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Background and Aims: After endoscopic resection (ER) of early esophageal adenocarcinoma (EAC), the optimal management of patients with high-risk histologic features for lymph node metastases (ie, submucosal invasion, poor differentiation grade, or lymphovascular invasion) remains unclear. We aimed to evaluate outcomes of endoscopic follow-up after ER for high-risk EAC. Methods: For this retrospective cohort study, data were collected from all Dutch patients managed with endoscopic follow-up (endoscopy, EUS) after ER for high-risk EAC between 2008 and 2019. We distinguished 3 groups: intramucosal cancers with high-risk features, submucosal cancers with low-risk features, and submucosal cancers with high-risk features. The primary outcome was the annual risk for metastases during follow-up, stratified for baseline histology. Results: One hundred twenty patients met the selection criteria. Median follow-up was 29 months (interquartile range, 15-48). Metastases were observed in 5 of 25 (annual risk, 6.9%; 95% confidence interval [CI], 3.0-15) high-risk intramucosal cancers, 1 of 55 (annual risk, .7%; 95% CI, 0-4.0) low-risk submucosal cancers, and 3 of 40 (annual risk, 3.0%; 95% CI, 0-7.0) high-risk submucosal cancers. Conclusions: Whereas the annual metastasis rate for high-risk submucosal EAC (3.0%) was somewhat lower than expected in comparison with previous reported percentages, the annual metastasis rate of 6.9% for high-risk intramucosal EAC is new and worrisome. This calls for further prospective studies and suggests that strict follow-up of this small subgroup is warranted until prospective data are available.

Midsized annulenes are known to undergo rapid π-bond shifting. Given that heavy-atom tunneling plays a role in planar bond shifting of cyclobutadiene, we computationally explored the contribution of heavy-atom tunneling to planar π-bond shifting in the major (CTCTCTCT, 5a) and minor (CTCTTCTT, 6a) known isomers of [16]annulene. UM06-2X/cc-pVDZ calculations yield bond-shifting barriers of ca. 10 kcal/mol. The results also reveal extremely narrow barrier widths, suggesting a high probability of tunneling for these bond-shifting reactions. Rate constants were calculated using canonical variational transition state theory (CVT) as well as with small curvature tunneling (SCT) contributions, via direct dynamics. For the major isomer 5a, the computed SCT rate constant for bond shifting at 80 K is 0.16 s–1, corresponding to a half-life of 4.3 s, and indicating that bond shifting is rapid at cryogenic temperatures despite a 10 kcal/mol barrier. This contrasts with the CVT rate constant of 8.0 × 10–15 s–1 at 80 K. ...

Investigating the situations that lead women to seek treatment for drug addiction is necessary, as women experience the organic, social, and family damage caused by addiction intensely.The aim of this study was to describe situations that lead women to seek treatment for drug addiction.This is an exploratory, descriptive study, with a qualitative approach, carried out in a CAPS Ad service in the state of Minas Gerais (CAAE: 92864518.4.0000.5145). Open interviews were conducted in September 2018 with 24 of 28 women assisted by the service. The discourse of the collective subject was the basis of the data analysis.Social, family, and health problems were the main damaging impact of drug addiction among the women and were represented by the following: death of loved ones, violence from partners, theft, cognitive problems, hypertension, and diabetes. Specifically, it was affective and material losses experienced during the period of addiction that led the women to seek treatment.It is necessary to facilitate women's access to treatment for drug addiction and to incorporate their families into the treatment through activities that will reinforce the former's commitment to any proposed therapeutics; in addition, goals to reconstruct bonds within the family environment should be established.

