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In freshwater ecosystems in the northwest United States, the distribution and movements of fish between their essential habitats are particularly impacted by the presence of hydroelectric dams. Bull Trout Salvelinus confluentus and Westslope Cutthroat Trout Oncorhynchus clarkii var. lewisi are two fish species of concern inhabiting the Pend Oreille River between Idaho and Washington states. The purpose of this study was to identify the behavior and habitat use of Bull Trout and Westslope Cutthroat Trout in the restricted area of the Pend Oreille River, downstream of Albeni Falls Dam (AFD), using a long-term radio-telemetry dataset. Between 2015 and 2018, 24 Bull Trout and 24 Westslope Cutthroat Trout were captured, tagged, and released downstream AFD. Among the fish tagged, 79% (n = 19 of 24) of Bull Trout and 67% (n = 16 of 24) of Westslope Cutthroat Trout were detected during the study period. Our results revealed movements of fish towards tributary confluences mostly in May, June, and July for both species with Bull Trout traveling longer distances than Westslope Cutthroat Trout. Although the sample size was limited, Bull Trout individual movements towards the dam suggested attempts to re-ascend the river, indicating the importance of restoring upstream connectivity.

A new genus, Mystocestus, is proposed to accommodate a new species, Mystocestus anindoi n. g., n. sp. from Mystus vittatus (Bloch) (type host) in West Bengal and Mystus cavasius (Hamilton) (Siluriformes: Bagridae) in Maharashtra, India. The new genus is most similar to Lucknowia Gupta, 1961 in the shape of the body, which is elongate, slightly tapering towards the anterior end, and scolex, which is digitiform, but differs in the shape of the ovary, which is H-shaped (vs. inverted A-shaped in Lucknowia), the absence of a seminal receptacle (present in Lucknowia) and exclusively cortical vitelline follicles (vs. some follicles in the medulla in the latter genus). Molecular data support the erection of the new genus and place it close to Bovienia Fuhrmann, 1931, species of which can be easily distinguished by exclusively lateral vitelline follicles (lateral and median in the new genus), the presence of a seminal receptacle (absent in Mystocestus) and scolex shape (digitiform, with blunt or slightly concave anterior edge in the new genus vs. small, unspecialized or spatulate in Bovienia). The convoluted taxonomy of tapeworms placed in Mystoides Mathur, 1992 is critically reviewed to clean up taxonomic chaos in Indo-Malayan caryophyllideans. Mystoides was erected in an unpublished PhD thesis and thus its generic name becomes unavailable and also, its type species is conspecific with Lucknowia fossilisi Gupta, 1961 from the stinging catfish, Heteropneustes fossilis (Bloch). Other species of this genus are also conspecific with L. fossilisi. In addition, specific names of most of these taxa are unavailable because they were described in unpublished theses or conference abstracts. Based on recent revisions of Indo-Malayan caryophyllideans, the following nine genera with 15 species are considered valid (numbers of species of individual genera are provided in parentheses): Bovienia (3), Djombangia (1), Lucknowia (2), Lytocestus (2), Mystocestus (1), Pseudocaryophyllaeus (2) (all family Lytocestidae); Adenoscolex (1), Lobulovarium (2), Paracaryophyllaeus (1) (all family Caryophyllaeidae).

Cosmetocleithrum Kritsky, Thatcher & Boeger, 1986 (Dactylogyridae) represents one of the most species-rich groups (22 species currently recognized as valid) of all dactylogyrid parasites infecting Neotropical catfishes. Species of Cosmetocleithrum exhibit a remarkable affinity towards catfishes of the Doradidae and the Auchenipteridae. However, phylogenetic relationships between members of this genus have not been yet analysed. This study analysed newly obtained partial sequences of the 28S ribosomal RNA gene of seven species of Cosmetocleithrum, including its type species C. gussevi Kritsky, Thatcher & Boeger, 1986, along with several other dactylogyrids infecting siluriform, gymnotiform, perciform and characiform fishes. Cosmetocleithrum appeared as an evolutionary recent group, composed of two well-defined lineages: lineage 1 includes parasites of doradids – namely, C. bulbocirrus, C. confusum, C. parvum and C. bifurcum – whereas lineage 2 is composed of species from doradids – that is, C. rarum, C. gussevi, C. gigas, C. trachydorasi and C. falsunilatum – together with parasites of auchenipterids – namely, C. laciniatum and C. baculum. The search for synapomorphies to characterize taxonomic groups within Cosmetocleithrum appears challenging, since the morphology of their haptoral elements is quite conservative, and that of the copulatory complex is highly variable between species. The results of the present study support the recent synonymization of Paracosmetocleithrum Acosta, Scholz, Blasco-Costa, Alves & Silva, 2018 with Cosmetocleithrum. Whereas the 28S ribosomal DNA data resolved Cosmetocleithrum as monophyletic, the statistical support for the lineage was low, rendering its phylogenetic position between other Neotropical dactylogyrids yet undefined.

