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Besides their influence on climate and cloud formation, many organic and inorganic substances in aerosol particles pose a risk to human health. Namely, polycyclic aromatic hydrocarbons (PAH) and heavy metals are suspected to be carcinogenic or acutely toxic. The detection and quantification of such compounds is difficult if only small amounts of particulate matter (PM) are available. In addition, filter samples are often complex and time-consuming to prepare for chromatographic measurements and elemental analysis. Here, we present a method based on high-resolution atmospheric pressure laser desorption ionization mass spectrometry imaging (AP-LDI-MSI) and statistical analysis which allows the analysis and characterization of very small sample quantities ( m/z 228) were mostly more than twice as high as in Hangzhou. Both cities showed high levels of heavy metals and potentially harmful organic compounds, although their share of total particulate matter was significantly higher in the samples from Tehran. The pre-treatment of the samples was reduced to a minimum with this method, and only small amounts of particles were required to obtain a comprehensive picture for a specific filter sample. The described method provides faster and better control of air pollution in heavily polluted megacities. Graphical abstract

Vasectomy is considered to be the simplest, most effective and cheapest method of fertility control in men, with a significantly lower risk of morbidity and mortality compared to tubal ligation in women. Patient informed consent is particularly important and should include potential irreversibility, surgical options, anesthesia, possible complications as well as postoperative behavior and the need for re-evaluation. There are different access routes available with conventional and no-scalpel vasectomy as well as different techniques for closing the ends of the vas deferens. To confirm sterility the European Association of Urology (EAU) recommends that an ejaculate analysis should be performed 3 months after the procedure and after approximately 20 ejaculations. Complications are relatively rare, although particularly vasectomy failure due to recanalization has to be considered. Approximately 3-6% of vasectomized men strive for a refertilization, which with experienced surgeons is successful in about 90% of cases.

The chemical composition of aerosol particles strongly influences the earth’s climate, including their effects as sediments reducing the reflectivity of snow surfaces. Source apportionment and transportation pathways of such particles help to assess their contribution to regional surface-radiative heating. The chemical composition of particles in the free troposphere was studied at the Jungfraujoch (3580 m asl) in the Swiss Alps, using the laser mass spectrometer LAMPAS 2 during the CLACE-1 campaign. Statistical methods and lab measurements of reference particles were used to investigate the source and aging of field-measured particles. Desert sand, igneous rock and river sediment were used as model systems to differentiate between aged and non-aged atmospheric particles. Dried-up snow-water particles showed a particle composition typically found at the measurement site, largely influenced by carbonaceous and organic particles from local sources. During on-line measurements between 17 and 24 March 2000, sand particles from two sandstorm events were a significant source for less-aged mineral particles. Our results show that desert-sand particles can be transported over long distances and that silicate-rich particles in particular are only slightly altered in the atmosphere. We assume that both, the carbonaceous fraction as well as the fresh mineral particles lead to a warming effect at the measurement site due to their intrinsic properties of low solubility and strong light absorption, decreasing the surface reflectivity of the Alpine snow layer. The results allow for a better assessment of environmental influences and particles’ impact on the local climate in the Alpine region at the Jungfraujoch. Copyright © 2021 American Association for Aerosol Research

Das Mikrobiom als Gesamtheit mikrobieller Lebensformen in definierten Korperbereichen hat grose Bedeutung in der Regulation wichtiger Funktionen des Makroorganismus. Welche Bedeutung hat das Wundmikrobiom fur die Behandlung chronischer Wunden? Welche Wechselwirkungen bestehen zu anderen Mikrobiomen, und welche Schlussfolgerungen ergeben sich daraus fur das Wundmanagement? Abstriche oder Debridementproben aus Wunden werden kultur- bzw. genbasiert auf mikrobielle Erreger untersucht. Aus den genetischen Ergebnissen ergibt sich das Wundmikrobiom. Die Erreger werden nach Art und proportionalem Vorkommen bewertet und verschiedenen Faktoren wie Lokalisation und Art der Wunde, Erkrankung und Nebendiagnosen zugeordnet. Im Wundmikrobiom finden sich erheblich mehr Keimspezies und -mengen im Vergleich zu konventionellen mikrobiologischen Nachweismethoden. Das Wundmikrobiom steht in direkter Beziehung zum Hautmikrobiom und zeigt eine komplexe und zu verschiedenen Untersuchungszeiten unterschiedliche Zusammensetzung, auserdem inter- und intraindividuelle Unterschiede. Bei Wunden von diabetischen Patienten zeigen sich krankheitsspezifische Veranderungen, z. B. dominieren Staphylokokkenspezies, bei Nichtdiabetikern dagegen Streptokokken. Die Analyse des Wundmikrobioms befindet sich im Anfangsstadium. Es zeigt sich bereits, dass es bei hamodynamischen Storungen krankheitsspezifische Beziehungen zum Wundmikrobiom gibt, die auch Hinweise auf den Verlauf geben konnen. Die aus dem Hautmikrobiom bekannten Phanomene mit Auswirkungen auf Pathogene durften auch in der Wunde wirksam werden. Hier zeigen sich Wege moderner antiinfektiver Behandlungsoptionen wie der Besiedlungsmodulation jenseits der konventionellen antimikrobiellen Chemotherapie auf.

