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Durch ein multidisziplinares Team und einen moglichst gynakologisch-onkologisch ausgebildeten Operateur wird das Management einer pathologischen Plazentation (Placenta-accreta-Spektrum) verbessert. Fur eine erfolgreiche Durchfuhrung der Sectio-Hysterektomie sind einige essenzielle operative Schritte empfehlenswert.

Underdeveloped immunity during the neonatal age makes this period one of the most dangerous during the human lifespan, with infection-related mortality being one of the highest of all age groups. It is also discussed that vaccination during this time window may result in tolerance rather than in productive immunity, thus raising concerns about the overall vaccine-mediated protective efficacy. Cyclic di-nucleotides (CDN) are bacterial second messengers that are rapidly sensed by the immune system as a danger signal, allowing the utilization of these molecules as potent activators of the immune response. We have previously shown that cyclic di-adenosine monophosphate (CDA) is a potent and versatile adjuvant capable of promoting humoral and cellular immunity. We characterize here the cytokine profiles elicited by CDA in neonatal cord blood in comparison with other promising neonatal adjuvants, such as the imidazoquinoline resiquimod (R848), which is a synthetic dual TLR7 and TLR8 agonist. We observed superior activity of CDA in eliciting T helper 1 (Th1) and T follicular helper (TfH) cytokines in cells from human cord blood when compared to R848. Additional in vivo studies in mice showed that neonatal priming in a three-dose vaccination schedule is beneficial when CDA is used as a vaccine adjuvant. Humoral antibody titers were significantly higher in mice that received a neonatal prime as compared to those that did not. This effect was absent when using other adjuvants that were reported as suitable for neonatal vaccination. The biological significance of this immune response was assessed by a challenge with a genetically modified influenza H1N1 PR8 virus. The obtained results confirmed that CDA performed better than any other adjuvant tested. Altogether, our results suggest that CDA is a potent adjuvant in vitro on human cord blood, and in vivo in newborn mice, and thus a suitable candidate for the development of neonatal vaccines. Keywords: cyclic di-adenosine monophosphate (CDA); cyclic di-nucleotides (CDN); first dose efficacy; neonatal vaccines; stimulator of interferon genes (STING).

Aims This is an official interdisciplinary guideline published and coordinated by the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (OEGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking regions and is backed by numerous professional societies and organizations. The aim of this guideline is to provide an evidence- and consensus-based overview of the diagnostic approach and the management of hormonal contraception based on a systematic evaluation of the relevant literature. Methods To compile this S3-guideline, a systematic search for evidence was carried out in PubMed and the Cochrane Library to adapt existing guidelines and identify relevant reviews and meta-analyses. A structured evaluation of the evidence was subsequently carried out on behalf of the Guidelines Commission of the DGGG, and a structured consensus was achieved based on consensus conferences attended by representative members from the different specialist societies and professions. Recommendations Evidence-based recommendations about the advice given to women requesting contraception were compiled. The guideline particularly focuses on prescribing contraceptives which are appropriate to womenʼs individual needs, take account of her personal circumstances, and have few or no side effects.

Optogenetics is the genetic approach for controlling cellular processes with light. It provides spatiotemporal, quantitative and reversible control over biological signaling and metabolic processes, overcoming limitations of chemically inducible systems. However, optogenetics lags in plant research because ambient light required for growth leads to undesired system activation. We solved this issue by developing plant usable light-switch elements (PULSE), an optogenetic tool for reversibly control- ling gene expression in plants under ambient light. PULSE combines a blue-light-regulated repressor with a red-light-inducible switch. Gene expression is only activated under red light and remains inactive under white light or in darkness. Supported by a quantitative mathematical model, we characterized PULSE in protoplasts and achieved high induction rates, and we combined it with CRISPR–Cas9-based technologies to target synthetic signaling and developmental pathways. We applied PULSE to control immune responses in plant leaves and generated Arabidopsis transgenic plants. PULSE opens broad experimental avenues in plant research and biotechnology.

