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This design-based research study examined the first two cycles of development, enactment, analysis, and redesign of the Power of Data (POD) Facilitation Academy. Professional Learning and D...

This paper reports preliminary yet compelling kinematical inferences for N ~ 600 carbon-rich dwarf stars that demonstrate around 30% to 60% are members of the Galactic halo. The study uses a spectroscopically and non-kinematically selected sample of stars from the SDSS, and cross-correlates these data with three proper motion catalogs based on Gaia DR1 astrometry to generate estimates of their 3-D space velocities. The fraction of stars with halo-like kinematics is roughly 30% for distances based on a limited number of parallax measurements, with the remainder dominated by the thick disk, but close to 60% of the sample lie below an old, metal-poor disk isochrone in reduced proper motion. An ancient population is consistent with an extrinsic origin for C/O >1 in cool dwarfs, where a fixed mass of carbon pollution more readily surmounts lower oxygen abundances, and with a lack of detectable ultraviolet-blue flux from younger white dwarf companions. For an initial stellar mass function that favors low-mass stars as in the Galactic disk, the dC stars are likely to be the dominant source of carbon-enhanced, metal-poor stars in the Galaxy., 7 pages, 1 table, and 3 figures. Accepted to MNRAS

In hot deserts, plants cope with aridity, high temperatures, and nutrient-poor soils with morphological and biochemical adaptations that encompass intimate microbial symbioses. Whereas the root microbiomes of arid-land plants have received increasing attention, factors influencing assemblages of symbionts in above-ground tissues have not been evaluated for many woody plants that flourish in desert environments. We evaluated the diversity, host affiliations, and distributions of endophytic fungi associated with photosynthetic tissues of desert trees and shrubs, focusing on non-succulent woody plants in the species-rich Sonoran Desert. To inform our strength of inference, we evaluated the effects of two different nutrient media, incubation temperatures, and collection seasons on the apparent structure of endophyte assemblages. Analysis of >22,000 tissue segments revealed that endophytes were isolated four times more frequently from photosynthetic stems than leaves. Isolation frequency was lower than expected given the latitude of the study region, and varied among species a function of sampling site and abiotic factors. However, endophytes were very species-rich and phylogenetically diverse, consistent with less-arid sites of a similar latitudinal position. Community composition differed among host species, but not as a function of tissue type, sampling site, sampling month, or exposure. Estimates of abundance, diversity and composition were not influenced by isolation medium or incubation temperature. Phylogenetic analyses of the most commonly isolated genus (Preussia) revealed multiple evolutionary origins of desert-plant endophytism and little phylogenetic structure with regard to seasonality, tissue preference, or optimal temperatures and nutrients for growth in vitro. Together, these results provide insight into endophytic symbioses in desert plant communities, and can be used to optimize strategies for capturing endophyte biodiversity at regional scales.

Endohyphal bacteria (EHB) can influence fungal phenotypes and shape the outcomes of plant-fungal interactions. Previous work has suggested that EHB form facultative associations with many foliar fungi in the Ascomycota. These bacteria can be isolated in culture, and fungi can be cured of EHB using antibiotics. Here, we present methods for successfully introducing EHB into axenic mycelia of strains representing two classes of Ascomycota. We first establish in vitro conditions favoring reintroduction of two strains of EHB ( Luteibacter sp.) into axenic cultures of their original fungal hosts, focusing on fungi isolated from healthy plant tissue as endophytes: Microdiplodia sp. (Dothideomycetes) and Pestalotiopsis sp. (Sordariomycetes). We then demonstrate that these EHB can be introduced into a novel fungal host under the same conditions, successfully transferring EHB between fungi representing different classes. Finally, we manipulate conditions to optimize reintroduction in a focal EHB-fungal association. We show that EHB infections were initiated and maintained more often under low-nutrient culture conditions and when EHB and fungal hyphae were washed with MgCl 2 prior to reassociation. Our study provides new methods for experimental assessment of the effects of EHB on fungal phenotypes and shows how the identity of the fungal host and growth conditions can define the establishment of these widespread and important symbioses.

