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We test whether and why non-binding, self-set goals are effective even though individuals can easily revise such goals. Depending on the treatment, subjects either set a goal a few days before working on an online task or right at the start of the task. In the former case, they may or may not be explicitly asked to revise their goal at the start of the task. Consistent with the hypothesis that goals are self-regulation tools, we observe that goals set before the task are larger than goals set at the start of the task. And they are effective: Subjects work more when a goal was set a few days before the task than when it was set at the start of the task. Importantly, these results arise even though subjects revise their initial goals. They do so no matter whether goal revision is made explicit or not – suggesting that goal revision is an important factor for goal non-achievement

The mismatch of oxygen supply and demand during hemorrhagic shock disturbs endoplasmic reticulum (ER) homeostasis. The resulting accumulation of unfolded proteins in the ER lumen, which is a condition that is defined as ER stress, triggers the unfolded protein response (UPR). Since the UPR influences the extent of organ damage following hemorrhagic shock/reperfusion (HS/R) and mediates the protective effects of stress preconditioning before ischemia-reperfusion injury, the current study investigated the mechanisms of ER stress preconditioning and its impact on post-hemorrhagic liver damage. Male C56BL/6-mice were injected intraperitoneally with the ER stress inductor tunicamycin (TM) or its drug vehicle 48 h prior to being subjected to a 90 min pressure-controlled hemorrhagic shock (30±5 mmHg). A period of 14 h after hemorrhagic shock induction, mice were sacrificed. Hepatocellular damage was quantified by analyzing hepatic transaminases and hematoxylin-eosin stained liver tissue sections. Additionally, the topographic expression patterns of the ER stress marker binding immunoglobulin protein (BiP), UPR signaling pathways, and the autophagy marker Beclin1 were evaluated. TM injection significantly increased BiP expression and modified the topographic expression patterns of the UPR signaling proteins. In addition, immunohistochemical analysis of Beclin1 revealed an increased pericentral staining intensity following TM pretreatment. The histologic analysis of hepatocellular damage demonstrated a significant reduction in cell death areas in HS/R+TM (P=0.024). ER stress preconditioning influences the UPR and alleviates post-hemorrhagic liver damage. The beneficial effects were, at least partially, mediated by the upregulation of BiP and autophagy induction. These results underscore the importance of the UPR in the context of HS/R and may help identify novel therapeutic targets.

Research has reported the associations between objective or subjective neighborhood greenness and health, with low agreement between the greenness scores. College students are prone to poor health, and data are lacking on home and university environments. We studied the agreement between greenness parameters and the associations of objective greenness with health in different locations. Three hundred and seventy-seven college students were recruited, with a mean age of 24 years, in the city of Graz, Austria. Objective and perceived greenness was assessed at home and at university. Health measures included the WHO-5 questionnaire for mental health, the IPAQ questionnaire (short) for physical activity and sedentariness, and body mass index. Per location, quintile pairs of objective and perceived greenness were classified into underestimates, correct estimates or overestimates. Interrater reliability and correlation analyses revealed agreement between greenness scores at home but not at university. ANOVA models only showed poorer mental health for students underestimating greenness at university (M = 51.38, SD = 2.84) compared to those with correct estimates (M = 61.03, SD = 1.85). Agreement between greenness scores at home but not at university was obtained, and mental health was related to the perception of greenness at university. We conclude that reliable and corresponding methods for greenness scores need to be developed.

Objective To compare surgical success, postoperative intraocular pressure and complication rates between trabeculectomy and XEN gelstent surgery in a cohort of glaucoma patients in a typical clinical setting. Methods A retrospective cohort study of consecutive patients with refractory open-angle glaucoma including patients who underwent either stand-alone XEN gelstent insertion with Mitomycin C or trabeculectomy with Mitomycin C between 2016 and 2018 at the University Eye Hospital Mainz, Germany. Primary outcome measure was the proportion of surgical success 1 year after surgery. Patients with an IOP ≤18mmHg, an intraocular pressure reduction of >20% and in no need of revision surgery or topical medication were considered a complete surgical success. If topical therapy was necessary, they were considered a qualified success. Multivariable logistic regression analysis was carried out for the primary outcome including gender, age, preoperative intraocular pressure and number of medication classes used preoperatively as adjustment variables. Results 171 eyes of 144 patients were included, including 82 eyes of 58 patients in the XEN group and 89 eyes of 86 patients in the trabeculectomy group. The primary outcome defined as the proportion of surgical success after 1 year (mean 11.1 months ± 2.2) was similar for both groups. The complete success proportion was 65.5% (95%-CI: 55.6–75.9%) in the trabeculectomy group, and 58.5% (95%-CI: 47.6–69.4%) in the XEN group and not statistically different in our analysis model (crude OR = 0.61; 95%-CI: 0.31–1.22; adjusted OR = 0.66; 95%-CI: 0.32–1.37). The intraocular pressure reduction, as secondary outcome measure, was higher in the trabeculectomy group (10.5 mmHg) compared to the XEN group (7.2 mmHg; p = 0.003) at the 12-month follow-up. Conclusion Both XEN gelstent implantation and trabeculectomy show similar proportions of surgical success and of complications and are therefore both recommendable for clinical routine. However, trabeculectomy seems to be more effective in lowering intraocular pressure than the XEN implantation. A prospective randomized clinical trial is necessary to evaluate differences in the long-term clinical outcome.

