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Soil structure is sensitive to intensive soil management. It can be ameliorated by a reduction in soil cultivation and stimulation of plant and microbial mediators for aggregate formation, with the latter being a prerequisite and measure for soil quality. Cover crops (CCs) are part of an integrated approach to stabilize or improve soil quality. Thereby, the incorporation of diverse CC mixtures is hypothesized to increase the positive effects of CC applications. This study entailed an investigation of the legacy effect of CCs on soil aggregates after three crop rotations in the second main crop (winter wheat) after the last CC treatment. Four CCs (mustard, phacelia, clover, and oat) cultivated in pure stands and with a fallow treatment were compared to a mixture of the four CC species (Mix4) and a highly diverse 12-plant-species mixture (Mix12) in a long-term field experiment in Germany. The organic carbon (OC) distribution within macroaggregate fractions (16–8, 8–4, 4–2, 2–1, and <1 mm) and their aggregate stability were measured by dry- and wet-sieving methods, and the mean weight diameter (MWD) was calculated from water-stable aggregates. The results showed that, compared to the fallow, all CCs increased the MWD between 10 % and 19 % in soil under the following main crop. The average MWD increase over the fallow was slightly higher for CC mixtures (16 %) than for single CCs (12 %). Most of the OC (67.9 % on average) was stored in the <1 mm aggregate fraction, highest in the topsoil and decreasing with soil depth. The intermediate fractions (8–4 mm, 4–2 mm, 2–1 mm) stored 8.5 %, 10.5 %, and 11.0 % of the total OC, while 2.1 % was stored in the 16–8 mm fraction. Higher MWD improvement at the 20–30 cm depth also indicates additional benefits from a reduction in the cultivation depth. Structural equation modelling (SEM) suggests that single CCs were more likely to increase OC storage in small macroaggregates <1 mm, while CC mixtures were more likely to increase OC in the largest fraction (8–16 mm). Different individual CC species or mixtures exhibited varying involvement in the formation of different aggregate fractions. We provide evidence that litter quality, root morphology, and rhizosphere input, which affect microbial mediators of aggregate formation, might be the main reasons for the observed differences between CC treatments. Cover crops are valuable multifunctional tools for sustainable soil management. Here, we showed that they contribute to structure amelioration in arable soils. Increasing the functional diversity of plant species in CC mixtures could be a strategy to further enhance the positive effects of CCs in agroecosystems. [ABSTRACT FROM AUTHOR]

Soil structure is sensitive to intensive soil management. It can be ameliorated by a reduction in soil cultivation and stimulation of plant and microbial mediators for aggregate formation, latter a prerequisite and measure for soil quality. Cover crops (CC) are part of an integrated approach to stabilize or improve soil quality. Thereby, the incorporation of diverse CC mixtures is hypothesized to increase the positive effects of CC applications. This study entailed an investigation of the legacy effect of CC on soil aggregates after three crop rotations in the second main crop (winter wheat) after the last CC treatment. Four CCs (mustard, phacelia, clover, and oat) cultivated in pure stands and a fallow treatment were compared to a mixture of the four CC species (Mix4) and a highly diverse 12 plant species mixture (Mix12) in a long-term field experiment in Germany. The organic carbon (OC) distribution within macroaggregate fractions (16–8, 8–4, 4–2, 2–1 and < 1 mm) and their aggregate stability were measured by dry and wet sieving methods, and the mean weight diameter (MWD) was calculated from water-stable aggregates. The results showed that compared to the fallow, all CCs increased the MWD between 10 and 19 % in soil under the following main crop. The average MWD increase over the fallow was slightly higher for CC mixtures (16 %) than for single CCs (12 %). Higher MWD improvement at the 20–30 cm depth also indicates additional benefits from a reduction in the cultivation depth. Structural equation modelling (SEM) suggests that single CCs were more likely to increase OC storage in small macroaggregates < 1 mm, while CC mixtures were more likely to increase OC in the largest fraction (8–16 mm). Different individual CC species or mixtures exhibited a varying involvement in the formation of different aggregate fractions. We provide evidence that litter quality, root morphology and rhizosphere input, which affect microbial mediators of aggregate formation, might be the main reasons for the observed differences between CC treatments. Cover crops are valuable multifunctional tools for sustainable soil management. Here, we showed that they contribute to structure amelioration in arable soils. Increasing the functional diversity of plant species in CC mixtures could be a strategy to further enhance the positive effects of CC in agroecosystems. [ABSTRACT FROM AUTHOR]

