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Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der Schleimhäute von Nase und Nasennebenhöhlen. Eine eosinophile Entzündung wird als häufiger Endotyp beschrieben. Der Anti-IL-5-Antikörper Mepolizumab ist seit November 2021 als Zusatztherapie zu intranasalen Glukokortikosteroiden für die Behandlung Erwachsener mit schwerer chronischer Rhinosinusitis mit Nasenpolypen zugelassen, wenn systemische Glukokortikosteroide oder eine Operation keine ausreichende Krankheitskontrolle bewirken. Während nationale und internationale Empfehlungen für den Einsatz von Mepolizumab bei CRSwNP existieren, ist bislang nicht hinreichend festgelegt worden, wie diese Therapie überwacht wird, welche Folgedokumentation notwendig ist und wann sie ggf. beendet werden sollte. Methoden In einer Literatursuche wurden die bisherigen Daten zur Behandlung der CRSwNP mit Mepolizumab analysiert und die vorhandene Evidenz durch Recherchen in MEDLINE, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library ermittelt. Es wurden Humanstudien berücksichtigt, die im Zeitraum bis einschließlich 10/2022 publiziert wurden. Ergebnis Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen und eventuelle Therapiepausen sowie eine Beendigung der Therapie bei Anwendung von Mepolizumab für die Indikation CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue, nichtoperative Therapieansätze mit Biologika für Patient*innen mit schweren, unkontrollierten Verlaufsformen. Hier geben wir Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen, eventuelle Therapiepausen oder eine Beendigung der Therapie bei einer Mepolizumab-Behandlung als Zusatztherapie mit intranasalen Glukokortikosteroiden zur Behandlung von erwachsenen Patient*innen mit schwerer CRSwNP, die mit systemischen Glukokortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden kann.

Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der Schleimhäute von Nase und Nasennebenhöhlen. Eine Typ-2-Inflammation als immunologischer Mechanismus wird als häufigster Endotyp beschrieben. Der Anti-IL-4-/-IL-13-Antikörper Dupilumab ist seit Oktober 2019 als Zusatztherapie zu intranasalen Glukokortikosteroiden für die Behandlung Erwachsener mit schwerer chronischer Rhinosinusitis mit Nasenpolypen zugelassen, wenn systemische Glukokortikosteroide oder eine Operation keine ausreichende Krankheitskontrolle bewirken. Während nationale und internationale Empfehlungen für den Einsatz von Dupilumab bei CRSwNP existieren, ist bislang nicht hinreichend festgelegt worden, wie diese Therapie überwacht und wann sie ggf. beendet werden sollte. Methoden In einer Literatursuche wurden die bisherigen Daten zur Behandlung der CRSwNP mit Dupilumab analysiert und die vorhandene Evidenz durch Recherchen in MEDLINE, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library ermittelt. Es wurden Humanstudien berücksichtigt, die im Zeitraum bis einschließlich 05/2022 publiziert wurden. Ergebnis Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen und eventuelle Therapiepausen sowie eine Beendigung der Therapie bei Anwendung von Dupilumab für die Indikation CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue nichtoperative Therapieansätze mit Biologika für Patienten mit schweren, unkontrollierten Verlaufsformen. Wir geben hier Empfehlungen für die Verlaufskontrolle, das Einhalten von Therapieintervallen, eventuelle Therapiepausen oder eine Beendigung der Therapie bei einer Dupilumab-Behandlung als Zusatztherapie mit intranasalen Glukokortikosteroiden zur Behandlung von erwachsenen Patienten mit schwerer CRSwNP, die mit systemischen Glukokortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden können.

Zusammenfassung Hintergrund Die chronische Rhinosinusitis mit Nasenpolypen (CRSwNP) ist eine multifaktorielle entzündliche Erkrankung der paranasalen Schleimhäute, der als häufigstem Endotyp eine eosinophile Inflammation zugrunde liegt. Der Anti-IL-5-Antikörper Mepolizumab wurde im November 2021 für die Therapie der schweren CRSwNP zugelassen. Methoden In einer Literatursuche wurde die Immunologie der CRSwNP analysiert und die vorhandene Evidenz ermittelt durch Recherchen in Medline, PubMed sowie den nationalen und internationalen Studien- und Leitlinien-Registern und der Cochrane Library. Es wurden Humanstudien berücksichtigt, die bis einschließlich 12/2021 publiziert wurden und in denen die Wirkung von Mepolizumab bei CRSwNP untersucht wurde. Ergebnis Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Anwendung von Mepolizumab bei CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerungen Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue nichtoperative Therapieansätze mit Biologika für Patienten mit schweren Verlaufsformen. Mepolizumab ist seit November 2021 zugelassen zur Zusatztherapie mit intranasalen Kortikosteroiden zur Behandlung von erwachsenen Patienten mit schwerer CRSwNP, die mit systemischen Kortikosteroiden und/oder chirurgischem Eingriff nicht ausreichend kontrolliert werden können.

