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Climate change threatens agricultural productivity worldwide, resulting in higher food prices. Associated economic gains and losses differ not only by region but also between producers and consumers and are affected by market dynamics. On the basis of an impact modeling chain, starting with 19 different climate projections that drive plant biophysical process simulations and ending with agro-economic decisions, this analysis focuses on distributional effects of high-end climate change impacts across geographic regions and across economic agents. By estimating the changes in surpluses of consumers and producers, we find that climate change can have detrimental impacts on global agricultural welfare, especially after 2050, because losses in consumer surplus generally outweigh gains in producer surplus. Damage in agriculture may reach the annual loss of 0.3% of future total gross domestic product at the end of the century globally, assuming further opening of trade in agricultural products, which typically leads to interregional production shifts to higher latitudes. Those estimated global losses could increase substantially if international trade is more restricted. If beneficial effects of atmospheric carbon dioxide fertilization can be realized in agricultural production, much of the damage could be avoided. Although trade policy reforms toward further liberalization help alleviate climate change impacts, additional compensation mechanisms for associated environmental and development concerns have to be considered.

Climate change has impacts on agricultural yields, which could alter cropland requirements and hence deforestation rates. Thus, land-use responses to climate change might influence terrestrial carbon stocks. Moreover, climate change could alter the carbon storage capacity of the terrestrial biosphere and hence the land-based mitigation potential. We use a global spatially explicit economic land-use optimization model to (a) estimate the mitigation potential of a climate policy that provides economic incentives for carbon stock conservation and enhancement, (b) simulate land-use and carbon cycle responses to moderate climate change (RCP2.6), and (c) investigate the combined effects throughout the 21st century. The climate policy immediately stops deforestation and strongly increases afforestation, resulting in a global mitigation potential of 191 GtC in 2100. Climate change increases terrestrial carbon stocks not only directly through enhanced carbon sequestration (62 GtC by 2100) but also indirectly through less deforestation due to higher crop yields (16 GtC by 2100). However, such beneficial climate impacts increase the potential of the climate policy only marginally, as the potential is already large under static climatic conditions. In the broader picture, this study highlights the importance of land-use dynamics for modeling carbon cycle responses to climate change in integrated assessment modeling.

Reactive nitrogen (Nr) is an indispensable nutrient for agricultural production and human alimentation. Simultaneously, agriculture is the largest contributor to Nr pollution, causing severe damages to human health and ecosystem services. The trade-off between food availability and Nr pollution can be attenuated by several key mitigation options, including Nr efficiency improvements in crop and animal production systems, food waste reduction in households and lower consumption of Nr-intensive animal products. However, their quantitative mitigation potential remains unclear, especially under the added pressure of population growth and changes in food consumption. Here we show by model simulations, that under baseline conditions, Nr pollution in 2050 can be expected to rise to 102-156% of the 2010 value. Only under ambitious mitigation, does pollution possibly decrease to 36-76% of the 2010 value. Air, water and atmospheric Nr pollution go far beyond critical environmental thresholds without mitigation actions. Even under ambitious mitigation, the risk remains that thresholds are exceeded.

Background: This study analyses the outcome of a transosseous suture fixation for the ulnar collateral ligament (UCL) of the thumb, which is performed completely internally., Methods: 60 patients with distal rupture of the UCL of the thumb were surgically treated with a transosseous suture technique. Patients with ligament tears surgically treated within 14 days after injury were included in Group 1 (n=33); patients with delayed surgical treatment (>14 days after injury) in Group 2 (n=13). Group 3 (n=14) contained patients with avulsion fractures. Subjective, functional, and radiological outcomes were evaluated after at least 24 months, and up to an average of 68 months after surgery. Statistical analysis was performed using the Kruskal-Wallis test, Mann-Whitney test, chi-square test, and Wilcoxon test., Results: No significant differences were seen for the disability of the arm, shoulder and hand (DASH) scores among the groups. The average DASH score was 2.4±3 points in Group 1, 4.6±9 points in Group 2 and 5±8 points in Group 3. The visual and verbal pain analogue scales showed significant differences between Groups 1 and 2 at (p=0.02) and after exertion (p=0.03). Significant differences were seen for the flexion of the interphalangeal joint in Group 1 (p=0.004) and the radial abduction of the thumb in Group 3 (p=0.001), as compared to the contralateral hand. Furthermore, significant differences were obtained for the pinch strength between the thumb and the ring finger in Group 1 (p=0.03) and 3 (p=0.04), as well as pinch (p=0.02) and key strength (p=0.03) of the little finger in Group 1, again compared to the contralateral hand. Group 3 (p<0.001) showed significantly more radiological bony alterations at the distal UCL insertion than the other groups., Conclusions: This study shows good to very good subjective, functional, and radiological results in all 3 groups. Therefore, we recommend this transosseous suture fixation as an affordable, practicable technique for the treatment of acute rupture of the UCL of the thumb with and without avulsion fractures., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: This study analyses the outcome of a transosseous suture fixation for the ulnar collateral ligament (UCL) of the thumb, which is performed completely internally., Methods: 60 patients with distal rupture of the UCL of the thumb were surgically treated with a transosseous suture technique. Patients with ligament tears surgically treated within 14 days after injury were included in Group 1 (n = 33); patients with delayed surgical treatment (> 14 days after injury) in Group 2 (n = 13). Group 3 (n = 14) contained patients with avulsion fractures. Subjective, functional, and radiological outcomes were evaluated after at least 24 months, and up to an average of 68 months after surgery. Statistical analysis was performed using the Kruskal-Wallis test, Mann-Whitney test, chi-square test, and Wilcoxon test., Results: No significant differences were seen for the disability of the arm, shoulder and hand (DASH) scores among the groups. The average DASH score was 2.4 ± 3 points in Group 1, 4.6 ± 9 points in Group 2 and 5 ± 8 points in Group 3. The visual and verbal pain analogue scales showed significant differences between Groups 1 and 2 at (p = 0.02) and after exertion (p = 0.03). Significant differences were seen for the flexion of the interphalangeal joint in Group 1 (p = 0.004) and the radial abduction of the thumb in Group 3 (p = 0.001), as compared to the contralateral hand. Furthermore, significant differences were obtained for the pinch strength between the thumb and the ring finger in Group 1 (p = 0.03) and 3 (p = 0.04), as well as pinch (p = 0.02) and key strength (p = 0.03) of the little finger in Group 1, again compared to the contralateral hand. Group 3 (p < 0.001) showed significantly more radiological bony alterations at the distal UCL insertion than the other groups., Conclusions: This study shows good to very good subjective, functional, and radiological results in all three groups. Therefore, we recommend this transosseous suture fixation as an affordable, practicable technique for the treatment of acute rupture of the UCL of the thumb with and without avulsion fractures., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Necrotizing soft tissue infection is a life-threatening disease characterized by rapid progressive inflammation and necrosis of the subcutaneous and deep fascia with or without involvement of the adjacent muscles., Case Presentation: We report the case of a 62-year-old Caucasian woman with goiter recurrence who underwent a right-sided hemithyroidectomy. Postoperatively, she developed fulminant mediastinitis caused by group A β-hemolytic streptococcus and septic shock. Our patient survived this rare life-threatening complication., Conclusions: Initial atypical postoperative symptoms, such as personality changes or an unstable circulatory system, should lead a practitioner to consider the possibility of this severe complication and to begin therapy immediately.