Fungi interact closely with bacteria, both on the surfaces of the hyphae and within their living tissues (i.e. endohyphal bacteria, EHB). These EHB can be obligate or facultative symbionts and can mediate diverse phenotypic traits in their hosts. Although EHB have been observed in many lineages of fungi, it remains unclear how widespread and general these associations are, and whether there are unifying ecological and genomic features can be found across EHB strains as a whole. We cultured 11 bacterial strains after they emerged from the hyphae of diverse Ascomycota that were isolated as foliar endophytes of cupressaceous trees, and generated nearly complete genome sequences for all. Unlike the genomes of largely obligate EHB, the genomes of these facultative EHB resembled those of closely related strains isolated from environmental sources. Although all analysed genomes encoded structures that could be used to interact with eukaryotic hosts, pathways previously implicated in maintenance and establishment of EHB symbiosis were not universally present across all strains. Independent isolation of two nearly identical pairs of strains from different classes of fungi, coupled with recent experimental evidence, suggests horizontal transfer of EHB across endophytic hosts. Given the potential for EHB to influence fungal phenotypes, these genomes could shed light on the mechanisms of plant growth promotion or stress mitigation by fungal endophytes during the symbiotic phase, as well as degradation of plant material during the saprotrophic phase. As such, these findings contribute to the illumination of a new dimension of functional biodiversity in fungi.

IntroductionElectric indoor lighting can disturb sleep and increase depressive symptoms; both common complaints in psychiatric inpatients.AimsTo improve quality of sleep in patients using an indoor hospital lighting environment simulating nature in intensity, color, and circadian timing.MethodsInvestigator-blinded parallel group randomized controlled effectiveness trial supplied with qualitative interviews in an inpatient psychiatric ward with fully automatic and adjustable lighting. Admitted patients received a room with a naturalistic lighting environment (intervention group) or lighting as usual (control group). The primary outcome was the Pittsburg Sleep Quality Index and secondary outcomes included the Major Depression Inventory and WHO-five Well- Being Index.ResultsIn this ongoing trial, we included 28 patients (16 treated and 12 controls). Patients in the intervention group reported higher subjective sleep quality and sleep efficiency, lower use of sleep medication (mean difference, 4.68 mg; 95% CI, 0.54; 53.5), fewer depressive symptoms (mean difference, 5; 95% CI,–2; 13), but lower well-being (difference,–4 percentage points; 95% CI,–20; 16), compared with the control group. At discharge, fewer patients in the intervention group had experienced use of involuntary treatment. Qualitative data indicated no side effects apart from issues in performing indoor leisure activities in dim light.ConclusionsA naturalistic lighting environment was safe and improved sleep and mood in our small patient sample. The trial integrated well with routine clinical care and our sample reflected the heterogeneity of the target population (Funded by Region Midtjylland and others; Clinicaltrials.gov number, NCT02653040)Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)-infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%-9.5%) in 2008-2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected. © The Author 2015.

