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Das Retikulozyten-Hamoglobin-Aquivalent (RET-He) wird als Biomarker fur die Diagnostik und das Monitoring einer Eisendefizienz vorgestellt. Der Marker ist unabhangig von der akuten Phase und kann binnen weniger Minuten durch ein Blutbild bestimmt werden. Eisendefizienz oder Veranderungen im Eisenstatus der Erythropoese sind wegen der ca. 120-tagigen Lebenszeit von Erythrozyten mit klassischen hamatologischen Parametern wie Hamoglobin, mittleres korpuskulares Volumen, mittlerer zellularer Hamoglobingehalt oder auch mit der Bestimmung hypochromer Erythrozyten (%-Hypo) erst relativ spat zu erkennen. Das RET-He ist ein Biomarker zur Diagnose und zum Monitoring der Eisenversorgung fur die Erythropoese. Retikulozyten, die Vorstufen der reifen Erythrozyten, werden vom Knochenmark ins periphere Blut geschwemmt und reifen hier innerhalb von 2 Tagen zum reifen Erythrozyten aus. Die Bestimmung der Retikulozytenzahl erlaubt daher eine zeitnahe Aussage uber die Erythropoese. Eine Messung des Hamoglobingehalts der Retikulozyten spiegelt somit den aktuellen Eisenmetabolismus der Erythropoese wider und ermoglicht die Beurteilung der „Qualitat“ der Zellen. Veranderungen im Eisenstatus der Erythropoese konnten wesentlich fruhzeitiger erkannt werden. Es wird empfohlen, RET-He als routinemasig zu erhebenden praoperativen Marker einer latenten Anamie zu etablieren, um Risikopatienten kostengunstig zu identifizieren. Im Sinne einer perioperativen Prahabilitation und des Konzepts der „Enhanced Recovery After Surgery“ (ERAS) konnten Patienten mit einer Eisendefizienz fruhzeitig proaktiv behandelt werden, um Komplikationen vorzubeugen und verlangerte Krankenhausaufenthalte zu verhindern.

we present magnetic, mechanical and thermal modeling results for a 3 Tesla actively shielded whole body MRI (Magnetic Resonance Imaging) magnet consisting of coils with a square cross section of their windings. The magnet design was a segmented coil type optimized to minimize conductor length while hitting the standard field quality and DSV (Diameter of Spherical Volume) specifications as well as a standard, compact size 3 T system. It had an overall magnet length and conductor length which can lead to conduction cooled designs comparable to NbTi helium bath cooled 3 T MRI magnets. The design had a magnetic field homogeneity better than 10 ppm (part-per-million) within a DSV (Diameter of Spherical Volume) of 48 cm and the total magnet winding length of 1.37 m. A new class of MgB(2) strand especially designed for MRI applications was considered as a possible candidate for winding such magnets. This work represents the first magnetic, mechanical and thermal design for a whole-body 3 T MgB(2) short (1.37 m length) MRI magnet based on the performance parameters of existing MgB(2) wire. 3 Tesla MRI magnet can operate at 20 K at 67 % of its critical current.