Kidney transplantation (Ktx) in elderly has become increasingly accepted worldwide despite their higher burden of comorbidities. We investigated important risk factors affecting long-term patient and graft survival. We included all (n = 747) Ktx patients >60 years from 2000 to 2012 in Sweden. Patients were age-stratified, 60-64, 65-69 and >70 years. Follow-up time was up to 10 years (median 7.9 years, 75% percentile >10 years). Primary outcome was 10-year patient survival in age-stratified groups. Secondary outcomes were 5-year patient and graft survival in age-stratified groups and the impact of risk factors including Charlson comorbidity index (CCI) on patient and graft survival. Mortality was higher in patients >70 years, after 10 years (HR 1.94; 95% CI 1.24-3.04; P = 0.004). Males had a higher 10-year risk of death (HR 1.39; CI 95% 1.04-1.86; P = 0.024). Five-year patient survival did not differ between age groups. In multivariate Cox analysis (n = 500), hazard ratio for 10-year mortality was 4.6 in patients with CCI >= 7 vs. Funding Agencies|ChiesiChiesi Pharmaceuticals Inc; Stiftelsen for njursjuka and Njurforbundet

Knowledge of the parasite fauna of Australian freshwater fish is fragmentary and incomplete. An understanding of fish hosts and their associated parasites is vital for the successful management of aquatic ecosystems. In this study, we surveyed the parasite fauna of carp gudgeons (Hypseleotris spp.), a complex of species of Australian freshwater fishes, using morphology and molecular data for the 18S and 28S ribosomal RNA genes. We examined 137 individuals of three different taxa in the carp gudgeon species complex and found 16 parasitic taxa of the Digenea, Cestoda, Nematoda and Arthropoda (five adults and 11 larvae). Eleven parasites are reported for the first time from the carp gudgeons (Pseudodactylogyrus sp., Gyrodactylus sp., Clinostomum sp., Paradilepis patriciae, P. cf. kempi, two unidentified species of Paradilepis, Dendrouterina sp., Parvitaenia sp., two lineages of Cyclophyllidea gen. sp., Procamallanus sp., larvae of a spirurine nematode and Lernaea sp.), in addition to Apatemon cf. hypseleotris Negm-EldinDavies, 2001 and the invasive tapeworm Schyzocotyle acheilognathi (Yamaguti, 1934), which were previously reported from these fish hosts. Parasite species richness was double in Lake's and Midgley's carp gudgeons relative to western carp gudgeon. These findings highlight the key role of carp gudgeons as intermediate hosts for multiple parasites with complex life cycles using native birds as definitive hosts and the usefulness of DNA data for the identification of parasite larvae.

The incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33%. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008-2013), we implemented peri- and postoperative preventive measures and compared the results with the recent patient cohort (2014-2016).The records of 356 patients (712 mastectomies) were retrospectively reviewed. We compared the first cohort (C1, 01/2008 - 12/2013, 346 mastectomies; peri- and postoperative standard procedure and implementation of an algorithmic care path in our institution) with the recent cohort (C2, 01/2014 - 01/2016, 366 mastectomies) and introduced in C2 the following preventive measures: perioperative administration of tranexamic acid, intraoperative elevation of blood pressure to at least 120 mmHg before wound closure, bedrest and consequent wearing of compression bandage without removal 12 hours postoperatively. Comparison of complication rate, patient satisfaction and secondary revision rate was obtained in both cohorts.The mean operation time could be reduced from 103.6 minutes to 72.5 minutes (p 0.05). The overall complication rate could be diminished from 11.8% to 5.5% (p 0.05), the acute hematoma revision rate from 9.2% to 4.1% (p 0.05). Secondary revisions were similar in both patient cohorts. Patient satisfaction rate was ameliorated from 88% to 93.5% "very satisfied" to "satisfied" patients.Hematoma is the most common reason for reoperation in FTMTS patients. By implementation of peri- and postoperative preventive measures and additional application of an algorithmic care path we could achieve a significant reduction of complications, particularly of the hematoma evacuation rate. During 8 years clinical and operative treatment in FTMTS we could furthermore achieve a decrease in operative time and an ameliorated patient satisfaction with the aesthetic results.

