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To describe national trends in the utilization of endovascular approaches (including balloon angioplasty, atherectomy, and stent placement) for the management of femoropopliteal peripheral arterial disease (PAD).The Medicare Physician/Supplier Procedure Summary dataset containing 100% of Part B claims was interrogated for years 2011-2019. The Current Procedural Terminology codes specific for femoropopliteal angioplasty, stent placement, and atherectomy were used to create summary statistics for utilization by year, place of service (hospital inpatient, hospital outpatient, and office-based laboratory), and provider specialty (cardiology, radiology, and surgery).The use of atherectomy increased from 34,732 (33%) procedures in 2011 to 75,435 (53%) procedures in 2019, and atherectomy became the dominant treatment strategy for femoropopliteal PAD. The relative utilization of stent placement (36,793 [35%] to 28,899 [20%]) and angioplasty only (34,398 [32%] to 38,228 [27%]) decreased concomitantly from 2011 to 2019. By 2019, the use of atherectomy was twofold higher in office-based laboratories than in the outpatient hospital setting (44,767 and 20,901, respectively). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925 [43%]), whereas radiologists used angioplasty alone (5,928 [6%]) and surgeons stented (18,009 [37%]) most frequently. By 2019, all specialties utilized atherectomy most frequently (29,564 [59%] for cardiology, 10,912 [58%] radiology, and 33,649 [47%] surgery).The national approach to endovascular management of femoropopliteal PAD has changed since 2011 toward an implant-free strategy, including a multifold increase in the use of atherectomy. Discordant rates of atherectomy use between the ambulatory hospital and office-based settings highlight the need for comparative effectiveness studies to guide management.

Introduction Limited prospective data exist regarding epinephrine's controversial role in managing traumatic cardiac arrest (TCA). This study compared the maximum concentration (Cmax), time to maximum concentration (Tmax), plasma concentration over time, return of spontaneous circulation (ROSC), time to ROSC, and odds of ROSC of epinephrine administered by the endotracheal (ETT), intraosseous (IO), and intravenous (IV) routes in a swine TCA model. Methods Forty-nine Yorkshire-cross swine were assigned to seven groups: ETT, tibial IO (TIO), sternal IO (SIO), humeral IO (HIO), IV, CPR with defibrillation (CPRD), and CPR only. Swine were exsanguinated 31% of their blood volume and cardiac arrest induced. Chest compressions began 2 min post-arrest. At 4 min post-arrest, 1 mg epinephrine was administered, and blood specimens collected over 4 min. Resuscitation continued until ROSC or 30 min elapsed. Results The Cmax of IV epinephrine was significantly higher than the TIO group (P = 0.049). No other differences in Cmax, Tmax, ROSC, and time to ROSC existed between the epinephrine groups (P > 0.05). Epinephrine levels were detectable in two of seven ETT swine. No significant difference in ROSC existed between the epinephrine groups and CPRD group (P > 0.05). Significant differences in ROSC existed between all groups and the CPR only group (P Conclusions The pharmacokinetics of IV, HIO, and SIO epinephrine were comparable. Endotracheal epinephrine absorption was highly variable and unreliable compared to IV and IO epinephrine. Epinephrine appeared to have a lesser role than volume replacement in resuscitating TCA.

BACKGROUND: Otitis Media (OM) is one of the most common infections among children in developed countries and may result in temporary conductive hearing loss (HL) if accompanied by middle ear effusion (MEE). Ventilation tube insertion (VTI) is recommended as treatment for recurrent acute OM or chronic MEE with HL. HL may lead to impaired development of psychosocial skills. However, evidence for the developmental consequences of OM and the effect of VTI is inconsistent. The objectives of this study were to investigate 1) whether OM in early childhood is associated with long-term consequences of psychosocial development and 2) if VTI prevents the possible negative consequences of OM.METHODS: This study examined prospectively collected data from 52.877 children registered in the Danish National Birth Cohort (DNBC). Information about previous OM-episodes and VTI was obtained through systematic follow-up interviews at seven years, and The Strength and Difficulties Questionnaire (SDQ) containing questions about psychological wellbeing was completed. Five groups were defined based on OM-exposure and the presence of VTI. Baseline characteristics were analysed, and comparison of mean SDQ-scores for the five exposure groups was conducted. Means were adjusted for à priori defined confounding factors.RESULTS: Data from 52,877 children in the DNBC showed an association between OM and poorer SDQ-scores. VTI was associated with an additional increase, i.e. worsening, of the SDQ-score for boys, and only a slight beneficial effect on the girls' outcome. The groups differed in their baseline characteristics in e.g. maternal education, socio-economic status, breastfeeding, and prematurity.CONCLUSION: Significant associations between parent-reported OM in early childhood and later psychosocial health difficulties were found. VTI did not resolve this association.