The establishment of quantum communication links over a global scale is enabled by satellite nodes. We examine the influence of Earth's atmosphere on the performance of quantum optical communication channels with emphasis on the downlink scenario. We derive the geometrical path length between a moving low Earth orbit satellite and an optical ground station as a function of the ground observer's zenith angle, his geographical latitude, and the meridian inclination angle of the satellite. We show that the signal distortions due to regular atmospheric refraction, atmospheric absorption, and turbulence have a strong dependence on the zenith angle. The observed saturation of transmittance fluctuations for large zenith angles is explained. The probability distribution of the transmittance for slant propagation paths is derived, which enables us to perform the security analysis of decoy state protocols implemented via satellite-mediated links., Comment: 29 pages, 13 figures

Kreuzbandrisse (Rupturen des vorderen Kreuzbands, VKB) ziehen oft eine langwierige Rehabilitation und Wiedereingliederung nach sich. Die physiotherapeutische Nachbehandlung beinhaltet aktive und passive Masnahmen. Bislang existieren keine Studien zu neurodynamischen Aspekten der Rehabilitation von Kreuzbandrissen. Das Ziel der vorliegenden Studie bestand darin, die Veranderung der Bewegung des N. tibialis des betroffenen und nicht betroffenen Beins bei Probanden nach einer VKB-Ruptur zu untersuchen. Bestandteil der verblindeten Untersuchung der 19 Probanden waren der Knee Outcome Survey fur alltagliche Aktivitaten (KOS) und verschiedene Funktionsuntersuchungen (Slump-Test mit passiver Knieextension, Long Sitting Slump Test mit passiver Dorsalextension des oberen Sprunggelenks, Straight Leg Raise Test, belastete Dorsalextension im Stand). Die longitudinale Nervenexkursion des N. tibialis wurde mit bildgebendem Ultraschall in sitzender Slump-Position untersucht. Die Auswertung der Ultraschallvideos erfolgte mit einer Frame-by-frame Cross Correlation Software. Die Ergebnisse zeigten eine signifikant geringere Nervenexkursion des N. tibialis am betroffenen Knie. Allerdings fand sich kein klinisch signifikanter Zusammenhang zu den Funktionsuntersuchungen.

Random Telegraph Noise (RTN) effects are investigated in 65nm SRAM cells by using a new characterization method that provides a significant measurement time reduction. The variability induced in commercial SRAM cells is derived by applying statistical and physics based Montecarlo modeling to the experimental data. Results show that RTN can have a significant impact on the memory write operations and should therefore be taken into account during the memory design phase

Objectives Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Materials and methods Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90–99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. Results In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90–99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. Conclusions In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

Amusement park physics is a popular way to reinforce physics concepts and to motivate physics learners. This article describes a novel physics competition where students use simple tools to take amusement park ride measurements and use the data to answer challenging exam questions. Research into the impact of participating in the competition reveals positive effects such as the acquisition of experimentation skills and improved attitudes towards physics.

We are continuously witnessing the emergence of new data services and applications in wireless transmission systems, in particular mobile broadband services, which require enhancing user’s experience. The existing radio frequency based wireless communications are facing challenges in so far as being able to cope with these varied, sophisticated and bandwidth hungry services and applications. The ever evolving optical wireless communications (OWC) technology with its unique features such as a license-free frequency spectrum, an inherent security, and significantly higher transmission rates is seen as a potential alternative and complementary to the radio frequency based wireless communications, which can address some of these challenges. This technology can be used for short to long distance applications as in indoor visible light communications, ultra-violet, and free space optics. The chapter gives an overview of the OWC system focusing on the historical development and current status, as well as existing and envisioned applications areas.

Ab der Mitte des 19. Jahrhunderts trat mit der Durchsetzung der naturwissenschaftlichen Denkweise eine Verwissenschaftlichung der Medizin mit Grundung von Spezialfachern ein. In Wien hatte sich die medizinische Spezialdisziplin der Urologie sehr fruh wissenschaftlich selbstandig neben den chirurgischen Schulen etabliert. In Berlin und an den anderen deutschen Hochschulstandorten wurde die Spezialdisziplin Urologie an den Universitaten am Beginn des 20. Jahrhunderts von Dermatologen oder Chirurgen in der Lehre vertreten. Mit dem Beginn der „modernen Urologie“ begann auch der Kampf um die Anerkennung als selbstandige Disziplin. Die Urologie nahm ihren Ausgang sowohl von den beiden klassischen Disziplinen der Medizin, Chirurgie und Innere Medizin, als auch von den 2 von ihnen ausgehenden alteren Spezialdisziplinen Gynakologie und Dermatovenerologie. Im September 1906 wurde in Stuttgart die Grundung der „Deutschen Gesellschaft fur Urologie“ genau 10 Jahre nach dem ersten Versuch realisiert. 1907 wurde die „ Zeitschrift fur Urologie “ gegrundet.