Background: Chronic rhinosinusitis (CRS) is a heterogeneous and multifactorial inflammatory disease of the nasal and paranasal mucosa. To date, no internationally standardized uniform classification has been developed for this disease. Usually, a phenotype classification according to CRS with (CRSwNP) and without (CRSsNP) polyposis is performed. However, through a variety of studies, it has been shown that even within these phenotypes, different endotypes of CRS exist, each with a different underlying inflammatory pathophysiology. In this mini-review, we aim to outline the essential immunological processes in CRSwNP and to highlight the modern therapeutic options with biologics derived from this disease. Methods: Current knowledge on the immunological and molecular processes of CRS, especially CRSwNP, was compiled by means of a structured literature review. Medline, PubMed, national/international trial and guideline registries as well as the Cochrane Library were all searched. Results: Based on the current literature, the different immunological processes involved in CRS and nasal polyps were elaborated. Current studies on the therapy of eosinophilic diseases such as asthma and polyposis are presented and their results discussed. Conclusion: Understanding the immunological basis of CRSwNP may help to develop new personalized therapeutic approaches using biologics. Currently, 2 biologics (dupilumab, omalizumab) have been approved for the therapy of CRSwNP (polyposis nasi) in Europe.

Review of scientific instruments 93(5), 053903 (2022). doi:10.1063/5.0084480, The ability to visualize a sample undergoing a pressure-induced phase transition allows for the determination of kinetic parameters such as the nucleation and growth rates of the high-pressure phase. For samples that are opaque to visible light (such as metallic systems), it is necessary to rely on X-ray imaging methods for sample visualization. Here, we present an experimental platform developed at beamline P02.2 at the PETRA III synchrotron radiation source, which is capable of performing simultaneous X-ray imaging and diffraction of samples which are dynamically-compressed in piezo-driven diamond anvil cells (DACs). This set-up utilizes a partially-coherent monochromatic X-ray beam to perform lens-less phase contrast imaging (PCI), which can be carried out using either a parallel or focused-beam configuration. The capabilities of this platform are illustrated by experiments on dynamically-compressed Ga and Ar. Melting and solidification were identified based on the observation of solid/liquid phase boundaries in the X-ray images and corresponding changes in the X-ray diffraction patterns collected during the transition, with significant edge enhancement observed in the X-ray images collected using the focused-beam. These results highlight the suitability of this technique for a variety of purposes including melt curve determination., Published by American Institute of Physics, [S.l.]

Zusammenfassung Hintergrund Die chronische Rhinosinusitis (CRS) betrifft weltweit ca. 5–12 % der Allgemeinbevölkerung und wird traditionell eingeteilt in einen Phänotyp ohne (CRSsNP) und einen mit Ausbildung von Nasenpolypen (CRSwNP). Wurden Nasenpolypen bis vor kurzem eher als mechanisches Hindernis mit der Notwendigkeit einer operativen Beseitigung betrachtet, wird die CRSwNP heute als eine multifaktorielle entzündliche Erkrankung der nasalen und paranasalen Schleimhäute angesehen, der als Endotyp häufig eine T2-Inflammation zugrunde liegt. Biologika, die mit diesen Entzündungsmechanismen interferieren, stellen interessante neue Therapiemöglichkeiten dar. Methoden Das aktuelle Wissen zur Immunologie der CRSwNP und Wirkung von Biologika wurde mittels einer Literaturanalyse durch Recherchen in Medline, PubMed sowie den nationalen und internationalen Studien- und Leitlinienregistern und der Cochrane Library zusammengestellt. Ergebnisse Basierend auf der internationalen Literatur und bisherigen Erfahrungen werden von einem Expertengremium Empfehlungen für die Anwendung von Biologika bei CRSwNP im deutschen Gesundheitssystem auf der Grundlage eines Dokumentationsbogens gegeben. Schlussfolgerung Das Verständnis über die immunologischen Grundlagen der CRSwNP eröffnet neue nichtoperative Therapieansätze mit Biologika für Patienten mit schweren Verlaufsformen.

ZusammenfassungDurch transorale Lasermikrochirurgie wurden bei der Larynxkarzinomtherapie temporäre Tracheotomien reduziert, die Organerhaltraten erhöht und funktionelle Resultate verbessert. Goldstandard für die laserbasierte transorale Resektion eines Larynxkarzinoms ist der Einsatz des CO2-Laser, dabei sind onkologische Radikalität und postoperative Stimmfunktion individuell abzuwägen. Angiolytische Lasereffekte ermöglichen eine Beeinflussung des Tumormikromilieus durch zielgerichtete Gefäßobliteration und Blockierung der Angiogenese mit Schonung von schwingungsfähigem Gewebe für eine gute Stimmfunktion. Mit der Verabschiedung der S3-Leitlinie zur Diagnostik, Therapie und Nachsorge des Larynxkarzinoms wird eine nationale evidenzbasierte Standardisierung gefördert. International nimmt die Evidenz zur Kalium-Titanyl-Phosphat-Laser-Therapie laryngealer Schleimhautdysplasien und von T1a-Larynxkarzinomen zu. Auch bei juveniler Papillomatose und der Stützlaryngoskopie unter Narkose sowie für ausgewählte Patienten in Lokalanästhesie werden angiolytische Laser eingesetzt.