The reticulocyte hemoglobin equivalent (RET-He) is presented as a biomarker for the diagnostics and monitoring of iron deficiency. The marker is independent of the acute phase and can be determined within a few minutes by a blood count. Due to the approximately 120-day lifetime of erythrocytes, iron deficiency and changes in the iron status of erythropoiesis can first be recognized at a relatively late stage using classical hematological parameters, such as hemoglobin, mean corpuscular volume, mean cellular hemoglobin content and also with determination of hypochromic erythrocytes (% hypo). The RET-He is a cost-effective parameter for the diagnosis and monitoring of the iron supply for erythropoiesis. Reticulocytes, the precursors of mature erythrocytes, are washed out of the bone marrow into the peripheral blood and normally mature within 2 days to mature erythrocytes. The determination of the reticulocyte number therefore enables a timely statement about erythropoiesis. A measurement of the hemoglobin content of reticulocytes therefore reflects the actual iron metabolism of erythropoiesis and enables assessment of the quality of the cells. Changes in the iron status of erythropoiesis can thus be detected much earlier than by determining only the hemoglobin content of mature erythrocytes, i.e. the mean cellular hemoglobin content. It is recommended that the evaluation of RET-He should be carried out as an inexpensive routine preoperative marker of latent anemia in order to identify patients at risk. In the sense of a perioperative prehabilitation and the enhanced recovery after surgery (ERAS) concept, patients with iron deficiency can be treated proactively at an early stage in order to prevent complications and extended hospital stays.Das Retikulozyten-Hämoglobin-Äquivalent (RET-He) wird als Biomarker für die Diagnostik und das Monitoring einer Eisendefizienz vorgestellt. Der Marker ist unabhängig von der akuten Phase und kann binnen weniger Minuten durch ein Blutbild bestimmt werden. Eisendefizienz oder Veränderungen im Eisenstatus der Erythropoese sind wegen der ca. 120-tägigen Lebenszeit von Erythrozyten mit klassischen hämatologischen Parametern wie Hämoglobin, mittleres korpuskuläres Volumen, mittlerer zellulärer Hämoglobingehalt oder auch mit der Bestimmung hypochromer Erythrozyten (%-Hypo) erst relativ spät zu erkennen. Das RET-He ist ein Biomarker zur Diagnose und zum Monitoring der Eisenversorgung für die Erythropoese. Retikulozyten, die Vorstufen der reifen Erythrozyten, werden vom Knochenmark ins periphere Blut geschwemmt und reifen hier innerhalb von 2 Tagen zum reifen Erythrozyten aus. Die Bestimmung der Retikulozytenzahl erlaubt daher eine zeitnahe Aussage über die Erythropoese. Eine Messung des Hämoglobingehalts der Retikulozyten spiegelt somit den aktuellen Eisenmetabolismus der Erythropoese wider und ermöglicht die Beurteilung der „Qualität“ der Zellen. Veränderungen im Eisenstatus der Erythropoese könnten wesentlich frühzeitiger erkannt werden. Es wird empfohlen, RET-He als routinemäßig zu erhebenden präoperativen Marker einer latenten Anämie zu etablieren, um Risikopatienten kostengünstig zu identifizieren. Im Sinne einer perioperativen Prähabilitation und des Konzepts der „Enhanced Recovery After Surgery“ (ERAS) könnten Patienten mit einer Eisendefizienz frühzeitig proaktiv behandelt werden, um Komplikationen vorzubeugen und verlängerte Krankenhausaufenthalte zu verhindern.

Der Pilonidalsinus ist ein zunehmend haufig auftretendes Krankheitsbild, von dem besonders junge, arbeitsfahige Manner betroffen sind. Es gibt zahlreiche operative Behandlungsmethoden. Bei der Anwendung der verschiedenen Methoden entstehen unterschiedlich hohe Kosten. Die Auswahl des Operationsverfahrens hat deshalb nicht nur einen Einfluss auf die Lebensqualitat der Patienten, sondern auch auf die Hohe der Kosten fur das Gesundheitssystem. Wie hoch sind die direkten und indirekten Kosten der verschiedenen Operationsverfahren, und wie lassen sich bei gleichbleibender oder besserer Qualitat fur den Patienten Kosten senken? Die Autoren fuhrten eine Kostenanalyse der verschiedenen Operationsmethoden mithilfe einschlagiger Literatur und amtlicher Statistiken durch. Die primar offene Behandlung ist gesamtwirtschaftlich die kostenintensivste Methode, da besonders die Nachsorge und der lange Arbeitsausfall der Patienten hohe Kosten verursachen. Fur das Krankenhaus ist dieses Verfahren jedoch wegen der kurzen Operationszeit, der einfachen Durchfuhrung und der kurzen Liegedauer finanziell vorteilhaft. Das fuhrt zu hoheren Nachbehandlungskosten, einer hoheren Rezidivrate und zu mehr Ausfalltagen fur die Arbeitgeber. Das DRG-System (diagnosis related groups; diagnosebezogene Fallgruppen) setzt bei der Behandlung des Pilonidalsinus falsche okonomische Anreize, sodass die primar offene Technik fur die Krankenhauser finanziell vorteilhafter ist als andere Operationsmethoden. Dies ist eine mogliche Erklarung dafur, dass die primar offene Technik, obwohl sie eine hohere Rezidivrate aufweist als andere Operationsverfahren und gesamtwirtschaftlich teurer ist, in deutschen Krankenhausern immer noch am haufigsten durchgefuhrt wird.