Purpose This non-randomized, patient-access protocol, assessed both safety and efficacy outcomes following liposomal muramyl-tripeptide-phosphatidylethanolamine (L-MTP-PE; mifamurtide) in patients with high-risk, recurrent and/or metastatic osteosarcoma. Methods Patients received mifamurtide 2 mg/m2 intravenously twice-weekly ×12 weeks, then weekly ×24 weeks with and without chemotherapy. Serum concentration-time profiles were collected. Adverse events within 24 hours of drug administration were classified as infusion-related adverse events (IRAE); other AEs and overall survival (OS) were assessed. Results The study began therapy in January 2008; the last patient completed therapy in October 2012. Two hundred five patients were enrolled; median age was 16.0 years and 146/205 (71%) had active disease. Mifamurtide serum concentrations declined rapidly in the first 30 minutes post-infusion, then in a log-linear manner 2–6 hours post-dose; t1/2 was 2 hours. There were no readily apparent relationships between age and BSA-normalized clearance, half-life, or pharmacodynamic effects, supporting the dose of 2 mg/m2 mifamurtide across the age range. Patients reported 3,679 IRAE after 7,482 mifamurtide infusions. These were very rarely grade 3 or 4 and most commonly included chills + fever or headache + fatigue symptom clusters. One- and 2-year OS was 71.7% and 45.9%. Patients with initial metastatic disease or progression approximated by within 9 months of diagnosis (N = 40) had similar 2-year OS (39.9%) as the entire cohort (45.9%) Conclusions Mifamurtide had a manageable safety profile; PK/PD of mifamurtide in this patient access study was consistent with prior studies. Two-year OS was 45.9%. A randomized clinical trial would be required to definitively determine impact on patient outcomes. Pediatr Blood Cancer 2014;61:238–244. © 2013 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc.

The Gulf War and its aftermath have testified once again to the significance placed on the meanings and images of Vietnam by US media and culture. Almost two decades after the end of hostilities, the Vietnam War remains a dominant moral, political and military touchstone in American cultural consciousness. Vietnam War Stories provides a comprehensive critical framework for understanding the Vietnam experience, Vietnam narratives and modern war literature. The narratives examined - personal accounts as well as novels - portray a soldier's and a country's journey from pre-war innocence, through battlefield experience and consideration, to a difficult post-war adjustment. Tobey Herzog places these narratives within the context of important cultural and literary themes, including inherent ironies of war, the "John Wayne syndrome" of pre-war innocence, and the "heavy Heart-of-Darkness trip" of the conflict itself.

Grazing incidence and grazing emission X-ray fluorescence spectroscopy (GI/GE-XRF) are techniques that enable nondestructive, quantitative analysis of elemental depth profiles with a resolution in the nanometer regime. A laboratory setup for soft X-ray GEXRF measurements is presented. Reasonable measurement times could be achieved by combining a highly brilliant laser produced plasma (LPP) source with a scanning-free GEXRF setup, providing a large solid angle of detection. The detector, a pnCCD, was operated in a single photon counting mode in order to utilize its energy dispersive properties. GEXRF profiles of the Ni–Lα,β line of a nickel–carbon multilayer sample, which displays a lateral (bi)layer thickness gradient, were recorded at several positions. Simulations of theoretical profiles predicted a prominent intensity minimum at grazing emission angles between 5° and 12°, depending strongly on the bilayer thickness of the sample. This information was used to retrieve the bilayer thickness gradient. The...

Effects of habitat fragmentation vary greatly between organisms. Traits such as dispersal mode and habitat preference may explain these differences. We predict that organisms with low dispersal abilities respond mainly to habitat isolation whereas aerial colonisers respond to the amount of suitable habitats at the landscape scale. To test these predictions 30 sites were chosen that varied independently in the level of isolation from woody habitats and in the percentage of woody habitats in 500 m circumference. At each site seven cherry trees were established. Overwintering arthropods were sampled using cardboard hides. Glue rings were attached around tree stems to distinguish between walking and aerial colonisers. As predicted for walking dispersers earwig abundance was strongly affected by habitat isolation. In contrast three species of ballooning spiders responded neither to glue rings nor to habitat isolation. Instead they were affected by habitat amount in accordance with their preferred habitats. These results strongly encourage the use of species traits to predict effects of landscape fragmentation on organisms. However additional factors such as interactions between species groups need also to be taken into account.