An improved accuracy is researched in flat and silicon based nano-calorimeters related to fluid reaction via drop-to-drop 'reaction' or via a steady state in continuous injection of two reactants inside a working chamber. Two types of the experimental aspects of the sensitivity changes, related to 3-D effects, are described: drop effects and volume rate effects. To increase the accuracy, well-controlled joule measurements are dissipated in the manufacturer resistance and in several resistances in carefully controlled experiments. The shape factor (SF) values reduce the manufacturer's joule sensitivity up to fifty per cent. a working methodology is proposed: the results are compared with the standard TRIS reaction. The results suggest that the systematic error can be reduced to ±5%.

Wahrend im englischen Sprachraum seit langem Monographiesammlungen zu fachpragenden Originalarbeiten vorliegen, existieren fur den deutschen Sprachraum weder Sammlungen noch Einordnungen. Infolge der kurzen Halbwertszeit aktuellen Fachwissens geraten die Pionierarbeiten in Vergessenheit und werden heute oftmals im—Gegensatz zum englischen Schrifttum—nicht einmal mehr zitiert. Daruber hinaus sind sie in vielen deutschen Bibliotheken auch aus konservatorischen Grunden weder auszuleihen, geschweige denn zu kopieren und daher in der Regel kaum noch zuganglich. Gustav Simons bahnbrechende Monographie gehort neben Max Nitzes „Lehrbuch der Kystoskopie“ zu den fachpragenden Monographien der internationalen Urologie. Neben einer grosen renommierten Instrumentensammlung besitzt das Archiv und Museum der Deutschen Gesellschaft fur Urologie in Dusseldorf eine umfassende Sammlung von Einzelartikeln, Monographien und Buchpublikationen zur Urologie und angrenzender Gebiete aus mehreren Jahrhunderten.

Fibulin-1 is an extracellular matrix protein overexpressed in epithelial ovarian and breast cancers. In estrogen receptor (ER)-positive ovarian and breast cancer cell lines, fibulin-1 mRNA levels are markedly increased by estrogens. Transfection experiments using fibulin-1 promoter constructs indicate that 17beta-estradiol (E2) increases fibulin-1 gene transcription and that ERalpha is more potent than ERbeta to mediate E2 regulation of the transfected fibulin-1 promoter. Using SL2 cells devoid of specificity protein 1 (Sp1) and site-directed mutagenesis of GC boxes, we evidenced that the E2 regulation occurs through a proximal specificity protein 1 binding site. In addition, we show that fibulin-1C and -1D mRNAs, the two major fibulin-1 splicing variants, are differentially induced by E2. The induction of both mRNAs variants is direct and independent of a newly synthesized protein intermediate. Interestingly, actinomycin D chase experiments demonstrate that E2 treatment selectively shortens the fibulin-1D mRNA half-life. This indicates that estrogens affect differentially the stability of fibulin-1 variants and may explain the lower accumulation of fibulin-1D mRNA on E2 treatment. In conclusion, our data show that estrogens, via ERalpha, are key regulators of fibulin-1 expression at both the transcriptional and posttranscriptional levels. The preferential induction of the fibulin-1C variant, which is overexpressed in ovarian and breast cancer, might play an important role in estrogen-promoted carcinogenesis.