Purpose To investigate the retinal nerve fiber layer profile measured by optical coherence tomography and its relation to refractive error and axial length. Methods The Gutenberg Health Study is a population-based study in Mainz, Germany. At the five-year follow-up examination, participants underwent optical coherence tomography, objective refraction and biometry. Peripapillary retinal nerve fiber layer (pRNFL) was segmented using proprietary software. The pRNFL profiles were compared between different refraction groups and the angle between the maxima, i.e., the peaks of pRNFL thickness in the upper and lower hemisphere (angle between the maxima of pRNFL thickness [AMR]) was computed. Multivariable linear regression analysis was carried out to determine associations of pRNFL profile (AMR) including age, sex, optic disc size, and axial length in model 1 and spherical equivalent in model 2. Results A total of 5387 participants were included. AMR was 145.3° ± 23.4° in right eyes and 151.8° ± 26.7° in left eyes and the pRNFL profile was significant different in the upper hemisphere. The AMR decreased with increasing axial length by −5.86°/mm (95% confidence interval [CI]: [−6.44; −5.29], P < 0.001), female sex (−7.61°; 95% CI: [−8.71; −6.51], P < 0.001) and increased with higher age (0.08°/year; 95% CI: [0.03; 0.14], P = 0.002) and larger optic disc size (2.29°/mm2; 95% CI: [1.18; 3.41], P < 0.001). In phakic eyes, AMR increased with hyperopic refractive error by 2.60°/diopters (dpt) (95% CI: [2.33; 2.88], P < 0.001). Conclusions The pRNFL profiles are related to individual ocular and systemic parameters. Translational Relevance Biometric parameters should be considered when pRNFL profiles are interpreted in diagnostics, i.e., in glaucoma.

In multivariate analysis, GS of the regular prostatectomy specimen was the only statistically significant parameter for pT2R1 prostate cancer.

In der Literatur zeigen sich förderliche Assoziationen von objektiv und subjektiv empfundener Grünheit der Umgebung mit mentaler Gesundheit, körperlicher Aktivität und dem Body Mass Index (BMI). Betrachtet wurde die Grünheit von Wohnorten oder allgemein, während Daten über Arbeitsplätze oder andere Orte fehlen.Das Ziel war mit drei Forschungsfragen neue Erkenntnisse in diesem Bereich zu erschließen:1.Ist die subjektiv empfundene Grünheit der Umgebung am Wohnort und der Universität unabhängig voneinander mit mentaler Gesundheit assoziiert?2.Ist die subjektiv empfundene Grünheit am Wohnort und der Universität unabhängig voneinander mit körperlicher Aktivität assoziiert und führt zu einem niedrigeren BMI? Ist die subjektiv empfundene Grünheit am Wohnort und der Universität unabhängig voneinander mit körperlicher Inaktivität assoziiert und führt zu einem niedrigeren BMI? 3.Gibt es eine Übereinstimmung zwischen Indikatoren für objektive und subjektiv empfundene Grünheit? Ist die Übereinstimmung am Wohnort höher als an der Universität?Es zeigten sich positive Assoziationen zwischen der subjektiv empfundenen Grünheit und der mentalen Gesundheit. Keine Assoziationen gab es für körperliche Aktivität und BMI. Gefunden wurde eine negative Assoziation zwischen subjektiv empfundener Grünheit am Wohnort und körperlicher Inaktivität, aber nicht an der Universität. Die Übereinstimmung von objektiver und subjektiv empfundener Grünheit war am Wohnort klein bis moderat, für die Universität jedoch nicht vorhanden.Die Ergebnisse weisen darauf hin, dass mehr Augenmerk auf die Weiterentwicklung von Universitätsarealen gelegt werden sollte – zusätzlich zu „grünen“ Wohnorten. Außerdem werden zur Erfassung von objektiver und subjektiver Grünheit validierte, reliable und übereinstimmende Methoden benötigt. Zukünftige Forschung sollte diversere Populationen und Teilstichproben sowie andere geographische Gebiete einbeziehen, um den Einfluss der Umgebung untersuchen zu können. Previous research reported beneficial associations between objective and perceived neighborhood greenness with mental health, physical activity and body mass index (BMI). There has been a focus on green space at people’s home environment or in general, but data are lacking on greenness at working places or other locations.The aim of this thesis is to address the knowledge gaps in this area, leading to these three research-questions:1.Is perceived greenness in the home environment and at university independently associated with mental health?2.Is perceived greenness independently associated with physical activity in the home environment and at university, leading to lower scores of obesity indicators? Is perceived greenness independently associated with sedentariness in the home environment and at university, leading to lower scores of obesity indicators?3.Is there agreement between objective and perceived greenness scores? And is agreement higher for the greenness at home than for the university-environment?Positive associations between perceived greenness at home and university and mental health were found. No associations were obtained for physical activity and BMI. However, a negative association between perceived greenness at home and sedentariness was found, which could not be shown for the university environment. Agreement between objective and perceived greenness at home was small-to-moderate, but there was no agreement between greenness dimension at university.The results indicate that more attention should be paid to developing university campuses, in addition to green living areas. Furthermore, validated, reliable and corresponding methods are needed for assessing both objective and perceived greenness scores. Future research is warranted in more diverse populations and subsamples, investigating the influence of the environmental properties of other spaces people are spending time at, as well as in other geographic locations. Arbeit an der Bibliothek noch nicht eingelangt - Daten nicht geprüft Abweichender Titel laut Übersetzung des Verfassers/der Verfasserin Dissertation Karl-Franzens-Universität Graz 2020