PURPOSE: The purpose of this study was to evaluate the safety and clinical value of MR-guided biopsies in an open 0.2 T low-field system. MATERIALS AND METHODS: A total of 322 patients with suspicious lesions of different body regions were biopsied in a low-field MRI system (0.2 T, Concerto, Siemens). The procedures were guided using T 1-weighted Flash sequences (TR/TE = 100 / 9; 70°). The lesions were repeatedly biopsied using the coaxial technique with a 15-gauge (diameter 2 mm) puncture needle. Complications and biopsy findings were analyzed retrospectively. RESULTS: In all cases the biopsy procedures were successfully performed with MR guidance. In 298 patients diagnosis was able to be confirmed on the basis of the probes. The clinical follow-up showed that in 24 patients the lesions were missed by MR-guided biopsy. From this a sensitivity of 86 %, a specificity of 87 % and an accuracy of 93 % were calculated. In two patients major complications were observed (morbidity rate 0.6 %). CONCLUSION: MR-guided biopsy can be performed safely and precisely in a low-field MR system and are a supplement to US or CT-guided biopsies.

We report on the effect of an alkylating agent sensing of a nucleophilic unit, Pyridine-Thiophene (PyTh), on the polaron recombination in a co-polymer [Poly(3-hexylthiophene)] n (PyTh) m ( m ≈ 0.025 n ). We show that by exposing the co-polymer to an alkylating agent, such as methyl iodide, the recombination rate increases substantially, possibly due to the introduction of additional recombination pathways created by the charge transfer between the electron deficient alkylated pyridinium sites and the electron rich thiophene polymer backbone. We also establish the bi-molecular-dispersive nature of the polaron recombination mechanism by following the modulation frequency and excitation intensity dependencies of the polaron photoinduced absorption.

Everolimus (EVL), an antagonist of mammalian target of rapamycin, has been recently introduced into solid organ transplantation either associated with low dose of anticalcineurins (CNI) or replacing them in an attempt to avoid nephrotoxicity and chronic allograft nephropathy. Due to the molecular similarities with sirolimus, it has been expected that there would be the same incidence of metabolic changes and adverse events. We retrospectively studied kidney allograft recipients converted from CNI to EVL during a 12-month period. Patients received a standard dose of EVL starting at 1.5 mg/d and thereafter titrating to achieve trough levels in the range of 3 to 5 ng/mL. Patients achieved mean EVL trough levels of 5.2, 4.0 and 4.5 ng/mL at 1, 6, and 12 months, respectively. One year following conversion, the calculated creatinine clearance increased from 57 to 63 mL/min and proteinuria did not change. Fasting blood glucose levels decreased significantly following conversion to EVL. During the same time, no significant changes were observed in body weight, body mass index, albumin, cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipid-lowering medication requirements, blood magnesium, and uric acid. We concluded that EVL did not negatively influence various nutritional parameters.

PURPOSE To evaluate transpulmonary chemoembolization (TPCE) as a symptomatic palliative method for treating inoperable primary lung tumors. MATERIALS AND METHOD From 2002 to 2005, 17 patients (17 males, 3 females; average age: 64.5 years) suffering from primary lung tumors were treated in 3.6 sessions (range: 2 to 8) using TPCE. The patients had the following primary tumors: adenocarcinoma (n = 6), pleural mesothelioma (n = 2), squamous cell carcinoma (n = 1), small cell carcinoma (n = 1), and non-small cell carcinoma (n = 7). After femoral vein puncture, tumor-supplying pulmonary arteries were selectively explored, and 5 - 10 mg mitomycin C and 5 - 10 mL lipiodol and microsphere particles (Spherex) (20 - 70 microm in diameter) were applied with balloon protection. Diagnosis and follow-up were performed in 4-week intervals with unenhanced and contrast-enhanced computed tomography (CT). The mean follow-up was 11.3 months. RESULTS Treatment was well tolerated by all patients with no major side effects or complications. The laboratory parameters were not significantly influenced. 11.8 % of the patients (n = 2) showed high or moderate lipiodol uptake, and 76.5 % (n = 13) showed low lipiodol uptake. After evaluation of morphologic criteria, a mean volume regression of 12.1 ml (40.4 %) of the embolized areas was achieved in four patients (23.5 %), while a constant value was identified during follow-up for seven patients (41.2 %). In six patients (35.3 %), progression of the treated lung tumors was recorded. The tumor increased by a mean of 38.37 ml (165.38 %). CONCLUSION TPCE is a well-tolerated palliative treatment option for patients with primary lung tumors.