An kaum einem anderen Organ lasst sich die Entwicklung des medizinischen und technischen Fortschritts in den letzten 150 Jahren so gut verdeutlichen wie an der Prostata. Die Geschichte der radikalen Prostatektomie ist zunachst gepragt von den Schwierigkeiten beim Zugangsweg zu dem Organ. Im Jahr 1867 fuhrte Theodor Billroth in Wien die erste partielle Prostatektomie beim Prostatakarzinom uber einen perinealen Zugang durch. 1904 waren es Hugh Hampton Young und William Stewart Halsted die am Johns Hopkins Hospital in Baltimore die erste erfolgreiche extrakapsulare perineale Prostatektomie durchfuhrten und so eine neue Ara begrundeten. In Deutschland entwickelte Prof. Friedrich Voelcker in Halle im Jahr 1924 die sog. ischiorektale Prostatektomie. Terence Millin war es vorbehalten im Jahr 1945 die erste Serie retropubischer Prostatektomien zu publizieren. 1952 wurde der sakroperineale Zugang nach Thiermann und die sakrale Prostatektomie nach Ubelhor eingefuhrt. 1991 schlieslich startete mit der ersten laparoskopischen Prostatektomie ein neues Zeitalter in der Prostatachirurgie. Eine Entwicklung, die in der Einfuhrung der laparoskopischen DaVinci-Prostatektomie durch Binder 2001 gipfelte. Vom Stiefkind der urologischen Chirurgie, um das man geflissentlich einen grosen Bogen machte, weil man tief greifende Komplikationen furchtete, mauserte sich die Prostata im Laufe der Zeit zum obskuren Objekt der Begierde. Das Stiefkind wurde zum Lieblingskind.

The search query used in this study. Medline, EMBASE and the Cochrane database were searched in september 2015 for relevant articles. After inclusion and exclusion, 18 relevant articles reporting on PET scanning of aortic aneurysms were included. (DOCX 20 kb)

Wireless communications using free space optics (FSO) are sensitive to atmospheric conditions. Clear-air turbulence can introduce severe impairments reducing FSO channel availability. Radiosounding profiles, available near Rome (Italy) and Munich (Germany), are used to estimate the power scintillation index through a new physical refractive index structure constant model and to estimate scintillation fade statistics for near-infrared FSO. Preliminary qualitative validation is performed using FSO campaign near Munich for both terrestrial and slant links.

Um 1850 charakterisiert der Breslauer Chirurg Theodor Middeldorpf (1824–1868) treffend: “Kleine Steine, junge Leute, gute Erfolge selbst bei jeder Methode, grosse Steine, alte decrepide Subjekte, viele Todte” [5].

The miniaturized calorimetric devices furnish a reduced working flat surface and permits measurements with extremely low-mass quantities. The experimental sensitivity shows relevant position dependence with x-y surface coordinates and with z-distance. The device identification is realized via a 2-D model based in Fourier general equation. Using the Marquardt method the experimental flat surface device can be identified and the fitted parameters used to simulate the behavior of the experimental system. From the model, the effects of several dissipation configurations can be evaluated. Also, via the RC-analogy, a way to 3-D experimental devices is roughly described.

In the present study the iontophoretic transdermal delivery of three different glucocorticoids through a confluent monolayer of MDCK cells, mimicking biological barriers, was studied. For this experiment an in vitro model with platinum electrodes for iontophoresis and MDCK cells was developed. With this model investigations concerning the biocompatibility of the cells depending on different current densities and the iontophoretic permeation of the three glucocorticoids through the cell monolayer were carried out. The permeation behavior of this living biological barrier should be very similar to the non-living barrier, human stratum corneum. Different current densities (12.74-38.22 microA/cm2) and a pulsatile application of continuous current to the cell monolayer were investigated. The pulsatile application of the current resulted in a step-like permeation profile. In all cases the electric current induced an reversible increase of the porosity of the cell monolayer demonstrated by transepithelial electrical resistance measurements and by sodium fluorescein assay.

This paper analyzes the importance of the German language and German culture and institutional development of urology in Japan in the early 20th century, starting from the development of the medical school for Japanese in Germany and their function in the process of modernization of the Meiji period (1868-1912). Examples of bi-directional German-Japanese relations in medicine, which also included an integrated knowledge transfer, are shown. The study is based mainly on Japanese and German sources about Japanese physicians in Germany as well as contemporary publications in German and international medical journals. Methodologically, the article combines quantitative analysis with individual biographical aspects.

An acoustical assessment was performed on the Combat Arms Firing Range at Whiteman AFB in April 2013. It was determined that the noise in the firing range met the definition of impulse noise in AFOSH Standard 48-20; however, CATM instructors and students are still potentially exposed to peak sound pressure levels that exceed the allowable limits of AFOSH Standard 48-20. Therefore, it was recommended that hearing protection, either single or double, be worn during weapons live-fire training.