KurzfassungDie steigende Anzahl an Produktvarianten hat Auswirkungen auf Neu- und Umplanungsprojekte von Fabriken. Die Kenntnis über diese Auswirkungen ist für die Wirtschaftlichkeit einer Fabrik von elementarer Bedeutung. Auf der einen Seite können Auswirkungsvorhersagen für eine frühzeitige Initiierung von Fabrikanpassungen genutzt werden. Auf der anderen Seite ermöglichen diese Kenntnisse eine höhere Genauigkeit bei der Bewertung potenzieller Varianten. Aktuell fehlt ein einheitliches und umfassendes Vorgehen, um ebendiese Auswirkungen vorherzusagen. In diesem Beitrag wird eine Systematik vorgestellt, die es erlaubt, Auswirkungen einer veränderten Variantenvielfalt auf eine Fabrik zu antizipieren.

Previous studies reported contradictory evidence for associations between perceived greenness and obesity mediated by physical activity, focusing on people&rsquo, s homes or general greenness. Data are lacking in other environments. We studied the association of perceived greenness at home and at university with BMI and physical activity. An online survey collected data from 601 participants, living and studying in and around the city of Graz, Austria, mean age of 24 years. Greenness was assessed using questions on quality of and access to green space, Body mass index (BMI) was derived from self-reported measures, physical activity and sedentariness were measured using the IPAQ questionnaire (short version). On average, BMI was 22.6 (SD = 3.7), physical activity was 63.3 (SD = 51.7) METh/week, and participants spent 5.8 (SD = 4.0) h/day sitting. Regression analyses revealed no associations between perceived greenness and BMI and physical activity for all environments, but a negative association for sedentariness and perceived greenness at home, but not at university. The results indicate a relation between perceived greenness and sedentariness, which differs for the home-and study environment.

Der Hodenhochstand bzw. Kryptorchismus stellt die haufigste kongenitale Anomalie des neugeborenen Jungen dar. Aufgrund neuer Erkenntnisse wurden die Empfehlungen der nationalen und internationalen Fachgesellschaften bezuglich Diagnostik und Therapie kurzlich geandert. Der nachfolgende Beitrag fasst den aktuellen Stand zusammen.