Zusammenfassung Hintergrund Eine Mastopexie nach massivem Gewichtsverlust stellt eine besondere Herausforderung in der Mammachirurgie dar. Der Brusthügel ist oft stark abgeflacht mit reduzierter Hautqualität. Die chirurgische Vorgehensweise basiert in erster Linie auf einer Umformung des Drüsengewebes statt auf einer Straffung des Hautmantels. Publizierte Techniken beinhalten eine Plikation, Suspension und Autoaugmentation. Das vorhandene ortsständige Gewebe (Brustdrüse, Fettgewebe, Dermofettlappen) wird vollumfänglich verwendet mit dem Ziel, eine Brust mit stabiler Projektion nachhaltig zu formen. Die Entwicklung einer solchen Technik wird präsentiert. Patienten und Methoden Es handelt sich um eine retrospektive Analyse von 68 Patientinnen (136 Brüste), bei denen eine modifizierte Ribeiro-Technik mit superomedialer Mamillenstielung durch eine Suspension mit einem inferioren dermoglandulären Lappen durchgeführt wurde. Darüberhinaus beinhaltet die vorgestellte Technik eine Einbeziehung der lateralen Interkostalarterien-Perforatorlappenplastik (LICAP flap) sowie des medialen Brustpfeilers als zusätzliche Volumengewinnung zum Ribeiro-Lappen. Dies trägt wesentlich zur Autoaugmentation des oberen Brustpols bei, führt zur Verschmälerung der verbreiterten Brust, bildet einen internen BH und redefiniert die Inframammärfalte. Die Ergebnisse zur Komplikationsrate, Patientenzufriedenheit, Brustwarzensensibilität und Korrekturrate wurden überprüft. Ergebnisse Von 01/2011–12/2016 führten wir 136 Auto-Augmentationsmastopexien durch. Das Durchschnittsalter betrug 41,2 Jahre, der durchschnittliche Body-Mass-Index (BMI) war 27,1 kg/m2, der durchschnittliche Gewichtsverlust war 54,3 kg, der durchschnittliche Mamillen-Jugulum-Abstand war 32,3 cm, die durchschnittliche OP-Dauer betrug 109 Minuten. Bei 12 Brüsten erfolgte eine freie Brustwarzentransplantation. Die Komplikationsrate lag bei insgesamt 5,1 %, die Korrekturrate bei 17,6 %. 95 % der Patientinnen waren „sehr zufrieden“ bis „zufrieden“ mit dem ästhetischen Ergebnis bei in 85 % „sehr gut“ bis „gut“ erhaltener Brustwarzensensibilität. Fazit Die Modifikation der Ribeiro-Technik mit zusätzlicher Anwendung der medialen und lateralen Brustanteile (LICAP flap) erlaubt eine Autoaugmentation des oberen Brustpols bei Patientinnen nach massivem Gewichtsverlust. Die Brustumformung durch Raffung und Suspension des residualen Brustgewebes soll die Langzeitformstabilität der Brust verbessern und die Inzidenz einer erneuten Ptosis verringern. Die präsentierte Vorgehensweise stellt eine reproduzierbare, verlässliche Methode mit geringer Komplikationsrate dar.