Vasectomy is considered to be the simplest, most effective and cheapest method of fertility control in men, with a significantly lower risk of morbidity and mortality compared to tubal ligation in women. Patient informed consent is particularly important and should include potential irreversibility, surgical options, anesthesia, possible complications as well as postoperative behavior and the need for re-evaluation. There are different access routes available with conventional and no-scalpel vasectomy as well as different techniques for closing the ends of the vas deferens. To confirm sterility the European Association of Urology (EAU) recommends that an ejaculate analysis should be performed 3 months after the procedure and after approximately 20 ejaculations. Complications are relatively rare, although particularly vasectomy failure due to recanalization has to be considered. Approximately 3-6% of vasectomized men strive for a refertilization, which with experienced surgeons is successful in about 90% of cases.Die Vasektomie gilt als einfachste, effektivste und kostengünstigste Methode der Fertilitätskontrolle des Mannes, bei deutlich geringerem Morbiditäts- und Mortalitätsrisiko im Vergleich zur Tubenligatur bei der Frau. Die Aufklärung ist besonders wichtig und sollte die potenzielle Irreversibilität, Operationsvarianten, die Betäubung, mögliche Komplikationen sowie das postoperative Verhalten und die Notwendigkeit von Kontrollen beinhalten. Zur Verfügung stehen unterschiedliche Zugangswege mit der konventionellen und der Non-Skalpell-Vasektomie sowie unterschiedliche Techniken zum Verschluss der Samenleiterenden. Zur Bestätigung der Sterilität soll nach Empfehlung der European Association of Urology (EAU) eine Ejakulatanalyse 3 Monate nach dem Eingriff erfolgen. Komplikationen sind insgesamt selten, wobei hier insbesondere auf das Vasektomieversagen durch eine Rekanalisation eingegangen werden sollte. Etwa 3–6 % der vasektomierten Männer streben im Verlauf eine Refertilisierung an, welche bei erfahrenen Operateuren in etwa 90 % der Fälle gelingt.

Background: Cold atmospheric plasma (CAP) is increasingly used in the field of oncology. Many of the mechanisms of action of CAP, such as inhibiting proliferation, DNA breakage, or the destruction of cell membrane integrity, have been investigated in many different types of tumors. In this regard, data are available from both in vivo and in vitro studies. Not only the direct treatment of a tumor but also the influence on its blood supply play a decisive role in the success of the therapy and the patient&rsquo, s further prognosis. Whether the CAP influences this process is unknown, and the first indications in this regard are addressed in this study. Methods: Two different devices, kINPen and MiniJet, were used as CAP sources. Human endothelial cell line HDMEC were treated directly and indirectly with CAP, and growth kinetics were performed. To indicate apoptotic processes, caspase-3/7 assay and TUNEL assay were used. The influence of CAP on cellular metabolism was examined using the MTT and glucose assay. After CAP exposure, tube formation assay was performed to examine the capillary tube formation abilities of HDMEC and their migration was messured in separate assays. To investigate in a possible mutagenic effect of CAP treatment, a hypoxanthine-guanine-phosphoribosyl-transferase assay with non malignant cell (CCL-93) line was performed. Results: The direct CAP treatment of the HDMEC showed a robust growth-inhibiting effect, but the indirect one did not. The MMT assay showed an apparent reduction in cell metabolism in the first 24 h after CAP treatment, which appeared to normalize 48 h and 72 h after CAP application. These results were also confirmed by the glucose assay. The caspase 3/7 assay and TUNEL assay showed a significant increase in apoptotic processes in the HDMEC after CAP treatment. These results were independent of the CAP device. Both the migration and tube formation of HDMEC were significant inhibited after CAP-treatment. No malignant effects could be demonstrated by the CAP treatment on a non-malignant cell line.

Background and purpose — The neck–shaft angle (NSA) is valuable for diagnostics and therapy of the hip, but current reference values derive mostly from studies on anatomic specimens, small cohorts, or are hospital-based. Moreover, associated factors such as age, sex, or anthropometric data have rarely been considered. Therefore, we determined associated factors for NSA and reassessed the historical reference values in a general adult population. Methods — NSAs on both sides of 3,226 volunteers from the population-based Study of Health in Pomerania (SHIP) were measured with MRI. SHIP drew a representative sample of the population of Pomerania (northeastern Germany). NSAs were compared with sex, age, and anthropometric data by bivariable linear regression models. Reference values were assessed by quantile regressions for 2.5th and 97.5th percentiles. Results — The mean NSA was 127° (SD 7), while men had a lower NSA than women (95% confidence interval [CI] 0.4°–1.4°). The reference range was 114°–140°. Age was inversely associated with NSA (CI –0.2 to –0.1). Body height was positively associated with the NSA, while BMI and waist circumference showed a negative association. There was no association between body weight and NSA. Interpretation — The historical lower limit of 120° might be too high, so the radiological prevalence of hip pathology might have been overestimated. The previously reported influence of age, sex, and body height on the NSA has been confirmed.

