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BACKGROUND: Edema and subjective leg complaints (e.g. pain, heaviness) after long standing or sitting, are defined as orthostatic leg complaints or occupational edema. Compression hosiery should help to prevent or decrease those symptoms. OBJECTIVE: Assess the effects on leg discomforts and leg volume and wearing comfort in two medical below-knee compression stocking types (A vs. B) with an interface pressure of 18 –20 mmHg and a below-knee-low-pressure support stocking (LPSS) with an interface pressure of 8–10mmHg (C). METHODS: Two different types of below-knee medical compression stockings and a LPSS were examined in this randomized, blinded, crossover trial in volunteers having leg discomforts and edema after being in an upright position during the day. Participants were divided into two cohorts, and each type of stocking was worn for three consecutive days in one week with a subsequent washout phase. The assessment of effects and wearing comfort was ascertained by questionnaires. Volume changes in the lower leg were measured with the Bodytronic 600® (Bauerfeind AG, Zeulenroda, Germany). RESULTS: A significant reduction of lower leg volume (mean stocking A: 204.7 ml; mean stocking B: 153.5 ml; mean stocking C: 48.2 ml) and a significant reduction of the life-quality dimension leg-complaints (p

Summary: Background: Leg discomfort is common in the general population. Volume increase and discomfort in the lower legs especially occur in occupations with long standing or sitting periods and less movement. Are both related to each other? Patients and methods: A time-controlled standing period of 15 min was performed in this nonrandomized controlled study to investigate the change and temporal relationship of volume increase and the occurrence of lower leg discomfort. Sensations of discomfort and the urge to move were queried using a numerical rating scale from 0 to 10 (NRS). Correlation analysis was conducted between the lower leg volume and the data regarding the discomfort and urge to move in each subject. Further, linear mixed effect models were performed to detect a causal relationship between the lower leg volume and the sensations of discomfort/urge to move in the standing period. Results: Lower leg volume increased by an average of 63 ml (p

BACKGROUND: Edema caused by orthostasis is a common clinical picture in the medical and occupational context. Medical compression therapy with compression stockings (CS) is considered a conservative therapeutic standard in edema therapy. The effect of CS on leg discomfort and the increase of the lower leg volume during a standing load still remains questionable. In addition, it is not entirely known whether there is a correlation between volume increase and discomfort in these individuals. METHOD: A timed, controlled standing load of 15 min was conducted by the participants in this non-randomized controlled study to analyze the change in and correlation between lower leg volume increase and the occurrence of lower leg discomfort under compression therapy. Below-knee CS with an interface pressure of 23–32 mmHg were used. The lower leg volume was measured following previous studies using an optical three-dimensional volume (ml) measurement system, and sensations of discomfort and the urge to move were asked about using a numerical rating scale (NRS) of 0–10. The subjects conducted a leg movement for 15 s immediately after the standing period; the data were collected again subsequently. A correlation was calculated between the lower leg volume and the data regarding the discomfort and urge to move for each participant. The experiments had already been performed as part of a previous study including the same subjects who did not wear CS. The results of the study conducted here were compared with those of the participants who did not wear CS to investigate the effect of the CS. RESULTS: Lower leg volume increased by an average of 27 ml (p

ZusammenfassungIn der vorliegenden Studie wurde die Prävalenz der Besiedlung mit multiresistenten Keimen an 155 Patienten aus der onkologischen und 157 Patienten aus der kardiologischen Rehabilitation mittels mikrobiologischen Screenings untersucht. Dabei zeigten 4,5% der onkologischen und 4,5% der kardiologischen Rehabilitationspatienten eine Besiedlung mit multiresistenten Erregern. Am häufigsten wurden 2-MRGN und ESBL (2,9%) nachgewiesen. Onkologische Rehapatienten zeigten doppelt so hohe Prävalenzraten für 3-MRGN im Vergleich zu kardiologischen (2,6 und 1,3%). Insgesamt zeigen onkologische und kardiologische Rehabilitationspatienten vergleichsweise niedrige Prävalenzraten für multiresistente Krankenhauskeime.