Zusammenfassung Hintergrund Eine Mammareduktionplastik bei Gigantomastie stellt eine Herausforderung in der Mammachirurgie selbst bei sehr erfahrenen plastischen Chirurgen dar. Extrem lange Mamillenstiele beeinträchtigen die Blutversorgung des Mamillenareolenkomplexes. Der massiv gedehnte Hautmantel erschwert die Brustformung und effektive Reduktion. Die Ribeiro-Technik stellt einen etablierten Standard zur Mammareduktion in unserer Klinik dar. Ziel der Studie war ein Review unserer Vorgehensweise bei Gigantomastie im Vergleich mit der aktuellen Literatur. Patienten und Methoden Im Zeitraum von 01/2009–12/2016 erfolgten in unserer Klinik bei 760 Patientinnen 1247 Mammareduktionsplastiken. In 294 Reduktionen (23,6 %) war das Einschlusskriterium der Gigantomastie (Resektionsgewicht > 1000 g pro Brust) erfüllt. Die Technik nach Ribeiro mit superomedialer Mamillenstielung und Bildung eines inferioren dermoglandulären Lappens zur Auffüllung des oberen Brustpols und Prävention eines bottoming outs wurde als Standard implementiert. Bei Patientinnen mit einem Mamillen-Jugulum-Abstand von > 40 cm erfolgte eine freie Brustwarzentransplantation. Die Outcome-Parameter Komplikationsrate, Patientenzufriedenheit, Brustwarzensensibilität und Notwendigkeit einer Korrekturoperation wurden retrospektiv überprüft. Ergebnisse Bei 174 Patientinnen erfolgten 294 Mammareduktionsplastiken mit mehr als 1000 g pro Brust. Das Resektionsgewicht lag im Mittel bei 1389,6 g pro Brust (1000–4580 g). Das Durchschnittsalter betrug 43,5 (18–76) Jahre, der durchschnittliche Body-Mass-Index (BMI) war 29,2 (19–40) kg/m2, der durchschnittliche Mamillen-Jugulum-Abstand war 34,8 (27–52) cm, die durchschnittliche OP-Dauer betrug 117 (72–213) Minuten. Bei 30 Reduktionen erfolgte eine freie Brustwarzentransplantation. Die Komplikationsrate lag bei insgesamt 7,8 %. Korrekturoperationen erfolgten in 16 %. 93 % der Patientinnen waren „sehr zufrieden“ bis „zufrieden“ mit dem ästhetischen Ergebnis bei in 88 % „sehr gut“ bis „gut“ erhaltener Brustwarzensensibilität. Fazit Bei der Ribeiro-Technik handelt es sich um eine gut etablierte, vielseitig einsetzbare Standardtechnik zur Mammareduktion, die reproduzierbare, formstabile Ergebnisse in hoher Qualität liefert. Bei Patientinnen mit Gigantomastie stellt dieses Verfahren ebenso eine effektive komplikationsarme Methode dar, um eine Volumenreduktion mit ästhetisch sehr zufriedenstellenden Ergebnissen zu erreichen.

OBJECTIVE: The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). SUMMARY AND BACKGROUND DATA: Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov: NCT00355862), the effect of sirolimus on the recurrence of HCC after LT was investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was not met, outcomes were improved for patients in the sirolimus-treatment arm in the first 3 to 5 years. To learn more about the key variables, a multivariate analysis was performed on the SiLVER-trial data. PATIENTS AND METHODS: Data from 508 patients of the intention-to-treat analysis were included in exploratory univariate and multivariate models for overall survival (OS), DFS and a competing risk analysis for HCC recurrence. RESULTS: Sirolimus use for ≥3 months after LT for HCC independently reduced the hazard for death in the multivariate analysis [hazard ratio (HR): 0.7 (95% confidence interval, CI: 0.52-0.96, P = 0.02). Most strikingly, patients with an alpha-fetoprotein (AFP) ≥10 ng/mL and having used sirolimus for ≥3 months, benefited most with regard to OS, DFS, and HCC-recurrence (HR: 0.49-0.59, P = 0.0079-0.0245). CONCLUSIONS: mTOR-inhibitor treatment with sirolimus for ≥3 months improves outcomes in LT for HCC, especially in patients with AFP-evidence of higher tumor activity, advocating particularly for mTOR inhibitor use in this subgroup of patients. CLINICAL TRIAL REGISTRATION: EudraCT: 2005-005362-36 CLINICALTRIALS.GOV:: NCT00355862. ispartof: ANNALS OF SURGERY vol:272 issue:5 pages:855-862 ispartof: location:United States status: published

Acanthogyrus (Acanthosentis) maroccanus (Dollfus, 1951), an insufficiently described quadrigyrid acanthocephalan of cyprinid fishes from Northwest Africa, is redescribed based on recently collected specimens from the Algerian barb Luciobarbus callensis (Valenciennes) in Algeria. Newly observed morphological features for A. (A.) maroccanus include the arrangement of proboscis hooks (not in regular circles), the male reproductive structures extending into the copulatory bursa and the presence of a para-receptacle structure and vaginal sleeve. The mechanism of copulation of this acanthocephalan is described based on several copulating pairs. The phylogenetic position of A. (A.) maroccanus within Eoacanthocephala was assessed based on partial 28S rDNA sequences. Maximum likelihood and Bayesian inference analyses placed A. (A.) maroccanus in a clade with Palliolisentis (Demidueterospinus) ophiocephalus (Thapar, 1931), both species included in the Quadrigyridae, the only family within the Gyracanthocephala.

