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Biomaterial and stem cell delivery are promising approaches to treating myocardial infarction. However, the mechanical and biochemical mechanisms underlying the observed therapeutic benefits require further clarification. This computational study aimed to assess deformation and resulting transforming growth factor β (TGF-β) expression of stem cells injected with the biomaterial into the infarcted heart. A microstructural finite element model of a mid-wall equatorial infarcted myocardial region was developed fromex vivomicrocomputed tomography data of a rat heart with left ventricular infarct and intramyocardial biomaterial injectate. Nine cells were numerically seeded in the injectate of the microstructural model. The microstructural and a previously developed biventricular finite element model of the same rat heart were used to quantify the deformation of the cells during a cardiac cycle for a biomaterial elastic modulus (Einj) ranging between 4.1 and 405,900 kPa. The cellular TGF-β expression was determined with a mathematical relationship of deformation and TGF-β expression developed from existing experimental data and single-cell finite element analysis. Deformation and TGF-β expression of the transplanted cells were largest at Einjof 7.4 kPa, matching that of the cells, and decreased for an increase and decrease in Einj. Cell deformation and TGF-β expression were more sensitive to Einjchanges for softer (Einj≤ 738 kPa) than stiffer biomaterials. Combining the microstructural and biventricular finite element models enables quantifying micromechanics and signalling of transplanted cells in the heart. The platform offers broader scope forin silicoinvestigations of biomaterial and cell therapies for myocardial infarction and other cardiac pathologies.

Hair is a preferred material to detect exposure or use of illegal drugs in children. In the present study, we investigated a total of 387 hair samples for commonly applied illegal drugs of children up to 16 years. Analysis was by liquid chromatography/mass spectrometry with LOQs of 0.01 ng/mg hair for all analytes except tetrahydrocannabinol carboxylic acid with an LOQ of 0.1 pg/mg hair. Results were firstly compared with our in-house statics on results from adults' hair, and secondly to literature data. We started from the assumption that drug concentrations decrease with increasing age.Results were assigned to 4 different age groups (< 1 year, 1-< 6 years, 6-< 14 years, 14-16 years). As expected, higher results were obtained in age groups 1 and 2. The lowest concentrations were present in age group 3, whereas an increase could be observed in group 4 except heroin. In babies, positive results may be due to in utero exposure, breast milk feeding, and a close physical contact. All drugs under investigation such as cannabinoids, cocaine, amphetamines, and opiates have been detected in breast milk as well as in skin excretions such as sebum, sweat and cutaneous cells. For most drugs, average concentrations in children hair were lower than in adult hair when compared with our in-house statistics. Interestingly, the increase of cannabinoids, cocaine, and amphetamines concentrations in adolescents' hair points to a deliberate use of these drugs possibly in addition to passive exposure. This observation shows that age groups 1 and 4 are most vulnerable if caregivers or parents are drug users, even if the sources of positive drug findings differ.

Intramyocardial delivery of biomaterials is a promising concept for treating myocardial infarction. The delivered biomaterial provides mechanical support and attenuates wall thinning and elevated wall stress in the infarct region. This study aimed at developing a biventricular finite element model of an infarcted rat heart with a microstructural representation of anin situbiomaterial injectate, and a parametric investigation of the effect of the injectate stiffness on the cardiac mechanics.A three-dimensional subject-specific biventricular finite element model of a rat heart with left ventricular infarct and microstructurally dispersed biomaterial delivered one week after infarct induction was developed fromex vivomicrocomputed tomography data. The volumetric mesh density varied between 303 mm-3in the myocardium and 3,852 mm-3in the injectate region due to the microstructural intramyocardial dispersion. Parametric simulations were conducted with the injectate’s elastic modulus varying from 4.1 to 405,900 kPa, and myocardial and injectate strains were recorded.With increasing injectate stiffness, the end-diastolic median myocardial fibre and cross-fibre strain decreased in magnitude from 3.6% to 1.1% and from −6.0% to −2.9%, respectively. At end-systole, the myocardial fibre and cross-fibre strain decreased in magnitude from −20.4% to −11.8% and from 6.5% to 4.6%, respectively. In the injectate, the maximum and minimum principal strains decreased in magnitude from 5.4% to 0.001% and from −5.4% to −0.001%, respectively, at end-diastole and from 38.5% to 0.06% and from −39.0% to −0.06%, respectively, at end-systole.With the microstructural injectate geometry, the developed subject-specific cardiac finite element model offers potential for extension to cellular injectates andin silicostudies of mechanotransduction and therapeutic signalling in the infarcted heart with an infarct animal model extensively used in preclinical research.