The microbiome, collective microbial life in defined areas of the body, is of great importance.What is the significance of the wound microbiome in the treatment of chronic wounds? Which interactions exist with other microbiomes and which conclusions can be drawn for wound management?Swabs or debridement samples from wounds were analysed for microbial growth by culture or gene-based techniques. The genetic results are used to determine the wound microbiome. The pathogens were evaluated according to proportion of different species and related to different factors like type and location of wound, disease and underlying illnesses and to define the wound microbiome.In comparison with conventional microbiological detection methods the wound microbiome comprises many more types and quantities of species. The wound microbiome is related to skin microbiome showing complex and time-dependent composition, as well as inter- and intraindividual differences. Diabetic wounds exhibit disease-related changes, e.g. staphylococcal species dominate whereas streptococcal species dominate in nondiabetic wounds.The analysis of wound microbiome is still at an early stage; however it has already been shown that in hemodynamic disorders there are disease-specific relationships with the wound microbiome, which can also provide clues about the course of the disease. Phenomena from the skin microbiome should also be effective in wounds. In this context modern antimicrobial treatment options beyond conventional chemotherapy like colonization modulation become possible.

Purpose: To identify factors influencing medical students to choose radiology in the four-month clinical elective in the final year of medical school following radiology subinternships. Materials and Methods: A subsample of medical students in a nationwide German online survey evaluated a subinternship in radiology (19 items). They were divided into four groups: Students who could imagine doing a clinical elective in radiology in the practical year based on their experiences during the subinternship (“yes, based on subinternship”), students who could not (“no, based on subinternship”) and students who had made this decision prior to the subinternship (“yes, prior to subinternship” and “no, prior to subinternship”). Results: 94 medical students evaluated a radiology subinternship (54.4 % females). Based on their experiences during the subinternship, 54 students (57.4 %) intended to do a final year clinical elective in radiology, 39 of them (41.5 %) being encouraged by the subinternship. 40 (42.6 %) reported having a negative attitude towards a clinical elective in radiology, 16 of them (17.0 %) having made this decision based on their subinternship experience. Groups did not differ regarding gender (p = 0.396) and age (p = 0.853). Students motivated to do a final year clinical elective in radiology experienced excellent academic teaching (p = 0.001) and practical involvement (p = 0.003), achieved their learning goals more often (p = 0.001), were better integrated into the team (p = 0.001), and acquired more practical skills (p = 0.003). Overall satisfaction was higher in these groups (p = 0.001). Conclusion: Satisfaction with a radiology subinternship is crucial for motivating medical students to do a final year clinical elective in radiology. A structured subinternship and continuous mentoring should be targeted to keep students connected to radiology. Key Points: • Radiology subinternships influence further interest in the specialization. • The quality and structure of teaching critically influence student satisfaction. • Team integration and practical involvement positively affect the attitude towards a specialization. Citation Format: • Kasch R, Wirkner J, Hosten N et al. Subinternship in Radiology – A Practical Start to the Specialization? Fortschr Rontgenstr 2016; 188: 1024 – 1030

After debridement and before dressing a wound with maggots of calliphorid flies, one frequently performed step is the application of antiseptics to the prepared wound bed. However, the concomitant application of antiseptic agents during maggot therapy is regarded controversial as antiseptics may interfere with maggots' viability. In this experimental in vitro study, the viability of fly maggots was investigated after exposure to various antiseptics frequently used in wound care. Here, we show that Lucilia sericata fly maggots can survive up to an hour's exposure to wound antiseptics such as octenidine, povidone-iodine or polihexanide. Concomitant short-term application of wound antiseptics together with maggots on wound beds is tolerated by larvae and does not impair their viability.

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.

Hintergrund Offene Frakturen gehoren weiterhin zu den Herausforderungen der Unfallchirurgie und Diskussionen uber den am besten geeigneten Therapieansatz sind haufig. Akribisches Weichteilmanagement ist entscheidend, um einen optimalen Heilungsverlauf zu erreichen. Allerdings fehlt vielen ublichen Therapieempfehlungen die Evidenz.

BACKGROUND The available evidence regarding normal ranges for the center-edge angle and the alpha angle derives from a few small studies, and associated factors such as sex and anthropometric factors have not been well evaluated. Knowing more about normal values for these parameters is critical, because this can inform decisions about when to perform elective hip preservation surgery. Population-level studies would provide considerable clarity on these issues, but to our knowledge, no such studies are available. QUESTIONS/PURPOSES The purposes of this study were (1) to use MRI in patients of a population-based study to establish normal values for the alpha and center-edge angles in the normal adult hip; and (2) to determine whether age, sex, or anthropometric variables were associated with differences in these values. METHODS We used MRI images (1.5 T) of 3226 participants of the Study of Health in Pomerania (SHIP). SHIP is a population-based study that started with 4308 participants in 1997. Participants were recruited randomly from official inhabitant data files as a stratified cluster sample of the population from a defined region in northeastern Germany. To ensure a representative epidemiologic cohort, stratification variables were sex, age, and city of residence. Between 2008 and 2012, 1094 of these participants underwent whole-body MRI with pelvic sequences in the second followup. In parallel, the next cohort, SHIP-Trend, started with the same protocol in which 2132 participants underwent MRI examination. Reference values were calculated by quantile regressions for the 2.5 and 97.5 percentiles. Associations with the demographic features sex, age, weight, height, body mass index (BMI), and waist circumference were analyzed by bivariate linear regression models. RESULTS The mean center-edge angle was 31° (± 7°) with a corresponding calculated normal range of 17° to 45°. The mean alpha angle was 55° (± 8°) with a corresponding calculated normal range between 39° and 71°. Men (30° ± 7°) had a lower center-edge angle than women (32° ± 8°) (p < 0.001, β = 1.4°; 95% confidence interval [CI], 0.9°-1.9°) and a higher alpha angle (57° ± 8° versus 52° ± 7°, p < 0.001, β = 5.7°; 95% CI, 5.2°-6.3°). Moreover, a higher center-edge angle for the left side was found (33° ± 8° versus 30° ± 8°, p < 0.001, β =3.2°; 95% CI, 3.0°-3.4°). In addition to sex, we found that age, height, waist circumference, and BMI affected both center-edge angle and alpha angle. Weight was associated with the alpha angle as well. Because of these associations, age- and sex-adjusted reference values with belonging formulas were calculated. CONCLUSIONS The range of normal center-edge and alpha angles is quite wide. Therefore, only markedly abnormal angles may be associated with pathology. Moreover, center-edge angle and alpha angle are associated with age, sex, and anthropometric factors, which have to be taken into account for better interpretation. CLINICAL RELEVANCE The association of abnormal radiographic values with true clinical hip pathology is tenuous at best. Assuming that a patient with an abnormal radiograph requires treatment is unwise. The clinical picture has to be substantial for therapeutic decisions.