Der Sinus pilonidalis ist eine Erkrankung des Unterhautgewebes, bei dem Infektionen und Haare eine zentrale Rolle spielen. Derzeit stehen verschiedene Therapieoptionen zur Verfugung, die sich insbesondere in ihrer Invasivitat deutlich unterscheiden. Es existiert jedoch kein Verfahren, das alle Vorteile einer hohen Heilungsrate, einer geringen Rezidivrate und minimaler Belastung fur den Betroffenen vollkommen erfullt. Unklar ist zum einen der Stellenwert der Antibiotikagabe als unterstutzende Masnahme zu operativen Verfahren. Als neue minimal-invasive Verfahren wurden endoskopische Techniken und die Anwendung des Lasers zur Behandlung des Sinus pilonidalis eingefuhrt. Nach den derzeit vorliegenden Studien kann keine Empfehlung fur die Anwendung von Antibiotika als parenterale bzw. enterale Gabe oder als lokale Anwendung gegeben werden; dies muss dem Ermessen und der Erfahrung des Operateurs uberlassen werden. Wahrend fur die alleinige Behandlung eines Sinus pilonidalis durch eine Laserkoagulation derzeit noch keine ausreichende Evidenz vorliegt, konnte die Laserepilation im Rahmen der postoperativen Rezidivvermeidung durchaus eine Rolle spielen. Studien deuten darauf hin, dass sie anderen Verfahren zur Haarentfernung (Rasur, Cremes) uberlegen ist und die Rezidivrate senken kann. Eine Anwendung konnte insbesondere bei Problemfallen erwogen werden. Fur die endoskopischen Techniken ist derzeit ebenfalls keine abschliesende Bewertung moglich. Es handelt sich um ein minimal-invasives Verfahren, das seine Vorteile gegenuber der wesentlich einfacher und kostengunstiger durchzufuhrenden Pit-Picking-Methode erst noch unter Beweis stellen muss.

During the year 2015 and 2016, we surveyed the main pistachio growing counties in California to assess the health of pistachio trees and investigate the occurrence of canker and soil borne diseases. Numerous orchards were visited throughout the San Joaquin Valley to diagnose unusual symptoms and investigate the causes of decline of pistachio trees. Canker diseases causing branch and scaffold dieback were observed commonly in mature pistachio orchards. New fungal pathogens associated with cankers included Cytospora species, Diaporthe ambigua (=Phomopsis ambigua), and Colletotrichum karstii. A pathogenicity test using fungi isolated from cankers was conducted in the field to determine the ability of these fungi to produce cankers. Results of this study showed that all species tested were pathogenic to pistachio, causing extensive lesions and vascular discolorations just a few months after infection. Among them, Cytospora species were the most aggressive fungal pathogens and are considered new threats to pistachio in California. Other disease symptoms observed commonly in our surveys included declining trees characterized by chlorotic foliage as well as wilting, defoliation and eventual tree death. Trunks often expressed gumming together with crown rot symptoms. Investigations of the causes of pistachio tree decline revealed the occurrence in orchards of several Phytophthora species including P. niederhauserii, P. cinnamomi and P. taxon walnut. Other fungi isolated from declining pistachio trees and rootstocks included Fusarium oxysporum, F. solani, F. equiseti and F. proliferatum and Macrophomina phaseolina. Pathogenicity in pistachio of the various soil borne pathogens were conducted in potted UCB-1 plants maintained in a greenhouse. Pathogenicity studies showed that all the various fungi can colonize and damage the vascular tissues of UCB-1 seedling rootstocks, causing substantial lesions and vascular discolorations. To date, the present project allowed to identify several new pathogens currently affecting the health of pistachio trees in California.