Die radikale Zystektomie (rCx) stellt nach wie vor die haufigste Therapieoption beim lokal begrenzten muskelinvasiven Urothelkarzinom in Deutschland dar. Verschiedene Modifikationen in der pra-, peri- und postoperativen Phase haben zu einer deutlichen Verbesserung des Outcomes gefuhrt. Die vorliegende Arbeit soll einen guten Uberblick uber die aktuelle Datenlage hinsichtlich einer optimalen Vorbereitung und Durchfuhrung der rCx mit anschliesender Harnableitung bei Patienten mit Harnblasenkarzinom geben. Hinsichtlich der Vorbereitung, der Durchfuhrung der rCx sowie der anschliesenden Harnableitung erfolgten jeweils separate Datenanalysen. Die Zeit von der Indikation bis zur Durchfuhrung der rCx sollte optimal genutzt werden. Hierbei ist insbesondere auf die fruhzeitige Einstellung von Komorbiditaten zu achten. Zahlreiche ERAS-(„enhanced recovery after surgery“) und Fast-track-Konzepte sollten fester Bestandteil des therapeutischen Managements sein. Bei der Durchfuhrung der rCx mit Anlage einer Neoblase spielt der Erhalt der Kontinenz und der Erektionsfahigkeit eine besondere Rolle. Gerade die Behandlung in einem spezialisierten Zentrum mit hoher Fallzahl kann hier zu einer Verbesserung des Outcomes fuhren. Auch die rCx mit intra- oder extrakorporaler Harnableitung wird inzwischen in minimal-invasiver roboterassistierter Technik durchgefuhrt. Bei der rCx mit folgender Harnableitung ist es sinnvoll und notwendig nach neuen Moglichkeiten zur weiteren Reduktion von Komplikationen zu suchen und damit einhergehend eine Verbesserung des Outcomes sowie der Lebensqualitat unserer Patienten zu erreichen.

Modifikationen in der endourologischen Therapie von Harnblasentumoren haben das Ziel, bekannte Schwachen der konventionellen transurethralen Resektionstechnik (z. B. Tumorfragmentierung) zu verbessern (En-bloc-Resektion, ERBT) oder den allgemeinen Behandlungsrhythmus zu vereinfachen (Vaporisation). Die vorliegende Ubersichtsarbeit prasentiert die aktuelle Datenlage im Hinblick auf die verwendeten Techniken, die zu erwartende histopathologische Qualitat der Praparate, die perioperativen Komplikationen und das onkologische Ergebnis. Sowohl fur die ERBT als auch fur die Vaporisation erfolgten jeweils separate Datenrecherchen. Zum Thema ERBT wurden 27 und zum Thema Vaporisation 15 Artikel identifiziert. Zumeist wird die ERBT durch eine zirkumferentielle Inzision in die Mukosa durchgefuhrt. Alternativ kann der Tumor von vorne unterminierend enukleiert werden. Die Resektionsqualitat lasst sich anhand hoherer Detrusornachweisraten (90–100 %) verbessern. Relevante Unterschiede zur konventionellen transurethralen Resektion der Harnblase (TURB) im Hinblick auf die perioperative Komplikationsrate wurden nicht nachgewiesen, allenfalls eine verringerte Rate einer N. obturatorius bedingten Blasenperforation bei der Laser-ERBT. Hinsichtlich der Rezidivraten zeigt sich ein statistisch nicht signifikanter Trend zugunsten der ERBT. Vaporisationen eignen sich fur Patienten mit niedriger Risikokonstellation in der primaren TURB. Sie konnen unter Anwendung von Lokalanasthetika ambulant und ohne Narkose durchgefuhrt werden. Die ERBT zeigt vielversprechende Ergebnisse im Hinblick auf die Verbesserung der histopathologischen Auswertbarkeit. Die Umsetzung der Vaporisation als flachendeckend eingesetzte Methodik scheitert derzeit am deutschen Vergutungssystem.

Das Urothelkarzinom der Harnblase zahlt zu den haufigsten Malignomen des unteren Harntrakts und nimmt bis zu 7% aller Krebserkrankungen in der westlichen Welt ein. Es kann durch mehrere exogene Noxen begunstigt oder ausgelost werden. Als Hauptrisikofaktor gilt Tabakkonsum. Das Kardinalsymptom ist die schmerzlose Hamaturie. In der Diagnostik nimmt die Urethrozystoskopie neben der Sonografie den wichtigsten Stellenwert ein. Bei Tumornachweis sollte eine nachfolgende transurethrale Resektion der Blase (TUR-B) durchgefuhrt werden. Bei nicht-muskelinvasiven Tumoren kann eine Nachresektion und/oder eine adjuvante Instillationstherapie der Blase notig sein. Bei muskelinvasiven Tumoren stellt die radikale Zystektomie nach einer neoadjuvanten systemischen Chemotherapie die kurative Therapie der Wahl dar. Im metastasierten Krankheitsstadium nimmt die palliative Chemotherapie den grosten Stellenwert ein.