Cost efficiency and defect passivation are the two major challenges that thin-film solar cells have to overcome for economic competitiveness. For Cu(In,Ga)Se 2 solar cells, the first is addressed by an increase of the Ga/In ratio, which widens the bandgap favorably for tandem applications and reduces the requirement of costly, rare In. The second is addressed by heavy alkali post-deposition treatments. However, the maximum device efficiency is typically achieved with a comparably low Ga/In ratio, which is in contrast to the economic interest of a higher Ga/In ratio and makes it paramount to identify, understand and mitigate the sources of local underperformance in Ga-rich cells. In this work, we investigate a series of Cu(In,Ga)Se 2 cells with varying Ga/In concentration in the absorber, using multi-modal scanning x-ray microscopy. In particular, we analyze differences in chemical composition and electrical performance on the nanoscale, with a focus on the effect of Rb. We find that In-rich cells show, along with a greater overall performance, a more homogeneous distribution of the nanoscale performance compared to the Ga-rich cells. Our analysis on Rb suggests that this effect is due to a more effective passivation of structural defects in the absorbers, i.e. voids and grain boundaries. These results shine light on the causes of the superiority of Ga-poor/In-rich absorbers and substantiate the trend to higher defect density for Ga-rich absorbers.

Less than a year after the first detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), vaccines have been approved for routine use in numerous countries and have already been used in mass vaccination programs. Vaccines include the mRNA BNT162b2 and mRNA 1273. Allergic reactions and anaphylaxis account for a substantial proportion of the adverse reactions to these vaccines observed to date, but overall they are rare. The incidence of anaphylaxis in the context of SARS-CoV‑2 vaccination with the mRNA vaccines appears to be approximately 10-fold higher than with previous vaccines, at approximately 1 per 100,000 vaccine injections. One focus of the present article is a systematic review of the components of mRNA vaccines against " coronavirus disease 2019 " (COVID-19). Differences from established vaccines are addressed and the allergic potential of liposomes, polyethylene glycol, tromethamine/trometamol, and mRNA are discussed. Another focus is on the clinical presentation and course of allergic reactions to the COVID-19 vaccines. This is followed by a discussion of the therapeutic approach to anaphylactic reactions, as well as the drugs and medical supplies required to treat them. It is important to note that any vaccinee may be affected by anaphylaxis, regardless of whether or not allergic diseases are already known. Therefore, every vaccination site and every vaccinator must be prepared to recognize and treat severe allergic reactions.Weniger als ein Jahr nach der Entdeckung des „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2) wurden in zahlreichen Ländern Impfstoffe für den Routineeinsatz zugelassen und bereits in der Massenimpfung eingesetzt, darunter die mRNA-Impfstoffe BNT162b2 und mRNA-1273. Allergische Reaktionen und Anaphylaxien machen einen wesentlichen Teil der bislang beobachteten unerwünschten Reaktionen auf diese Impfstoffe aus, sind insgesamt aber selten. Die Inzidenz von Anaphylaxien im Kontext der SARS-CoV-2-Impfung mit den mRNA-Impfstoffen scheint mit ungefähr 1 auf 100.000 Impfinjektionen etwa zehnmal so hoch zu sein wie bei früheren Impfstoffen. Ein Schwerpunkt des vorliegenden Beitrags ist die systematische Betrachtung der Inhaltsstoffe von mRNA-Impfstoffen gegen die „coronavirus disease 2019“ (COVID-19). Dabei wird auf die Unterschiede zu etablierten Impfstoffen eingegangen und das allergische Potenzial von Liposomen, Polyethylenglykol, Tromethamin/Trometamol sowie mRNA diskutiert. Ein weiterer Fokus sind die klinische Präsentation und der Verlauf allergischer Reaktionen nach Applikation der COVID-19-Impfstoffe. Im Anschluss wird auf das therapeutische Vorgehen bei anaphylaktischer Reaktion und die dafür notwendigen Medikamente und medizinischen Materialien eingegangen. Zu beachten ist, dass eine Anaphylaxie jeden Geimpften treffen kann, unabhängig davon, ob bereits allergische Erkrankungen vorbekannt sind. Daher muss jede Impfstelle und jeder Impfarzt darauf vorbereitet sein, schwere allergische Reaktionen zu erkennen und zu behandeln.