Obstetric sphincter damage is the most common cause of fecal incontinence in women. Between one-third and two-thirds of women who sustain a recognized third-degree tear during delivery subsequently suffer from fecal incontinence. We should therefore try to reduce the rate of high-grade tears as much as possible. But this rate can only be used as an outcome indicator for the quality of obstetric departments if the recognition and classification of sphincter injury is similar across departments in different hospitals.Eine Verletzung des analen Sphinkters stellt einen wesentlichen Risikofaktor für die Entwicklung einer analen Inkontinenz bei Frauen dar. Ein bis zwei Drittel der Frauen, bei denen unmittelbar nach der Entbindung ein Dammriss (DR) Grad III festgestellt wird, leiden an analen Inkontinenzsymptomen. Eine möglichst niedrige Rate höhergradiger Dammrisse ist deshalb anzustreben. Diese Rate ist als Ergebnisindikator zur Beschreibung der Qualität einer geburtshilflichen Abteilung aber nur dann verwendbar, wenn eine vergleichbare Qualität der Wahrnehmung und Klassifizierung von analen Sphinkterverletzung in den Abteilungen besteht.

SummaryBackground: Severe and very rare obstetric complications (e.g. eclampsia, postpartum haemorrhage or uterine rupture), typically culminate in a chaotic, uncontrollable sequence of events. Outcome for mother and child depends on whether doctors and midwives are able to quickly take correct decisions and initiate optimal treatment.Objectives: GerOSS (German Obstetric Surveillance System) aims at generating deeper insight into relevant risk factors to improve diagnosis and treatment of severe complications during pregnancy and delivery. As such it is primarily conceived as a system for quality improvement and less as a register. Another focus is the provision of an information and communication platform for dissemination of these insights. Finally, incidences of selected rare obstetric events may be derived.Methods: These rare events are monitored for two to five years in Lower Saxony, Bavaria and Berlin. Quantitative analyses of aggregate data are complemented with in depth case based anonymised evaluations by experts. The temporal sequence of measures taken as well as the management of care is inspected. Participants receive a feedback of comments on the synopsis of individual cases. Aggregate data results are published and made available through the GerOSS platform. A scientific advisory committee ensures the link with the professional scientific bodies. A comparison within INOSS (International Network of Obstetric Survey Systems) allows additional insights into the treatment of obstetric rare diseases and complications. More reliable estimates of the incidence of such events can be computed and compared within a larger database.Results: Following the implementation in three federal states in Germany in 2010, participation in GerOSS-Project has increased to 100% of all hospitals with a delivery unit in Lower Saxony, 30% in Bavaria and 80% in Berlin. Feasibility of the project is shown by successful implementation of GerOSS. Quantitative analyses enable construction of risk profiles (e.g. for the prevalence of hysterectomies and uterine ruptures) such that tailored treatment algorithms may be derived. Age, body mass index and previous caesarean section are common risk factors when complications occur. Respective recommendations have not always been adhered to in the diagnosis and therapy of such cases. The presentation of initial GerOSS results has paved the path for first changes in obstetric care.Conclusions: The envisaged expansion of GerOSS to an interactive platform will allow dissemination of insights such that optimal obstetric care and transferal among all involved medical facilities may see future enhancements via the internet or even through smartphone applications.

Der praktizierende Gynakologe wird bei seiner taglichen Arbeit nicht nur mit urogynakologischen Erkrankungen, sondern auch mit Erkrankungen des Anorektums konfrontiert. Dabei ist er meist der erste Ansprechpartner der Frauen bei anorektalen Erkrankungen. Ihm kommt somit ein besondere Stellung im interdisziplinaren Team aus Proktologe, Chirurg, Gastroenterologe, Gynakologe und Dermatologe bei der Diagnostik und Therapie anorektaler Erkrankungen zu. Aus dem umfangreichen Gebiet der Proktologie fokussiert die vorliegende Ubersicht auf die anorektalen Veranderungen, die besonders im Zusammenhang mit Schwangerschaft und Geburt von Bedeutung sind und Symptome der analen Inkontinenz bedingen.

Although caesarean section of a second twin after vaginal birth of the first twin is rare, it nevertheless has clinical importance as an acute emergency situation with high perinatal morbidity and mortality. We therefore found it appropriate to describe the obstetric management of such cases, including an overview of the literature and our own data. According to reports in the literature, 113 deliveries of second twins (3.4%) were carried out by section in 3342 twin births. At our department in Tubingen there were 497 twin births (1.9%) in 26 095 births. Of these the second twin was delivered by section in 11 cases (2.2%). This represents a statistical frequency of 0.04% of all births. As shown by case histories and our own study, the indications for abdominal delivery of the second twin were predominantly the prolapse of the umbilical cord or of small parts due to transverse or breech presentation, with simultaneous retraction of the cervix. Of our 11 births with emergency section, one child died postpartum. Because of above-mentioned risks the twin delivery must always be performed in a fully equipped facility, including facilities for intensive neonatal care.