The California pistachio cultivars 'Kerman' and 'Peters' have an estimated requirement of 58 and 60 chill portions, respectively. In California's Central San Joaquin Valley, the recent combination of warmer winter temperatures and sharply decreased fogs have resulted in a reduction of winter chill accumulation. In 2015 and 2016, kaolin clay was applied to dormant pistachio trees attempting to increase chill accumulation by reflecting radiant heat. Four treatments including kaolin clay, kaolin clay plus 470 dormant oil, 470 dormant oil, and an untreated control were made to nine year old pistachio trees. Kaolin clay applications (33 kg ha-1) were applied twice with the first application occurring after leaf drop in mid-December and the second occurring in early-January. A 6% 470 dormant oil solution was applied at 150 L ha-1 on February 6th, 2016. Treatments were approximately 1.9 ha in size and were replicated four times utilizing a randomized complete block design. Temperature sensors measuring external wood temperature on the north and south side were installed on a single tree in multiple blocks. Yield was determined for each plot and evaluated for size and quality. Local weather station measurements indicate that adequate chill was received in 2015-2016. Never-the-less, wood surface temperatures in kaolin treated trees were lower than the untreated control, producing an increase in chill portion accumulation by ~15%. Yield, however, was higher in the 470 dormant oil than in the kaolin clay or untreated control (3,330 kg ha-1 vs. 2,796 and 2,774 kg ha-1, respectively). Results suggest that kaolin clay may be useful in increasing chill portion accumulation, but only if applied early in the dormant period. Our results also confirmed earlier reports that dormant oil increases pistachio yield in marginal to adequate chill years. Both techniques should be utilized as tools to help mitigate variable climate within pistachio orchards.

There is an urgent need to develop climate smart agroecosystems capable of mitigating climate change and adapting to its effects. In California, high commodity prices and increased frequency of drought have encouraged orchard turnover, providing an opportunity to recycle tree biomass in situ prior to replanting an orchard. Whole orchard recycling (WOR) has potential as a carbon (C) negative cultural practice to build soil C storage, soil health, and orchard productivity. We tested the potential of this practice for long term C sequestration and hypothesized that associated co-benefits to soil health will enhance sustainability and resiliency of almond orchards to water-deficit conditions. We measured soil health metrics and productivity of an almond orchard following grinding and incorporation of woody biomass vs. burning of old orchard biomass 9 years after implementation. We also conducted a deficit irrigation trial with control and deficit irrigation (-20%) treatments to quantify shifts in tree water status and resilience. Biomass recycling led to higher yields and substantial improvement in soil functioning, including nutrient content, aggregation, porosity, and water retention. This practice also sequestered significantly higher levels of C in the topsoil (+5 t ha-1) compared to burning. We measured a 20% increase in irrigation water use efficiency and improved soil and tree water status under stress, suggesting that in situ biomass recycling can be considered as a climate smart practice in California irrigated almond systems.

Parallel tempering, or replica exchange, is a popular method for simulating complex systems. The idea is to run parallel simulations at different temperatures, and at a given swap rate exchange configurations between the parallel simulations. From the perspective of large deviations it is optimal to let the swap rate tend to infinity and it is possible to construct a corresponding simulation scheme, known as infinite swapping. In this paper we propose a novel use of large deviations for empirical measures for a more detailed analysis of the infinite swapping limit in the setting of continuous time jump Markov processes. Using the large deviations rate function and associated stochastic control problems we consider a diagnostic based on temperature assignments, which can be easily computed during a simulation. We show that the convergence of this diagnostic to its a priori known limit is a necessary condition for the convergence of infinite swapping. The rate function is also used to investigate the impact of asymmetries in the underlying potential landscape, and where in the state space poor sampling is most likely to occur., Comment: 49 pages, 7 figures

Optimizing stimulation frequency based on a mathematical model that can predict skeletal muscle force and fatigue may improve the effectiveness of functional electrical stimulation systems. Potentially, optimal stimulation patterns can maximize muscle force production while also delaying the onset of muscle fatigue. In this paper, dynamic optimization was used to generate an optimal, frequency varying pulse train that maintains a desired isometric knee extension without unnecessarily fatiguing the muscle. The optimization method employed a predictive mathematical model of muscle force and fatigue. Knee extension experiments were conducted on an able-bodied participant to identify the model parameters. To test the effectiveness of the optimized train to delay muscle fatigue, a second knee extension experiment was conducted to compare the performance of the optimized stimulation train and a 50Hz constant frequency train. The peak force and the force time integral of the optimized stimulation train were found to be higher than the 50Hz constant frequency train. These preliminary results show that optimizing stimulation patterns, based on a subject specific predictive mathematical model, may potentially delay the onset of muscle fatigue while obtaining desired force profiles.