Transoral laser microsurgery (TLM) for treatment of laryngeal cancer has reduced temporary tracheotomies, increased organ preservation rates, and improved functional results. Gold standard for laser-based transoral resection of laryngeal cancer is the application of CO

BACKGROUND The TNM (tumor, nodes, metastasis) classification is updated periodically according to the literature and international recommendations. With the 8th edition, notable changes have been developed especially with regard to oropharyngeal cancer. MATERIALS AND METHODS The modifications as well as the practicability of the classification for staging of oropharyngeal cancers are demonstrated on the basis of cases from the tumor database. RESULTS The latest edition of the TNM classification realizes requirements to differentiate between human papilloma virus (HPV) positive and HPV-negative tumors during staging. Furthermore, the prognostic relevance of extranodal extension of lymph node metastases was integrated into the classification. While downstaging is performed regarding N category and Union Internationale Contre le Cancer (UICC) stage in many p16-positive tumors, for p16-negative tumors, extranodal spread mostly leads to a notable upstaging. Due to limited specificity of the p16 immunostaining, the relevance of false positive results has to be underlined. Missing integration of smoking behavior, limited standardization of the extranodal extension examination technique, as well as high demands on the documentation quality should be kept in mind. CONCLUSION Clinical trials will have to show whether deescalation strategies regarding p16-positive carcinomas are supported by the changes made in the TNM staging system. A prospective multicenter study should examine the universal applicability, the appropriateness for all sublocations, as well as the prognostic significance of the current edition.

Chronic rhinosinusitis (CRS) is one of the most frequent chronic diseases. Among these patients the prevalence of immune defects is higher than in the healthy general population.A selective review of the literature was carried out in PubMed and Medline covering the period between 2008 and 2019. Additionally, recent German publications in journals not listed in the abovementioned databases were analyzed.The diagnostic workflow with respect to the immunodeficiency consists of a detailed anamnesis and physical examination, laboratory tests and the antibody reaction to polysaccharide vaccines and antigens. Beside antibiotic treatment, vaccinations and immunoglobulin replacement are available. Notwithstanding the above, functional endoscopic surgery of the paranasal sinuses should be performed according to guideline recommendations.Patients with CRS who do not sufficiently respond to conservative and surgical treatment should be checked for underlying immunodeficiencies.

The Anglo American Platinum Rustenburg Base Metals Refiners (RBMR) is the largest producer of nickel cathode in South Africa. It treats slow-cooled matte to recover a platinum group metal-containing magnetic fraction for downstream processing and a nonmagnetic fraction to produce nickel and copper cathode, cobalt sulphate, and sodium sulphate. The refinery was recently expanded from 21 to 33 kt/a nickel. During the ramp-up phase, the sulphur removal section was found to be a constraint to throughput. Nickel hydroxide is precipitated from nickel spent electrolyte by addition of sodium hydroxide, and filtration of the nickel precipitate allows sulphur to be removed from the circuit as aqueous sodium sulphate in the filtrate. The filtration fluxes were found to be limiting the circuit's capacity. An obvious solution would have been to install additional filtration capacity at significant capital cost and long lead times. RBMR chose rather to first initiate a collaborative project with Anglo American Technical Solutions to better understand the impact of process conditions on filtration characteristics and to evaluate whether the filtration flux could be increased by improving the quality of the nickel precipitate. A deeper understanding of nickel hydroxide precipitation chemistry and kinetics in the context of high nickel and sodium hydroxide concentrations was developed, guided by precipitation theory and confirmed by laboratory tests and plant observations. It was found that the filtration rate could be significantly improved by modifying the precipitate characteristics. A new precipitation process was engineered and retrofitted into the existing plant. Since start-up of the new precipitation system, the available capacity of the sulphur removal section has more than doubled, and control of the process has improved with the better agitation. This paper describes the theory and results used to design the new agitation system, as well as the impact of the change on capital investment, operability, and process efficiency.

Chronic rhinosinusitis (CRS) is a heterogeneous and multifactorial inflammation of the nasal and paranasal mucosa. Until now, no internationally standardized classification could be developed. In most cases, CRS is phenotypically classified according to chronic rhinosinusitis with (CRScNP) and without nasal polyps (CRSsNP). However, recent studies could show that there are numerous endotypes within these phenotypes based on different inflammatory mechanisms. This review describes the important immunological mechanisms of CRScNP and highlights modern treatment options with biologicals directly addressing particular immunological processes.Current knowledge on immunological and molecular processes of CRS, particularly CRScNP, was extracted from Medline, PubMed, national and international study- and guideline-registers, and the Cochrane library by a systematic review of the literature.Based on current literature, various immunological mechanisms for CRS and CRScNP could be identified. Relevant studies for the treatment of eosinophilic conditions such as asthma or CRScNP are presented and, if available, results of these studies are discussed.The growing insight into the underlying immunological mechanisms of CRScNP could pave the way for new personalized treatment options such as biologicals in the future.

In the course of restoration of the middle ear, routine histological examinations are initiated in many cases, although a middle ear cholesteatoma can be clinically diagnosed in a normal case.To determine the correlation between the surgeons' diagnosis and that of the pathologist and comparison with literature data. To check the rate of unexpected diagnoses. Analysis of the costs and survey of German ENT clinics with regard to handling of the histological examination in suspected cholesteatoma.Retrospective evaluation of cholesteatoma cases of the ENT Department of the University Medical Center of Mainz from 2010-2015. Germany-wide postal survey of ENT clinics.In all, 449 operations for the rehabilitation of a middle ear cholesteatoma, of which there were 312 (69.5%) first diagnoses and 137 (30.5%) recurrences. A histological examination was conducted in 78.6%. For first diagnoses, the sensitivity of the clinical assessment was 97.9%, specificity 10%, positive predictive value 96.3%, and negative predictive value 16.7%. Recurrences showed values of 100%, 40%, 97.1% and 100%. Unexpected malignant findings did not occur. This routine histological examination was performed by 58.6% of German ENT hospitals. A total of 80% of those questioned this to be useful. A histological examination cost an average of 14.06 €.Intraoperatively, there is a high degree of accuracy in diagnosing cholesteatoma. The cost factor of the histological examination is low and should not be the basis for the decision. The ear microscopy and the experience of the ear surgeon should be decisive for the decision for histological examination.