Aim To describe the indication and technique of microbiological wound investigation in treating infected or colonised wounds with or without multi-drug resistant microorganisms (MDROs). The clinical symptoms and criteria of locally or systemically infected wounds are summarized and described. Method An interdisciplinary consensus of microbiological wound diagnosis was elaborated between representatives of different medical specialities. Moreover, some perspectives on future wound diagnostics were presented. Results The panel agreed on ten clinical signs, situations and symptoms, which give the indication for further microbiological wound investigation: formation of pus, clinical signs or suspicion of an infection, suspicion or presence of a surgical site infection, localised progredient infection with or without systemic involvement (e.g. joint empyema, phlegmone), gangrene formation and necrotising fasciitis, ulcerative neoplasia, burn wounds with > 15% thermally injured surface area, exacerbation of dermatological disorders, localised wound infection without sign of systemic involvement after 3 days treatment with antiseptics without obvious clinical improvement, and chronic skin lesion with indication to screen for MDROs. The panel agreed that no indication for microbiological investigation is given in acute wounds without signs of infection and uncomplicated superficial wounds. Today, the gold standard for microbiological investigation is processing tissue biopsies in the laboratory. However, in many instances it may be easier and more rapid to perform a wound swab. If swabs are obtained, the Essener circle or the Levine technique shall be applied. Wound swabs, however, are the method of choice in screening for wound colonisation with MDROs. Additionally, information is summarised pertaining to transport and processing of microbiological wound specimens Also, potential applicability of future wound diagnostic methods based on genomic, metabolomic and proteomic approach are discussed. Conclusion Beside a full understanding of all clinical symptoms and clinical experience of wound experts the correct microbiological wound investigation will be the basis for a succesfull management of infected wounds.

Influenza A virus infections are a major cause for respiratory disease in humans, which affects all age groups and contributes substantially to global morbidity and mortality. IAV have a large natural host reservoir in avian species. However, many avian IAV strains lack adaptation to other hosts and hardly propagate in humans. While seasonal or pandemic influenza A virus (IAV) strains replicate efficiently in permissive human cells, many avian IAV cause abortive non-productive infections in these hosts despite successful cell entry. However, the precise reasons for these differential outcomes are poorly defined. We hypothesized that the distinct course of an IAV infection with a given virus strain is determined by the differential interplay between specific host and viral factors. By using Spike-in SILAC mass spectrometry-based quantitative proteomics we characterized sets of cellular factors whose abundance is specifically up- or down-regulated in the course of permissive vs. non-permissive IAV infection, respectively. This approach allowed for the definition and quantitative comparison of about 3500 proteins in human lung epithelial cells in response to seasonal or low-pathogenic avian H3N2 IAV. Many identified proteins were similarly regulated by both virus strains, but also 16 candidates with distinct changes in permissive vs. non-permissive infection were found. RNAi-mediated knockdown of these differentially regulated host factors identified Vpr binding protein (VprBP) as pro-viral host factor since its down-regulation inhibited efficient propagation of seasonal IAV while over-expression increased viral replication of both seasonal and avian IAV. These results not only show that there are similar differences in the overall changes during permissive and non-permissive imfluenza virus infections, but also provide a basis to evaluate VprBP as novel anti-IAV drug target.

Although surgical site infections (SSI) in dermatologic operative procedures are extremely rare, it is important to understand risks and etiological factors to initiate risk assessment and specific preventive measures. SSI commonly are associated with a complicated, long-term and expensive outcome. Typical wound pathogens of these infections include a variety of multiresistant organisms along with Staphylococcus aureus, Staphylococcus epidermidis, hemolytic streptococci and the gram-negative bacilli Escherichia coli and Pseudomonas aeruginosa. Effective hygienic measures as part of an adequate quality management system should consider the critical points in the development of SSI, particularly in the setting of an outpatient dermatologic unit, such as preparation of the operative area, preoperative skin antisepsis, hand hygiene, safe and skilled technique by surgeons, and barrier nursing to prevent spread of pathogens. The baseline infection incidence in dermatologic surgery inherently is low; nevertheless significant improvements can be achieved by implementation of risk-adapted infection control measures.