In 1595, for the first time, Hildanus described an ileal diverticulum, which was thoroughly scrutinized and defined by Johann Meckel in 1809. In most cases, Meckel's diverticulum does not cause any problems. In a small number of patients however, these diverticula can become infected (diverticulitis) cause an obstruction of the intestine, or cause bleeding from the intestine. We present a case of simultaneous rupture of Meckel’s diverticulum and small bowel without abdominal pain following a penetrate trauma to the abdomen, sustained during a stab wound to the abdomen

“A visible and tangible artwork is a kind of persisting event. One or more artists made it at a certain time and in a specific place, even if no one knows just who, when, where, or why. Although created in the past, an artwork continues to exist in the present, long surviving its times. The first painters and sculptors died thirty thousand years ago, but their works remain . . . .” Gardner’s Art Through the Ages

Infinite swapping (INS) is a recently developed method to address the rare event sampling problem. For INS, an expanded computational ensemble composed of a number of replicas at different temperatures is used, similar to the widely used parallel tempering (PT) method. While the basic concept of PT is to sample various replicas of the system at different temperatures and exchange information between the replicas occasionally, INS uses the symmetrized distribution of configurations in temperature space, which corresponds to the infinite swapping limit of PT. The effect of this symmetrization and the enhanced information exchange between replicas is evaluated for three different biological systems representing different sampling problems in biology: (1) blocked alanine dipeptide, which is a small system and therefore optimal to evaluate sampling efficiency quantitatively, (2) Villin headpiece, which is used as a test case for the protein folding process, and (3) neuroglobin, which is used to evaluate the effects of enhanced information exchange between replicas for sampling the substate space of a folded protein. For these three test systems, PINS is compared to PT, and it is found that in all cases the sampling with PINS is substantially more efficient.

Es wird die Haufigkeit und die klinischen Parameter von abdominellen Verletzungen mit Eviszeration von Darm im Schockraum ermittelt. Wir fuhren eine retrograde Kohortenanalyse aller Schockraumpatienten des Chris Hani Baragwanath Academic Hospitals, Soweto, Johannesburg, Sudafrika im Zeitraum von 9/2000–5/2005 durch. Von 9010 Patienten erlitten 4390 penetrierende Verletzungen, davon 71 Patienten mit Eviszeration von Darm. 8/71 der Eviszerationen von Darm waren bei singularen Schussverletzungen, wahrend 60/71 der Eviszerationen aufgrund von singularen Stichverletzungen zu verzeichnen waren. 3 Patienten erlitten multiple Verletzungen. Herzfrequenz, Blutdruck und Schockindex in Bauchstichpatienten mit und ohne Eviszeration waren nicht signifikant unterschiedlich, sodass eine vagale Uberstimulierung aufgrund von Zug am Mesenterium weder durch Bradykardie noch durch Hypotonie belegt wurde. Die Mortalitat betrug 1/71(1,6 %; Schockraumdurchschnitt 4,2 %). Bei 71 Patienten mit Eviszeration von Darm fand sich weder eine erhohte Schockraummortalitat noch eine Kreislaufinstabilitat. Die Patienten waren ausreichend kreislaufstabil, um umfassende praoperative Diagnostik durchzufuhren.