Objectives: The objective of this study was to define the natural genotypic variation of the HIV-1 integrase gene across Europe for epidemiological surveillance of integrase strand-transfer inhibitor (InSTI) resistance. Methods: This was a multicentre, cross-sectional study within the European SPREAD HIV resistance surveillance programme. A representative set of 300 samples was selected from 1950 naive HIV-positive subjects newly diagnosed in 2006-07. The prevalence of InSTI resistance was evaluated using quality-controlled baseline population sequencing of integrase. Signature raltegravir, elvitegravir and dolutegravir resistance mutations were defined according to the IAS-USA 2014 list. In addition, all integrase substitutions relative to HXB2 were identified, including those with a Stanford HIVdb score=10 to at least one InSTI. To rule out circulation of minority InSTIresistant HIV, 65 samples were selected for 454 integrase sequencing. Results: For the population sequencing analysis, 278 samples were retrieved and successfully analysed. No signature resistance mutations to any of the InSTIswere detected. Eleven (4%) subjects hadmutations at resistance-associated positions with an HIVdb score =10. Of the 56 samples successfully analysed with 454 sequencing, no InSTI signature mutationsweredetected, whereas integrase substitutionswithanHIVdbscore=10were found in8(14.3%) individuals. Conclusions:No signature InSTI-resistant variantswere circulating in Europe before the introduction of InSTIs. However, polymorphisms contributing to InSTI resistancewere not rare. As InSTI use becomes more widespread, continuous surveillance of primary InSTI resistance is warranted. These data will be key to modelling the kinetics of InSTI resistance transmission in Europe in the coming years. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Background: One out of ten newly diagnosed patients in Europe was infected with a virus carrying a drug resistant mutation. We analysed the patterns over time for transmitted drug resistance mutations (TDRM) using data from the European Spread program.Methods: Clinical, epidemiological and virological data from 4317 patients newly diagnosed with HIV-1 infection between 2002 and 2007 were analysed. Patients were enrolled using a pre-defined sampling strategy.Results: The overall prevalence of TDRM in this period was 8.9% (95% CI: 8.1-9.8). Interestingly, significant changes over time in TDRM caused by the different drug classes were found. Whereas nucleoside resistance mutations remained constant at 5%, a significant decline in protease inhibitors resistance mutations was observed, from 3.9% in 2002 to 1.6% in 2007 (p = 0.001). In contrast, resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) doubled from 2.0% in 2002 to 4.1% in 2007 (p = 0.004) with 58% of viral strains carrying a K103N mutation. Phylogenetic analysis showed that these temporal changes could not be explained by large clusters of TDRM.Conclusion: During the years 2002 to 2007 transmitted resistance to NNRTI has doubled to 4% in Europe. The frequent use of NNRTI in first-line regimens and the clinical impact of NNRTI mutations warrants continued monitoring. © 2014 Frentz et al.; licensee BioMed Central Ltd.

The choice of a reactor concept is vital for the success of a research project in plasma-enhanced chemical vapour deposition (PECVD). Two reactor designs are introduced. The so-called remote PECVD (RPECVD) design is characterized by the separation of the plasma from the reaction zone. The moving electrode (ME) concept incorporates a paralle plate reactor with adjustable electrode spacing. Examples are presented to demonstrate applications of the two concepts. Evaluation of a new precursor for Si-X (X = C, N x , O 2 , etc.) films is accomplished with RPECVD. RPECVD is also suitable for the treatment of sensitive substates (III–V) semiconductors, plastics). In turn, ME-PECVD should be destined for purposes where two or more process steps have to be combined. An example is proposed with a novel intermetal dielectric process.

Gallstones accompanied by dyspeptic symptoms, were long not considered to be silent. The complaints were thought to be caused by the gallstones, and were termed gallstone dyspepsia. Up to 47% of all cholecystectomies are performed for dyspeptic symptoms. Numerous control studies have, however, all demonstrated that dyspeptic symptoms in stone carriers and controls with no gallstones occur with equally frequency, and that it is not possible to differentiate gallstone-specific dyspepsia. The frequent concomitance of dyspepsia and gallstones, is coincidental, and there is no causality involved. Thus, gallstones accompanied by dyspepsia must be considered silent stones. Not the silent gallstone, but gallstone dyspepsia is the myth.