Hintergrund Postoperative Wundinfektionen in Unfallchirurgie und Orthopadie sind in einer Ara von technischem Fortschritt und alternder Bevolkerung von besonderer Bedeutung, da sie meist einen komplizierten, langwierigen und teuren Heilungsverlauf verursachen.

This review considers qualifying standards of wound management, explains the hypothesis for the applicability of tissue tolerable plasma (TTP) and lists the TTP effects relevant for wound healing. TTP fulfils these requirements in-vitro and in-vivo together with its demonstrated good tissue tolerability. Cases of treatment of chronic wounds in pets are presented which healed by TTP in combination with polihexanide or octenidine within 3 to 24 weeks. It may be concluded that TTP is a new option for the treatment of chronic wounds.

Purpose The aim of this study was to investigate whether urinary bladder volume (UBV) and blood alcohol concentration (BAC) correlate in a cohort of emergency trauma patients. Furthermore, the feasibility of semi-automated 3D-CT volumetry for urinary bladder volumetry calculations in whole-body CT examinations was elucidated. Material and methods Whole-body CT scans of 831 individuals treated in the emergency department with suspected multiple injuries were included. Manual 3D-CT volumetry of the urinary bladder was performed and the mechanism of injury, patient demographics, BAC, serum creatinine, and hematocrit were retrospectively analyzed. Semi-automated calculation of UBV was performed in 30 patients. Statistical analysis included ROC analysis to calculate cut-off values, sensitivity, and specificity. The Mann-Whitney test and Spearman's correlation coefficient were used to detect significant correlations between UBV and BAC. Results Manual 3D-CT volumetry showed maximum sensitivity and specificity with a cut-off value for urinary bladder volume of 416.3 mL (sensitivity 50.9%; specificity 76.3%; AUC 0.678). With a cut-off value of 4.2 mL/μmol for the creatinine quotient (quotient of serum creatinine and UBV), the sensitivity was 64.2% (specificity 67.0%; AUC 0.681). Semi-automated 3D-CT volumetry resulted in lower UBV values compared to those obtained with manual 3D-CT volumetry. Conclusion Semi-automated 3D-CT volumetry is a reliable method to quantify UBV. UBV correlates with positive BAC results. A UBV above 416 mL seen on an initial whole-body CT must raise suspicion of alcohol intoxication. The creatinine quotient is an even more sensitive and specific parameter for the detection of alcohol intoxication.

After debridement and before dressing a wound with maggots of calliphorid flies, one frequently performed step is the application of antiseptics to the prepared wound bed. However, the concomitant application of antiseptic agents during maggot therapy is regarded controversial as antiseptics may interfere with maggots' viability. In this experimental in vitro study, the viability of fly maggots was investigated after exposure to various antiseptics frequently used in wound care. Here, we show that Lucilia sericata fly maggots can survive up to an hour's exposure to wound antiseptics such as octenidine, povidone‐iodine or polihexanide. Concomitant short‐term application of wound antiseptics together with maggots on wound beds is tolerated by larvae and does not impair their viability.

Open fractures are orthopaedic emergencies that carry a high risk for infection, non-union and soft tissue complications. Evidence-based treatment is impeded by the lack of high-quality evidence-based studies. The aim of this investigation was to elucidate the current practice of open fracture management in Germany and to determine major differences in treatment. Surgeons were asked to complete an online questionnaire consisting of 45 items developed by an expert consensus. The first part covered questions on general principles of open fracture management. The second part included questions on soft tissue management, the preferred method of initial surgical stabilisation, microbiological testing, employment of pulsatile lavage and local antibiotics, antibiotic regimen, second-look operations, and blood testing. Of 653 respondents, 364 (65 %) completed the first part and 314 (48 %) completed the second part of the online survey. 55 % answered that a standard operating procedure for the diagnosis and treatment of patients with open fractures exists in their hospital. Only 25 % leave pre-hospitalisation applied dressings intact until arrival of the patient in the operating room, and 40 % make this decision depending on information provided by pre-hospitalisation emergency personnel. 84 % participants exclude the use of antibiotic-coated implants in the treatment of open fractures. The favoured stabilisation method in Gustilo type I fractures is definitive internal osteosynthesis and primary wound closure for 61 % of respondents. In Gustilo type II (74 %) and type III fractures (93 %), temporary external fixation is preferred. High-pressure pulsatile lavage is used by 22 % responding surgeons in Gustilo type I fractures, 53 % for type II fractures and 67 % for type III fractures. Open fracture management differs considerably among surgeons in Germany. Further studies are needed to deliver high-quality evidence concerning primary fracture stabilisation, soft tissue management and second-look operations. Existing evidence-based recommendations for general treatment, antibiotic prophylaxis and soft tissue management should be followed more strictly in clinical practice.

