiency level of about 9%. Small area (0.5 cm2) cells cut out of such CIS modules reach maximum efficiencies close to 11%. Strong efforts have been made to develop a new sequential Cu(In,Ga)S2 (CIGS) process suitable for production of large-scale CIGS solar modules thereby enabling module efficiencies above 10%. CIGS-based solar cells are—quite similar to CIS-based modules—prepared from sputtered metals subsequently sulfurized using rapid thermal processing in sulfur vapor. Such Cu(In,Ga)S2 solar cells reach material record efficiencies about 13%. The cells are characterized by high open-circuit voltages up to 890 mV. Based on the results of the “Helmholtz Zentrum Berlin” (HZB), Sulfurcell has successfully scaled this process to our typical module size of 125 cm × 65 cm and is currently piloting the process for mass production. This paper will give an overview of electrical and structural parameters of world's first large-scale CIGS modules. CIGS module and cell parameters will be compared with standard CIS module and cell parameters and measured CIGS efficiency temperature coefficients will be compared with typical temperature coefficients of modules based on established PV technologies.

Cloud infrastructure becomes the primary business environment for all types of enterprises during recent years. In cloud computing security is a fundamental concern, loss of control and potential lack of trust prevent large set of potential customers to immerse in the cloud world. One of the major key problem is how one can test, monitor or measure the underlying Cloud infrastructure from user/customer space. We have developed a solution which is able to examine the infrastructure, from security point-of-views. We offer a clear, adaptable, concise and easy-to-extend framework to assess the underlying cloud infrastructure. Our developed solution is generic and multipurpose it can act as a vulnerability scanner, and performance benchmarking tool at the same time. It is virtualized, it is agent based and collects assessment information by the decentralized Security Monitor and it archives the results received from the components and visualize them via a web interface for the tester/administrators. In this paper we present our virtualized cloud security monitor and assessment solution, we describe its functionalities and provide some examples of its results captured in real systems.

The implementation of innovative methods and concepts for microsurgery – especially in the context of endovascular and interventional treatment – require properly fitted and resized instruments. These surgical tools, such as micro-guiding systems, must be of the highest quality regarding reliability and accuracy while additional medical requirements for the application in the human body have to be fulfilled. In this paper an innovative hydrostatic microactuator system for controlling the rotational degree of freedom of microsurgery instruments is presented. From the possible hydrostatic motor designs, an annular gear motor in orbit setup has been chosen based on its suitability for micro manufacturing. The innovative actuator design includes a rotor-integrated control for connecting the actuator’s individual positive-displacement chambers. Firstly, a macro-model of the new actuator was fabricated and tested. The obtained test results have already confirmed the functionality and show the actuator’s exciting potential. Currently the macro-model is further resized and the micro fabrication process is being developed.

To determine if fine needle aspiration (FNAB) of mycobacterial lymphadenopathy can differentiate infection with M. bovis BCG(BCG) fromM. tuberculosis(TB) and whether HIV status affects discriminatory cytological features. A retrospective study of culture positive, fine needle aspiration biopsies of lymph nodes in children (

A key barrier to the realization of personalized medicine for cancer is the identification of biomarkers. Here we describe a two-stage strategy for the discovery of serum biomarker signatures corresponding to specific cancer-causing mutations and its application to prostate cancer (PCa) in the context of the commonly occurring phosphatase and tensin homolog ( PTEN ) tumor-suppressor gene inactivation. In the first stage of our approach, we identified 775 N -linked glycoproteins from sera and prostate tissue of wild-type and Pten -null mice. Using label-free quantitative proteomics, we showed that Pten inactivation leads to measurable perturbations in the murine prostate and serum glycoproteome. Following bioinformatic prioritization, in a second stage we applied targeted proteomics to detect and quantify 39 human ortholog candidate biomarkers in the sera of PCa patients and control individuals. The resulting proteomic profiles were analyzed by machine learning to build predictive regression models for tissue PTEN status and diagnosis and grading of PCa. Our approach suggests a general path to rational cancer biomarker discovery and initial validation guided by cancer genetics and based on the integration of experimental mouse models, proteomics-based technologies, and computational modeling.