Experiences with medical and surgical treatment modalities in 13 patients with a sporadic ZES, followed up for 1-16 yrs., are presented. Gastric hypersecretion can effectively be controlled by H2-blockers or Omeprazol. Insufficiently adjusted drug dose and drug effect escape are the main reasons of complications from insufficiently suppressed gastric hypersecretion. A tumor-like lesion could be detected by angiography in 8 and by CT scanning in 6 out of 9 patients, US was of no use in detecting solitary adenomas. 8 patients underwent surgery for tumor resection, 4 could be cured definitely with a non-metastatic primary adenoma in the pancreas (2), the liver (1) and a peripancreatic lymphnode (1). Gastrin-producing endocrine tumors as the cause of an unusually virulent ulcer disease due to excessive gastric hypersecretion were first described by Zollinger and Ellison nearly 30 years ago. Albeit rare, they deserve our special attentiveness because they pose specific therapeutic problems unknown in common peptic ulcers and other kinds of tumors. Because the patients are, above all, endangered by their ulcer complications, management of patients with Zollinger-Ellison-Syndrome (ZES) has to aim first and foremost at eliminating the excessive gastric hypersecretion and only secondly at removing the hormonproducing tumor. Management of patients along these guidelines has changed decisively during the last years: Previously, elimination of gastric hypersecretion was only achieved by total gastrectomy, whereas now gastric acid excess can effectively be controlled by antisecretory drugs. More over, being no longer under deadline pressure by ulcer complications and having improved imaging techniques at our disposal search for gastrinomas has become more successful.(ABSTRACT TRUNCATED AT 250 WORDS)

The radio horizon of satellite signals for an observer on earth is measured with a satellite of 780-km average altitude and a beacon frequency of 108 Mc/s. The analyzed data consist of measurements from 295 orbits from July 13, 1961, to December 4, 1961. The statistical distribution of radio horizon data differs considerably from the geometric horizon and from the radio horizon calculated to allow for refraction effects using an equivalent radius of 4/3 the earth's radius. The observed radio horizon depends on seasonal changes as well as on the topographical regions along which the radio waves travel when the satellite is at low elevation. During summer the data are sporadic, in contrast to fall and winter when the data are more uniform. The either sporadic or uniform nature of the data is ascribed to the seasonal variation of the ionosphere. However, whereas the average radio horizon along sea is at all times longer than the corresponding geometric horizon by approximately 300 miles, the one along land was always found to be considerably shorter during the summer and late fall and only slightly longer during the winter. The lengthening along sea goes beyond the radio horizon calculated with 4/3 the earth's radius. It is suggested that a tropospheric duct, facilitated by the Gulf stream near our station and greater abundance of water vapor above sea, is responsible for lengthening the radio horizon along sea.

Ionograms of the topside ionosphere obtained from the Alouette satellite during a period of more than a year have been reduced to ‘real height’ profiles. Data obtained between September 1963 and January 1964 have been studied in detail. The effective radio horizon of Fort Monmouth enables a study of the upper ionosphere between 15° and 65°N geographic latitude and 50° and 100°W longitude. Curves of plasma frequencies and of electron density at fixed altitudes have been prepared as a function of latitude, longitude, and time of day. Special attention has been given to the effects of magnetic disturbances as revealed on the contours. During the observed magnetic storms, the measured altitudes for specific plasma frequencies were decreased by more than 200 km. Another parameter, the integrated electron content in the topside ionosphere, has been compared with ƒoF2. The assistance of five bottomside sounding stations located within the radio horizon of Fort Monmouth and computer programs for reducing topside and bottomside ionograms to real height profiles made it possible to study the difficulties in matching topside and bottomside profiles. Many topside and bottomside profiles have been found to match closely when the observed ƒoF2 values of topside and bottomside ionograms differ by not more than 0.3 Mc/s. Matching was observed for differences of 1° to 2° of the geographic positions of the ground station and the subsatellite point. Discrepancies on topside and bottomside ionograms (different geographic locations, nonmatching ƒoF2) are exhibited.

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In a patient with long-standing iron deficiency anemia, diffuse gastric antral vascular ectasia was found endoscopically. Diagnostic problems were the misinterpretation of the macroscopic finding as hemorrhagic inflammation and the microscopic confirmation of the diagnosis from small biopsy particles. Resection of the antrum resulted in a persistent normalization of hematologic parameters. Focal ischemia due to microthrombi in mucosal vessels might be the cause of the tendency of this vascular malformation to bleed.