Summary Background Psoriasis is a chronic inflammatory skin disorder affecting about 2% of white-skinned individuals. Epidemiological data on the prevalence and degree of coronary artery calcification (CAC) as an indicator for cardiovascular diseases in patients with psoriasis are contradictory. Objectives To study the prevalence and degree of CAC as an indicator for cardiovascular diseases in 32 patients with psoriasis matched for age, sex and risk factors to an equally sized control population. Methods Noncontrast-enhanced 16-row spiral computed tomography was performed in patients and controls. Results We found a significantly increased prevalence (59AE4% vs. 28AE1%, P ¼ 0AE015) and severity (CAC score according to Agatston 3AE7 vs. 0AE0, P ¼ 0AE019) of CAC in patients with psoriasis. Multiple linear regression calculations identified psoriasis as a likely independent risk factor for CAC. Conclusions Our results point towards the potentially systemic nature of the inflammatory processes underlying the pathogenesis of psoriasis, which may therefore be considered a potentially severe systemic disease.

Purpose To analyze the proton magnetic resonance spectroscopic data ( (1)H MRS) of normal liver parenchyma with regard to age, sex, body mass index and location in the liver. Materials and methods 45 healthy volunteers age 24 to 65 years were examined with an optimized single-voxel (1)H MRS using a 1.5-T scanner. A spin echo sequence with a TR of 1500 ms and a TE of 135 ms was used, allowing in-phase detection of the choline signal. Weak water suppression was achieved using a chemical shift selective suppression (CHESS) technique. Each examination included the measurement of three voxels with a voxel size of 18 x 18 x 18 mm (3) in different areas of the liver. The volunteers were divided into different age-based groups (young: or = 44 years), BMI (normal weighted: 25 kg/m (2)) and sex. Results In the acquired spectra different lipid (e. g. [CH (2)] (n)), choline, glutamine, glutamate and glycogen-glucose-complex resonances were detected. The analysis of the spectra, however, only focused on the concentrations of choline and (CH (2)) (n) and the relative concentrations of the choline-to-(CH (2)) (n)-ratios. In the older volunteers the relative concentration of the choline-to-(CH (2)) (n)-ratio was significantly decreased by 0.213 +/- 0.193 in comparison to the younger subjects (p = 0,031). Further statistical analysis confirmed a significant decrease of the choline-to-(CH (2)) (n)-ratio by 0.223 +/- 0.180 in obese volunteers compared to volunteers of a standard weight (p = 0,016). The significant difference between the choline-to-(CH (2)) (n)-ratio in female versus male volunteers was calculated with an increase of 0.483 +/- 0.172 (p = 0,000). The location of the voxel in the liver parenchyma did not yield a significant difference in the choline-to-(CH (2)) (n)-ratio. Conclusion The analysis of the proton liver MRS of healthy volunteers indicated a significant difference in the choline-to-(CH (2)) (n)-ratio depending on age, sex, and BMI with a confidence interval of 95 %. The different choline-to-(CH (2)) (n)-ratio could be the result of the body fat distribution depending on age and sex and also of the increased fat portion of the body in obese volunteers.

In Deutschland wie in anderen Industrielandern stellen der Diskusprolaps und die damit verbundene Schmerzsymptomatik ein bedeutsames und zunehmendes Gesundheitsproblem dar. Wenn die Moglichkeiten der konservativen Therapie ausgeschopft sind, ist die Nukleolyse als minimalinvasive Alternative zur Operation zu diskutieren. Hierbei werden unter CT-Steuerung chondrolytische oder quelldruckmindernde Substanzen in den Nucleus pulposus einer protrudierten Bandscheibe injiziert. Unter den zahlreichen Substanzen, die bisher zum Einsatz kamen, erwies sich v. a. die Nukleolyse mit einem Ozon-Sauerstoff-Gemisch als viel versprechend. Neben seiner hohen Wasserbindungskapazitat vermag Ozon die Schmerzmediatoren vor Ort uber mehrere Monate zu hemmen, wirkt antiinflammatorisch und durchblutungsfordernd. Ozon wandelt sich im Korper in reinen Sauerstoff um und besitzt eine geringe Allergenitat. Bei der Nukleolyse handelt es sich um das alteste minimalinvasive Verfahren zur Therapie eines Bandscheibenvorfalls. Vergleichende Studien konnten eine Uberlegenheit neuerer Therapiekonzepte, z. B. der perkutanen Nukleotomie oder der Laserbehandlung, nicht bestatigen.