Duodenal ulcer recurrence and gastritis are reduced with successful Helicobacter pylori treatment. Serology is accurate in the diagnosis of H. pylori, but its value in determining eradication is unproved. To evaluate the usefulness of serology in monitoring treatment, we measured serial serum antibodies in three patient groups: eradication success (N = 57), eradication failure (N = 19), and untreated patients (N = 24). Eradication was determined by Warthin Starry staining of antral biopsies and repeat 13C breath tests at six weeks. Subsequent 13C breath tests were then performed at three-month intervals to monitor eradication. IgG antibody concentrations to H. pylori were determined by a commercially available ELISA kit. Serology concentrations remained constant throughout the study period in the untreated patients. IgG concentrations decreased slightly in the treatment failure group at six weeks but thereafter remained at baseline values. In the eradicated group, serum IgG concentrations decreased 26% by three months, 43% by six months and 55% at nine and 12 months (P0.001). A 20% reduction in IgG concentrations by six months was associated with successful treatment (sensitivity 86% and specificity 88%). We conclude that serology is a potentially useful way to monitor H. pylori treatment success.

Unter den eitrigen Osteomyelitiden bzw. Arthritiden stellt die bakterielle Sakroiliitis eine grose Seltenheit dar. Ihre operative Therapie ist nach erfolgloser konservativer Behandlung, bei Abszesbildung, septischen Zustanden sowie Vorliegen von neurologischen Ausfallen indiziert. Zwischen 1983 und 1990 wurden 9 Patienten nach diesen Kriterien operativ mit Ausraumung des entzundlichen Bereichs, primarer Arthrodese des Sakroiliakalgelenks mittels autologem Knochenspan, adjuvanter Antibiotikatherapie sowie postoperativer Immobilisation behandelt. Eine Nachuntersuchung, durchschnittlich 47 Monate postoperativ, ergab in 6 von 8 Fallen gute funktionelle und rontgenologische Ergebnisse, 2 Patienten klagten uber geringe Restbeschwerden. Bei keinem der Nachuntersuchten kam es zu einem Rezidiv, ein Patient war postoperativ an den Folgen einer langfristigen, bereits praoperativ bestehenden Sepsis verstorben. Nach diesen Ergebnissen sollte die operative Behandlung der bakteriellen Sakroiliitis rechtzeitig erwogen werden, da dann die Operation mit einer geringen Komplikationsrate verbunden ist und nur eines geringen operationstechnischen Aufwands bedarf.

The centrally acting α2-adrenoceptor agonist clonidine was used to assess the sensitivity of α2-adrenergic neurotransmis-sion in man, using receptor-binding studies and clonidine-induced growth hormone response. Neither acute (2 μg/kg body weight) nor subchronic (3 days, 2 × 150 μg/kg body weight) administration of clonidine affected platelet α2-adrenoceptor number in humans as judged by 3H-yohimbine and 3H-UK-14,304 binding. The same treatment also did not modify central postsynaptic α2-adrenoceptor function in the same individuals as assessed by clonidine-induced growth hormone responses. Similarly, subchronic (3 days, 500 μg/kg body weight, i.p.) or chronic (14 days, 500 μg/kg, i.p.) administration of clonidine to mice failed to change 3H-yohimbine or 3H-UK-14,304 binding sites in membranes prepared from frontal cortex. On the other hand, in vitro experiments using mouse frontal cortex or human platelet membranes showed pronounced reduction of 3H-UK-14,304 but not of 3H-yohimbine binding sites after incubation with several adrenoceptor agonists. The data indicate that acute and subchronic clonidine treatment may not change α2-adrenoceptor sensitivity in humans or mice as assessed both at the functional and receptor level.

Subcutaneous fat necrosis of the newborn is a rare, transient panniculitis of full-term infants. Diagnosis is usually made clinically; however, a biopsy is sometimes required. Fine-needle aspiration biopsy (FNAB) offers an alternative to biopsy. The cytology shows a spectrum of changes ranging from clumped lobules of fat with opaque cytoplasm to necrotic aspirates with dispersed fat cells with opaque cytoplasm, foamy macrophages, multinucleated giant cells, lymphocytes, and neutrophils. Radially orientated, refractile, needle-shaped crystals are visible in the cytoplasm of the fat cells and loose lying in the necrotic background. FNAB offers an alternative to biopsy with good results.