Tension pneumothorax is one of the leading causes of preventable death in both military and civilian trauma patients. Needle decompression is recommended in trauma guidelines as an emergency procedure to relieve increased intrapleural pressure. The main reason for decompression failure is reported to be insufficient needle length in proportion to the chest wall thickness (CWT). So far, population-based epidemiologic data on CWT are missing. Therefore, it was the aim of this work to investigate the CWT in the second intercostal space, midclavicular line, based on magnetic resonance imaging data of a large population-based sample. The second aim of this study was to explore the potential risk of iatrogenic lesions caused by the proximity of the intended puncture track to the internal mammary artery.A total of 2,574 healthy volunteers (mean [SD] age, 53.3 [13.9] years; range, 21-89 years) from the population-based cohort Study of Health in Pomerania (SHIP) were enrolled. CWT and the distance from the intended puncture track to the internal mammary artery were investigated with the chest sequences of a standardized 1.5-T whole-body magnetic resonance imaging.For all 5,148 measured sites in 2,574 volunteers, the mean (SD) CWT was 5.1 (1.4) cm. The mean body mass index was determined to be 27.7 kg/m. The CWT correlated significantly with body weight and body mass index. The internal mammary artery was located medial to the intended puncture site in all participants; the mean (SD) distance was 5.7 (0.7) cm on the right and 5.5 (0.7) cm on the left side.Based on the population-based epidemiologic data presented in this study, the use of a needle of 7 cm in length is recommended to decompress a tension pneumothorax in the second intercostal space in the midclavicular line, which might successfully decompress more than 90% of the participants in this study. When using this anterior approach at the anatomically correct puncture site, safety margin to the internal mammary artery is sufficient so that the risk of iatrogenic lesion of the internal mammary artery should be minimal.Therapeutic/care management study, level IV.

A single particle mass spectrometer LAMPAS 2 (Laser Mass Analyzer for Particles in the Airborne State) was combined with an ultrasonic anemometer to provide a measurement system for monitoring environmental substance exchange as caused by emission/deposition of aerosol particles. For this study, 681 mass spectra of detected particles were sorted into groups of similarity by a clustering algorithm leading to five classes of different particle types. Each single mass spectrum was correlated to corresponding anemometer data (vertical wind vector and wind speed) in a time-resolved analysis. Due to sampling constraints time-resolution was limited to 36 s, as a result of transition time distributions through the sampling tube. Vertical particle flow (emission/deposition) was determined for all particles based on these data as acquired during a measuring campaign in Giessen, Germany. For a selected particle class a detailed up- and downwards flow consideration was performed to prove the developed approach. Particle flow of that class was dominated by an emission trend as expected. The presented combination of single-particle mass spectrometry and ultrasonic anemometry provides for the possibility to correlate chemical particle data and wind data in a distinct assignment for the description of turbulent particle behavior near earth surface. Results demonstrate the ability to apply the method to real micrometeorological systems, if sampling issues are properly considered for an intended time resolution.

Although potato cannons are an area of great interest among internet users, they are almost completely unknown in the medical community. These simple ballistic devices are made from plastic plumbing pipes and are powered with propellant gas from aerosol cans. By combustion of the gas-oxygen mixture, a high pressure is produced which propels the potato chunks through the barrel. It is the aim of this study to investigate the hazardous potential of these shooting devices. Test shots were performed using three illegally manufactured potato cannons that were confiscated by police authorities. Velocity, impulse, kinetic energy, and energy density were calculated. The risk of head and chest injuries was investigated by using Sturdivan's Blunt Criterion (BC), an energy based five parametric trauma model assessing the vulnerability to blunt weapons, projectile impacts, and behind-body-armor exposures. The probability of lethality due to blunt impact trauma to the chest was assessed using Sturdivan's lethality model. For potential head impacts, all test shots far exceeded the critical BC (head) value which corresponds to a 50% risk of skull fracture. The risk of injury with regard to chest impacts was similar. All but two test shots far exceeded the critical BC (chest) value corresponding to a 50% risk of sustaining a thoracic skeletal injury of Abbreviated Injury Scale 2 or 3. The probability of a lethal injury due to blunt chest impact was as high as 20%. To conclude, this work demonstrates that potato cannons should be considered dangerous weapons rather than as toys used by adventurous adolescents.

Heparin can induce heparin-induced thrombocytopenia (HIT). The combined effect of type of surgery (major vs minor) and heparin on this prothrombotic immune reaction to platelet factor 4 (PF4)/heparin was analyzed. In a randomized, double-blind study, trauma patients receiving low-molecular-weight (LMWH) or unfractionated heparin (UFH) for thrombosis prophylaxis were assessed for PF4/heparin-antibody seroconversion, HIT, and thrombosis according to type of surgery. The risk for seroconversion was higher than major versus minor surgery odds ratio, 7.98 [95% confidence interval, 2.06-31.00], P = .003, controlled for potential confounders, as was the risk for HIT (2.2% [95% confidence interval, 0.3%-4.1%] vs 0.0%, P = .010). During LMWH compared with UFH thromboprophylaxis, HIT (1 of 298 vs 4 of 316; P = .370) and PF4/heparin seroconversion (1.7% vs 6.6%; P = .002) were less frequent, driven by differences in patients undergoing major surgery (incidence of HIT: LMWH 0.8% vs UFH 4.0%; P = .180; seroconversion rates: 4.0% vs 17.0%; P = .001). After minor surgery, no case of HIT occurred. The severity of trauma and the need for major surgery strongly influence the risk of an anti-PF4/heparin immune response, which is then increased by UFH. In major trauma certoparin may be safer than UFH because it induces HIT-antibody seroconversion, and the corresponding risk of HIT, less frequently.