Background: The aim of this study was to examine the influence of age, body mass index (BMI) and leg dominance on the PRT, balance control and foot position sense., Materials and Methods: The proprioception of the ankle was investigated in 210 participants. All participants completed a questionnaire. The PRT was measured on a tilting platform. The position sense test was performed. Balance control was assessed with the Biodex Stability System (BSS), measuring the overall stability index (OSI) at the stable level 8 and the unstable level 2. Correlation analyses were performed between these data and age, BMI and leg dominance, using the Spearman-Rho coefficient with a two-sided significance level of p < 0.05., Results: Significant increases of the PRT and OSI in correlation to increased age and BMI were noted for both legs (p < 0.05). No positive correlation to age, BMI or leg dominance could be demonstrated for the foot position sense test. The PRT of the right leg was always significantly faster than that of the left leg, irrespective of leg dominance (p < 0.05). Surprisingly, individuals with a dominant right leg achieved better OSI scores in left single leg stance at the unstable level 2 (p < 0.05)., Conclusion: The PRT and the postural stability correlate with age and BMI, whereas the position sense test of the ankle does not. Furthermore, the PRT in right legs is always faster. This should be noted when functional ankle stability is evaluated in patients.

In 58 patients of 585 fractures of the ankle we demonstrated the disruption of the tibiofibular syndesmosis. Near to osteosynthetic repair the tibiofibular diastrasis was restored with the syndesmosis-plate by Rhamanzadeh. Postoperative treatment happened plaster-free. Complete weight bearing was achieved pain-dependend after 2 until 4 weeks. This equipment is following from the dynamical fixation of the tibiofibular syndesmosis by preserving the physiological movements between tibia and fibula. Removement of syndesmosis-plate ensued with the remaining osteosynthetical material after one year.

Eosinophilic granuloma is a solitary form of histiocytosis X with a usually good prognosis. Sometimes spontaneous healing can even occur. The authors report a case of a 30-month-old boy who presented an eosinophilic granuloma of the lateral orbital wall. The correct diagnosis was obtained after computed tomographic scan followed by fine needle aspiration biopsy with histopathologic examination. The tumor increased rapidly, including a medial displacement of the globe and limitation of the eye movement. So chemotherapy (Vinblastine) with corticotherapy was performed. The clinical course was favorable, with no evidence of recurrence or systemic involvement. The originality of this case was the young age of the patient, the course and the efficacy of treatment. The authors emphasize the management of the disease.

The authors study ocular complications, mainly retinal, in three patients with myotonic dystrophy. The association of cataract, ocular hypotony, reticular or butterfly-shaped dystrophy of the macular pigmentary epithelium was observed in all cases. A bibliographical study regarding retinal lesions: clinical aspects (macular lesions and peripheral retinopathy), retinal functions (visual acuity, color sense, dark adaptation, electrophysiological examinations), histopathological aspects with proliferation of peripheral pigmentary epithelium, retinal and choroidal fibrohyalinosis. The authors report vitreous and retinal modifications (disc, macula, retinal vessels, peripheral retinopathy), evolutive aspects, electrophysiological anomalies in order to understand at best Steinert's ocular lesions.

The authors demonstrate how a delay in diagnosis, in the case of an orbito-cranial foreign body, serves to underscore importance of CT in even minor, orbito-facial injuries, when there is some suspicion of intracranial penetration. This examination, which should be requested as soon as possible in such cases, usually permits detection of the intracranial foreign body. However, if the image is much clearer than those of conventional X-rays, it can in certain cases, remain a matter of subtle interpretation, particularly in cases of less dense materials such as wood.