Traditional beta-blocking eye drops preserved with benzalkonium chloride show an adverse effect on the precorneal tear film, which can be measured by checking the break-up-time (BUT). To decide, whether this adverse effect is caused more by the beta-blocking drug or the preservative, we tested the influence of timolol eye drops without preservative in single dose units Timosine) on the BUT in a prospective, open study. These eyedrops caused no significant shortening of the BUT in persons, which where untreated before. Patients using preserved beta-blocking eye drops and having irritations of their eyes showed significant prolongation of the BUT after changing the therapy to Timosine. Preservative-free beta-blocking eye drops are a real improvement in the therapy of glaucoma patients with irritated eyes.

purpose, patients, and methods: Helicobacter pylori (HP) is present in more than 90% of duodenal ulcers (DUs). To investigate the pathophysiology in those patients with DU who are HP-negative compared with those who are HP-positive, we interviewed consecutive patients prior to endoscopy regarding factors often associated with ulcer disease. At esophagogastroduodenoscopy, antral biopsy specimens were obtained for urease test, culture, and Warthin Starry staining for HP in all patients with DU who did not have active bleeding. results: Compared with HP-positive patients who had DU, HP-negative patients with DU were more likely to be aspirin users and less likely to have had prior ulcers. HP-positive patients with DU had more severe antral inflammation than HP-negative patients. Whites were more likely to be HP-negative than blacks. HPnegative patients with DU most commonly presented with bleeding, whereas HP-positive patients with DU presented with pain. conclusions: Our findings suggest a different mechanism for DUs in patients who are HP-positive versus those who are HP-negative, and this difference might have a bearing on treatment. The absence of HP should lead to a more thorough search for nonstereidal anti-inflammatory drug/aspirin use, Zollinger-Ellison syndrome, and other potential causes of DUs.

Although a large variety of biochemical effects have been reported for lithium (Li) and carbamazepine (Cbm), the final molecular mechanism underlying their therapeutic efficacy for recurrent affective disorders is still unknown. The data presented here clearly indicate that therapeutic concentrations of both drugs inhibit sodium nitroprusside-induced accumulation of cGMP in human lymphocytes to about the same extent. The effect is not seen for other antidepressants, and shows pronounced interindividual variations in healthy volunteers. A similar effect of lithium and carbamazepine can also be demonstrated for the cGMP accumulation of central neurons using the model of dissociated cells of the mouse brain. The results are discussed in view of a common mechanism of action of both drugs. Furthermore, it is speculated that the individual sensitivity of the cGMP generating system of human lymphocytes to both drugs might be used to predict therapeutic response or nonresponse of the individual patient.

Amyloidosis is usually considered as a cause of motor disorders of the esophagus, including achalasia. However, most patients with amyloid in the esophagus are AL-type amyloid. We report what we believe is the fourth case of secondary amyloidosis (AA-type) resulting from rheumatoid arthritis. Clinically and radiologically the picture was that of achalasia.

Aims: The introduction of clearly defined histopathological criteria for a standardised evaluation of the periprosthetic membrane, which can appear in cases of total joint arthroplasty revision surgery. Methods: Based on histomorphological criteria, four types of periprosthetic membrane were defined: wear particle induced type (detection of foreign body particles; macrophages and multinucleated giant cells occupy at least 20% of the area; type I); infectious type (granulation tissue with neutrophilic granulocytes, plasma cells and few, if any, wear particles; type II); combined type (aspects of type I and type II occur simultaneously; type III); and indeterminate type (neither criteria for type I nor type II are fulfilled; type IV). The periprosthetic membranes of 370 patients (217 women, 153 men; mean age 67.6 years, mean period until revision surgery 7.4 years) were analysed according to the defined criteria. Results: Frequency of histopathological membrane types was: type I 54.3%, type II 19.7%, type III 5.4%, type IV 15.4%, and not assessable 5.1%. The mean period between primary arthroplasty and revision surgery was 10.1 years for type I, 3.2 years for type II, 4.5 years for type III and 5.4 years for type IV. The correlation between histopathological and microbiological diagnosis was high (89.7%), and the inter-observer reproducibility sufficient (85%). Conclusion: The classification proposed enables standardised typing of periprosthetic membranes and may serve as a tool for further research on the pathogenesis of the loosening of total joint replacement. The study highlights the importance of non-infectious, non-particle induced loosening of prosthetic devices in orthopaedic surgery (membrane type IV), which was observed in 15.4% of patients.

Der ungewohnliche Fall einer direkten Perforation von Silikonpartikeln aus dem Handgelenk in die Sehnenscheide des M. flexor pollicis longus mit Ausbildung einer tumorosen Synovialitis und sekundarem Karpaltunnelsyndrom wird vorgestellt. Klinisches und radiologisches Bild sowie Bedeutung der Silikonsynovialitis und der heutige Stand der Indikationen fur die Implantation von Silikon-Handgelenksspacern werden diskutiert.