An acoustical assessment was performed on the 303IS transmission monitoring at Osan AB in May 2012. It was determined that personnel performing transmission monitoring duties were exposed to hazardous noise. Exposures at certain workstations were over the adjusted 12-hour exposure limit. Recommendations include enrolling personnel in the hearing conservation program, installing electronic filtering, use of noise cancellation headphones, and further investigation to determine root causes of hazardous noise levels.

An acoustical assessment was performed on the Combat Arms Firing Range at Kunsan AB in May 2012. It was determined that the noise in the firing range did not meet the definition of impulse noise in AFOSH Standard 48-20 due to acoustical reflections, particularly off the side walls. Therefore, it was recommended that acoustical absorption be added to these side walls to reduce the reverberant field.

An acoustical evaluation of the engine test cell facilities at Misawa AB, Japan, was performed in December 2012. This assessment was accomplished to help determine overall sound pressure levels during multiple power settings of aircraft engine run-up procedures. It was determined that personnel performing these duties are exposed to hazardous noise levels. Therefore, it was recommended that engine test cell facilities should remain labeled as hazardous noise areas, personnel should be enrolled in the hearing conservation program and receive audiograms, and noise dosimetry should be performed to better characterize the cumulative noise exposures.

The aim of this study was to evaluate the current practice of the use of perioperative antithrombotic drugs to prevent arterial thrombo-embolic complications during arterial vascular surgery by Dutch vascular surgeons. Aim was also to compare the results with the literature and to evaluate the effect of guidelines.A comprehensive questionnaire was sent to all Dutch vascular surgeons performing arterial reconstructive surgery.The response rate was 84%. Acetylsalicylic acid (ASA) was continued perioperatively by most surgeons (91%). Clopidogrel was discontinued by the majority of respondents (65%). During operation 97% of surgeons administered unfractionated heparin (UFH) before arterial clamping. A minority (11%) measures peroperatively anticoagulant activity in patients' blood. After infrainguinal venous bypass most surgeons (81%) preferred monotherapy with vitamin K antagonists (VKA), in agreement with the Dutch guideline in this respect. Before the introduction of the guideline in 2005, a survey was performed in 2004. Results of our 2011 survey showed more respondents (6% to 11%) prescribed ASA or VKA according to these guidelines.This survey showed a recognizable pattern of variation for perioperative arterial thrombosis prophylaxis amongst Dutch vascular surgeons, in agreement with reports from other countries over the past 20 years. Although a higher percentage of surgeons complied in 2011 with existing guidelines than in 2004, guidelines were not completely met. Possibly because current guidelines are not fully supported by evidence and do not cover all aspects of perioperative arterial thrombosis prophylaxis. Clearly there is need for (more) convincing data based on RCT's concerning the various aspects of perioperative arterial thrombosis prophylaxis.

Biodegradable implants containing 10 mg of gentamicin each were prepared by compressing the polymer-drug mixture. The liberation of gentamicin from the implants and the biodegradation of the implants were investigated by following in vitro and in vivo experiments. Implants based on pure poly( l -lactic acid) (L-PLA) released the incorporated antibiotic throughout 30 days with a decreasing delivery rate. During the first 24 h L-PLA implants released a total amount of 3600 μg gentamicin. Within 14 days the release rate had decreased to about 12 μg/day. The release profile of implants based on dl -lactic acid-glycolic acid copolymer (RG 502) was completely different. About 1900 μg were released from the copolymer implants during the first 24 h. Release rate decreased to a value of about 3 μg/day 15 days after implantation. In a second phase, starting 20 days after implantation, drug delivery increased again to reach values of about 100 μg/day at the end of the experiment, i.e. 28 days after implantation. Very good tissue compatibility arises from the absence of inflammatory reactions throughout the entire time of implantation as shown by microscopy examinations. The developed implants based on biodegradable polymers are suited for the treatment of acute and chronic bone and tissue infections due to their specific release profiles, their excellent histocompatibility and their biodegradability.