Background The therapeutic effectiveness of compression therapy depends on the selection of compression hosiery. Objectives To assess efficacy and tolerability of graduated elastic compression stockings (GECS) and inverse graduated elastic compression stockings (PECS). Methods Thirty-two healthy volunteers and thirty-two patients with chronic venous insufficiency were analysed; wear period: one week for each stocking type (randomised, blinded). Primary outcome: volume reduction of ‘Lower leg’ (Image3D®) and ‘Distal leg and foot’ (water plethysmography). Secondary outcomes: clinical symptoms of chronic venous insufficiency assessed by the Venous Clinical Severity Score, side effects and wear comfort in both groups. Results Volume of ‘Lower leg’: significant reduction in healthy volunteers (mean GECS: −37.5 mL, mean PECS: −37.2 mL) and in patients (mean GECS: −55.6 mL, mean PECS: −41.6 mL). Volume of ‘Distal lower leg and foot’: significant reduction in healthy volunteers (mean GECS: −27 mL, mean PECS: −16.7 mL), significant reduction in patients by GECS (mean: −43.4 mL), but non-significant reduction by PECS (mean: −22.6 mL). Clinical symptoms of chronic venous insufficiency were improved significantly better with GECS than with PECS, p Conclusion GECS and PECS reduce volume of the segment ‘Lower leg’ in patients and healthy volunteers. Patients’ volume of the ‘Distal lower leg and foot’, however, were diminished significantly only by GECS ( p = 0.0001). Patients’ complaints were improved by both GECS and PECS, and GECS were superior to PECS.

Summary: Background: Because of side effects like skin dryness and consecutive symptoms like itching the therapy of chronic venous insufficiency (CVI) with medical compression stockings (MCS) can lead to a diminished wear comfort and restricted compliance. Compression stockings with integrated skin care may have a positive influence on the skin hydration and moreover a positive effect on patients compliance. Patients and methods: In this monocentric, randomized prospective, controlled trial a below knee conventional MCS was compared to a medical compression stocking with integrated skin care (MCS-SC), interface pressure range 23–32 mmHg. Participants: 50 patients with CVI. Primary outcome: skin hydration. Secondary outcomes: transepidermal water loss, skin roughness, leg volume, interface pressure and questionnaires about quality of life and wear comfort. Results: In patients wearing MCS the skin moisture decreased (p = 0.021) and the skin roughness increased significantly (p = 0.001), whereas in patients wearing the MCS-SC skin moisture and skin roughness changed only slightly (n.s.). These protective effects of MCS-SC compared to MCS were most common in patients with CVI at stage 3 (p = 0.046), in male patients (p = 0.013) and patients with initial dry skin (p = 0.034). Both MCS reduced lower leg volume, MCS by 80 ml (p

Staphylococcus aureus may be the most important wound pathogen and causative for most of surgical site infections. As many anti-staphylococcal drugs are useless because of resistance, novel antimicrobial strategies are strongly needed and may be provided by cold atmospheric plasma (CP), which is being currently investigated for antiseptic efficacy. To test the antimicrobial properties of CP against Staphylococcus aureus, 168 methicillin-susceptible isolates (MSSA) and 50 methicillin-resistant isolates (MRSA) were treated with two technically different plasma sources [an atmospheric pressure plasma jet (APPJ) and a dielectric barrier discharge plasma (DBD)] in vitro. CP treatment allowed a reproducible and significant growth reduction of MRSA and MSSA. However, MRSA was significantly less susceptible to treatment with DBD than was MSSA, while no difference between MRSA and MSSA was found using APPJ. As the initial physical antiseptic on skin, CP may be suitable for rapid decolonization of microbial pathogens in vivo. Each device must undergo validated efficacy testing prior to clinical application, as device related differences may occur.

We investigated the prevalence of multidrug resistant pathogens in patients of oncologic and cardiologic rehabilitation units with 155 oncologic and 157 cardiologic patients undergoing microbiologic screening. It was found that 4.5% of oncologic as well as cardiologic patients were colonized with multidrug resistant pathogens. 2-MRGN and ESBL were the most encountered species (2.9%). 3-MRGN were found twice as frequent in oncologic patients (2.6 and 1.3%). Overall oncologic and cardiologic patients exhibit comparatively low prevalence rates for multidrug resistant pathogens.In der vorliegenden Studie wurde die Prävalenz der Besiedlung mit multiresistenten Keimen an 155 Patienten aus der onkologischen und 157 Patienten aus der kardiologischen Rehabilitation mittels mikrobiologischen Screenings untersucht. Dabei zeigten 4,5% der onkologischen und 4,5% der kardiologischen Rehabilitationspatienten eine Besiedlung mit multiresistenten Erregern. Am häufigsten wurden 2-MRGN und ESBL (2,9%) nachgewiesen. Onkologische Rehapatienten zeigten doppelt so hohe Prävalenzraten für 3-MRGN im Vergleich zu kardiologischen (2,6 und 1,3%). Insgesamt zeigen onkologische und kardiologische Rehabilitationspatienten vergleichsweise niedrige Prävalenzraten für multiresistente Krankenhauskeime.

