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Objective: Sacrocolpopexy (SCP) is the gold standard for apical prolapse treatment. However, the technical performance of each SCP is strongly dependent on the surgeon's own discretion and comparison of clinical outcomes with respect to urinary incontinence (UI) is difficult. We developed a comprehensible laparoscopic surgical technique for the treatment of apical prolapse with UI. Methods: A total of 120 women with UI underwent laparoscopic bilateral SCP for apical prolapse. Thereby, the uterosacral ligaments (USLs) were bilaterally replaced by polyvinylidene fluoride (PVDF) tapes of identical length and shape, which were fixed at defined anatomical landmarks (cervix/vaginal vault and S1). Results: The restoration of apical vaginal support was achieved in 116 patients (97%); restoration failed in the first 4 patients owing to the use of fast-absorbable sutures. Seventy-eight patients (65%) with mixed and urgency UI symptoms before surgery achieved continence. The mean hospitalization was 3 days; no major complications were observed intraoperatively. Conclusion: The advantage of laparoscopic cervicosacropexy (laCESA) and laparoscopic vaginosacropexy (laVASA) lies in the comprehensible surgical technique (clearly defined technique) and the minimal amount of material used (no polypropylenes). The possibility of a short operating time and short hospitalization depicts this laparoscopic bilateral USL replacement as one treatment alternative in patients with apical prolapse suffering from UI.

Die Einfuhrung der nichtinvasiven Pranataltests (NIPTs) im August 2012 in Deutschland hat in den letzten 5 Jahren das pranatale Screening nach fetalen Aneuploidien entscheidend verandert. Die haufigen Trisomien 13, 18 und 21 konnen durch NIPTs mit einer hohen Sensitivitat und Spezifitat detektiert werden. Momentan wird von den Anbietern versucht, die Indikationen fur NIPTs auf immer mehr genetische Erkrankungen auszuweiten. Die aktuelle Situation und mogliche zukunftige Entwicklungen sollten jedoch vor der Markteinfuhrung von neuen Testsystemen kritisch hinterfragt werden.

Die Pranataldiagnostik hat in den letzten Jahren eine enorme Entwicklung durchlaufen. Durch die Verbesserung der Ultraschalldiagnostik und die Einfuhrung des Ersttrimesterscreenings hat sich die Anzahl der invasiven pranatalen diagnostischen Eingriffe mehr als halbiert. Die seit Kurzem verfugbaren, nichtinvasiven Tests an zellfreier fetaler DNA aus mutterlichem Blut forcieren diese Entwicklung noch weiter, sodass invasive Eingriffe in naher Zukunft immer seltener zum Einsatz kommen werden und damit auch die Zahl eingriffsbedingter Fehlgeburten weiter sinken wird.

Zusammenfassung Die zytogenetischen Analysen an Fruchtwasserzellen oder an Chorionzotten sind die Standardmethoden der invasiven Pränataldiagnostik. In besonderen Fällen stellen die Fetalblutanalyse oder die Untersuchung fetaler Zellen anderen Ursprungs eine gute Ergänzung dar, um den tatsächlichen fetalen Chromosomensatz zu ermitteln. Die Chromosomenanalyse erlaubt die Beurteilung des gesamten Genoms auf lichtmikroskopischer Ebene. Bei molekulargenetischen Analysen monogener Erkrankungen werden native Chorionzotten für eine derartige, gezielte Untersuchung bevorzugt verwendet. Die schnelle Entwicklung der nichtinvasiven genetischen Pränataldiagnostik kann die Optionen werdender Eltern, bestimmte genetisch bedingte Störungen auszuschließen, erweitern und auf den Einsatz der invasiven pränatalen Diagnostik maßgeblich Einfluss nehmen.

Suburethral tapes are placed “tension-free” below the urethra. Several studies reported considerable differences of the distance between urethra and tape. These distances ranged from 1 to 10 mm amongst different patients. This either caused urethral obstruction or had no effect on urinary incontinence. Therefore, we decided to standardize the procedure by placing a Hegar dilator of 8-millimeter diameter in the urethra and another Hegar dilator of 4-millimeter diameter between the urethra and the tape during transobturator tape placement. Using that simple technique, which we named “TOT 8/4,” we observed that 83% of the tapes were placed in the desired distance between 3 and 5 millimeters below the urethra.