We report on the recombination kinetics of photoexcited polarons and triplet excitons in films of poly(2-methoxy-5-(2′-ethyl-hexyloxy)- 1,4-phenylene vinylene) (MEH-PPV) and MEH-PPV/C 60 mixtures. Experimentally, the dependence of the polaron and exciton photoin- duced absorption bands on the excitation intensity and modulation frequency was measured, covering a dynamic range of 4–5 orders of magnitude. We have found that in all cases the recombination kinetics can be successfully described as a “bimolecular dispersive” recom- bination, with the following characteristics of the photoinduced absorption, (a) Sublinear modulation frequency dependence (ω − α , α γ ,γ

Enterotoxigenic Escherichia coli (ETEC), which produces heat labile toxin (LT) and/or heat stable toxin (ST), is considered to be the most common known cause of travellers’ diarrhoea (TD). Owing to the antigenic similarity between cholera toxin and LT, immunization with inactivated oral B-subunit/whole-cell cholera vaccine (BS–WC) offers short term (3 months) but significant (>67%) protection against TD caused by LT-related ETEC. Since it expresses the cholera toxin B (CTB) subunit, the live attenuated oral cholera vaccine strain CVD 103-HgR, may induce similar protection. A trial was performed to determine if CVD 103-HgR live oral cholera vaccine would provide a protective efficacy of at least 50% against TD. In addition, the protective efficacy of the vaccine against TD specifically due to LT–ETEC and LT/ST–ETEC was determined. Volunteers (n = 134) travelling to Indonesia, India, Thailand or West-Africa were randomised to receive either a placebo (n = 65) or the vaccine (n = 69). In the placebo group, 46% reported an episode of diarrhoea, compared to 52% in the vaccine group. No significant group differences were found with regard to incidence, duration or severity of all caused TD or ETEC-associated TD. However, ETEC-associated TD occurred earlier in the placebo group (median 5 days), compared to the vaccine group (median 15 days). In conclusion, CVD 103-HgR live oral cholera vaccine failed to provide a 50% protection against TD. This study does not exclude that the vaccine may offer a short-lived protection against ETEC-associated TD. However, the power of the study was limited by the unexpected low incidence of LT–ETEC-associated diarrhoea (9% of all TD) compared to ST-associated TD (24% of all TD).

Objective Renal transplantation is the most successful therapy to improve survival and quality of life for patients with end-stage renal disease. Living donors have been used as an alternative to reduce the stay on the waiting list. Laparoscopic living donor nephrectomy has become the standard procedure for renal transplantation. Minimally invasive surgery involves less postoperative pain with less analgesic requirements allowing shorter hospital stay for the donor. Material and Methods We retrospectively analyzed demographic and intraoperative data and surgical complications for 46 patients who underwent laparoscopic living donor nephrectomy between March 2001 and March 2011. Results Mean donor age was 41 years. Mean operative time was 170 ± 45 minutes. The average cold ischemic time was 40 minutes and warm ischemic time was 26 minutes. Twenty-one patients were donors for pediatric receptors. Fourty patients underwent left laparoscopic nephrectomy, the other 6 patients underwent right laparoscopic nephrectomy due to vascular anatomic variant. Right laparoscopic nephrectomy was converted in 1 case (2.2%) due to renal vein laceration without donor morbidity and without compromise of graft function. Renal function at the second day post donor nephrectomy was measured using serum creatinine averaged 1.2 mg/dL with a mean increase of 0.4 mg/dL from baseline, with normalization after 30 days. No patient required blood transfusion, and there were no immediate surgical complications, infections, or mortality. One patient developed an incisional hernia in relation to the site of kidney removal. The mean hospital stay was 5 ± 1 days. Conclusions Laparoscopic nephrectomy in our experience is a safe technique without postoperative morbidity or mortality. It is associated with low levels of pain, early discharge and early return to physical activity and work, good sense of aesthetic results, and long-term graft function comparable to traditional nephrectomy and cadaveric grafts.

Purpose: To evaluate the clinical value of magnetic resonance imaging (MRI) of the uterus and the pelvis in infertile female with symptomatic endometriosis for the assessment of uterine morphology and function. Materials and Methods: Forty-one infertile women (mean age: 33.2 years) with symptomatic endometriosis documented by laparoscopy were evaluated with high-field MRI (Sonata, Siemens) using T2- and T1-weighted sequences. In addition, the patients underwent hysterosalpingoscintigraphy (HSSG) for evaluation of the uterotubal transport capacity. Pathologic findings of the uterine junction zone were correlated with the laparoscopic results, clinical symptoms and uterotubal transport capacity. Results: Adenomyosis was diagnosed on T2-weigthed MR-images in 35 (85.4%) patients (focal adenomatosis in 26 patients and diffuse adenomatosis in 9). Patients showing signs of adenomyosis tended to be older than patients without adenomyosis (mean age 34.1 years vs. 30.1 years) and showed a longer history of symptomatic endometriosis. A positive transport capacity in HSSG was observed in 73.1% (19/ 26) of the patients with focal adenomyosis and in only 22.2% (2/ 9) of patients with diffuse adenomyosis. In 83.3% (5/6) of the patients without signs of adenomyosis, a positive uterotubal transport was documented. Conclusion: MRI of the uterus is a helpful diagnostic tool for the diagnosis of adenomyosis and for planning further therapies. Patients with the diagnosis of adenomyosis showed a reduced uterotubal transport capacity that depended on the severity of adenomyotic changes and might be a possible cause of infertility.