A 49-year old man was found dead at home next to a glass containing a dried, white, crystalline substance and near a bag containing pills with the imprint XANAX, the trade name of alprazolam. A comprehensive screening of material collected during the autopsy revealed the presence of etizolam and caffeine in lethal concentrations (0.77 μg/mL and 190 μg/mL) but no trace of alprazolam. Benzodiazepine analogue etizolam is rarely prescribed in Germany, and as a result there are not many reports about fatal cases. It has anxiolytic, hypnotic, sedative and muscle-relaxant properties and is used for the short-term treatment of anxiety and panic attacks. The purine alkaloid caffeine, conversely, is the most widely used central nervous system stimulant. The following report outlines potentially the first reported case of a lethal combination of the downer etizolam and the upper caffeine in medical literature. [ABSTRACT FROM AUTHOR]

Background: Postoperative erectile dysfunction (ED) is one of the potential after-effects of radical prostatectomy. The aim of this study was to learn which caregivers inform the patients prior to the intervention about the risk of ED, which individuals the patients discuss this issue with, and whether the patients preoperatively consider use of a PDE5 inhibitor for proerectile therapy after the operation.Methods: Using the IIEF-5 questionnaire, the preoperative erectile function of 110 patients was evaluated after the hospital admission interview. The patients were asked who had informed them about the risk of postoperative ED. They were also asked in whom they had confided to discuss this issue and whether they were prepared to undergo postoperative proerectile therapy with a PDE5 inhibitor. The patients were subsequently assigned to one of two groups: group I, consisting of those with a preoperative IIEF score > or = 21, or group II, those with a preoperative IIEF score <21.Results: The answers given by groups I and II did not differ significantly. The median patient age was the same, 68, in both groups. In addition to being informed about postoperative ED by the hospital doctor on admission (100%), the patients were informed about this by the following individuals (results for group II in parentheses): board-certified urologist, 81.8% (74%); general practitioner (GP), 27.3%; partner, 12.1% (11.7%); self-help groups, 0% (2.6%); and friends, 3% (6.5%). Patients also discussed the risk of postoperative ED with the following individuals (results for group II in parentheses): local urologist, 66.7% (63.4%); partner, 45.5% (42.9%); hospital doctor, 39.4% (42.9%); GP, 21.2% (23.4%); friends, 9.1% (14.3); or no one, 3% (5.2%). Regarding whether patients were willing to undergo postoperative therapy using a PDE5 inhibitor, 36.4% in group I and 32.5% in group II said yes, 12.1% in group I and 11.7% in group II said no, and 51.5% in group I and 55.8% in group II were undecided.Conclusion: Irrespective of the patient's erectile status, the hospital doctor and the local urologist informed the patients about the risk of postoperative ED. Satisfactory information delivered by at least two people occurred in over 70% of all cases. The most frequent confidant of the patient for discussing this issue was his local urologist. Fewer than 50% of the patients discussed this topic with their partners. Possible reasons for underestimating the importance of sexual function could be the frequent taboo status of sexuality as a discussion topic in relationships, as well as preoperative distress. These circumstances should be taken into account by offering sufficient information, including that on the availability of postoperative proerectile therapy, for both the patient and his partner as early as possible, i.e., at the stage of choosing a treatment option. [ABSTRACT FROM AUTHOR]