Eine allgemein gultige Definition der pulmonalen Hyperinflation gibt es nicht. Es sollten stets sowohl lungenfunktionelle als auch typische klinische Zeichen beachtet werden. Bei erhohtem Residualvolumen (RV) und normwertiger totaler Lungenkapazitat (TLC) spricht man von einer relativen Uberblahung, bei zusatzlich erhohter TLC von einer absoluten Uberblahung. Zudem wird die statische von der dynamischen Hyperinflation unterschieden. Die statische Hyperinflation ist charakterisiert durch eine chronische Destruktion des Lungengewebes und Abnahme der Lungenelastizitat. Die dynamische Hyperinflation ist situationsabhangig, beispielsweise im Rahmen einer korperlichen Belastung oder eine Exazerbation, und spielt eine entscheidende Rolle in der Pathophysiologie der chronisch obstruktiven Atemwegserkrankungen. Der wichtigste lungenfunktionelle Parameter ist die funktionelle Residualkapazitat (FRC) und beschreibt die Luftmenge, welche nach der normalen Ausatmung in den Lungen verbleibt. Die FRC kann mittels Ganzkorperplethysmographie, Auswasch- oder Dilutionsmethode gemessen werden. Die verschiedenen Methoden konnen zu abweichenden Ergebnissen fuhren. Dies sollte daher unbedingt bei der Interpretation und Dokumentation berucksichtigt werden.

This article studies factors affecting how policy actors perceive the effectiveness of political institutions involved in complex water governance systems. The ecology of games framework argues that participants are more likely to perceive institutions as effective when the benefits of solving collective action problems outweigh the transaction costs of developing political contracts within these institutions. The authors hypothesize that transaction costs are a function of conflict, type of participation, political knowledge, scientific knowledge, and actor resources. Survey results suggest that the importance of these different sources of transaction costs varies across study sites in the Tampa Bay watershed in Florida, the Sacramento–San Joaquin River delta in California, and the Parana River delta in Argentina. Based on the observed differences, some initial ideas are sketched about the evolution of complex governance systems from fairly simple and informal rules and networks to well-established tapestries of many formal institutions.

Methods for observing policy networks have not kept up with the development of new network analytic techniques required to understand governance in complex settings. We compare three unobtrusive methods for observing policy networks based on hyperlinks between policy actor web sites, on media reports, and on public policy partnerships. Observations of one complex local water policy arena with all three methods provide a comparison of the general as well as actor-specific network characteristics in the three observed networks. The core network of actors observed by all methods has similar network level statistics, highly correlated relationships measured by Quadratic Assignment Procedures models, and the same significant network microstructures as measured by Exponential Random Graph Models. The full networks including actors observed by any method also exhibit similar actor-level characteristics, although the correlations across networks are stronger for bridging capital measures than for bonding capital measures, and each method has different apparent biases. Once biases are accounted for, similarities suggest that these methods may provide useful proxies for each other and for other relationships that are more difficult or impossible to measure, particularly when combined to offset each method's biases. If so, they can extend the range of policy networks observable with limited resources across space and time.

The interaction between the vapor plume and the incident laser radiation affects remote laser welding. Relating to laser systems with an emitted wavelength around 1 μm, a significant loss mechanism can be traced back to the extinction by laser-induced particle formation. Due to the tight coupling between the particle formation and the evaporation rate inside the keyhole, the particle formation shows a strong dependence on the keyhole geometry and thus on process parameters (e.g. feed rate and laser beam power). In order to verify the relationship between particle formation and process parameters, the beam of a broadband LED was guided through the vapor plume during the welding processes with a fiber laser. The attenuated probe beam was analyzed in dependence on the wavelength. In addition, the propagation of the vapor plume was investigated by using high speed imaging.

ZusammenfassungAngeborene Thrombozytopathien sind komplexe Erkrankungen. Zur optimalen Blutungsprophylaxe und -behandlung empfehlen wir eine Abklärung und Diagnose der zugrunde liegenden Funktionsstörung. Dazu steht eine interdisziplinäre Leitlinie zur Verfügung (AWMF # 86–003 S2K; Hämostaseologie 2014; 34: 201–212).Die Behandlung ist auf den Defekt, die Thrombozytenzahl, das Lebensalter und die klinischen Umstände abzustimmen. Die Transfusion von Thrombozyten allein kann wegen der damit verbundenen Risiken unangemessen sein. Empfohlen wird ein stufenweiser und individualisierter Behandlungsplan. Antifibrinolytika sind generell anwendbar, besonders bei der Quebec-Erkrankung. Desmopressin ist älteren Kindern vor behalten und vor allem zur Behandlung der Storage- Pool-Erkrankungen und nicht klassifizierter Defekte geeignet. Rekombinanter FVIIa ist zwar nur für die Behandlung der Thrombasthenie Glanzmann mit Alloantikörpern zugelassen, wird jedoch in der klinischen Praxis auch bei Thrombozytendefekten mit schwerer Blutungsneigung eingesetzt. Das Ziel dieser Leitlinie ist die Behandlung von Patienten mit angeborenen Thrombozytenfunktionsstörungen bestmöglich zu unterstützen.