The TNM (tumor, nodes, metastasis) classification is updated periodically according to the literature and international recommendations. With the 8th edition, notable changes have been developed especially with regard to oropharyngeal cancer.The modifications as well as the practicability of the classification for staging of oropharyngeal cancers are demonstrated on the basis of cases from the tumor database.The latest edition of the TNM classification realizes requirements to differentiate between human papilloma virus (HPV) positive and HPV-negative tumors during staging. Furthermore, the prognostic relevance of extranodal extension of lymph node metastases was integrated into the classification. While downstaging is performed regarding N category and Union Internationale Contre le Cancer (UICC) stage in many p16-positive tumors, for p16-negative tumors, extranodal spread mostly leads to a notable upstaging. Due to limited specificity of the p16 immunostaining, the relevance of false positive results has to be underlined. Missing integration of smoking behavior, limited standardization of the extranodal extension examination technique, as well as high demands on the documentation quality should be kept in mind.Clinical trials will have to show whether deescalation strategies regarding p16-positive carcinomas are supported by the changes made in the TNM staging system. A prospective multicenter study should examine the universal applicability, the appropriateness for all sublocations, as well as the prognostic significance of the current edition.

Introduction Redo surgery or reintervention following conventional or endovascular aortoiliac reconstruction often requires exclusion of new aneurysms. In the present study the potentials of endovascular management of such lesions are investigated. Methods All patients with endovascular reoperation for of newly developed aortoiliac aneurysms were identified from a prospectively run data-base. The indications and results of endovascular therapy were analysed retrospectively. In detail, data were analysed for the type of original operation, interval until and kind of reoperation, and results concerning survival, technical success and complications. Results From 12 / 2003 through 3 / 2007 195 patients with aortoiliac aneurysms were operated. Endovascular repair was performed in 15 cases of previously excluded aneurysms. Mean age of these 15 patients (12 men) was 73 (64-85) years. Ten patients had a primary conventional (group A) and 5 patients had a primary endovascular (group B) aneurysm repair. The mean time interval between the first and second operation was 8.9 (1-26) years. The secondary endovascular therapy in group A was successful in all cases. In group B endoleaks type I a (n = 1), I a / b (n = 1), II (n = 2) and III (n = 1) were treated. One type II endoleak could only be treated successfully by conversion to open repair, the other one was successfully treated by reintervention. All but one patient are alive and -remained free of pathological findings during a median follow-up of 13 (2-39) months. Discussion Because of the clearly elevated operation risk of redo surgery after conventional or endovascular aneurysm repair, endovascular aneurysm exclusion represents the method of first choice. The reasonable selection and combination of procedures allows for an optimal adaptation of therapy to the individual case.

Intestinal protozoal infestation and antibodies against Entamoeba histolytica were determined in 614 employees of the Hamburg sewage works and compared with control groups without occupational sewage contact. The protozoal infection rate was significantly higher in sewer-men than in control persons. There was a positive correlation between the duration of exposure to sewage and the frequency of intestinal protozoal infestation. The risk of infection by sewage was higher than by a short journey to tropical or subtropical countries. Immunodiagnostic results showed no significant differences of invasive activity of E. histolytica between both investigated groups. On the basis of parasitological results classification of amoebiasis and giardiasis as occupational diseases in exposed persons is recommended.

BACKGROUND The prospective diagnostic efficiency of quantitative glutathione S transferase (GSTP1) promoter hypermethylation analysis in biopsy washing samples has not been determined so far. METHODS Biopsies were obtained prospectively from 86 patients suspicious for prostate cancer (CaP). After isolation of DNA from biopsy washings and bisulfite conversion methylated and unmethylated GSTP1 sequences were specifically quantitated by real-time fluorescence PCR. Relative degrees of methylation were compared to results of histopathological examination. RESULTS Increased relative methylation was found for the CaP group (mean 28.1%) compared to biopsies without histological evidence for malignancy (5.2%; P