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IONOSPHERIC perturbations observed at Fort Monmouth, New Jersey, over a distance of more than 1,200 km following the launch of Apollo 14 were attributed1 to the arrival of an atmospheric shock front which splits2 at ionospheric heights into ion acoustic and normal acoustic modes. An opportunity to repeat these observations was provided by the launching of Apollo 15 on July 26, 1971, at 0834 EST. Ionograms were taken at our station (74: 07:52 W longitude; 40:23:25 N latitude). Ionograms taken simultaneously at Wallops Island (75:29 W longitude; 37:51 N latitude) were made available by courtesy of National Oceanic and Atmospheric Administration (NOAA). We converted all ionograms to true-height.

Comparison of Experimental Data of the Effective Ion Mass in the Upper Ionosphere with a Theoretical Structure

SATELLITE communications systems using the UHF range are subject to fading along the transionospheric path. These fadings are of the same nature as the amplitude scintillations which were first known from radio star observations. They are caused by irregularities of the electron distribution which varies in space and time.

WHEN considering ionospheric sunrise effects one must remember that the light of sunrise at a specific ionospheric height has been filtered through the entire atmosphere before reaching a point of ground sunrise; also the light has had the filtering action of the air between the point of ground sunrise and the westward point at that ionospheric altitude. Thus the ionization power of solar radiation at high altitudes is reduced to mere heat effects during the time before ground sunrise. In this respect, vibrational excitation1 may have to be considered, but specifically at lower altitudes. Furthermore, existing drifts in the ionosphere, such as winds and waves in the neutral gas as well as electron and ion fluxes, have some influence. A downward electron flux is typical for a period after midnight or before dawn2. During winter, an arrival of electrons from the conjugate ionosphere (which is in summer and has an earlier sunrise) may play a part by increasing the pre-sunrise ion and electron temperatures especially at European mid-latitudes3. Finally, the diurnal cycle of the ionospheric motions, that is the downward move of the F-region maximum from an altitude of 400 km before sunrise to an altitude of 250 km after sunrise, has to be considered (H. F. Bates in a paper read to the US URSI spring meeting in 1968). Together, these effects are likely to produce a turbulent motion within the ionosphere at a specific point of first illumination.

Defects of the ANF system in cirrhosis have not been demonstrated in terms of absolute deficiency of plasma levels or by evidence of major abnormalities of processing in patients with cirrhosis. In the present study, the responsiveness of the ANF system to acute volume stimulation by water immersion and the diuretic and natriuretic effects of ANF infusion were examined. Stimulation of ANF release by 1-h immersion was significantly blunted in ten cirrhotic patients with ascites (increase of plasma ANF by 46 +/- 18%), whereas 11 cirrhotics without ascites showed a 104 +/- 16% increase, similar to the 117 +/- 29% stimulation in 25 healthy controls. Immersion increased urinary volume by 3.6 +/- 0.6/2.0 +/- 0.8/0.7 +/- 0.4 ml/min and urinary sodium excretion by 146 +/- 38/75 +/- 43/43 +/- 19 mumol/min in controls/cirrhotics without/cirrhotics with ascites. Infusion of ANF for 30 min prompted an increase in diuresis and natriuresis in seven cirrhotic patients, which was less marked in patients with ascites, as compared to patients without ascites. Thus, the stimulus response coupling for ANF may be impaired in patients with cirrhosis and ascites.

Through a survey 751 patients, in whom an endoscopic papillotomy (EPT) had been tried, were registered to the end of 1981. EPT was technically successful in 695 cases (92,5%). Control investigations were available for 650 patients, the aim of therapy being achieved in 594 cases (91,4%). The main indication was choledocholithiasis, 90,2%--among them 10% with gallbladder in situ--followed by benign papillary stenosis without stones (5,9%), carcinoma of the Vaterian papilla (3,2%) and rare indications such as ascaridiasis, choledochocele and stones of the pancreatic duct (0,7%). 53 patients suffered from more serious complications (7,6%), 18 had to be operated on (2,6%), and 7 patients died due to EPT (1%). The results are in agreement with those of other statistics from various countries.

Continuous pH measurements were undertaken on 15 patients for the study of gastrooesophageal reflux during 12 hours after ingestion of test meals of protein, fat and carbohydrate. During 4 hours reflux has been increased by the different diets to similar extents.