Modellbildung und Simulation in den Umweltwissenschaften sind seit Jahren etablierte Methoden, die vorwiegend zur Analyse von Okosystemkompartimenten und Okosystemen eingesetzt werden. Der Beitrag untersucht, inwieweit mit einem Modell- und wissensbasierten Ansatz, uber monothematische Analysen hinaus, komplexe, unstrukturierte und fachubergreifende Entscheidungssituationen erfasst, Planungsprozesse unterstutzt und Simulationsergebnisse verbessert werden konnen. Ausgangspunkte sind mehrdimensionale Wertzuweisungen an Okosysteme und vielfaltige Forderungen von Seiten der Planungspraxis an die Reproduzierbarkeit und die Nachvollziehbarkeit von Entscheidungsfindungen. Umweltentscheidungen verbinden sachbezogene Analysen mit normativen Werthaltungen und bilden das Fundament fur Empfehlungen zum umweltgerechten Handeln. Sechs Einflussfakturen auf die Entwicklung und Anwendung von Systemen zur Entscheidungsunterstutzung werden strukturiert vorgestellt. Anhand von drei Fallstudien werden exemplarisch modell- und wissensbasierte Systeme zur Unterstutzung der Entscheidungsfindung im Rahmen von Raumnutzungskonflikten, der Larmbelastigung und der Vegetationsentwicklung von Feuchtwiesen beschrieben. Die Schlussfolgerungen stellen neuere modelltechnische Verbesserungen fur Entscheidungsunterstutzungssysteme vor und skizzieren zukunftige Herausforderungen im Rahmen der anwendungsbezogenen Okosystemforschung. Keywords: Bewertung; Bewertungssystem; Data Mining; Data Warehouse; Decision Support System; DSS; Expertensystem; Feuchtwiese; Fuzzy Logic; kunstliche Intelligenz; Larmbelastigung; Leitbild; linguistische Variable; Online Analytical Processing; Raumnutzungskonflikt; Umwelt-Unterstutzungssystem; Vegetationsentwicklung; wissensbasierte Modellierung; Wissensmanagement

To evaluate the immunogenicity and tolerability of Epaxal in infants and children, 30 infants (aged 6-7 months) and 30 children (aged 5-7 years) received a single intramuscular dose of the aluminium-free virosomal hepatitis A virus (HAV) vaccine Epaxal and a booster dose after 12 months. Anti-HAV antibody titres were measured at baseline (before injection), at 1 and 12 months after primary vaccination, and 1 month after the booster vaccination. Sixteen evaluable infants had maternal anti-HAV antibodies at baseline. Complete seroprotection (titre >/= 20 mIU/ml) was achieved by all infants and children at Month 1 and at Month 12. Additionally, all subjects showed a strong antibody response to booster vaccination. In infants without maternal anti-HAV antibodies, the response was four-fold higher than in those with maternal anti-HAV antibodies. Both doses of Epaxal were well tolerated. These preliminary data suggest that Epaxal is an effective hepatitis A vaccine for children and infants from 6 months of age.

PURPOSE To evaluate safety and precision of liver tumor biopsies performed in an open low field system using different sequence techniques. MATERIALS AND METHODS In 47 patients with liver tumors, MR-guided biopsies were performed in a low field system (0.2 Tesla, Magnetom Open, Siemens) using two different sequences. The procedure was monitored with T1-weighted FLASH sequences (TR/TE = 100/9; 70(3)) in all patients and with FISP-Rotated-Keyhole-sequence (TR/TE = 18/8; 90(3)) in additional 20 patients. After positioning of the needle tip in the tumors, 166 biopsy specimens were acquired with 16 G cutting needles (Somatex*). The diameter of the biopsied lesions ranged from 1 to 10 cm (mean diameter 3.2 cm). Visibility of the needles and precision of the biopsies were evaluated. RESULTS All interventional biopsies were performed without vascular or organ injuries. Adequate specimens for histologic interpretation were obtained in 42 cases (89.3%). The biopsy results were non-specific in 2 patients (4.2%) and the lesions missed in 3 patients (6.3%). Mean in-room time was 35 minutes and the intervention time was 8.3 minutes. T1-weighted FLASH images proved optimal for confirming needle-tip placement during the biopsies or punctures. Organs, tumors and vessels were easily identified. The FISP sequence proved to be inferior in visualizing vessels and tumors. CONCLUSION MR-guided liver biopsies are safely and precisely performed using T1-weighted FLASH-sequences with sufficient visualization of the lesions and might be complementary to US- or CT-guided biopsies.