Die endovaginale Magnetresonanztomographie (MRT) ermoglicht eine hochauflosende Abbildung des Beckenbodens, insbesondere der Muskelschichten des analen Sphinkterkomplexes. Bei sieben gesunden Nulliparae wurden Starke und Volumen der analen Muskulatur bestimmt. Im Vergleich zu publizierten sonographischen Daten sind die Meswerte fur die Starke des Musculus sphincter ani internus im MRT groser, die Werte fur die Dicke des Musculus sphincter ani externus dagegen kleiner. Dies ist durch eine detailliertere Abbildung der Muskelschichten im MRT und eine deutlichere Abgrenzung der Umgebungsstrukturen erklarbar. Mit Hilfe der erhaltenen Normwerte sollten sich anatomische Veranderungen des analen Sphinkters im Sinne einer Hypertrophie bzw. Atrophie leicht beurteilen lassen. Die endovaginale MRT ist ein hilfreiches Instrument in der Diagnostik morphologischer Sphinkterveranderungen der weiblichen analen Inkontinenz.

Up to date, initial or recurrent pregnancy has been reported in 46 patients suffering from Gaucher's disease. In the present review of the literature, potential complications and therapeutic concepts are outlined and a case report of a 22-year-old primipara is presented.

Nicht geburtsbedingte Genitalverletzungen bei der Frau sind selten und werden meist bei Madchen im Alter von 4-12 Jahren beobachtet. Ursache dieser traumatischen Genitalverletzungen sind Sport- und Spielverletzungen, Fremdkorperpenetrationen, sexuelle Traumen und Verkehrsunfalle. Die operative Versorgung erfolgt nach den ublichen Regeln der Wundversorgung und bei Verletzungen von verschiedenen Organen ist oft eine multidisziplinare Zusammenarbeit erforderlich.

We report on a case of a 55-year old patient with a great adnexal tumour (10 x 5 x 8 cm), on the left side with infiltration of the bladder and the pelvis with recurring urinary retention in the kidney. Histological examination revealed an intrauterine device-associated actinomycosis. Following a 6-month high dose penicillin therapy, the abdominal hysterectomy with adnexectomy and partial resection of the bladder with new implantation of the ureter (Boari) was performed. The postoperative period was uneventful, the urogram normal.

Previously it was shown that minK protein expression in uterus is regulated by estrogen. In the present study, we were interested in putative direct effects of estrogen on minK protein induced K+ currents (IminK) in Xenopus oocytes. Superfusion with 17-beta-estradiol (1 microM) resulted in an inhibition of minK-induced currents, but had no appreciable effects on the delayed rectifier and inward rectifier K+ channels Kv1.1 and Kir2.1, respectively. The inhibition of IminK by 17-beta-estradiol was concentration-dependent, with an IC50 of approximately 0.5 microM. In the presence of 17-beta-estradiol, the conductance-voltage relationship was shifted to more depolarized potentials. IminK inhibition occurred also in the presence of the estrogen-receptor antagonist tamoxifen, suggesting that a mechanism independent of estrogen receptors is involved. The synthetic estrogen diethylstilbestrol (DES) also inhibited IminK but with a lower affinity (IC50 of 4.5 microM), while cortisol and progesterone had only weak effects on IminK. In summary, the results indicate that estrogens directly inhibit IminK.

This paper reports the epidemiology of hospital-diagnosed acute viral hepatitis in U.S. Air Force personnel from 1980-89. First hospitalizations for viral hepatitis generally declined, ranging from 24.6 to 47.2 per 100,000 personnel. Hepatitis rates were higher among men, (RR = 1.3; 95% C.I., 1.1-1.5) and higher among blacks, compared to whites (RR = 1.4; 95% C.I., 1.3-1.6). Analysis of risk associated with various occupations demonstrated an increased risk of viral hepatitis for procedurally oriented medical personnel (physicians, clinical nurses, dentists) when compared to all other occupations (RR = 1.5; 95% C.I., 1.1-1.9). Pilots and navigators demonstrated a decreased risk of acute viral hepatitis. Members hospitalized for hepatitis B had a prior or concurrent diagnosis for sexually transmitted disease in 37% of cases; for drug abuse, 32% of cases. Serum samples from 332 individuals demonstrated that hepatitis A had the highest rate of agreement (84%) between serology and hospital discharge diagnosis. Only 3% of individuals with the diagnosis of NANB hepatitis were positive for hepatitis C.