In a short survey recent results of research on gastrin are presented. Special stress is laid upon the mechanism of liberating gastrin, the role of the vagus in this process and the consequences of gastric surgery on serumgastrin. In clinical practice the differential diagnosis of hypergastrinemia in ulcer disease is very important, for it will have a decisive influence on the therapeutic decisions and the specific kind of surgical treatment.

Plasma concentrations of 5-(2-chlorophenyl)-7-ethyl-1,3-dihydro-1-methyl-2H-thieno[2,3-e][1,4]diazepin-2 -one (clotiazepam, CTZ, Trecalmo), a thienodiazepine anti-anxiety agent, and two of its metabolites (hydroxy- and desmethyl-clotiazepam) are reliably quantified by electron capture GLC. After addition of diazepam as internal standard, 1-ml plasma samples are extracted with benzene-isoamyl alcohol (98.5:1.5). The organic extract is evaporated to dryness, reconstituted, and directly chromatographed using a 3% SP-2250 liquid phase at 260 degrees C. Sensitivity limits are 1-3 ng of each of the 3 compounds per ml of plasma. The method is applicable to clinical pharmacokinetic studies in humans. After p.o. ingestion of a single 5-mg dose of clotiazepam by three healthy volunteers the drug was rapidly absorbed. Values of elimination half-life were 6.5, 7.0, and 17.8 h, respectively. The two metabolites appeared and disappeared approximately in parallel with the parent compound. Clotiazepam was more than 99% bound to plasma protein.

During the last years the non-surgical drainage of the bile ducts developed to an efficient treatment method and is a real enrichment in the concept of treatment of the malignant obstruction of the bile ducts. In no more radically operable carcinomas in the area of the bile ducts, the pancreas or the porta of the liver it is to be preferred to a palliative drainage operation. In case the drainage of the bile ducts shall not be used therapeutically (through-drainage), an inner drainage in form of an endoprosthesis should always be preferred. As a procedure of the 1st choice the endoscopic retrograde technique is recommended, as procedure of 2nd choice the percutaneous transhepatic technique. Benign basic diseases are more infrequently the reason for the insert of a bile duct drainage. The main indications are general inoperability in non-extractable calculi in the common bile duct. In our own cases patients could be followed up up to 3.5 years. No complications were observed. The occlusion of prostheses does apparently not play a role.

In the clarification of circumscribed processes in stomach and duodenal bulb radiodiagnostics and endoscopy supplement themselves in an ideal way. The endoscopy seems to have advantages in recognition and explanation of findings on the cardial and subcardial parts of the stomach as well as on the operated stomach. Deformation of the duodenal bulb and changes of the post-stenotic parts can be better judged radiologically. The complete healing of an ulcer is exactly recognisable only by means of endoscopy. Linear ulcers are often not to be seen in radiodiagnostics. With the help of the aimed biopsy the decision on benignity or malignity of the ulcerating process has become easier. Every radiologically not certainly explainable findings and every discrepancy between X-ray picture and complaints of the patients should bring about an endoscopic examination.

The pathological stereotypies frequently observed among severely mentally retarded and autistic persons are highly rhythmical in nature. Most attempts to quantify such behavior, however, have not analyzed stereotypy in terms of its cyclical properties. In the present paper we have detailed a method for electronically transducing stereotyped body-rocking and analyzing its frequency and amplitude characteristics with a standard polygraph and microprocessor. The relationship between stereotyped body-rocking and cardiac activity was also described using time-series analysis. The method described should provide a sensitive index of various experimental manipulations and treatment effects.

In 62 cadaver-donor-allograft recipients we observed 11 times gastrointestinal complications 7 times (11%) an ulcer or an erosion of the mucous membrane could be secured gastroscopically. The therapeutic remedy of choice seems to be the well-timed 2/3-resection after Billroth II, since a too long hesitation increases the number of complications, has a negative influence on the choice of the intervention and increases the lethality.