Summary Background and objectives Detection of methicillin-resistant Staphylococcus aureus (MRSA) carriage requires well-defined risk factors (RFs). Except for “chronic wounds”, RFs are mostly specified in national recommendations. To avoid ineffective and expensive screening, we divided the entity “wounds” into different categories and calculated further RFs in dermatologic patients. Patients and Methods After a surveillance period with general MRSA screening, we correlated MRSA results with wound categories and dermatologically relevant diagnoses. We analyzed the screening efficacy by adding potential new RFs. Results Ulcers (pressure, arterial, combined pressure/arterial ulcers, ulcers otherwise unclassified), type 2 diabetes mellitus (DM), and atopic dermatitis (AD) were significantly associated with MRSA carriage. Tumors (subgroup basal and squamous cell carcinoma) were also significantly associated with MRSA carriage but had a protective odds ratio. Differentiation of wound types did not provide added benefit. In all MRSA-positive patients with chronic wounds, other RKI-listed RFs or type 2 DM were found. Screening sensitivity was increased combining classic RFs (except wounds) with type 2 DM and AD. Conclusions In dermatologic patients, AD and type 2 DM were identified as new RFs. Distinct wound types were also found to be significant RFs, but differentiated screening offers no benefit. When screening patients according to national recommendations, excluding wounds but including type 2 DM and AD, there is no loss of sensitivity.

Background. Today, highly sophisticated devices deliver cold atmospheric pressure plasma (CAPP) with a multitude of bioactive properties, opening the window to a new medical field: plasma medicine. Different techniques to create the optimal plasma device for different medical indications are currently being explored. However, even a 100 years ago, CAPP was briefly used in the related form of high-frequency therapy. The objective of our study was to compare historic with modern techniques regarding antimicrobial efficacy. Methods. First, 26 different clinical isolates of relevant wound pathogens were treated in vitro with a historic violet wand (VW) and 2 modern plasma sources (kINPen 09 and dielectric barrier discharge [DBD]) and the obtained inhibition areas (IAs) were compared. Second, a biofilm model was used to compare biofilm inactivation by VW, DBD, ethanol, and polyhexanide treatment. Results. DBD with the largest electrode produced the largest IAs. VW showed results similar to 2 different modes of the kINPen 09. IAs of VW were enlargeable by attaching a larger electrode. Against biofilms, VW was less effective than DBD but more effective than ethanol 70% and polyhexanide. Conclusion. The proven antimicrobial efficacy of VW may encourage the development of new, potent plasma devices based on the very simple and inexpensive technique of the historic high-frequency apparatus.

The purpose of the study was to investigate the clinical efficacy of repetitive IgE immunoadsorption (IA) cycles in severe atopic dermatitis (AD) with high serum IgE levels. A total of seven patients with severe AD with a history of no significant or longterm Scoring Atopic Dermatitis (SCORAD) reduction and total serum IgE levels >700 IU/mL were enrolled. The patients received one to five series of IA (Ig-Therasorb adsorber columns; Miltenyi Biotec, Teterow, Germany) each consisting of five consecutive treatments which were performed on a monthly regimen. Overall, one patient received one, two patients two, one patient three, two patients four and one patient five cycles of IA. IA was well tolerated in all the studied AD patients and led to a significant decrease of SCORAD and IgE levels during each IA cycle in all the patients. The relative decrease of SCORAD and serum IgE levels after treatment was 11.1% and 80%, respectively, after five immunoadsorption series, 24.1% and 83.6%, respectively, after four series, 37.6% and 75.9%, respectively, after three series, 27.9% and 74.2%, respectively, after two series, and 25.1% and 74.8% after the 1st IA cycle. One of the patients exhibited a long lasting clinical benefit over more than 12 months after the 5th IA cycle. Repetitive IA with more than two cycles at intervals of 4 weeks induces a profound and persisting IgE reduction which is remarkable clinical efficacy improving SCORAD in severe AD with high serum IgE levels.

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Objectives: To assess the clinical safety of a new short-stretch 2-layer compression system (3Mtm Cobantm 2 Lite) in patients with peripheral arterial occlusive disease (PAOD). This system combines a low resting pressure with a high working pressure. Methods: A pilot study was performed in 15 subjects with moderate PAOD, i.e. an ABPI of 0.5-0.8. Co-existing chronic venous insufficiency or leg ulcer was not mandatory. All subjects received the compression system which was reapplied at each study visit (days 1, 2, 3, 4, 7, 10, 14). The safety parameters were: sub-bandage pressure immediately after application, pressure-related skin damage, hypoxia-related pain, and adverse events. A product comfort questionnaire was completed at the last visit. Results: The average sub-bandage pressure of 30 mmHg defined by the protocol was achieved. No pressure-related skin damage or hypoxia-related pain was found. The reported adverse device effects were as expected for compression therapies, including dry skin and pruritus. The product comfort questionnaire completed by the subjects showed a good tolerability profile. Conclusion: The short-stretch 2-layer compression system (3Mtm Cobantm 2 Lite) was safe and well tolerated in subjects with moderate PAOD.