UNLABELLED Specific binding sites for diadenosine polyphosphates (Ap (4)A, Ap (5)A, Ap (6)A) exist in VSMC (cultured vascular smooth muscle cells). These compounds may regulate VSMC growth and proliferation which is a key event in atherogenesis. Since diabetes is a known risk factor for atherosclerosis, the proliferation of VSMC from normoglycemic (control) and hyperglycemic (diabetic) rats were compared and the possibly involved receptors for diadenosine polyphosphates inducing this effect were investigated. Diabetes was induced by streptozotocin (66 mg/kg i.p.) and VSMC were prepared from rat aorta (primary culture). ( (3)H)thymidine incorporation was a measure of cell proliferation. For all diadenosine polyphosphates tested a stimulatory effect was observed as a bell-shaped concentration-response curve and a maximum effect at 10 micro M (physiological concentration). Ap (6)A has the most prominent effect (247.8 +/- 33.2 % increase over basal). In VSMC of diabetic rats the effects were even more prominent (Ap (5)A: 430.1 +/- 62.7 %). ATP (a degradation product of Ap (6)A) is able to increase the maximum effect of 10 micro M Ap (6)A. UTP (P2Y (2) agonist) exhibits a weaker proliferation. 1 micro M suramin (P2 receptor antagonist) shifts the concentration response curve of ATP and of Ap (6)A to the right. In contrast, 10 micro M PPADS (P2 X receptor antagonist) has no effect. There is no difference between VSMC of normal and diabetic rats in this respect. ADP, AMP, and adenosine exhibit a dual proliferative effect. The effect of either of these 3 compounds is much higher in VSMC of diabetic rats than of controls. 2MeSATP (P2Y (1) agonist) and alpha,beta-Methylen-ATP (P2X agonist) were not effective in VSMC of both normoglycemic and diabetic rats. IN CONCLUSION The proliferative effect of diadenosine polyphosphates and some degradation products is more pronounced in VSMC of diabetic than of normal rats. Ap (6)A acts maximally by itself and not by its degradation product ATP. Adenosine receptors or an unknown P2Y (ApxA) receptor may be involved in proliferative effects, but not P2X and P2Y (1) receptors irrespective of a diabetic situation.

Incorporating non-economic criteria into an automated process synthesis procedure enables an engineer to prune, more easily and more effectively, the large design space early in the design process. Although existing synthesis procedures are based on the use of steady state modelling, issues such as operability and flexibility are best handled through the use of dynamic models. This paper describes a discrete programming approach, implemented in the Jacaranda synthesis tool, incorporating dynamic modelling for the generation of process designs, which meet specified criteria for operability or flexibility. Particular attention is given to implementation issues, including especially how to incorporate dynamic modelling efficiently in an automated environment. An example of the design of separation sequences with good start-up and feed disturbance behaviour is presented.

Die optimale Versorgung des politraumatisierten Patienten verlangt ein koordiniertes interdisziplinares Vorgehen, wobei zwischen der Erstversorgung am Unfallort, der meist in der Klinik durchgefuhrten Akutversorgung und der spater auch durch den niedergelassenen Kollegen gewahrleisteten Spatversorgung von evtl. Folgezustanden des Traumas differenziert werden muss. Der nachfolgende Beitrag beschaftigt sich sich mit der Diagnostik und der Therapie der Verletzungen von Harnblase und Urethra, da diese Verletzungen des ableitenden Harntrakts bei politraumatisierten Patienten neben dem Nierentrauma die hochste Inzidenz aufweisen.

The aim of this study was to monitor the presence of sulfate-reducing bacteria (SRB) at different sites in the mouths of both healthy individuals and periodontitis patients. In 20 healthy subjects and 21 periodontitis patients, samples were taken from the palate, vestibulum, dorsum of the tongue, supragingival plaque, and periodontal pockets. In order to demonstrate growth of SRB, samples were incubated in an anoxic chamber in a reduced growth-medium for SRB, with an iron-indicator for sulfide production. The SRB were detected throughout the oral cavity. They were found on the mucosa in 10% of both healthy subjects and periodontitis patients. On the tongue and in supragingival plaque, the frequency of detection was slightly higher (22% of the subjects). In contrast, 86% of the periodontitis patients harbored SRB in one or more pockets. In 1/3 of the patients, SRB were present in all 3 pockets that were sampled. The data indicated that SRB belong to the normal oral microbiota, and have a preference for periodontal pockets.