BackgroundThe use of artificial colloids has declined in critical care, whereas they are still used in perioperative medicine. Little is known about the nephrotoxic potential in noncritically ill patients during routine surgery. The objective of this trial was to evaluate the influences of albumin 5% and balanced hydroxyethyl starch 6% (130/0.4) on renal function and kidney injury.MethodsOne hundred urologic patients undergoing elective cystectomy were randomly assigned for this prospective, single-blinded, controlled study with two parallel groups to receive either albumin 5% or balanced hydroxyethyl starch 6% (130/0.4) as the only perioperative colloid. The primary endpoint was the ratio of serum cystatin C between the last visit at day 90 and the first preoperative visit. Secondary endpoints were estimated glomerular filtration rate and serum neutrophil gelatinase-associated lipocalin until the third postoperative day and risk, injury, failure, loss, and end-stage renal disease criteria at postoperative days 3 and 90.ResultsThe median cystatin C ratio was 1.11 (interquartile range, 1.01 to 1.23) in the albumin and 1.08 (interquartile range, 1.00 to 1.20) in the hydroxyethyl starch group (median difference = 0.03; 95% CI, –0.09 to 0.08; P = 0.165). Also, there were no significant differences concerning serum cystatin C concentrations; estimated glomerular filtration rate; risk, injury, failure, loss, and end-stage renal disease criteria; and neutrophil gelatinase-associated lipocalin. Infusion requirements, transfusion rates, and perioperative hemodynamics were similar in both groups.ConclusionsWith respect to renal function and kidney injury, this study indicates that albumin 5% and balanced hydroxyethyl starch 6% have comparable safety profiles in noncritically ill patients undergoing major surgery.

Background Currently, stratification of patients with bladder cancer (BC) mainly relies on histopathologic and clinical staging. Furthermore, inflammation plays an important role in the pathogenesis of BC. With the preoperative platelet-to-leukocyte ratio (PLR), we introduce a novel prognostic marker based on routine hematologic values in patients undergoing radical cystectomy (RC). Patients and Methods In our cohort of 665 patients undergoing RC (2004-2015) for urothelial carcinoma of the bladder (UCB), we analyzed a variety of preoperative hematologic parameters. We investigated the effect of thrombocytosis, leukocytosis, and the PLR on the oncologic outcomes, including cancer-specific survival (CSS), progression-free survival (PFS), and overall survival (OS). Both univariate (log-rank test) and multivariate (Cox regression) analysis were performed. The prevalence of thrombocytosis and leukocytosis and differences in the PLR was assessed using the Mann-Whitney U test. The cutoff levels for leukocytosis, thrombocytosis, and the PLR were defined using receiver operating characteristic curve analysis, with the 5-year CSS as the binary classifier. Results A PLR of ≤ 28 (CSS, P = .033; OS, P = .029) and leukocytosis (CSS, P = .01; OS, P = .001; PFS, P = .003) were significantly associated with adverse oncologic outcomes using the log-rank test. On multivariate regression analysis, the PLR (CSS, P = .022; OS, P = .025) remained a significant prognostic marker among the standard staging variables and hemoglobin level. Advanced BC disease was significantly more prevalent in the patient subgroup with a low PLR (pT2-pT4, 35%; vs. pT ≤ 1, 24%; P = .006) and leukocytosis (pT2-pT4, 46%; vs. pT ≤ 1, 30%; P + , 49%; vs. pN0, 39%; P Conclusion To the best of our knowledge, the present study is the first report of the preoperative PLR as a prognostic factor in patients undergoing RC for UCB. Compared with other inflammatory markers in BC, the PLR can be assessed without additional effort. External validation and its combination with other parameters might improve current prognostication systems for UCB.