The study was undertaken to compare antitumor efficacy of electrochemotherapy (ECT) with cold plasma therapy (CP) in a melanoma mouse model. After melanoma implantation into the flank of C57BL/6N mice, CP by two different plasma sources (APPJ and DBD) was applied directly to the tumor surface. ECT was performed with bleomycin intravenously at a field strength of 1000 V/cm without or combined with CP. Primary endpoints were tumor growth acceleration (TGA), daily volume progression (DVP) and survival after treatment. Both plasma sources as single treatment showed a significant TGA delay, which proved less effective than ECT. CP (APPJ) combined with ECT (ECJ) significantly improved per cent mouse survival, with significant superiority compared with ECT. Plasma therapy alone albeit less effective seems a potential alternative to ECT in patients with melanoma and can be applied manifold in a session without general anaesthesia. Accordingly, CP alone and combined with ECT may serve as new option in palliative skin melanoma therapy.

OBJECTIVE To investigate macro- and microperfusion during 14 days of treatment with a new 2-layer compression system (3M™ Coban™ 2 Lite), designed for patients with leg ulcer and concomitant peripheral arterial occlusive disease. METHODS A single-centre, open-label, prospective pilot study was performed with 15 subjects suffering from peripheral arterial occlusive disease with an ankle brachial pressure index (ABPI) of 0.5-0.8, who volunteered to have their 'study leg' bandaged with the new system. Coincident leg ulcer or chronic venous disease was not mandatory. All subjects received the new compression system, which stayed in place from 1 up to 4 days according to scheduled study visits. The system was reapplied by study personnel at each clinical visit (days 1, 2, 3, 4, 7, 10 and 14). The study participation stopped after 14 days. At each clinical visit safety assessments were performed: measurement of acral pulsation to capture macroperfusion; laser Doppler fluxmetry to capture microperfusion; clinical signs of pressure related skin damage, hypoxia-related pain and sub-bandage pressure measurement. In addition, the leg volume was measured and a comfort questionnaire was completed. RESULTS An average sub-bandage pressure in standing position of approximately 30 mmHg was measured at the B1 location immediately after bandage application. Laser Doppler fluxmetry demonstrated positive effects on microcirculation regarding vasomotion and respiratory reflux. No change of the cardiac signal appeared. For acrale pulsations a high intraindividual variability was found with no clear interference to the bandage application. No pressure-related skin damage or hypoxia-related pain was detected. CONCLUSION After application of the new compression system in subjects with moderate PAOD, laser Doppler fluxmetry indicated significant improvements of the microcirculation. High variability and lack of correlation to clinical symptoms was found for the acral pulsation. The new compression system revealed a high grade of tolerability and a good safety profile.

Summary Background To optimize preventive measures to control MRSA, we investigated retrospectively the suitability of a multiple site screening model and the optimal sampling technique to detect MRSA in a university-based phlebology and skin cancer center in Germany. Patients and Methods During 4.5 years samples of 3 712 inpatients in a dermatologic department were analyzed for MRSA by conventional microbiologic cultures and in parallel by PCR. Samples were taken from nares, wounds and skin lesions. Results MRSA was detected in 60 inpatients (1.6%). 268 of 7 269 (3.7%) samples at admission and during hospital stay were found positive n 96 (35.8%) of these were swabs of nares, 59 (22.0%) surveillance swabs, 53 (19.8%) wound swabs and 42 (15.7%) from other dermatologic lesions. Twenty-five of 60 patients (41.7%) were found positive only in the nares, 10 (16.7%) patients only in wounds and 4 (6.7%) patients only in lesions. 166 (61.9%) of all positive culture samples became positive 24 hours after cultivation, 86 (32.1%) after 48 hours, and 16 (6.0%) after 72 hours. Conclusions Highest sensitivity to detect MRSA can be reached by combining three swabs: nares, wounds and skin lesions (itriple-testi). Culture of screening specimens for 72 hours is recommended.

BACKGROUND Below knee two-component compression stockings (AD) have revealed as effective for compression treatment of venous leg ulcers. Upto groin, thigh length stocking (AG) may enhance clinical effects, however wear comfort of these stocking may be affected. OBJECTIVE venous haemodynamic in relation to the length of compression stockings. METHODS A two-component AD stocking (37 mmHg) and two thigh length stockings (AG 37, with an interface pressure of 37 mmHg; AG 45, with an interface pressure of 45 mmHg) were tested by 16 patients with CVI. Leg volume changes and venous ejection fraction and venous filling index were measured, whilst quality of life and wear comfort were surveyed by questionnaires. RESULTS Volume of both the lower limb and the thigh was reduced by AG stockings, whereas AD stockings reduced only the volume of the lower limb and increased thigh volume. Venous hemodynamic, ejection fraction and filling index were improved by AG and AD stockings, AG, however, was superior to AD. Quality of life and comfort of the stockings was assessed as good for AG 37 mmHg, AG 45 mmHg and AD 37 mmHg. CONCLUSIONS Thigh length two component stockings (AG) were shown to be superior to below knee stocking (AD) with regard to volume reduction and venous hemodynamic, yet wear comfort was not impaired. These results imply that healing of trophic skin changes e.g. ulcers will be faster when thigh length two component stocking will be worn.