Fragestellung: Die eigenen Ergebnisse mit der Penisschaftbegradigung nach Essed bei der Behandlung von Penisdeviationen werden vorgestellt und mit den Daten der Literatur, sowohl fur die Methode nach Essed als auch nach Nesbit verglichen. Material und Methode: Zwischen Oktober 1991 und Dezember 1996 wurden 61 Patienten an unserer Klinik operiert. In 65,6 % der Falle (n = 40) lag eine kongenitale Penisdeviation vor, wahrend bei den ubrigen 34,4 % eine Induratio penis plastica (IPP) als Grunderkrankung bestand. Die Nachuntersuchung erfolgte im Rahmen einer klinischen Visite oder durch einen Fragebogen mit einer mittleren Follow-up-Zeit von 40 Monaten. Ergebnisse: Das Patientenalter lag zwischen 15 und 65 Jahren (Mittel 31,3) und die ursprungliche Deviation des Penis betrug 20° bis 90° (Mittel 47,4°). 47,5 % der Patienten mit kongenitaler Deviation und nur 10 % der Patienten mit IPP konnten vor dem Eingriff Geschlechtsverkehr ausuben. Rezidive einer erneuten Deviation waren beim kongenitalen Krankheitsbild mit 22,5 % deutlich seltener als im Rahmen einer IPP mit 42,9 % (mittlere Rezidivrate fur alle Patienten 29,5 %). Eine postoperative Erektionsstorung wurde nur bei 2 Patienten (3,3 %) beobachtet. 20 Patienten (32,8 %) empfanden jedoch dauerhaft storende Schmerzen bei mechanischem Druck auf die Nahtstellen, wobei nur einem Patienten dadurch ein Geschlechtsverkehr nicht mehr moglich war. Schlusfolgerung: In der Literaturubersicht findet sich eine zu unseren Ergebnissen vergleichbar hohe Rezidivrate fur das Verfahren nach Essed. Im Vergleich dazu weist die Nesbit-Operation deutlich bessere Erfolgsraten auf. Da sie in der Literatur nicht mit einer hoheren Komplikationsrate behaftet ist, scheint sie somit der Essed-Operation uberlegen zu sein. Purpose: Penile deviation, either congenital or due to Peyronie's disease, can be corrected by simple plication of the tunica albuginea as described by Essed. Our own experience with this method is presented and compared to the data of both the Essed and the Nesbit procedure as reported in the literature. Materials and methods: From 1991 to 1996, the Essed procedure was performed in 61 patients. 65.6 % (n = 40) had congenital deviation and 34.4 % (n = 21) suffered from secondary deviation due to Peyronie's disease. Non-absorbable inverting interrupted sutures were used and follow-up was done either during routine clinical follow-up or by standardized questionnaire. Patient age ranged from 15 to 65 years (mean 31.3) and the mean follow-up time was 39.8 months (12 - 75). Preoperative penile deviation was between 20° and 90° (mean 47.4°). Only 47.5 % of the patients with congenital and 10 % with Peyronie's disease were able to perform sexual intercourse at all. Results: 18 patients (29.5 %) had a recurrent deviation following surgery. This failure rate was higher in the patient group with Peyronie's disease (42.9 %) than in the group with congenital deformation (22.5 %). Postoperatively, 2 patients (3.3 %) reported de novo erectile dysfunction. 20 patients (32.8 %) complained of persistent discomfort or pain at the area of the still palpable plication sutures. 45.9 % stated penile shortening after surgery, but only 21.3 % felt bothered. Conclusions: Our results are in accordance with the literature, showing a higher recurrence rate of deviation than the Nesbit procedure. Furthermore, one-third of all patients complained of discomfort from the non-absorbable sutures. For both methods, the risk of recurrent disease is higher in patients with Peyronie's disease, and, in both techniques, an equally low incidence of erectile dysfunction is evident. Therefore, the Nesbit procedure seems to be superior.

Bei Untersuchungen zur Ermudungsfestigkeit interstitiell freier Stahle sind mit dem Auftreten interkristalliner Schwingungsrisse erstmals Schadensmechanismen aufgetreten, die den Einsatzbereich dieses fur seine hervorragenden mechanischen Eigenschaften bekannten Werkstoffes erheblich begrenzen konnen. In metallographischen Untersuchungen konnten die fur dieses Schadensbild bekannten Ursachen wie die Bildung von schalenformigem Tertiarzementit oder die Schwachung der Korngrenzen durch Ausscheidungen ausgeschlossen werden. Im vorliegenden Beitrag werden Untersuchungsergebnisse mit hochauflosenden elektronenoptischen Analyseverfahren (TEN, AES) vorgestellt. Investigations of initiation of intercrystalline fatigue cracks of interstitial free (IF-) steels While investigation the fatigue strength of interstitial free steels, intercrystalline fatigue cracks have occurred as a damage which could reduce the application range of this material, being wellknown for its excellent depth drawing features. Through metallographic examination the known causes of the damage like formation of grain cover tertiary zementit of precipitations on the grain boundaries could be excluded. In this paper investigation results are represented which are received through high-resolution analyses techniques (TEM, AES).

We have used data from the OPAL detector at LEP to reconstruct D∗ mesons and secondary vertices in jets. We have studied the hemispheres of the events opposite these jets and obtain values of the hemisphere charged particle multiplicity in Z0 → uu, dd, ss, Z0 → cc and Z0 → bb events of nuds = 10.41 ± 0.06 ± 0.09 ± 0.19; nc = 10.76 ± 0.20 ± 0.14 ± 0.19; nb = 11.81 ± 0.01 ± 0.12 ± 0.21 where the first errors are statistical, the second systmatic and the third a common scale uncertainty. We find the difference in total charged particle multiplicity between c and b quark events and light (u, d, s) quark events to be δcl = 0.69 ± 0.51 ± 0.35; δbl = 2.79 ± 0.12 ± 0.27. These results are compared to the predictions of various models and QCD based calculations.