A combined actuation and deflection sensing technique employing electromagnetic actuation and piezoresistive MOS-transistor sensing for CMOS-integrated resonators has been developed. It is exemplified for a cantilever resonator with on-chip amplifier, but is broadly applicable to other resonator types. The high efficiency of electromagnetic actuation significantly reduces the required operation power and allows for the use in portable devices. The resonator can be operated in a self-oscillation mode with a minimum power consumption of 69 μW. The minimum Lorentz force necessary was found to be 43 nN. By use of stress-sensitive PMOS-transistors as active loads, the size of the piezoresistive Wheatstone bridge is significantly reduced compared to diffused piezoresistors. Thirdly, the post-processing sequence of the cantilever resonator has been optimized, so that only one photolithography step is necessary to release the whole mechanical structure to facilitate the fabrication and reduce fabrication costs.

This article describes the implementation and analysis of an automated system for the distribution of medications and supplies in an ambulatory clinic setting. Distribution, charging, and control of medications and supplies provided to ambulatory clinics is an issue that presents numerous problems for hospital pharmacy departments. A combined automated unit to handle both supplies and medications was studied as an alternative to traditional manual systems. Problems with our manual system were identified. A comparative analysis of revenue, medication and supply cost before and after automation is presented. Increases in revenue, decreases in supply cost, and improved medication expense documentation were noted with the automated system.

Zielsetzung. Vorstellung der Wertigkeit der kontrastmittelverstarkten Mehrschicht-Computertomographie (MS-CT) bei der Evaluation abdomineller Neoplasien mit Schwerpunkt primare Lebertumoren, Pankreaskarzinom und kolorektales Karzinom. Material und Methodik. Optimierte Untersuchungsprotokolle fur die Mehrschicht-Computertomographie unter Verwendung oraler und intravenoser Kontrastmittelapplikation werden prasentiert. Ergebnisse. Fur die primaren Lebertumoren wie das hepatozellulare Karzinom und cholangiozellulare Karzinom werden Treffsicherheiten von 82–94% erreicht. Fur das Pankreaskarzinom werden diagnostische Treffsicherheiten erzielt von 85–96%. Fur die Diagnostik des kolorektalen Karzinoms sind die Ergebnisse relevant beim Staging des Primartumors, der Lymphknotenmetastasierung sowie weiterer Organmetastasen in Leber und Lunge. Die Ergebnisse erreichen dabei die Werte von 86–92% fur die Sensitivitat, Spezifitat und diagnostische Genauigkeit. Schlussfolgerung. Die kontrastmittelverstarkte Mehrschicht-Computertomographie (MS-CT) stellt eine schnelle und verlassliche Untersuchungsmodalitat zur Detektion und zum Staging abdomineller Neoplasien dar im Hinblick auf die vorgestellten Schwerpunkte Oberbauch und kolorektales Karzinom.

Changes in nutrient partitioning in stems and leaves of peanut (Arachis hypogaea L.) were examined after girdling of stems by Spissistilus festinus (Say) (Homoptera:Membracidae), the three-cornered alfalfa hopper. Under field conditions amino acids increased more than 12-fold in concentration in the 2 cm stem section above the girdle compared to below the girdle or control stems for newly formed girdles (less than 7–11 days). Asparagine and proline were the predominant amino acids, and increased 40- and 60-fold, respectively, above the girdle compared to below the girdle. There was no buildup of nutrient assimilates for the older girdled stems that had callused (and presumably recovered from feeding injury). A time course from 1–11 days was followed under greenhouse conditions, and girdled regions remained enriched in sugars for one day and amino acids for four days after girdle formation. After girdle formation most S. festinus responded to nutrient sinks by feeding within 5 mm above the girdle. This behavior was most pronounced one day after girdle formation, but persisted for seven days after girdle formation. During this period a new girdle was often formed within 10 mm above the original girdle. Under field conditions, stems and leaves derived from stems that had sustained an early or late season girdle generally had a reduced dry weight, total nitrogen content, and total carbon content; however, significant differences did not always occur. Thus, although temporary changes occurred in nutrient partitioning in girdled stems, there appears to be longer term negative growth effects on leaves and stems.