Background Cold atmospheric plasma could constitute an alternative against multi-drug resistant pathogens. Susceptibility of enterococci to cold atmospheric plasma was investigated in vitro. Methods 39 clinical isolates of enterococci were grouped dependent on the most important resistance patterns and treated on agar using dielectric barrier discharge plasma. These included enterococci with combined vancomycin- and high-level gentamicin resistance, high-level resistance to gentamicin (HLGR) only, vancomycin resistance alone (VRE), and enterococci susceptible to both. Susceptibility to cold atmospheric plasma was evaluated based on the zones of inhibition and examined in terms of the enterococcal group and the “degree” of drug resistance. Results Cold atmospheric plasma treatment killed all groups. Comparison of VRE and HLGR strains with non-VRE and non-HLGR isolates concerning zones of inhibition revealed that enterococci with special resistance patterns (VRE and HLGR) showed significantly smaller zones of inhibition than the sensitive ones. The mean of all isolates, irrespective of belonging to groups, showed smaller zones of inhibition with increasing “degree” of drug resistance. Conclusions Cold atmospheric plasma treatment killed all isolates of enterococci, but its efficacy depended on the “degree” of drug resistance and on membership in special resistance groups with particular clinical-outbreak importance. However, a possible role of the different genetic lineages, which might be prone to acquiring more or less resistance phenotypes, may also play a role in this context. Electronic supplementary material The online version of this article (doi:10.1186/s13099-016-0122-4) contains supplementary material, which is available to authorized users.

Summary Background Over the past few years, plasma medicine has become an important field in medical science. Cold plasma has proven anti-inflammatory, antimicrobial and antineoplastic effects. Aim To test the decontamination power of two cold plasma sources [low-temperature atmospheric pressure plasma jet (APPJ) and dielectric barrier discharge plasma (DBD)] in vivo on human fingertips. Methods After 3, 15, 30, 60, 90, 120, 150, 180, 210 and 240 s of spot treatment with the APPJ and DBD, the log reduction factors (RFs) of physiological (PF) and artificially (AF) contaminated flora ( Staphylococcus epidermidis and Micrococcus luteus ) were calculated. The bacterial load was determined after counting. Tolerance (paresthesia, pain and heat) was measured using a numerical rating scale. Findings Both plasma devices led to a significant reduction in PF and AF. The maximum log reduction factors for PF were 1.3 for the DBD at 210 s and 0.8 for the APPJ at 60 s. For AF, the maximum log reduction factors were 1.7 for the DBD at 90 s and 1.4 for the APPJ at 120 s. Treatment with both devices was well tolerated. Conclusion Both the APPJ and DBD were highly effective in eradicating PF and AF from the fingertips of healthy volunteers. No plasma-resistant isolates were observed. Cold plasma appears to have potential for skin disinfection. For hand hygiene purposes, plasma exposure times would need to be reduced significantly by technical means.

Summary Background: Cold plasma, a new treatment principle in dermatology based on ionic discharge delivering reactive molecular species and UV-light, exhibits strong antimicrobial efficacy in vitro and in vivo. Before implementing plasma as new medical treatment tool, its safety must be proven, as well as assessing skin tolerance and patient acceptance. Patients and Methods: We investigated the plasma effects of three different plasma sources (pulsed, non-pulsed atmospheric pressure plasma jet (APPJ) and a dielectric barrier discharge (DBD)) on the transepidermal water loss (TEWL) and skin moisture after treating the fingertips of four healthy male volunteers. Results: TEWL values were reduced by pulsed APPJ and DBD by about 20% but increased after non-pulsed APPJ by 5–20%. TEWL values normalized 30 min after all forms of plasma treatment. Skin moisture was increased immediately and 30 min after treatment with pulsed APPJ but was not affected by non-pulsed APPJ and DBD. Conclusions: All plasma treatments were well-tolerated and did not damage the skin barrier nor cause skin dryness. Cold plasma fulfils basic recommendations for safe use on human skin and as future option may serve as the first physical skin antiseptic.