Drug testing in hair can complement conventional blood and urine analysis as it enlarges the window of detection and may allow a differentiation of heavy from moderate or rare use. Databases of drug concentrations in biological matrices are a valuable support in interpreting analytical results. In forensic toxicology, several databases exist especially for blood/serum samples. In the present paper, the concentration distributions of more than 100 legal and illegal drugs such as narcotic drugs, opioids, antidepressants, antipsychotics, benzodiazepines, and major metabolites detected in authentic Caucasian hair samples in our laboratory are summarized. Depending on availability, the proximal sections of 1-6 cm in length were analyzed by liquid chromatography/tandem mass spectrometry following extraction of the finely chopped specimens by ultrasound in methanol. The data may present a helpful basis also for other laboratories for an initial evaluation of their results. However, these statistical data should not be used uncritically without including the circumstances of the particular case and the analytical procedures used. In addition, each laboratory in charge of interpreting results from hair analysis should balance own results as far as available with this data base.

We use the resonant dipole-dipole interaction between Rydberg atoms and a periodic external microwave field to engineer XXZ spin Hamiltonians with tunable anisotropies. The atoms are placed in one-dimensional (1D) and two-dimensional (2D) arrays of optical tweezers. As illustrations, we apply this engineering to two iconic situations in spin physics: the Heisenberg model in square arrays and spin transport in 1D. We first benchmark the Hamiltonian engineering for two atoms and then demonstrate the freezing of the magnetization on an initially magnetized 2D array. Finally, we explore the dynamics of 1D domain-wall systems with both periodic and open boundary conditions. We systematically compare our data with numerical simulations and assess the residual limitations of the technique as well as routes for improvement. The geometrical versatility of the platform, combined with the flexibility of the simulated Hamiltonians, opens up exciting prospects in the fields of quantum simulation, quantum information processing, and quantum sensing., This work is supported by the European Union (EU) Horizon 2020 research and innovation program “Programmable Atomic Large-Scale Quantum Simulation” (PASQuanS) under Grant Agreement No. 817482, the Agence National de la Recherche (ANR, project RYBOTIN), the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany’s Excellence Strategy EXC2181/1-390900948 (the Heidelberg STRUCTURES Excellence Cluster), within the Collaborative Research Center SFB1225 (ISOQUANT), the DFG Priority Program 1929 “GiRyd” (DFG WE2661/12-1), and by the Heidelberg Center for Quantum Dynamics. C.H. acknowledges funding from the Alexander von Humboldt foundation, T.F. from a graduate scholarship of the Heidelberg University (LGFG), and D.B. from the Ramón y Cajal program (RYC2018-025348-I). F.W. is partially supported by the Erasmus+ program of the EU. We also acknowledge support by the state of Baden-Württemberg through Baden-Württemberg high performance computing (bwHPC) and the DFG through Grant No. INST 40/575-1 FUGG (JUSTUS 2 cluster).

While details remain unclear, initiation of woven bone mineralization is believed to be mediated by collagen and potentially nucleated by bone sialoprotein (BSP). Interestingly, our recent publication showed that BSP and type XI collagen form complexes in mineralizing osteoblastic cultures. To learn more, we examined the protein composition of extracellular sites of de novo hydroxyapatite deposition which were enriched in BSP and Col11a1 containing an alternatively spliced "6b" exonal sequence. An alternate splice variant "6a" sequence was not similarly co-localized. BSP and Col11a1 co-purify upon ion-exchange chromatography or immunoprecipitation. Binding of the Col11a1 "6b" exonal sequence to bone sialoprotein was demonstrated with overlapping peptides. Peptide 3, containing three unique lysine-triplet sequences, displayed the greatest binding to osteoblastic cultures; peptides containing fewer lysine triplet motifs or derived from the "6a" exon yielded dramatically lower binding. Similar results were obtained with 6-carboxyfluorescein (FAM)-conjugated peptides and western blots containing extracts from osteoblastic cultures. Mass spectroscopic mapping demonstrated that FAM-peptide 3 bound to 90 kDa BSP and its 18 to 60 kDa fragments, as well as to 110 kDa nucleolin. In osteoblastic cultures, FAM-peptide 3 localized to biomineralization foci (site of BSP) and to nucleoli (site of nucleolin). In bone sections, biotin-labeled peptide 3 bound to sites of new bone formation which were co-labeled with anti-BSP antibodies. These results establish the fluorescent peptide 3 conjugate as the first nonantibody-based method to identify BSP on western blots and in/on cells. Further examination of the "6b" splice variant interactions will likely reveal new insights into bone mineralization during development.

The use of multiparametric magnetic resonance imaging (mpMRI) is becoming increasingly more important for the primary diagnostics of prostate cancer (PCa) and for monitoring under active surveillance. Current studies confirmed that the use of mpMRI can increase the detection of clinically significant PCa and reduce the detection rate of insignificant PCa as well as the rate of unnecessary biopsies. The information from mpMRI can be cognitively used for in-bore biopsy and using fusion biopsy systems. There are no clear recommendations on the access approach for fusion biopsy (e. g. transrectal or perineal), whereby higher rates of rectal bleeding and infections have been described for transrectal access compared to perineal access. The increasing rate of antibiotic resistance as well as restricted indications for the use of quinolones are a major challenge for transrectal biopsy.