PUPOSE To document acute thioridazine toxicity from the symptoms only, through the development of ophthalmoscopic signs and recovery of dark adaptation and electroretinogram responses. These findings support the thesis that visual loss is metabolic and reversible if diagnosed early. METHODS Case Report. RESULTS A case is presented of acute thioridazine toxicity with documentation of the development of symptoms before any ophthalmoscopic evidence of toxicity. This case uniquely shows the time course of dark adaptation, showing both delay in adaptation and elevated final threshold, it includes full electrophysiologic studies from within the first weeks of symptoms and regular follow-up demonstrating marked recovery of dark adaptation in terms of both delay and final threshold, a nearly normal electroretinography and normal color vision within 10 months. CONCLUSION Our findings give support to the thesis that functional visual disturbance is primarily metabolic and reversible if detected early in the course of toxicity.

Die Gynakomastie ist definiert als uni- oder bilaterale persistierende Brustdrusenvergroserung des Mannes, die von einer nur palpatorisch vergroserten Brustdruse bis hin zu einem weiblichen Thoraxerscheinungsbild reichen kann. In dieser Arbeit wird ein Algorithmus vorgestellt, der die Auswahl des geeigneten chi­rurgischen Verfahrens in Abhangigkeit von den morphologischen Aspekten des vorliegenden Befundes erleichtern soll. Es handelt sich um eine retrospektive Analyse von 118 Patienten (217 mannliche Mammae), die im Zeitraum von 01/2009 bis 08/2012 operiert wurden. Hierbei wurden die Ergebnisse von drei unterschiedlichen chirurgischen Therapieverfahren in Abhangigkeit von vier Schweregraden hinsichtlich der Outcome-Parameter Komplikationsrate, Patientenzufriedenheit, Brustwarzensensibilitat und Notwendigkeit einer Korrekturoperation uberpruft. Bei einem geringen bis moderaten Ausgangsbefund ohne Hautuberschuss (Grad I–IIa nach Simon) erfolgt die subkutane Mastektomie uber eine semizirkulare periareolare Inzi­sion sowie eine angleichende wasserstrahlassistierte Liposuktion. Bei vorhandenem Hautuberschuss und gut tastbarer Brustdruse (Grad IIb) erfolgt zusatzlich eine periareolare konzentrische Straffung. Bei den seltenen einer weiblichen Brust entsprechenden Befunden (Grad III) wird ein inframammarer Zugang mit kaudaler Stielung des Mamillen-Areolen-Komplexes verwendet. 167 Mammae (77%) konnten uber einen periareolaren Zugang operiert werden, 40 Mammae (18%) mit zusatzlicher periareolarer Straffung und zehn (5%) uber einen inframammaren Zugang mit kaudaler Mamillenstielung. Die Komplikationsrate lag bei 4,1%. Korrekturoperationen waren bei 17 Mammae (7,8%) erforderlich. Eine Patientenbefragung ergab eine hohe Zufriedenheit: 88% der Patienten waren „sehr zufrieden“ bis „zufrieden“, die Sensibilitat der Brustwarzen wurde von 83% der Patienten als „sehr gut“ bis „gut“ bewertet. Die operative Behandlung der Gynakomastie sollte moglichst narbensparend unter Respektierung der asthetischen Einheit erfolgen. Hierbei ist die Wahl des operativen Verfahrens abhangig vom Schweregrad, dem Vorhandensein eines Hautuberschusses, sowie vom Volumen des zu resezierenden Brustdrusengewebes. Der vorgestellte Algorithmus ist komplikationsarm, im Klinikalltag leicht anzuwenden und zeigt eine gute ­Bewahrung der Brustwarzensensibilitat bei hoher Patientenzufriedenheit mit dem asthetischen Ergebnis.