Plasma medicine has become an emerging field in medical sciences since cold plasma has demonstrated important antimicrobial properties. As microbial plasma susceptibility data yet are not available, the susceptibility of 194 wound isolates exhibiting multiple antibiotic resistance was tested in vitro to CP and correlated with inhibition zones. Inhibition zones increased in parallel with the number of antibiotic classes to which the tested strain exhibit resistance. CP exhibited strong antimicrobial efficacy against most important clinical skin and wound pathogens in vitro irrespective of multidrug resistance.

Plasma medicine has become an emerging field in medical sciences since cold plasma has demonstrated significant antibacterial properties in vitro and in vivo. However, systematic antimicrobial plasma testing against bacteria, fungi, and parasites is still lacking. Chronic wounds, fungal skin and nail infections, and colonization with multidrug-resistant pathogens like Staphylococcus aureus (MRSA) often pose significant therapeutic and economical problems and new therapeutic concepts are strongly warranted. The challenge of worldwide increasing resistance problems including different pathogens like methicillin-resistant MRSA, vancomycin-resistant enterococci, and gram-negative species producing betalactam hydrolysing enzymes (extended spectrum s-lactamases) constitute the need for alternative antimicrobial treatments. Cold plasma therapy with a completely different mode of action compared to conventional antimicrobials may offer an alternative to conventional external antibiotic and antiseptic therapies. In order to estimate the possible role as physical antiseptic, basic susceptibility data from plasma are needed. To provide such data, the plasma susceptibility of representative skin and wound pathogens against low-temperature atmospheric pressure plasma jet (APPJ device) and dielectric barrier discharge plasma treatment was tested in vitro on agar. The same plasma sources were used to test clinical fungal isolates in vitro and isolates of the parasite demodex folliculorum ex vivo. Plasma treatment proved to be highly effective in eradicating all treated strains and species including Escherichia coli, Pseudomonas aeruginosa, Klebsiella group (K. pneumoniae ssp. pneumoniae, K. oxytoca), Staphylococcus aureus, hemolysing Lancefield Streptococci (group A and B), Proteus group (P. mirabilis, P. vulgaris), Acinetobacter spp., Stenotrophomonas spp., Enterococcus faecalis, Candida albicans, and Staphylococcus epidermidis. Plasma irradiation of Trichophyton rubrum, Trichophyton interdigitale, Microsporon canis, and the yeast Candida albicans was able to kill >90% of the organisms during 30 s in vitro with no isolate exhibiting resistance. The APPJ-plasma killed Demodex folliculorum after exposure time of 2 s. Our data suggest plasma as a possible new option in the treatment of microbial, fungal, and parasitic dermal infections.

BACKGROUND Unprotected hydrodynamic debridement can produce aerosols, with the risk of cross-contamination and infection for patients and medical staff. OBJECTIVE To evaluate the hygienic safety and the role of aerosol prevention of a pulsatile debridement. METHODS & MATERIALS Bacterial emissions during debridement of chronic ulcer wounds of seven patients using the Debri-Jet hydrodynamic in different modifications were analyzed. RESULTS Only a special aerosol prevention system (vacuum sensor, flexible cuff applicator) was able to effectively avoid the emission of infection relevant pathogens. The emitted pathogenic spectrum reflects the wound colonization of the individual patient wound; the most mobilized and emitted species were Staphylococcus aureus and Pseudomonas aeruginosa. CONCLUSION Unprotected pulsatile debridement can produce highly relevant bacterial emissions. Equipped with an elaborate aerosol prevention technique, the Debri-Jet is a hygienically safe and effective debridement system and poses no more hygienic risks than conventional debridement. Because even conventional nonhydrodynamic debridement can produce cross-contamination, basic hygienic precautions, including the wearing of masks, gloves, and eye-shield, and performance of the procedure by trained staff must be used during debridement. This work was supported in part by financial support from Human Med Aktiengesellschaft, D-19061 Schwerin without any influence over the scientific results of the investigation. Human Med, Schwerin, loaned the Debri-Jet system.

We investigated in patients with chronic venous insufficiency (CVI) and after compression therapy the fluxmotion within characteristic frequency bands, which were described earlier by Bracic and Stefanovska (Bull. Math. Biol. 60 (1998), 919-935).Therefore, the frequency spectra of laser Doppler flux data of the 36 patient's legs were compared with 41 legs of healthy subjects. In addition, 14 patients with CVI wore a compression stocking (interface pressure: 25-32 mmHg) or compression bandages and were measured after 4 weeks therapy. Data were analyzed by means of a Wavelet packet transformation (a combination of the Daubechies filter of order 4 and the Haar filter).We found significant differences between the patients and the healthy subjects in the frequency intervals of myogenic 0.06-0.16 Hz, respiratory 0.16-0.6 Hz and heart activity 0.6-1.6 Hz (p