PurposeThe paper aims to begin with a brief review of early banking and finance methods, early logistics routes through Europe, and message delivery modes in medieval China, the paper then proposes to move on to a comparative study of modern logistics modes in the European Union and in India – in particular the ports of Le Havre (France) and Mangalore (Karnataka).Design/methodology/approachThe data are derived from secondary sources, including the local press in India as well as official European Union (EU) documentation.FindingsGiven the cultural and political differences between the EU and India, their logistics and hinterland development are very different in deployment and scope: Le Havre “scores” much more highly than Mangalore and the EU is much more coherently developed than India.Practical implicationsLe Havre, France, and the EU are well placed through their integrated logistics development to merge with the proposed Euro‐Asia‐America “land‐bridge” which initially will be based on a redeveloped Trans‐Siberian rail network; whereas the southern “Silk Road” development, taking in India, is floundering due to many factors inhibiting implementation of this new network.Originality/valueThe paper will be of interest to those who wish to view the development of intercontinental logistics routes, and to grasp the future potential for new trade links between the Pacific and the Atlantic ports.

We know that firms in developed nations have practised supply chain management (SCM) for decades, but we ask here if they will be able to progress well under the modern regime of harder and faster e-just-in-time systems. The end-to-end supply chain is both a virtual and a physical reality linking the customer to many value-added manufacturers and assemblers with the intervention and support of logistics providers; and we must also be concerned with the reverse supply chain. For the purposes of this paper we assume the chains to be terminated mainly in Europe and the USA, but with origins having global outreach. We further assume SCM to be concerned not only with data and goods, but also in managing cultural and ethical issues. Essentially we shall discuss the challenges of knowledge management (KM) and organisational learning (OL) in SCM systems that embrace firms located in many countries, western as well as Asian, which, to promote KM and OL must have more (or less) permeable organisational boundaries a...

Von den bewusst registrierten Schwangerschaften enden ca.15% mit einem Spontanabort. Ungefahr 50% davon weisen numerische Chromosomenanomalien (Aneuploidien) auf.Diese resultieren uberwiegend aus chromosomal aberranten Gameten.Im Zusammenhang mit Verfahren der assistierten Fertilisation zeigten Chromosomenanalysen an unbefruchteten Oozyten und Spermatozoen, dass eine deutliche Praferenz fur chromosomale Verteilungsstorungen wahrend der Oogenese existiert und diese masgeblich zur Entstehung von Aneuploidien beitragen.Aufgrund spezifischer Probleme bei der zytogenetischen Analyse von meiotischen Eizellchromosomen besteht sowohl im Hinblick auf eine Verbesserung der Fixiertechniken als auch bezuglich der Weiterentwicklung spezifischer Analyseverfahren Handlungsbedarf. Die korrekte Erfassung von spezifischen Aneuploidien ermoglicht nicht nur die zuverlassige Ermittlung von Anomalien und deren Entstehungsmechanismen, sondern ist auch fur die Durchfuhrung einer zuverlassigen Prafertilisationsdiagnostik an Polkorpern entscheidend.Somit nimmt die Etablierung von adaquaten FISH-Verfahren, welche moglichst sichere Aussagen anhand der Analyse von Eizellchromosomen zulassen, einen besonderen Stellenwert kunftiger Entwicklungen ein.

The relationship between G 2 -phase checkpoint activation, cytoplasmic cyclin-B accumulation and nuclear phosphorylation of p34 C D C 2 was studied in Nijmegen breakage syndrome cells treated with DNA damaging agents. Experiments were performed on lymphoblastoid cell lines from four Nijmegen breakage syndrome patients with different mutations, as well as on cells from an ataxia telangiectasia patient. Lymphoblastoid cell lines were irradiated with 0.50-2 Gy X-rays and the percentage of G 2 -phase accumulated cells was evaluated by means of flow cytometry in samples that were harvested 24 h later. The G 2 -checkpoint activation was analysed by scoring the mitotic index at 2 and 4 h after treatment with 0.5 and 1 Gy X-rays and treatment with the DNA double-strand break inducer calicheamicin-yl. Cytoplasmic accumulation of cyclin-B was evaluated by means of fluorescence immunostaining or Western blotting, in cells harvested shortly after irradiation with 1 and 2 Gy. The extent of tyrosine 15-phosphorylated p34 C D C 2 was assessed in the nuclear fractions. Nijmegen breakage syndrome cells showed suboptimal G 2 -phase checkpoint activation respect to normal cells and were greatly different from ataxia telangiectasia cells. Increased cytoplasmic cyclin-B 1 accumulation was detected by both immunofluorescence and immunoblot in normal as well as in Nijmegen breakage syndrome cells. Furthermore, nuclear p34 C D C 2 . phosphorylation was detected at a higher level in Nijmegen breakage syndrome than in ataxia telangiectasia cells. In conclusion, our data do not suggest that failure to activate checkpoints plays a major role in the radiosensitivity of Nijmegen breakage syndrome cells.