Over 60 CVD diamond films with thicknesses in the range 2–600 μm, grown from C/H, C/H/O, C/H/Cl and C/H/N gas mixtures by microwave plasma CVD, combustion flame synthesis and r.f. plasma torch CVD, were compared in terms of their thermal, morphological, Raman and luminescence data. Correlation diagrams reveal that the content of sp2-hybridized carbon is the main factor determining the thermal properties of the films. Other parameters, e.g. thickness, crystallinity and defects, only influence the thermal performance by changing the phase purity. The presence of oxygen and nitrogen in the CVD gas phase restricts the thermal conductivity of the films to values well below the 2200 ± 200 W m−1 K−1 achieved for polycrystalline films, 250 μm thick, grown from methane and hydrogen. Diamond films with thicknesses of less than 4 μm and thermal conductivities of more than 700 W m−1 K−1 were grown from C/H and C/H/O mixtures.

The properties of hadronic Z0 decays with final state photons, measured with OPAL at LEP, have been compared with predictions from two different matrix element calculations ofO(ααs). Two calculations, GNJETS and EEPRAD, have been investigated which use different schemes to restrict the phase space around the poles of the cross section. Assuming the E0-JADE jet definition, both calculations describe the data well in large regions of phase space forycut values around 0.06. For very large and very small jet-photon masses some deviations from the predictions have been found, indicating the importance of higher order corrections. Significant differences between the calculations are only apparent in the predicted rate of 1-jet plus photon events. The rate is higher in GNJETS which reproduces the data better than EEPRAD.

The fraction of\(Z^0 \to b\bar b\); events in hadronicZ0 decays has been measured using the data collected by OPAL in 1992 and 1993. The presence of electrons or muons from semileptonic decays of bottom hadrons and the detection of bottom hadron decay vertices were used together to obtain an event sample enriched in\(Z^0 \to b\bar b\) decays. To reduce the systematic error on the measurement of the\(Z^0 \to b\bar b\) fraction, the efficiency of the\(b\bar b\) event tagging was obtained from the data by comparing the numbers of events having a bottom signature in either one or both thrust hemispheres. A value of $$\frac{{\Gamma (Z^0 \to b\bar b)}}{{\Gamma (Z^0 \to hadrons)}} = 0.2171 \pm 0.0021 \pm 0.0021$$ was obtained, where the first error is statistical and the second systematic. The uncertainty on the decay width\(\Gamma (Z^0 \to c\bar c)\) is not included in these errors. A fractional variation of this width by ±8% about its Standard Model prediction would result in a variation of the measured\(Z^0 \to b\bar b\) fraction of ±0.0015.

The decay τ−→π−−+vτ has been studied using data collected with the OPAL detector at LEP during 1992 and 1993. The hadronic structure functions for this decay are measured model independently assuming G-parity invariance and neglecting scalar currents. Simultaneously the parity violating asymmetry parameter is determined to be\(\gamma VA = 1.08 _{ - 0.41 - 0.25}^{ + 0.46 + 0.14} \), consistent with the Standard Model prediction of γVA=1 for left-handed tau neutrinos. Models of Kuhn and Santamaria and of Isgur et al. are used to fit distributions of the invariant 3π mass as well as 2π mass projections of the Dalitz plot. The model dependent mass and width of thea1 resonance are measured to be\(m_{a_1 } = 1.266 \pm 0.014_{ - 0.002}^{ + 0.012} \) GeV and\(\Gamma _{a_1 } = 0.610 \pm 0.049_{ - 0.019}^{ + 0.053} \) GeV for the Kuhn and Santamaria model and\(m_{a_1 } = 1.202 \pm 0.009_{ - 0.001}^{ + 0.009} \) GeV and\(\Gamma _{a_1 } = 0.422 \pm 0.023_{ - 0.004}^{ + 0.033} \) GeV for the Isgur et al. model. The model dependent values obtained for the parity violating asymmetry parameter are γVA=0.87±0.27−0.06+0.05 for the Kuhn and Santamaria model and γVA=1.10±0.31−0.14+0.13 for the Isgur et al. model. Within the Isgur et al. model the ratio of theS-andD-wave amplitudes is measured to beD/S=−0.09±0.03±0.01.

In hadronic Z0 decays collected by the OPAL experiment at LEP, event shape variables such as jet rates, jet masses, thrust and the energy-energy correlation for $$Z^0 \to b\bar b$$ events are compared to those for all flavours using secondary vertex information to tag the b quarks. The measured distributions are found to be well described by anO"(α s ) calculation for heavy quarks as well as by parton shower simulations. We also determine the ratio of the strong coupling constant for b quarks and all quarks, α b /α incl , from these distributions. We find $$\alpha _s^b /\alpha _s^{incl} = 0.994 \pm 0.005_{ - 0.012}^{ + 0.010} ,$$ where the errors are the statistical and systematic errors. The result can be converted into the ratio for b quarks relative to the complementary flavours udsc α b /α udsc =0.992±0.007 -0.015 +0.013 .

We have studied the production of D*± mesons in a sample of 1.25 million multihadronic decays of the Z0, in which 1969 candidates have been identified. We have determined the total multiplicity of charged D* mesons in multihadronic Z0 decays to be