Im klinischen Alltag sprechen medizinische und okonomische Grunde gegen den allzu sorglosen Einsatz von Fremdblutkonserven. Auf der Suche nach Alternativen, wie beispielsweise die Therapie der Anamie (z. B. Eisensubstitution, Folsauresubstitution, Stimulation der Erythropoese etc.), mussen daher die Gesamtkosten von Bluttransfusionen berucksichtigt werden. Die vorliegende Publikation will an einem Praxisbeispiel zeigen, wie sich die tatsachlichen Kosten einer Bluttransfusion aus Sicht eines Krankenhauses in Deutschland darstellen. Zur Ermittlung der Gesamtkosten, die bei Verwendung einer Fremdblutkonserve entstehen, wurden im Marienhospital Vechta die realen Ressourcenverbrauche im Zusammenhang mit Bluttransfusionen erfasst und ausgewertet. Es konnte gezeigt werden, dass die eigentlichen Beschaffungskosten mit durchschnittlich 97 EUR nur etwa 55 % der Gesamtkosten von 176 EUR pro Blutkonserve ausmachen. Von den Nebenkosten entfallen dabei 78 % auf Personal und 22 % auf Material. Alternativen, die bei einem reinen Vergleich der Einkaufspreise bisher ausschieden, konnen bei Betrachtung der Gesamtkosten die wirtschaftlichere Losung sein. Die Betrachtung einer einzelnen Klinik schrankt die Verallgemeinerung der Ergebnisse auf das gesamte Bundesgebiet ein. Im internationalen Kontext konnen diese jedoch als plausibel anerkannt werden. Fur Deutschland liegen bislang keine umfassenden Studien zu den Echtkosten von Blutpraparaten vor, sodass diese Publikation einen ersten Ansatzpunkt darstellt, diese Lucke mit weiteren Studien zu schliesen.

This chapter discusses the irrigation requirements of an almond orchard, and describes the impacts of drought stress on almond vegetative growth, in-season kernel and fruit bud development, as well as yield. The management of orchard irrigation in water-limited environments is also discussed. Additional factors and considerations of water management are presented, discussing the effects of crop load, negative effects of canopy reduction, increasing soil salinity from reduced water quantity or quality, cultivar influences on water requirements, micro-irrigation systems and timing of water applications, reduction of water losses through evaporation, removal of the cover crop, minimal impacts of anti-transpirants, reduction in nitrogen applications, and insect management.

In the present paper we examine the risk-sensitive and sampling issues associated with the problem of calculating generalized averages. By combining thermodynamic integration, stationary phase Monte Carlo, and infinite swapping techniques, we develop an approach for such problems and explore its utility for a prototypical class of applications.

Penetrierende Schussverletzungen des Kopfes sind in Europa bisher selten. Aufgrund zunehmender Kriminalitat und Terror muss mit einer Zunahme der penetrierenden Verletzungen des Kopfes gerechnet werden. In dieser Arbeit zeigen wir Unterschiede bei Intubationsraten im Rettungsdienst bzw. Schockraum bei Patienten mit stumpfem Kopftrauma (31,4 %) bzw. nach Schussverletzungen des Kopfes (52,5 %) auf. Es finden sich deutliche Unterschiede in der Mortalitat nach Verkehrsunfall (8,3 %) und nach Schussverletzungen des Kopfes (25,6 %). In diese Single-Hospital-Analyse der Notfallraumdaten des Chris Hani Baragwanath-Hospitals (CHB) Johannesburg, Sudafrika, wurden von 9/2000 – 5/2005 5602 Patienten in die Studie eingeschlossen. Die Endpunkte Intubation und Versterben des Patienten in der Notfallaufnahme wurden retrospektiv analysiert. Es zeigte sich, dass sich penetrierende Verletzungen vor allem im Thorax und Abdomen finden lassen. Penetrierende Kopfverletzungen bedingen eine Zunahme der Intubationsfrequenz von 31,4 % (stumpfes Kopftrauma) auf 52,5 % (Schussverletzung des Kopfes). Die Mortalitat nach Kopfverletzungen durch Verkehrsunfall betragt 8,3 % und nach einer Schussverletzung des Kopfes 25,6 %. Patienten mit einer Kopfschussverletzung sterben im Mittel 1 h nach dem Trauma. Patienten nach stumpfem Kopftrauma sterben signifikant spater erst nach 2,3 h ohne Notfalltherapie und 2,8 Stunden mit Notfalltherapie (p = 0,02; Log-rank-Test). Kopfschussverletzungen fuhren zu einer Zunahme der Intubationsfrequenz von 30 % auf 50 %, zu einer 3-fach hoheren Sterblichkeit sowie einem Ansteigen der fruhen Todesfalle trotz maximaler Therapie. Diese Todesfalle nach Schussverletzungen sind entweder am Einsatzort, wahrend des Transportes oder in der Notfallaufnahme zu erwarten.