// Annika Herlemann 1 , Alexander Kretschmer 1 , Alexander Buchner 1, 2 , Alexander Karl 1, 2 , Stefan Tritschler 1, 2 , Lina El-Malazi 1 , Wolfgang P. Fendler 3 , Vera Wenter 3 , Harun Ilhan 3 , Peter Bartenstein 2, 3 , Christian G. Stief 1, 2 and Christian Gratzke 1, 2 1 Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany 2 Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany 3 Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany Correspondence to: Christian Gratzke, email: christian.gratzke@med.uni-muenchen.de Keywords: prostate cancer, radical prostatectomy, biochemical recurrence, salvage lymph node dissection, PSMA PET/CT Received: April 19, 2017 Accepted: September 04, 2017 Published: September 21, 2017 ABSTRACT The management of patients with biochemical recurrence (BCR) after definitive treatment for prostate cancer remains controversial. Our aim was to determine survival rates and complications of salvage lymph node dissection (sLND) in patients with recurrent prostate cancer after radical prostatectomy, while evaluating biochemical response (BR) with two different positron emission tomography/computed tomography (PET/CT) tracers used for preoperative imaging. sLND was performed in 104 patients diagnosed with isolated nodal recurrence on either 18 F-fluoroethylcholine ( 18 F-FEC) or 68 Ga-PSMA-HBED-CC ( 68 Ga-PSMA) PET/CT. Surgical complications, BR, clinical recurrence (CR), and cancer-specific survival (CSS) were evaluated. Logistic regression was used to determine predictors of complete BR (cBR) and CR after sLND and survival rates were assessed. Median follow-up was 39.5 months. Median patient age and prostate-specific antigen (PSA) at sLND were 64 years and 4.1 ng/mL. Median number of lymph nodes (LNs) removed was 13; median number of positive LNs was 3 per patient. Rate of Clavien-Dindo Grade III complications was low (4.8%). 29.8% of patients developed cBR (PSA < 0.2 ng/mL), and 56.7% partial BR (PSA postoperative < PSA preoperative) after sLND. Patients with LN metastases diagnosed on 68 Ga-PSMA PET/CT showed a higher rate of cBR compared to 18 F-FEC PET/CT (45.7 vs. 21.7%, p = 0.040). PSA at sLND ( p = 0.031) and choice of PET tracer ( p = 0.048) were independent predictors of cBR. The 5-year BCR-free, CR-free and CSS rates were 6.2%, 26.0%, and 82.8%, respectively. While preoperative staging with 68 Ga-PSMA seems superior, only a limited number of patients developed cBR after surgery. Most patients experienced BCR and CR during follow-up.

Product development processes (PDP) in the manufacturing industry have been increasingly designed according to the principles of lean development (LD). This concept is based on the fundamentals of lean production systems (LPS) and was transferred into the specifics of PDP. Supporting this concept, numerous companies were already able to partially realize and anchor significant improvements in their PDP. In addition to these improvements, an enhanced relocation of individual tasks and activities in the direction of the suppliers can be continuously observed in the context of product development (PD). As a result, external development service providers and suppliers thus obtain considerable influence on the dimensions cost, quality, and time of PD. While the concept of LD is successfully adopted for the manufacturers, suppliers hardly or do not work at all according to these principles and methods. Recent studies show that these methods and principles are of limited use for suppliers. This circumstance results from the difference in the process structure and the supplier-specific task and activity depth. Due to the proven successes of LD, it is necessary that – for further serious measures of improvement in the PDP – measures of improvement can also be transferred to suppliers. This article pursues the question of how such a LD should be designed for small and medium-sized suppliers (SMSSes). For this purpose, the existing LD concept is explained, and the characteristics of SMSSes are highlighted. Supplier-specific requirements that need to be considered for SMSSes in LD arise from these characteristics. Suitable established principles and methods are to be included in the supplier-specific concept or, if necessary, adapted to changed requirements. The article's aim is to develop and present a comparative concept, which highlights the differences and is specifically adapted to the SMSSes’ requirements.

We objectively quantified daytime and nocturnal continence rates, and defined predictive features for favorable continence outcomes after radical cystectomy and orthotopic ileal neobladder creation.At 1 institution 1,012 cystectomies were performed between 2004 and 2015. Questionnaires evaluating the continence status were sent to 244 patients. To objectify postoperative urine loss daytime and nocturnal pad tests were performed. Continence was defined as the need for up to 1 safety pad and urine loss 10 gm or less per test. Predefined associative features were tested for an influence on continence outcomes. Statistical analysis was done with the Fisher exact and Mann-Whitney U tests, and linear logistic regression models. Significance was considered at p0.05.A total of 188 patients (77.0%) returned the questionnaires. Median followup was 61 months. Median daytime pad use was 1 pad per day (range 0 to 9). Median daily urine loss based on standardized pad testing was 8 gm (range 0 to 2,400). During the night a median of 1 pad (range 0 to 7) was used and median nocturnal urine loss was 28.5 gm (range 0 to 1,220). The continence rate was 54.3% during the day and 36.3% at night. On multivariate analysis good preoperative ECOG (Eastern Cooperative Oncology Group) status (OR 2.987, p = 0.010), retained sensation of bladder filling (OR 6.462, p = 0.003) and preoperative coronary heart disease (OR 0.036, p = 0.002) were independent predictors of daytime success. Based on preoperative risk factors a simple predictive score for daytime continence was created (AUC 0.725, p0.001).Continence rates after orthotopic ileal neobladder creation are lower than previously described when objective continence definitions are applied. Patients with good performance status, without coronary heart disease and with retained sensation of orthotopic ileal neobladder filling have better daytime continence outcomes.