OBJECTIVE To evaluate the performance of 4 different visualization techniques for multislice CT datasets from the coronary arteries in comparison to coronary angiography. MATERIAL AND METHODS 42 patients were examined prospectively using both multislice CT and angiocardiography. All CT scans were performed at collimation 4 x 1 mm, pitch 1.5 and a rotation time of 500 msec. Using retrospective ecg-gating, image reconstruction parameters were 1.25 mm slice thickness, 0.5 mm increment and kernel B30. Each patient's CT dataset subsequently was explored using axial, multiplanar, three-dimensional, and virtual endoscopic visualization modes. RESULTS Axial scans showed the highest sensitivity in the evaluation of stenoses (66.7%), followed by virtual endoscopy (55.9%), multiplanar (48.6%), and three-dimensional reformations (33.3%). With regard to the detection of atherosclerotic plaques, axial scans (71.2%), three-dimensional reformations (70.1%), and virtual endoscopy (69.1%) displayed comparable sensitivities, whereas multiplanar reformations showed distinctly lower results (55.6%). On combining the techniques a sensitivity of 74.2% for the detection of atherosclerotic plaques, of 72.0% for the identification of high-grade stenoses, respectively, was obtained. The specificity of all four visualization modes amounted to 91.9% and above. Best results have been obtained within the RIVA (sensitivity 85.2%). CONCLUSION For the detection of atheromatous changes CT angiocardiography does not achieve a sensitivity as high as angiocardiography and is restricted to the three major branches. At heart rates below 60 bpm axial scans showed the best correlation in the quantification and classification of atherosclerotic plaques.

Liver transplantation is the only treatment for patients with terminal acute and chronic diseases. Liver transplantation was started in Chile in 1985; our pediatric program began in 1993. The aim of this paper work was to present our experience from 1993 through 2004. One hundred and thirty two orthotopic liver transplants (OLT) were performed in children of mean age 5 years and median age 4 years (8 months to 15 years). The most frequent indications were biliary atresia, (43.1%) and acute liver failure (ALF; 20.4%), whose frequent cause was unknown but viral hepatitis A was the second one. A complete liver was transplanted in 59 patients, reduced in 39, split in one, and as an auxiliary liver in another one. Living related liver transplantation was performed in 32 cases (24.2%), of which thirty included segments II and III, and two, a right liver. A terminal arterial anastomosis was performed in 102 (77.2%) recipients and a graft interposition in 32 patients (24.2%). In 16 cases, biliary reconstruction was performed through an enterobiliary anastomosis. Immunosuppression included cyclosporine (Neoral), steroids, and azathioprine with conversion to tacrolimus (Prograf) as indicated. Rejection episodes, which were always biopsy-proven, were treated either with methylprednisolone or with antibodies. Biliary complications were the most frequent (21.4%) and the second cause was vascular complications (13%). Sixty-six patients suffered an acute rejection episode. Actuarial graft survival was 81.3% at 1 year and 72% at 5 years, while actuarial graft survival for ALF was 75.9% at 1 year and 67.8% at 5 years. Our results are comparable to those reported by most international groups.

Introduction In 1994 our group began its experience with pediatric liver transplantation. The experience gained during this period is the largest in the country, positioning the Hospital Luis Calvo Mackenna and Clinica Las Condes as major referral centers in the public and private sectors. The aim of this study was to report our experience of our pediatric liver transplantation program during this period. Methods The liver transplantation database of Hospital Luis Calvo Mackenna and Clinica Las Condes between January 1994 and July 2011 was reviewed recording age, gender, indications for transplantation, surgical technique, complications, and survival. Survival rates were calculated using Kaplan-Meier analysis. Results During the period described 230 transplantations were performed in 189 pediatric patients. Fifty-five percent were male patients. The average age was 5 years. The main causes of transplantation were biliary atresia (50%), fulminant hepatic failure (25%), and other cholestatic diseases by 10%. Vascular and biliary complications were the leading cause of graft loss and retransplantation. The overall rate of retransplantation at 5 years was 20%. The technique of living donor was used in 28% of the cases. The 1-year patient actuarial survival rate was 80%, 73% at 5 years, and 68% at 10 years. In the last 3 years the survival rate at 1 year exceeds 90%. Discussion Our program includes more than 90% of the national liver experience. The incorporation of living donor is a milestone that has enabled us to save many patients who previously died while waiting for an organ. Its use in cases of full acute liver failure has allowed us to dramatically reduce mortality on the waiting list. Our results in the last 3 years reflect the experience that results in a significant decrease in mortality, comparing favorably to other series published in the international literature.