Hyperekplexia (OMIM 138491) is primarily an autosomal dominant disease characterized by exaggerated startle reflex and neonatal hypertonia. If untreated it can be associated with sudden infant death from apnea or aspiration pneumonia and serious injuries. Different mutations of the alpha1-subunit of inhbitory glyzine receptor (GLRA1) could be found. Clonazepame, a gammaaminobutyric acid (GABA) receptor agonist is the therapy of choice. An early diagnose will lead to appropriate treatment and genetic counseling.

Background & Aims: Multiple tests are available for determining Helicobacter pylori infection. Our aim was to compare the sensitivity, specificity, and negative and positive predictive value of the most widely available tests for diagnosis of H. pylori . Methods: A total of 268 patients (mean age, 53.7 ± 15.8 years; 142 male and 126 female; 125 white and 143 nonwhite) was tested for H. pylori infection by [ 13 C]urea breath test (UBT), measurement of serum immunoglobulin (Ig) G and IgA antibody levels, and antral biopsy specimens for CLO test, histology, and Warthin-Starry stain. No patient received specific treatment for H. pylori before testing. The infection status for each patient was established by a concordance of test results. Results: Warthin-Starry staining had the best sensitivity and specificity, although CLO test, UBT, and IgG levels were not statistically different in determining the correct diagnosis. The absence of chronic antral inflammation was the best method to exclude infection. Stratification of results by clinical characteristics showed that UBT and chronic inflammation were the best predictors of H. pylori status in patients older than 60 years of age. IgA was a better predictor in white patients. Conclusions: The noninvasive UBT and IgG serology test are as accurate in predicting H. pylori status in untreated patients as the invasive tests of CLO and Warthin-Starry.

Background/Aims: Diarrhea is a significant problem in patients with acquired immunodeficiency syndrome (AIDS). The aim of this study was to determine octreotide effectiveness in refractory AIDS-associated diarrhea. Methods: In a 3-week protocol, 129 patients with a stool weight of >500 g/day despite standard antidiarrheal therapy were randomized to receive octreotide or placebo (3:2 ratio). Octreotide dose was increased 100 μg weekly to a maximum of 300 μg three times a day based on weekly 72-hour stool collections. Subsequently, patients received open-label octreotide at doses of up to 500 μg three times a day. Results: A 30% decrease in stool weight defined response. After 3 weeks, 48% of octreotide- and 39% of placebo-treated patients had responded ( P = 0.43). At 300 μg three times a day, 50% of octreotide- and 30.1% of placebo-treated patients responded ( P = 0.12). At a baseline stool weight of 1000–2000 g/day, 57% of octreotide- and 25% of placebo-treated patients responded ( P = 0.06). Response rates based on CD4 counts, diarrhea duration, body weight, human immunodeficiency virus risk factor, and presence or absence of pathogens showed no benefit of octreotide. Adverse events were more frequent in the octreotide-treated group. Conclusion: In the doses studied, octreotide was not more effective than placebo in patients with refractory AIDS-associated diarrhea. This lack of effectiveness may be attributable to inadequate sample size, doses, and duration of study treatment.

To evaluate the influence of Helicobacter pylori, nonsteroidal anti-inflammatory drug (NSAID) use, tobacco and alcohol use, age, gender, ethnic group, and the indication for endoscopy on the frequency of gastric and duodenal ulcers in patients referred for upper endoscopy.One thousand eighty-eight consecutive patients without prior antrectomy or active bleeding at endoscopy who were able to provide a history were interviewed prior to endoscopy, and antral biopsies were performed for H. pylori at endoscopy. Variables were tested for univariate association with duodenal or gastric ulcer and those variables with p0.25 were included in the logistic regression model building.One hundred seven patients had duodenal ulcer, 97 had gastric ulcers, and 5 had both. Significant risk factors in the final model for duodenal ulcer were H. pylori, history of previous ulcer, male gender, bleeding, and pain at presentation (p0.001), whereas alcohol was associated with a decreased risk (p = 0.026). H. pylori presence (p = 0.011), aspirin use (p = 0.009), and bleeding (p = 0.012) were associated with gastric ulcer in the final model; esophageal symptoms were associated with decreased risk of gastric ulcer (p = 0.003). NSAID use was associated with gastric ulcers only in those over 55 (p0.05), especially whites, and in nonwhites without prior ulcer. There was no interaction between H. pylori and NSAIDs.H. pylori was associated with an increased risk of duodenal and gastric ulcers. Aspirin increases the risk for gastric ulcer in patients of all ages, whereas nonaspirin, nonsteroidal use increases the risk for gastric ulcers to varying degrees in patients over age 55, depending on race and history of ulcer.