Background A questionnaire study was conducted to ask trauma surgery centers about thrombosis prophylaxis methods and strategies for the diagnosis and therapy of heparin-induced thrombocytopenia (HIT). Methods Questionnaires were sent by post to German hospitals with trauma surgery units inquiring about the use of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH), the duration of medication, and the HIT diagnosis. Questionnaires were evaluated descriptively. Results 314 of 685 questionnaires sent out were evaluable (46%): half were from general hospitals, 96 (31%) from specialized hospitals, and 53 (17%) from tertiary care hospitals (others: 8). In more than 90%, only LMWH was used. The mean duration of pharmacological thrombosis prophylaxis was 16.6+/-10.4 days (inpatient/outpatient). Only 10% adhered to the recommended platelet count controls every 2 days (days 5-14) for early detection of HIT. Conclusions While pharmacological thrombosis prophylaxis following trauma surgery seems to be generally performed according to guidelines, diagnosis and treatment of HIT need to be systematized.

BACKGROUND: High-pressure blast injuries to the hand due to vole captive bolt devices are serious injuries that are to a great extent unknown to emergency care operators and trauma surgeons. There is no study on the functional outcome of these patients. METHODS: We assessed the functional outcome of patients with injuries inflicted by vole captive bolt devices. Therefore, a protocol consisting of a physical examination and an assessment of static muscle power (grip and pinch strength) was performed. To capture the subjective experience of patients regarding their injury related disability and impairment, the DASH follow-up questionnaire was used. Based on clinical/radiologic findings and outcome, a classification of this unique subgroup of blast injuries was developed. RESULTS: The functional outcome of 34 patients suffering hand injuries due to captive bolt devices between 2004 and 2007 was assessed. A significant reduction of static muscle testing parameters compared with the uninjured hand was revealed. Fourteen patients lost a digit. Average time lost from work was 5.4 weeks. CONCLUSION: Vole captive bolt device-related hand injuries are followed by deterioration of hand function. The present observations alarmed national authorities. The manufacturers were required to take engineering and teaching measures to rule out handling errors that were identified as leading cause of injury. Language: en

Hochdruckinjektionen der Hand sind seltene, aber schwere Verletzungen. Wir berichten uber eine Hochdruckverletzung des Zeigefingers durch Hydraulikol, die aufgrund ihrer banalen Erscheinung durch den Verletzten zunachst ignoriert wurde, was zur Behandlungsverzogerung fuhrte. Die operative Behandlung offenbarte eine ausgedehnte Gewebeschadigung durch das olige Imprimat. Die sekundare Defektdeckung des Handruckens erfolgte durch eine Leistenlappenplastik.

Introduction Vole captive bolt devices are special mouse traps which belong to the spring guns. Devices and ammunition are available over the counter, age of consent (18 years) is the only legal restriction. Loaded with a 700 J cartridge the device is positioned in the vole passage. By slightly touching a metal ring in front of the muzzle the mouse triggers the shoot and is killed by a high-pressure gas jet. In spite of the high-potential danger causing injuries no study on accidents due to blank cartridge mouse shooters has been published yet. Methods Patients suffering hand injuries due to vole captive bolt devices were identified. Both type and severity of injury and treatment were recorded. An assessment instrument was designed to identify the critical circumstances leading to injury. Also safety regulations and security measures were examined. Results Between August 2004 and February 2007 20 male patients (average age 48.65 years) suffered accidental hand injuries due to vole captive bolt devices. Patterns of injury reached from cutaneous burning up to traumatic amputation of fingers and separation of the whole hand. In 9 of 20 cases an unintended shoot was triggered in secured status of the devices so the accidents were caused by failure of the security mechanism. Ballistic considerations, casualties and the injury pattern itself differ from well-studied hand injuries caused by blank cartridges or fireworks. Conclusion The study presents a previously unpublished injury pattern due to vole captive bolt devices. Forensic approach has to keep in mind this previously unknown mechanism as cause of accident or self-mutilation.

Nosocomial surgical site infections (SSI) are still important complications in surgery. The underlying mechanisms are not fully understood. The aim of this study was to elucidate the possible role of skin flora surviving preoperative antisepsis as a possible cause of SSI. We conducted a two-phase prospective clinical trial in patients undergoing clean orthopedic surgery at a university trauma center in northern Germany. Quantitative swab samples were taken from pre- and postantiseptic skin and, additionally, from the wound base, wound margin, and the suture of 137 patients. Seventy-four patients during phase I and 63 during phase II were investigated. Microbial growth, species spectrum, and antibiotic susceptibility were analyzed. In phase two, the clonal relationship of strains was additionally analyzed. 18.0 % of the swab samples were positive for bacterial growth in the wound base, 24.5 % in the margin, and 27.3 % in the suture. Only 65.5 % of patients showed a 100 % reduction of the skin flora after antisepsis. The microbial spectrum in all postantiseptic samples was dominated by coagulase-negative staphylococci (CoNS). Clonally related staphylococci were detected in ten patients [nine CoNS, one methicillin-susceptible Staphylococcus aureus (MSSA)]. Six of ten patients were suspected of having transmitted identical clones from skin flora into the wound. Ethanol-based antisepsis results in unexpected high levels of skin flora, which can be transmitted into the wound during surgery causing yet unexplained SSI. Keeping with the concept of zero tolerance, further studies are needed in order to understand the origin of this flora to allow further reduction of SSI.