We report on an 18-year-old female with de novo tandem duplication Xq23→Xq27–28. The breakpoints of the duplication segment have been mapped by FISH using a panel of locus specific YACs. Despite selective inactivation of the aberrant X chromosome, proven by a combination of molecular and cytogenetic studies, the patient exhibits mental retardation, dysmorphic features and short stature. Possible mechanisms explaining this unexpected finding are discussed.

Deletions of the distal short arm of chromosome 9 have been reported in association with gonadal dysgenesis and XY sex reversal. These findings suggest that this region harbors at least one gene that might be involved in sexual development. Recent studies narrowed the deletion interval to the subtelomeric region 9p24.3. This region contains three genes DMRT1, DMRT3, and DMRT2 characterized by a DM-domain that seems essential for sexual development in Nematoda and Arthropoda. We have investigated the possible role of this gene cluster in a fetus with ring chromosome 9 and male-to-female sex reversal. We could demonstrate by FISH analysis a very small deletion of the terminal short arm of chromosome 9 including the DM-domain gene cluster. This finding gives further evidence that hemiZygosity of this region can be the cause for male-to-female sex reversal.

For many years EDI was considered as costly but excellent for quick and safe exchange of trade information in freight transport operations. Today Internet settlement suggests different business possibilities, in many ways complementary to EDI. For the last couple of years, we can observe that thr Internet is becoming a pervasive technique. Large transport firms are now have a presence on the WEB, and propose direct services through this media. Also most of them use Intranet for their electronic links between their main trade partners. Individuals already apply to the Internet for electronic commerce. However a problem still remains: the gap due to the SMEs which are numerous along the logistic chain. In this paper, we will first explain the gap in the IT use by small transport firms, secondly we will present the use of information technologies in the transport logistics field. Then we will present the new way of indermediation in the transport and logistic, and we will finish by discussing how the role of these concerns would be modified by Internet/Intranet.

During the last few years, there has been a rapid development in prenatal diagnosis. Due to the improvements in sonographic examinations and the introduction of first-trimester screening, the number of invasive prenatal diagnostic procedures has dropped by more than 50 %. Recently, noninvasive prenatal diagnostic tests with cell-free fetal DNA from maternal blood have also become available and will further enhance this development. As invasive prenatal procedures will become less frequent in the near future, the proportion of procedure-related abortions will further decrease.

Summary Objective In vitro expansion is an important step to acquire sufficient cells in human tissue engineering technologies. The high number of chondrocytes needed for human articular cartilage implants requires in vitro expansion of the primary cells, bearing a theoretical risk of in vitro induced changes in the genomes. To gain more insights into this situation, model cultures were prepared and analyzed. Design 25 chondrocyte cell DNA samples from nine donors were analyzed by array comparative genomic hybridization (aCGH) on whole genome level and 28 chondrocyte cell samples from 16 individuals were analyzed by fluorescence in situ hybridization (FISH) on single cell level. The expanded cells were further characterized upon the chondrocytic mRNA phenotype by reverse-transciptase polymerase chain reaction (RT-PCR). Results The molecular karyotyping results revealed autosomal stability, but all male samples analyzed by aCGH displayed a variable loss of the Y-chromosome. These data were confirmed by FISH-experiments and suggest an age dependant effect toward the loss of the Y-chromosome in cultured chondrocytes. RT-PCR data for the mRNAs from collagen types I, II, and aggrecan and the pro-inflammatory cytokine interleukin-1s (IL-1s) did not reveal any correlation of transcriptional activity in cultures with Y-chromosome losses, nor were there statistically significant differences between cells from female and male donors. Conclusions While cells of male origin may suffer from an age-related loss of the Y-chromosome, there was no indication of a functional impairment. The data suggest some caution toward applying proliferative steps when considering chondrocytes from elderly male patients for tissue engineering approaches.