Obwohl Schuss- und Stichverletzungen in Deutschland selten sind, muss an Krankenhausern jeglicher Versorgungsstufen die akute Erstversorgung entsprechend Verletzter – auch in groserer Anzahl, wie beispielsweise nach einem Amoklauf – gewahrleistet sein. Wichtige Voraussetzungen fur ein gutes Outcome sind ein prioritatenorientiertes standardisiertes praklinisches Management, ein standardisiertes Schockraummanagement sowie, falls erforderlich, die rasche, pragmatische erste operative Phase im Sinne von „damage control surgery“. Im vorliegenden Beitrag werden Masnahmen fur Praklinik, Schockraum und erste operative Phase nach penetrierenden Hohlenverletzungen an Thorax und Abdomen vorgestellt.

We discuss here a convenient numerical approach for the construction of double-ended classical trajectories. This problem occurs frequently in both semiclassical and numerical path integral applications. The present approach utilizes a combination of simulated annealing and path integral methods.

Two superconducting magnets, mounted on a rocket sled are propelled by solid fuel rocket motors. During sled motion, the field from the magnets interacts with passive copper rails embedded in a concrete guideway to produce levitation and flight stability. Six flight tests have been successfully conducted to date with the most recent in April 2008 reaching 673 kilometer per hour. The magnets consist of racetrack coils, which are wet lay-up wound with rectangular NbTi wire. They were tested to 245 A with a peak field of 7.5 T and winding current density of 38 kA/cm2. The coils are bath cooled. A passive valving system prevents loss of liquid during rapid acceleration and deceleration. Boil-off gas cools an aluminum thermal shield and the current leads. In this paper we present the most recent magnet design, static and flight test results.

Molecular dynamics (MD) simulations are used to investigate the properties of empty and methane- and carbon-monoxide-containing hydrates. Intermolecular interactions are described by force fields including a combination of anharmonic bond potentials and accurate molecular electrostatics based on distributed multipoles. It is found that structural and spectroscopic properties and small differences between the systems can be correctly described with such an approach. In particular, spectra in the acoustic region (low-frequency lattice modes) delicately depend on the electrostatic interactions between the molecules for clathrates with different guests. Analysis of the radial distribution functions demonstrates that the short-range order is dominated by steric effects, whereas the long-range order is more sensitive to electrostatic interactions. Predictions are made for the acoustic modes of CO-containing clathrates and for the structural differences in the hydrogen radial distribution function between the CO...

We have studied the recent Italian guidelines on the management of Pilonidal Sinus Disease (PSD) published in Techniques in Coloproctology [1] with interest. Guidelines serve multiple purposes but predominantly aim to reduce inappropriate variation in practice. Achieving a balance between empirical evidence, interpretation of research and individual biases/preferences can be difficult but is crucial. The guidelines are, in part, provocative. Despite the authors’ certainty, it is still not known whether PSD arises due to lose hair penetrating the skin via a preformed sinus or by creating a new sinus [2]. Segre et al. state PSD incidence in Norway in 1995 was 26/100.000, but what is it in Italy today? In Germany, the incidence has increased between 2000 and 2012 from 51/100.000 to 94/100.000 [3]. While undisputedly the peak age at time of surgery is around 20 years, onset of symptoms over the age of 30 is not rare—this age group represents around 36 % of all new PSD (Fig. 1). To clarify, Buie coined the term ‘‘Jeep disease’’ in 1944 and Hardaway ‘‘Jeep rider’s disease’’ in 1958. Importantly, Favre et al. [4] recalculated Buie’s large numbers and concluded the incidence of PSD is not increased within military driving personnel, but this has gone mostly unnoticed. One needs to remain mindful that military personnel are predominantly young males who happen to be at highest risk of developing PSD. While many aspects of PSD remain to be elucidated, the guidelines could have addressed what converts asymptomatic PSD to symptomatic; why familial PSD behaves differently to sporadic (earlier onset and higher recurrence) as well as the role of personal hygiene. The extremes of age are more likely to have natal cleft contamination but are the least likely to develop PSD [3]— the time has truly come to stop insulting the patient! The guidelines recommend shaving as a ‘‘standard component of post-operative treatment in order to prevent recurrence’’ ignoring data suggesting a higher recurrence rate with shaving [5]. Literature detailing outcomes of PSD treatment with phenol is sparse and clouded by low numbers and short follow-up. It is not clear where phenol fits into the PSD management algorithm. Do the authors suggest phenol treatment be the first line for all symptomatic patients with chronic PSD? Little emphasis was placed on the observation that recurrence rate after (surgical) treatment of PSD is a function of time: 30 % of recurrences occur more than 4 years post-operatively. There is no debate that currently, paramedian closure techniques have the lowest recurrence rate and midline closure the highest. By stating ‘‘no clear & D. Doll ddoll@gmx.de; dolld@gmx.de