Two transportable laser mass spectrometers, Single Particle Analysis and Sizing System (SPASS) and Laser Mass Analyzer for Particles in the Airborne State (LAMPAS 2), have been applied to investigate the dependence of spectra patterns on instrumental parameters and data evaluation procedures in an inter-comparison experiment. Laboratory experiments showed the spectral response of both instruments for mineral particles before and after heterogeneous reactions. During a period of 47 h, both instruments determined size and chemical composition of several thousand single particles of an ambient particle population. Time-resolved evaluation (1-h resolution) of specific ion signals, which showed a characteristic temporal evolution, in combination with meteorological information, was used to select four periods for separate evaluation of particle spectra. Application of the two particle classification algorithms, fuzzy c-means clustering and k-means clustering, on the same data set (SPASS) showed only minor differences in spectral patterns and class abundances caused by the clustering method (“soft” or “hard” clustering). Spectral patterns determined for the data sets of two instruments (SPASS and LAMPAS 2) were similar for some particle types and could be compared directly (e.g., mineral or carbonaceous particles). For other types of particles, spectral patterns differed from each other and had to be interpreted using additional information on instrumental parameters (e.g., laser wavelengths or irradiance) and experimental conditions. The different response of SPASS and LAMPAS 2, as reflected in the different abundances of particle classes, indicates the necessity to determine adjustment factors for each instrument, for different particle classes, to enable a direct comparison of quantitative information from such online aerosol mass spectrometers and from bulk analysis. The reported results are an important basis for a general database of single particle spectra, spectral patterns of common and specific particle classes and abundances of these classes for atmospheric aerosols, showing their dependence on particle size, geographic location, meteorological conditions and time of analysis.

During the first Cloud and Aerosol Characterization Experiment (CLACE-1) in February and March 2000 various methods were used to characterize the aerosol at the high-alpine site Jungfraujoch, Switzerland (3580 m asl). One aim of the campaign was to perform the size-resolved chemical analysis of single particles under conditions of the free troposphere in real-time. Evaluation of single particle spectra measured predominantly in the size range between 0.5 and 5 μ m and determination of spectra patterns of the most frequent particle classes showed a great variability ranging from pure carbon particles over carbon particles internally mixed with salts and/or secondary components to mineral dust particles. Such mineral particles sometimes showed internal mixtures with carbon indicating scavenging effects of carbonaceous material by minerals. This can be due to coagulation or condensation of organic molecules on the mineral particles. Observation of internally mixed carbon particles is an indication for atmospheric transformation processes of pure carbon particles. Such internally mixed particles can strongly influence cloud formation due to an increase in particle size and hygroscopicity. High abundance of mineral and carbon-containing particles could be correlated to enhanced light absorption and light scattering coefficients, respectively. Semi-quantitative evaluation of mass spectra using relative sensitivity factors showed comparable ratios of selected ion pairs compared to bulk concentrations determined by ion chromatography.

This prospective study was performed to assess the benefits of magnetic resonance imaging (MRI) compared with plain radiographs in the diagnosis and analysis of transitional fractures in terms of fracture type, anatomy, and dislocation. During a 24-month period, 22 adolescents with a fracture of the distal tibial epiphysis were treated. In addition to plain film radiographs, MR images of the distal tibia were also obtained. Plain film radiographs and MR images were randomized and diagnosed by two surgeons and two radiologists. Fifteen transitional fractures were diagnosed using plain radiographs, while 17 transitional fractures could be found with MRI. Fracture type was misclassified, fracture displacement was underestimated in general, and rotational displacements were not visualized on plain film radiographs. MRI was found to provide anatomic detail and information superior to plain film radiographs.

BACKGROUND The practicability and acceptance of written information about heparin thrombosis prophylaxis and the associated risk of heparin-induced thrombocytopenia (HIT) was evaluated in a pilot study. PATIENTS AND METHODS All patients consecutively admitted to the department of trauma- and reconstructive surgery at the Ernst-Moritz-Arndt-University, Greifswald, Germany, with an indication for heparin thrombosis prophylaxis were give written information about thrombosis prophylaxis and the undesired drug effect HIT. After this, acceptance was evaluated using a standardized questionnaire. Primary endpoint was refusal of heparin for thrombosis prophylaxis, secondary endpoint acceptance and comprehensibility of the information. RESULTS None of the 460 patients included in the study subsequently refused thrombosis prophylaxis with heparin. The majority welcomed the information and thought it should be given to all patients that are about to be treated with heparin. Only 0.9 % of patients judged comprehensibility of the information to be insufficient. Anticipation of imminent heparin therapy (good/very good in 90 %) and appreciation of the quality of care was not judged to be unacceptable by any patient. CONCLUSIONS The present study demonstrates that giving information about heparin-induced thrombocytopenia during explanation of the risks and benefits of heparin thrombosis prophylaxis is feasible. This information--given in writing in our pilot study--was judged by patients to be comprehensible and necessary and did not lead to refusal of treatment. Lower incidence of HIT with use of low molecular weight heparins should be considered in the choice of drug for thrombosis prophylaxis.