Standard of care in the therapy of chronic venous insufficiency (CVI) is the use of graduated elastic stockings (GECS). This paper is based on a prospective, mono-centric, open randomised, controlled and cross over study and discusses the hemodynamic effects of GECS and inverse graduated compression stockings (PECS) in 32 healthy volunteers and 32 patients with CVI and the consecutive impact on comfort. The application of stockings was performed sequentially, the allocation of the first stocking was randomized and double blind, wearing period for each stocking type about 7 days with one week of break between wearing periods. Measurements of the interface pressure were carried out by Picopress®(Microlab Elettronica, Italy) and the venous drainage were registered by strain gauge plethysmography. Mean interface pressure: GECS (level B1): 27.3 mmHg; GECS (level C): 19,6 mmHg; PECS (level B1): 17,8 mmHg; PECS (level C): 24,7 mmHg. Significant increase of EF and decrease of VFI by wearing both types of compression stockings, comparatively GESC resulted in a significantly greater improvement of EF than the PECS. PECS were significantly easier to don and put on compared to the GECS, the PECS tended to slip towards the foot more often.

Detection of methicillin-resistant Staphylococcus aureus (MRSA) carriage requires well-defined risk factors (RFs). Except for "chronic wounds", RFs are mostly specified in national recommendations. To avoid ineffective and expensive screening, we divided the entity "wounds" into different categories and calculated further RFs in dermatologic patients.After a surveillance period with general MRSA screening, we correlated MRSA results with wound categories and dermatologically relevant diagnoses. We analyzed the screening efficacy by adding potential new RFs.Ulcers (pressure, arterial, combined pressure/arterial ulcers, ulcers otherwise unclassified), type 2 diabetes mellitus (DM), and atopic dermatitis (AD) were significantly associated with MRSA carriage. Tumors (subgroup basal and squamous cell carcinoma) were also significantly associated with MRSA carriage but had a protective odds ratio. Differentiation of wound types did not provide added benefit. In all MRSA-positive patients with chronic wounds, other RKI-listed RFs or type 2 DM were found. Screening sensitivity was increased combining classic RFs (except wounds) with type 2 DM and AD.In dermatologic patients, AD and type 2 DM were identified as new RFs. Distinct wound types were also found to be significant RFs, but differentiated screening offers no benefit. When screening patients according to national recommendations, excluding wounds but including type 2 DM and AD, there is no loss of sensitivity.

Summary Objective Intraoperative bacterial contamination is a risk factor for surgical site infections (SSIs). This prospective, randomized, blinded, controlled trial (Reg. No. BB08/12) investigated the effect of a cyanoacrylate-based skin sealant (InteguSeal) on intraoperative wound contamination during trauma surgery. Methods A total of 128 patients undergoing trauma surgery were assigned randomly to an intervention ( n =62) or a control group ( n =66). Surgical sites were investigated at three locations: maximum incision depth (base), wound margin prior to wound closure (margin), and the surgical sutures (suture). Colony-forming units (CFU) were counted after 48h of incubation. Results Overall, significantly lower CFU counts were obtained for samples from the intervention group at all three sample sites compared to the control group. The difference, however, was only significant for the suture site ( p =0.040). Conclusions Preoperative sealing reduced microbial contamination on sutures during surgery, while the overall wound contamination remained unchanged. Hence, prevention of the clinically more relevant deep SSIs may not be expected. However, this study was not designed to detect differences in the rate of SSI. The role of the reduction in suture contamination with regard to the prevention of SSI remains to be evaluated.

Objectives: To assess the clinical safety of a new short-stretch 2-layer compression system (3M

The purpose of the study was to investigate the clinical efficacy of repetitive IgE immunoadsorption (IA) cycles in severe atopic dermatitis (AD) with high serum IgE levels. A total of seven patients with severe AD with a history of no significant or longterm Scoring Atopic Dermatitis (SCORAD) reduction and total serum IgE levels700 IU/mL were enrolled. The patients received one to five series of IA (Ig-Therasorb adsorber columns; Miltenyi Biotec, Teterow, Germany) each consisting of five consecutive treatments which were performed on a monthly regimen. Overall, one patient received one, two patients two, one patient three, two patients four and one patient five cycles of IA. IA was well tolerated in all the studied AD patients and led to a significant decrease of SCORAD and IgE levels during each IA cycle in all the patients. The relative decrease of SCORAD and serum IgE levels after treatment was 11.1% and 80%, respectively, after five immunoadsorption series, 24.1% and 83.6%, respectively, after four series, 37.6% and 75.9%, respectively, after three series, 27.9% and 74.2%, respectively, after two series, and 25.1% and 74.8% after the 1st IA cycle. One of the patients exhibited a long lasting clinical benefit over more than 12 months after the 5th IA cycle. Repetitive IA with more than two cycles at intervals of 4 weeks induces a profound and persisting IgE reduction which is remarkable clinical efficacy improving SCORAD in severe AD with high serum IgE levels.