In der Geburtshilfe treten immer wieder Situationen auf, die eine maximale Erweiterung der Geburtswege erfordern. Der Geburtshelfer hat drei Moglichkeiten: 1. er kann die angelegte Episiotomie weiterreisen lassen - dies fuhrt, allem bei der medianen Episiotomie, haufig zum Dammris 111° 2. kann eine vorhandene Episiotomie um den Sphinkter ani externus herumgeleitet erweitert werden und 3. bietet sich die gezielte Durchtrennung des analen Sphinkters im Sinne einer kompletten Perineotomie an.

Die Prufung der Wertigkeit mutterlicher Entzundungsparameter und fetaler Tachykardie bei Diagnose oder Ausschlus eines Amnioninfektionssyndroms ist schwierig, da bereits bei Verdacht auf eine Infektion eine Antibiotikatherapie indiziert ist. Die volle Auspragung des Amnioninfektionssyndroms wird hierdurch oft unterdruckt. ahnlich wirken prophylaktische Antibiotikagaben.

Metal contacts to p‐type CuInSe2 and heterojunctions of the form n‐(CdZn)S/p‐CuInSe2 have been prepared, to investigate the electrical behavior and chemical composition of the resulting interfaces and to correlate the results with the composition and corresponding electrical properties of CuInSe2 . The results indicate that the observed variability of the back contacts and front junctions of different CuInSe2 samples can be attributed to the variable initial equilibrium concentration of the intrinsic defect states which dominate the crystals. The type and concentration of the dominant defects can be changed by thermal treatments and by interface induced effects due to the junction electric field and the chemical potential gradients. Diffusion into or out of the CuInSe2 crystals was not detected. More over, no composition or other chemical variation due to the deposition of the sulfide layer was observed.

A clinical evaluation of speech processing strategies for the Nucleus 22-electrode cochlear implant showed improvements in understanding speech using the new FOF1F2 speech coding strategy instead of the F0F2 strategy. Significant improvement in closed-set speech recognition in the presence of background noise was an additional advantage of the new speech processing strategy.

Studies have been undertaken to confirm the biologic safety of the Cochlear Corporation multi-electrode intracochlear implant. The materials used are biocompatible. The electrode array is flexible: it can be inserted with minimal or no trauma, providing the insertion is stopped when resistance is first felt. An atraumatic insertion is facilitated if a good view is obtained along the scala tympani of the basal turn of the cochlea by drilling through the crista fenestrae. The passage of the electrode around the cochlea can be facilitated if the electrode is rotated during insertion (clockwise for the left and anticlockwise for the right cochlea). The electrode can be explanted and another one reinserted with minimal or no trauma. A seal established around the electrode after an implantation period of 2 weeks can prevent infection extending from the middle to the inner ear. The electrical stimulus parameters produced by the Nucleus receiver-stimulator cause no loss of spiral ganglion cells or corrosion of the platinum band electrodes. Long-term stimulation has been carried out for up to 8 years in patients without affecting their clinical performance.

To summarize, our preliminary results indicate that some prelingually deaf patients may get worthwhile help from a multiple-electrode cochlear implant which extracts formants. They can understand words and running speech better when using the cochlear implant with lip-reading compared to lip-reading alone. It has been encouraging that these improvements can occur in young adults and teenagers. It has also been encouraging that some can recognize place pitch as well as rate pitch. There are, however, considerable variations in performance and this may be due to the following factors: whether they have had some hearing after birth, the method of education used, the motivation of the patient and age at implantation. In conclusion it is important to emphasize that deaf children are severely disadvantaged however good their teacher of the deaf. Research on cochlear implants offers hope for profoundly-totally deaf children. These developments will not replace the caring, competent educators but complement their skills. There is also a greater need than ever for an interdisciplinary approach to these children.