Rhinophyma is considered the end stage in the development of rosacea, accompanied by hypertrophy of the sebaceous glands, which causes an enlargement of the nose. It is an uncommon condition that often results in both functional and cosmetic impairment. A large variety of surgical and nonsurgical treatments have been published to treat it. Closure is usually obtained by wound granulating in by secondary intention, skin grafting or local flaps. Rarely these lesions can attain a giant size and pose a challenge in surgical treatment. We present a 63-year-old male with the necessity for tracheostomy at the ICU due to total nasal obstruction and recurrent episodes of pneumonia caused by a huge giant rhinophyma, which had undergone extreme growth in the last five years. The tumor was removed under general anesthesia by decortication with an electrosurgical wire loop to recreate the aesthetic units of the nose preserving the alar cartilage as well as the pilosebaceous appendages. The wounds healed in by secondary intention with a very pleasant cosmetic and improved functional result. The relevant literature is discussed. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

New developments and characteristics of high brilliant laser sources have led to new applications in the field of laser remote processing. Due to high particle formation rates within the vapor plume, a significant influence of the interaction between laser radiation and nanoparticles on the process may occur. The presented work shows results of the investigation of the dynamical formation of nanoparticles within the vapor plume during the welding of stainless steel with a 2 kW Multi-Mode fiber laser under laser remote conditions. The particle size distribution is measured by the evaluation of TEM-images, whereas, the plasma temperature and particle density are analyzed in dependence of the irradiation time.

Biliary atresia (BA) is the most common indication for LT in children. We investigated whether this diagnosis per se, compared to other chronic liver diseases (OCLD), had an influence on patient survival. Data from 421 Scandinavian children, 194 with BA and 227 with OCLD, listed for LT between 1990 and 2010 were analyzed. The intention-to-treat survival and influencing risk factors were studied. Patients with BA had higher risk of death after listing than patients with OCLD. The youngest (1 year) and smallest (10 kg) children with the highest bilirubin (510 μmol/L), highest INR (1.6), and highest PELD score (20) listed during 1990s had the worst outcome. Given the same PELD score, patients with BA had higher risk of death than patients with OCLD. For adolescents, low weight/BMI was the only prognostic marker. Impaired intention-to-treat survival in patients with BA was mainly explained by more advanced liver disease in younger ages and higher proportion of young children in the BA group rather than diagnosis per se. PELD score predicted death, but seemed to underestimate the severity of liver disease in patients with BA. Poor nutritional status and severe cholestasis had negative impact on survival, supporting the "sickest children first" allocation policy and correction of malnutrition before surgery.

This paper presents a conceptual framework for clarifying the network hypotheses embedded in policy theories and how they relate to macro-level political outcomes and micro-level political behavior. We then describe the role of statistical models of networks for testing these hypotheses, including the problem of operationalizing theoretical concepts with the parameters of statistical models. Examples from existing policy research are provided and potential extensions are discussed. This paper is forthcoming as the introduction to a special issue of the Policy Studies Journal on statistical models of policy networks. Paper Prepared for Political Networks Conference, 2011. Ann Arbor Note to PolNet 2011 Readers: Believe with Caution! This paper is in midstream so there are many missing references and sections that need additional work. We would welcome any comments that would help clarify the ideas in the paper, and especially persuade readers about the value of applying statistical models of networks to policy theory. Also, the references to the PSJ special issue might be confusing so feel free to ignore.

A characteristic of the laser ablation process of metals with high brilliant radiation is a significant formation of nanoparticles within the vapour plume. Due to the interaction between the incoming radiation and the particles, the intensity is attenuated at the workpiece. This leads to a decrease of the ablation rate and the related ablation velocity. In order to verify the influence of the interaction between nanoparticles and high brilliant radiation on the ablation process, experimental and theoretical results of the laser ablation process of stainless steel with a single mode fiber laser are presented. For an ablation process with an intensity of 1.9×10 8 W/cm², it is shown that the average particle size is 9 nm. Within a further time-dependent analysis of the correlation between particle formation and ablation velocity, the beam of a test laser is directed through the vapour plume and the angle-dependent scattered radiation is detected. The results point out that a decrease of the ablation velocity corresponds with an increasing of the particle density within the ablation plume.

Cob is an earthen building material comprised of sand, clay, straw, and water used for millennia to construct dwellings. Although cob construction largely died out during the nineteenth century, it is experiencing a revival in England and the Pacific Northwest of the United States. Little scientific research has investigated the engineering properties of cob, knowledge of which is important for modern-day design practices and code requirements. Researchers at Oregon State University investigated six different Oregon cob mixtures using a series of standard soils and concrete tests adapted for this material. The objectives were to characterize the constituents, to establish estimates for the magnitude of, and degree of variability in, the mixture properties, and to develop correlations between the engineering properties and mixture composition. Results indicated low to moderate variation in basic mixture properties (i.e., unit weight, moisture content, and sand equivalent), moderate variation in strength properties, and high variation in the elastic modulus. Several reasonable correlations were found between shrinkage, compressive strength, elastic modulus, and sand equivalent and between flexural strength and fiber tensile strength.