E-commerce businesses have been undergoing rapid development for the last five years in the United States and for the past two years in Europe. This sustained growth illustrates the existence of a demand for this type of service, particularly among the youth. Beyond the startup phase, e-commerce companies are continuing to generate significant losses, which point to organisational defects, the most serious being logistic support to this business. Analysis of the e-commerce issue is delicate, given the haziness of the activity's perimeter. E-commerce startups offer services similar to traditional mail-order, and consumer retailing is not clearly stating its objectives in creating its own e-commerce sites. Logistics is not an organisational technique that is adapted to the rapid and unpredictable changes that e-commerce is experiencing today. Logistics related problems in e-commerce vary according to the type of commercial activity involved, but they are often considerable and sometimes result from the precipitation with which these activities were set up.

In the present study, we developed a fluorescence in situ hybridization (FISH) strategy, which allows a reliable determination of the chromatid number of specific chromosomes in mature human oocytes. 168 unfertilized oocytes were analyzed by dual-color FISH with two direct-labeled locus-specific DNA probes for chromosome 13 and 21. To exclude FISH failures, metaphases with abnormal signal patterns were reanalyzed by multi-locus-FISH (ML-FISH) for chromosome 13 and 21. Following dual-color FISH, abnormal signal patterns were detected in 21 out of 108 metaphases (19.4%). 17 of these metaphases were reanalyzed by ML-FISH. In contrast to the first FISH, seven metaphases showed normal signal patterns after rehybridization, whereas ten metaphases remained abnormal. Out of these real aneuploid metaphases, five showed gain or loss of a single signal (= chromatid), two showed missing double signals (= chromosome) and three showed both. In conclusion, locus-specific FISH probes facilitate differentiation between first meiotic nondisjunction of whole chromosomes and prematurely divided chromatids. Moreover, simultaneous hybridization with a second locus-specific probe on the same chromatid (ML-FISH) helps to differentiate between FISH failures and real meiotic division errors and therefore, allows a more reliable analysis of aneuploidies in human oocytes.

Various technologies available for radio communication from cars are described. The drawbacks of current networks are outlined. New paradigms are presented-voiceless, asynchronous, and international roaming. Types of link are discussed-ubiquitous links (exclusive links), internetworking, and e-mail. >

The main goal of project COST 306 was to carry out a demonstration of electronic data interchange (EDI) through trials of live operation in the field of transport across national borders, at the European scale (EEC, EFTA), with real international trade partners, to demonstrate the feasibility of using EDI and drawn the conclusions for the future. For that purpose, formed transport chains had to use internationally accepted solutions which would facilitate the establishment of multilateral EDI and improve open transport information system connectivity. In order to evaluate the trial, a pre and post-survey of 40 participating companies was undertaken. In general, the conclusions from these surveys indicated a real satisfaction in the results of the trials. However, there are a number of problems that give rise to some concern, specifically a lack of available software and unsatisfactory connectivity between VANs and the inability of PTTs to provide adequate international communication facilities. On the other hand, the standardised COST 306 messages covered the business needs for which they were designed. >

Hierarchical-ring based multiprocessors are interesting alternatives to the more popular two-dimensional direct networks. They allow for simple router designs and wider communication paths than their direct network counterparts. There are several ways hierarchical-ring networks can be configured for a given number of processors. Feasible topologies range from tall, lean networks to short, wide networks, but only a few of these possess high throughput and low latency. We present the results of a simulation study: to determine how large hierarchical-ring networks can become before their performance deteriorates due to their bisection bandwidth constraints; and to derive topologies with high throughput and low latency for a given number of processors. We show that a system with a maximum of 120 processors and three levels of hierarchy can sustain most memory access behaviours, but that larger systems can be sustained, only if their bisection bandwidth is increased.

This paper proposes and evaluates prioritized direct shared-memory multiprocessor networks. We use three components to implement prioritized networks, namely, priority-based link arbitration, priority inheritance, and dynamic virtual channels. The two major results from our study are: (i) adding priorities to direct shared-memory multiprocessor networks can lead to reduced average transaction latencies and increased system throughput when running traditional parallel applications, and (ii) a prioritized multiprocessor network can be used to reduce the worst-case latencies of time-constrained traffic when it co-exists with best-effort traffic, without penalizing the average performance of best-effort traffic.