To analyse the impact of perioperative complications and complex treatment courses on postoperative health-related quality of life (HRQOL) after radical cystectomy (RC) and continent (ONB) or incontinent (IC) urinary diversion at multiple prospective time points. A total of 121 consecutive patients underwent RC with curative intent between 2013 and 2014. HRQOL was prospectively assessed preoperatively, after 3 and 12 months, using the QLQ-C30 questionnaire. The impact of complex perioperative treatment courses including cases requiring surgical re-interventions was retrospectively assessed using Martin criteria and the Clavien–Dindo scale. Urinary continence was determined using the validated ICIQ-SF questionnaire. Statistical analysis included Kruskal–Wallis ANOVA, Spearman’s rank correlation, and ordinal regression models (p

Purpose: To analyse prognostic features on quality of life (QoL) following radical cystectomy and urinary diversion via orthotopic neobladder in a single-centre patient cohort. Materials and Methods: Postoperative QoL of 152 patients was assessed retrospectively using the validated QLQ-C30 questionnaire. Potential associations of patient's quality of life including pre-and intraoperative characteristics, surgeon experience, postoperative time course, adjuvant therapies, and functional outcome were defined a priori and evaluated. Mann-Whitney-U-, Kruskal-Wallis-, Spearman correlation and post hoc-testing were used. A multivariate analysis using a multiple logistic regression model was performed. A p value 100 previous cystectomies, p=0.007), and nerve-sparing surgery (p=0.001). Patients who underwent secondary chemotherapy or radiotherapy had significant lower QLQ-C30 scores (p=0.04, p=0.02 respectively). Patients who were asymptomatic had a significantly higher quality of life (p

American football is known for its high risk of injury, especially in the professional field. Although the number of players in the German football league (GFL) has risen in recent years, data concerning the injury rates of German amateur players in American football are scarce.Analysis of the injury rates in league games and training sessions in amateur football according to playing positions and body region.Injuries of 123 American football players in a club playing in the second GFL (first and second team) were prospectively recorded over a period of 4 seasons (2014-2018). A complete history of injuries was obtained from 72 players. The injuries were classified using the Orchard sports injury classification system 10.1 (OSICS 10.1). The injury rates were calculated per 1000 athlete exposures (AE) for training as well as for league games with respect to the playing position and for each body region.Overall 142 injuries were recorded. On average there were 35.5 injuries per season and 1.9 injuries per player. Of the injuries 54.7% occurred during training and 46.1% during games. The risk of injury was significantly increased during league games (15.6 ± 16.3) compared to training (3.1 ± 2.7, p 0.0001). While wide receivers and cornerbacks had the highest overall injury rates, running backs had the highest injury risk during games (p = 0.046). Injuries to knees (27.3%) and shoulders (20.1%) were the most frequent. The shoulder was the body region injured most frequently during games (p = 0.002). Regarding the injury pattern, distorsions (30.9%) and contusions (22.5%) occurred more often compared to fractures (12.6%) and dislocations (16.1%). Concussion only contributed to 2.9% of the injuries.American football is a contact sport with high injury rates even in the German amateur field, especially during league games. Regarding body regions, shoulders and knees were predominantly affected while regarding the playing position, wide receivers and cornerbacks were particularly jeopardized. Therefore, a continuous close medical supervision during games and an intensive position-specific training seem to be necessary even in the amateur field in order to reduce the injury rate.

PurposeWe aimed to determine the prevalence of characteristics and pathologies of the vitreo‐macular interface within the general population.MethodsThe Gutenberg Health Study is a population‐based study in Germany, including an ophthalmological examination with refraction, biometry and optical coherence tomography (OCT) imaging. Characteristics of the vitreo‐macular interface were graded on volume scans including visibility of an epiretinal membrane, full‐thickness macular hole, lamellar hole and pseudohole. Overall and age‐specific prevalences including 95% confidence intervals [95%‐CI] were calculated. Association analyses were conducted to determine systemic and ocular factors that are associated with epiretinal membranes (the most common pathology) using multivariable logistic regression.ResultsA total of 1890 people aged 40–80 years were included in the study. Of these, 4.7% (95%‐CI: 3.8%–5.8%) had an epiretinal membrane in at least one eye, 0.1% a full‐thickness macular hole, 0.6% a lamellar hole and 0.6% a pseudohole. The presence of an epiretinal membrane was associated with higher age, myopic refractive error and prior retinal laser therapy, but not with gender, body height, body weight, smoking, prior cataract surgery or intraocular pressure.ConclusionsEpiretinal membranes are more frequent in older and myopic subjects and in those with prior retinal laser therapy.