Policy actors seek network contacts to improve individual payoffs in the institutional collective action dilemmas endemic to fragmented policy arenas. The risk hypothesis argues that actors seek bridging relationships (well-connected, popular partners that maximize their access to information) when cooperation involves low risks, but seek bonding relationships (transitive, reciprocal relationships that maximize credibility) when risks of defection increase. We test this hypothesis in newly developing policy arenas expected to favor relationships that resolve low-risk dilemmas. A stochastic actor-based model for network evolution estimated with survey data from 1999 and 2001 in 10 U.S. estuaries finds that actors do tend to select popular actors as partners, which presumably creates a centralized bridging structure capable of efficient information transmission for coordinating policies even without any government mandate. Actors also seek reciprocal bonding relationships supportive of small joint projects and quickly learn whether or not to trust their partners.

High-speed laser micro-perforation (“on-the-fly” technique) represents a processing technique for the time-efficient and cost-effective production of microsieves. In order to increase the perforation rate this process is researched with use of a brilliant laser source. These laser sources combine ample output power with an excellent beam quality. The high perforation rate [

Aim: Neurodevelopmental impairment in very preterm infants can be reasonably diagnosed by 18–24 months corrected age, whereas the predictive value of earlier assessments is debated. We hypothesized that neurological findings at 6 and 12 months indicative of subsequent cerebral palsy predict 18–24 months’ neurodevelopmental impairment. Methods: Neurodevelopmental examinations (Griffiths scales) at 20 months of age in 561 preterm infants (birth weight

Nanometer sized particles are formed within the vapor plume during the ablation of metal with laser radiation. Thereby, the particle formation rate depends strongly on the used intensity of the laser source. High brilliant laser sources have the ability to generate intensities higher than 1 ⋅ 108 W / cm 2 during cw operation. Due to the widespread use of high brilliant laser sources in research and industrial applications, it is important to investigate the influence of particle formation on the ablation process. Therefore, the presented work is focused on the particle formation during the ablation process of stainless steel with a single-mode fiber laser. Results of experimental work are shown and analyzed. In the experimental work a probe laser beam is directed through the ablation plume and the scattered intensity is analyzed. TEM images of particles show an average particle size of 9 nm at an intensity of 1.92 ⋅ 108 W cm 2 .

We explore how two populations learn to cooperate with each other in the absence of institutional support. Individuals play iterated prisoner's dilemmas with the other population, but learn about successful strategies from their own population. Our agent-based evolutionary models reconfirm that cooperation can emerge rapidly as long as payoffs provide a selective advantage for nice, retaliatory strategies like tit-for-tat, although attainable levels of cooperation are limited by the persistence of nonretaliatory altruists. Learning processes that adopt the current best response strategy do well only when initial conditions are very favorable to cooperation, while more adaptive learning processes can achieve high levels of cooperation under a wider range of initial conditions. When combined with adaptive learning, populations having larger, better connected learning relationships outperform populations with smaller, less connected ones. Clustered relationships can also enhance cooperation, particularly in these smaller, less connected populations.

Background Organ shortage has resulted in an increased use of expanded criteria donors for transplantation, in particular kidneys from older donors. There is limited data on the impact of donor age more than 75 years on kidney transplant outcome. Methods A retrospective single-center analysis on deceased donors more than 75 years and kidney transplant outcome in an old for old setting was performed. Histologic findings (global kidney score) in graft biopsies and deceased-donor scores were evaluated to observe if this information could be helpful in predicting outcome. Results Evaluation of data from 54 single kidney transplantations from 29 donors more than 75 years (median 77.5, range 75.2-86.1) were assessed. Ninety-three percent of the donors died of intracranial bleeding, and 69% had a history of hypertension or cardiovascular event(s). Median recipient age was 70.1 (range 50.6-82.4). Fifty-two grafts (96%) had posttransplant function. Death censored graft survival at 1, 3, and 5 years were 87%, 83%, and 83%, respectively. Patient survival was 81%, 75%, and 59% at the same time points. At follow-up at median 23 months (range 6-144 months), thirty-five recipients were alive with a median serum creatinine of 163 micromol/ L (range 103-348). Global kidney score and deceased donor score did not predict graft outcome. Conclusion Kidney transplants from deceased donors more than 75 years perform acceptable as single transplants and should be considered for use in older recipients.