Cold plasma, a new treatment principle in dermatology based on ionic discharge delivering reactive molecular species and UV-light, exhibits strong antimicrobial efficacy in vitro and in vivo. Before implementing plasma as new medical treatment tool, its safety must be proven, as well as assessing skin tolerance and patient acceptance.We investigated the plasma effects of three different plasma sources (pulsed, non-pulsed atmospheric pressure plasma jet (APPJ) and a dielectric barrier discharge (DBD)) on the transepidermal water loss (TEWL) and skin moisture after treating the fingertips of four healthy male volunteers.TEWL values were reduced by pulsed APPJ and DBD by about 20% but increased after non-pulsed APPJ by 5-20%. TEWL values normalized 30 min after all forms of plasma treatment. Skin moisture was increased immediately and 30 min after treatment with pulsed APPJ but was not affected by non-pulsed APPJ and DBD.All plasma treatments were well-tolerated and did not damage the skin barrier nor cause skin dryness. Cold plasma fulfils basic recommendations for safe use on human skin and as future option may serve as the first physical skin antiseptic.

In the present study we were interested, if apoptosis plays a role in the surrounding skin of venous ulcers, where microcirculatory disorders were already observed. For this purpose laser Doppler flow and partial oxygen pressure were measured in 17 patients at the ulcer edge, the transitional area of the lower leg and the thigh. Subsequently biopsies were taken from the respective sites and subjected to terminal deoxynucleotidyl transferase labelling (TUNEL) and immunohistochemistry using antibodies to determine the protein expression of Fas, Fas-L, Bax, Bcl-2, p53 and c-Myc. Laser Doppler flow was increased and transcutaneous oxygen partial pressure was decreased, with significant differences at the ulcer edge and the lower leg compared to the thigh. The skin biopsies did not show any differences when labelling for apoptotic cells. Keratinocytes of basal and spinous layer stained with antibodies against Fas, Fas-L and Bax in all probes of the three sites. c-Myc and p53 were negative in all keratinocytes of the skin probes. However, staining with Bcl-2 was significantly decreased at the ulcer edge in comparison to the lower leg and the thigh (p=0.017). Our study revealed that a disturbed microcirculation does not increase the number of apoptotic cells at the ulcer edge in patients with venous disease. The reduced staining pattern with Bcl-2 at the ulcer edge seems not to result in higher susceptibility to apoptosis, but it remains to be proven whether it is involved in epidermal acanthosis.

For a VITALI class of a metric space (X, d) a packing measure is introduced following the ideas of [7]. The Packing Theorem of VITALI is a powerful mean to derive density results for measures [1, 2, 3]. Conversely, the notion of packing measure allows us to give sufficient conditions for a measure that the packing theorem of VITALI hods.

Die Liste der wissenschaftlichen Veroffentlichungen von Felix Hausdorff ist relative kurz. Er verfaste nicht mehr als ein oder zwei Arbeiten im Jahr. Diese waren dafur von solider Qualitat. Seine fruhen Publikationen behandelten die verschiedensten Gebiete: Optik, Wahrscheinlichkeitsrechnung, Geometrie und Analysis. Hausdorffs Buch uber Mengenlehre [39] hat eine Epoche der Mathematik gepragt, und nahezujeder seiner spaten Artikel ist bis in die heutige Zeit hinein wirksam geblieben, hat neue Entwicklungen angeregt und eine Vielzahl von Nachfolgearbeiten initiiert.

A result of J. Mycielski says that on every metric space (X, ϱ) with a non-empty compact thick set C ⫅ X there exists a regular open-invariant Borel measure μ with μ(C) = 1. μ is called open-invariant if μ(A) = μ(B) for open isometric sets A, B ⫅ X. We relate this result to the notion of a Hewitt-Stromberg measure and give a new independent existence proof for such an open-invariant measure μ on a compact metric space (X, ϱ). This proof works by induction, the well-known metric outer measure construction of Caratheodory-Hausdorff and a new property of the covering number N(X, q) of X.

Measures on the hyperspace of the closed sets with the FLACHSMEYER-FELL topology are completely defined by their capacities. A necessary and sufficient condition is given for the weak convergence of a sequence of positive bounded σ-additive measures on the hyperspace in terms of their capacities.

Let τ be a monotone premeasure on a certain paving ϱ of a metric space (X, d) which is supadditive for metrically separated sets of ϱ. The outer measure μI of type I as defined in Rogers book [5] by τ is a metric outer measure and agrees with the metric outer measure μII of [5].

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