Zusammenfassung Hintergrund  Die Telemedizin wird zunehmend eingesetzt, um eine neurologische Expertise in Allgemeinkrankenhäusern für die akute Schlaganfallversorgung verfügbar zu machen. Es gibt jedoch kaum Untersuchungen, inwieweit die telemedizinische Beratung vom medizinischen Personal der behandelnden Klinik und von den Patienten akzeptiert wird. Methoden  Die Analysen wurden innerhalb des TEMPiS-Projekts (Telemedizinisches Projekt zur integrierten Schlaganfallversorgung) in Bayern, einem Netzwerk aus 2 Schlaganfallzentren und 12 regionalen Versorgungskrankenhäusern, durchgeführt. Evaluiert wurde in 2 Querschnittsuntersuchungen der Jahre 2004 und 2007 die subjektive Bewertung der Telekonsile bezüglich Video- und Audioqualität, Zeitaufwand sowie inhaltlicher Relevanz. Als Teil einer prospektiven krankenhausbasierten Interventionsstudie wurde untersucht, inwieweit die Behandlung in einer TEMPiS-Kliniken einen Effekt auf die Gesamtbewertung des Krankenhausaufenthaltes durch Patienten oder Angehörige hatte. Dabei wurde im Hinblick auf ausreichende Follow-up-Raten nur Bewertungen von Patienten berücksichtigt, die 3 Monate nach Schlaganfall ohne Hilfe zu Hause lebten. Zusätzlich wurde analysiert, ob der Prozessparameter „Patient wurde telekonsiliarisch vorgestellt“ (36% der TEMPiS-Patienten) zu einer Veränderung der Gesamtbenotung führte. Ergebnisse  In beiden Erhebungszeiträumen der Querschnittsuntersuchungen wurden 140 bzw. 127 Telekonsile evaluiert. Eine sehr gute Benotung wurde mehrheitlich in beiden Zeiträumen für Videoqualität, Zeitaufwand und inhaltliche Relevanz sowie im 2. Zeitraum für Audioqualität abgegeben. Kritisch wurde die akustische Qualität im 1. Zeitraum mit nur 22% sehr guten Bewertungen eingeschätzt. Die Gesamtbewertung der Krankenhausbehandlung wurde von 1044 Patienten der TEMPiS-Kliniken häufiger mit sehr gut als von 484 Patienten der Vergleichskrankenhäusern graduiert (56 vs. 47%, p Schlussfolgerungen  Der teleneurologische Konsiliardienst in der akuten Schlaganfallversorgung erfährt eine hohe und langfristig stabile Akzeptanz. Für die Gesamtbewertung der akut-stationären Schlaganfallbehandlung legen die Ergebnisse eine verbesserte Zufriedenheit mit der Schlaganfallbehandlung nach dem TEMPiS-Konzept nahe. Die telekonsiliarische Vorstellung selbst hat hierauf jedoch offensichtlich keinen entscheidenden Effekt. [ABSTRACT FROM AUTHOR]

Summary: The significance of cerebrovascular disorders is steadily increasing due to the demographic changes in western industrial societies. Therefore the implementation of telemedical networks seems tempting to improve deliverance of specialised stroke care in non-urban areas. Networks like TEMPiS, located in the rural area of south-eastern Bavaria, have shown to deliver high experienced stroke therapy to underserved areas. Mandatory for a high quality of supply is the appropriate technical equipment. Moreover, beside the teleconsultations, a continuous training should be performed. Mobile solutions allow more flexibility for the teleconsultants. [ABSTRACT FROM AUTHOR]

Background: Solid renal masses are increasingly treated with nephron-sparing surgery. As in other uro-oncological surgical techniques, minimally invasive and robotic-assisted techniques are becoming increasingly popular., Objectives: The perioperative results from minimally invasive nephron-sparing surgery versus open surgery were retrospectively compared., Materials and Methods: In our single center retrospective study, all patients who underwent nephron-sparing tumor excision between 2006 and 2016 were divided into two groups (group O = open approach and group M = minimally invasive approach). The (pre-)operative data, complications, and change in renal function were compared. Trifecta criteria (R0, no perioperative complications, ischemia ≤25 min) were used to determine success rates., Results: Of 329 patients, 310 were included for analysis (group O 123, group M 187). Patients in group O had significantly worse ASA score but comparable Charlson Index and significantly more pT3/4 tumors but equal PADUA-score when compared with group M. Otherwise, preoperative patient and tumor characteristics were comparable. Patients in group M had significantly shorter hospital stays (p < 0.001) and lower transfusion rates (p < 0.05). Trifecta criteria were more frequently met in group M than in O (M: 66.8% vs. 0: 49.6%; p < 0.001). Both major and minor complications were lower in group M (major: 10.7% vs 17.1%; minor: 13.9% vs. 26.0%; p < 0.05). Preservation of renal function was comparable in both groups. R0 rates did not differ significantly between groups (M: 97.8% vs O: 97.5%). Surgical procedure times were significantly longer in group M (p < 0.001; mean 30 min)., Conclusions: Minimally invasive, robotic assisted partial nephrectomy also proved to be successful in complex cases. In all aspects studied, the minimally invasive approach was shown to be at least equivalent to the open approach.