Spatial averaging Monte Carlo (SA-MC) is an efficient algorithm dedicated to the study of rare-event problems. At the heart of this method is the realization that from the equilibrium density a related, modified probability density can be constructed through a suitable transformation. This new density is more highly connected than the original density, which increases the probability for transitions between neighboring states, which in turn speeds up the sampling. The first successful investigations included the diffusion of small molecules in condensed phase environments and characterization of the metastable states of the migration of the CO ligand in myoglobin. In the present work, a general and robust implementation including rotational and torsional moves in the CHARMM molecular modeling software is introduced. Also, a procedure to estimate unbiased properties is proposed in order to compute thermodynamic observables. These procedures are suitable to study a range of topical systems including Lennard-Jones clusters of different sizes and the blocked alanine dipeptide (Ala)(2) in implicit and explicit solvent. In all cases, SA-MC is found to outperform standard Metropolis simulations in sampling configurational space at little extra computational expense. The results for (Ala)(2) in explicit solvent are in good agreement with previous umbrella sampling simulations.

The shortage of organ donors along with the increased number of waiting recipients have created the need for new strategies to expand the organ pool from donations after brain death. Organ procurement from brain-dead deceased donors is a complex task. Multiple, complicated operations are performed simultaneously. Very often, this involves numerous physicians and transplant coordinators. An extensive coordination between the thoracic and abdominal surgical teams is crucial for the successful procurement of all suitable organs. The quality of donor organs and the successful recovery therefore depends on a good communication. Organ procurement for transplantation should generally be performed in a calm and dignified atmosphere. The last wishes of the organ donor itself or the relatives must be respected unconditionally. In general, a dignified and respectful treatment of the organ donor is a condition sine qua non for each person involved in the process of organ procurement. The purpose of this article was to focus on the surgical aspects of organ donation after brain death. The proposed recommendations, in cases where they are applicable, are acceptable, however, one should never forget the importance of the ethical side of the issue with respect to the doctor-donating side relationship.

Field trials were conducted to evaluate the season long population dynamics and location (in leaf or on leaf surface) of an antibiotic resistant strain of the bacteriumPseudomonas syringaepv.tagetis(PST) applied to Canada thistle leaves. An application preceding 2 to 3 d of hot dry weather was compared to an application preceding 2 to 3 d of cool wet weather. Leaf samples were taken weekly to assess the population of PST found inside the leaves and on the leaf surface. While PST populations initially differed, populations were similar for both treatments one week after application. While this suggests that environment did not have a major impact, weather conditions for testing this hypothesis were not ideal. Over the first 35 d of the experiment, little rainfall was observed. PST populations were low and stable. However, rain events over the 40 d that followed resulted in great oscillations in mean PST populations and in some cases significant population increases. During dry periods, internal and total PST populations differed significantly, suggesting the external populations played a major part in population composition. However, the two sampling periods that closely followed three consecutive days of rainfall indicated internal populations were not significantly different from the total, suggesting that internal populations played the primary role in population composition. The results of this research provide evidence that rain events lead to overall PST population increases and to greater proportions of PST inside Canada thistle leaves, suggesting that it is better to apply PST during wet periods than dry.