Part 4: Data-Driven Production Management; International audience; Due to a growing number of product variants, shorter lead times, and global supply chains, planning and launching production systems is becoming increasingly important. Therefore, managing the period of production ramp-up becomes a competitive advantage. To handle the increasing complexity and uncertainty in this special phase, data availability is necessary in terms of efficient decision making. However, in this early phase of the product and production system lifecycle, data quantity and quality are not guaranteed. This is due to the degree of novelty of processes, technologies and human behaviors in this special phase. In this paper it will be analyzed that selected data from the factory planning phase as well as the factory operation phase needs to be jointly processed by ramp-up involved personnel as value adding information. Finally, the presented use case, as well as the derived data management approach, will help companies to better manage production ramp-ups in the future.

Introduction: Enhanced recovery after surgery (ERAS) concepts are implemented in various surgical disciplines. For patients undergoing radical cystectomy, prospective data are still rare. In the year 2014, our group could prove significant benefits of ERAS for these patients in a prospective randomized study compared to a conservative regimen. Objective: To evaluate long-term follow-up results of ERAS concepts in patients undergoing radical cystectomy for bladder cancer. Methods: Of the 101 patients who had initially prospectively been randomized to ERAS or a conservative regimen, 35 patients could be included in the study. Median follow-up time was 83 months. Primary end point assessed quality of life. Secondary end points were cancer-specific survival and overall survival. Results: Five to seven years after the initial inclusion to the study, no significant difference regarding quality of life parameters was detected (p values range between 0.112 and 0.970). Continence status in patients with neobladder showed no significant differences between ERAS and conservative regimens (p = 0.785). Cancer-specific survival in the ERAS group did not differ significantly from that in the conservative group (49 vs. 58%, p = 0.725). Conclusions: While ERAS represents an excellent way to improve postoperative reconvalescence and quality of life in the short-term follow-up, our data do not support the idea that there is also a long-term effect in terms of quality of life issues.

Background. Several anesthesiologic regimens can be used for open radical retropubic prostatectomy. The aim of this retrospective analysis was to compare the combined general epidural anesthesia and the combined spinal epidural anesthesia with regard to availability, efficacy, side effects, and perioperative time consumption in a high-volume center. Methods. A retrospective analysis was performed by querying the electronic medical records of 1207 consecutive patients from the database of our online documentation software. All patients underwent open radical retropubic prostatectomy from 01/2008 to 08/2011 and met the study criteria. Linear and multivariate regression analyses were performed to identify differences in parameters such as time consumption in the operating unit, hemodynamic parameters, volume replacement, and catecholamine therapy. Results. 698 (57.8%) patients have been undergoing open radical retropubic prostatectomy under combined spinal epidural anesthesia and 509 (42.2%) patients by combined general epidural anesthesia. Operating unit (p Conclusions. This retrospective study suggests that the combined spinal epidural anesthesia seems to be a suitable and efficient anesthesia technique for patients undergoing open radical retropubic prostatectomy. This specific approach reduces time in the operation unit and length of hospital stay.

INTRODUCTION AND OBJECTIVES:For many solid and malignant tumours thrombocytosis is associated with an impaired onclogical outcome concerning cancer specific survival (CSS).So far there is only limi...

Purpose: Early rehabilitation (ER) after radical cystectomy (RC) seems to be crucial for quality of life, education and prevention of complications after hospital discharge. We investigated an inpatient ER setting for bladder cancer (BC) patients. Methods: In total, 103 BC patients who underwent ileum neobladder reconstruction were included. The major issues from the patients’ point of view, functional outcome parameters and complications during ER were analysed. A Wilcoxon signed rank test was used to compare body mass index (BMI) and diurnal as well as nocturnal use of urinary pads before and after ER. Results: At the beginning of ER, the median Karnovsky performance scale score was 70% (interquartile range [IQR] 70–90%) and the mean BMI was 25.8 kg/m2 (IQR 21.9–27.9). The 4 most common complaints were urinary incontinence (80.6%), general weakness (73.8%), urinary mucus (49.5%) and mental distress (44.7%). During the programme, 28.2% of patients had a urinary tract infection requiring antibiotics and 15.5% presented a symptomatic acidosis. Median diurnal use of urinary pads significantly decreased during ER (4 vs. 3; p < 0.001). At the end of the ER programme, 76.0, 54.8 and 30.8% of the patients indicated an improvement of their physical capacity, incontinence and psychological distress respectively. Conclusions: Our study demonstrates the need for postoperative rehabilitation after RC. Further investigations should compare outcome parameters to ambulatory and outpatient ER models.