Introductory pharmacy practice experiences (IPPEs) are focused on sharpening the student's knowledge, skills, abilities, and attitudes related to becoming an effective member of the healthcare team. Currently, the literature on student pharmacists' perceptions focused only on advanced pharmacy practice experiences (APPEs). This study gathered perceptions of IPPEs from pharmacy students in their first through third year professional years.A voluntary pre- and post-survey instrument was administered to 367 first through third year professional students from Northeast Ohio Medical University (NEOMED) and Cedarville University at the beginning and end of the 2017-2018 academic year. Each survey utilized questions with Likert scales designed to detect differences in student expectations and experiences related to IPPE training. Questions primarily focused on demographics, objectives, goals, interprofessional teamwork, application of knowledge, and preceptor engagement. Students ages 18 and older who were enrolled at the participating institutions were eligible for inclusion in this study. Survey completion was voluntary, and students were not incentivized to participate.Sixty-six students completed the pre- and post- surveys with matching, identifiable data for analysis. Twenty-nine items demonstrated a more negative perception of IPPEs between the pre- and post-surveys (p 0.05). Eight items demonstrated a difference by institution (p 0.05), while three items demonstrated a difference between professional years (p 0.05).Student expectations of IPPEs were significantly less positive in the pre-survey than in the post-survey. Future studies should examine the implications of these results on student IPPE performance and methods to impact student perception of the value of IPPE training.

In this paper, a comprehensive design procedure for high voltage pulse power transformers is presented. The procedure is based on the finite element method (FEM) and contains an electrical model, a magnetical model, a thermal model of the transformer and a procedure for the isolation design. In addition, to avoid overvoltages within the winding, a model for the dynamic voltage distribution is included in the approach, as well. For validation of the models and the design procedure, a prototype has been built. There, the main focus is on evaluating the parasitics, which are crucial for the shape of the output voltage pulse. Further, the isolation design will be proofed by high voltage impulse tests. In the considered application, the required nominal pulse voltage amplitude is 44.2 kV with a pulse power of 4.42 MW, a pulse length of 5 µs and a maximal rise time of 1 µs.

The intrinsically weak signals in ultrafast electron microscopy experiments demand an improvement in the signal-to noise ratio of suitable electron detectors. We provide an experience report describing the installation and operation of a fiber-coupled CMOS based detector in a low energy electron microscope. We compare the detector performance to the traditional multi-channel-plate-based setup. The high dynamic range CMOS detector is capable of imaging spatially localized large intensity variations with low noise. The detector is blooming-free and overexposure appears uncritical. Overall, we find dramatic improvements in the imaging with the fiber-coupled CMOS detector compared to imaging with our previously used multi-channel-plate detector.

Hernias are a common occurrence with a correspondingly huge clinical and economic impact on the healthcare system. Parastomal and trocar hernias are rare in routine urological work. The therapy of parastomal hernias remains problematic but basically the surgeon is able to use conventional techniques with suture repair or procedures with mesh implantation. The conventional parastomal hernia repair with mesh can be classified into sublay, onlay and intraperitoneal techniques. Furthermore, a relocation of the stoma is possible. Trocar hernias represent a rare but hazardous complication. Due to the increase in keyhole surgery there is also the danger of a rise in their occurrence. Incisional hernias occur frequently in patients who have undergone laparotomy and for repair different surgical techniques and types of meshes are available. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostic and therapy of parastomal, trocar and incisional hernias.

Hernien sind haufige Erkrankungen mit entsprechenden klinischen Folgen fur unser Gesundheitssystem. Im urologischen Alltag finden sich vor allem Leisten- und Nabelhernien. Therapeutisches Ziel sind die Rekonstruktion und Stabilisierung des Leistenkanals, wozu sowohl konventionelle offen-operative Verfahren, als auch minimal-invasive Techniken zur Verfugung stehen. Beide Methoden lassen sich sowohl klassisch per Nahttechnik als auch unter Verwendung synthetischer Netze durchfuhren. Nabelhernien stellen nur selten eine Indikation fur Operationen dar, auch wenn diese mit kleinem Aufwand durchgefuhrt werden konnen. Diese Arbeit vermittelt dem Leser eine Ubersicht uber Epidemiologie, Pathogenese, klinische Symptomatik, Diagnostik und Therapie von Leisten-, Schenkel- und Nabelhernien.

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During the intervention phase, pharmacists promoted use of the outpatient pharmacy by patients admitted for these conditions using multiple methods. In each chart review, the patients readmitted for asthma or wheezing within thirty days were classified as either outpatient pharmacy users (OPP users) or non-OPP users. Differences in readmission rates between OPP users and non-OPP users, as well as differences in overall OPP utilization, were analyzed before and during the intervention phase using a Chi-square test. Results: The initial chart review found no significant difference in thirty day readmission rates between OPP users and non-OPP users (6.2% and 7.5%, respectively; χ 2 = 1.15; p = 0.274). The number of OPP users increased significantly from the first chart review to the second (11.8% and 45.9%, respectively; χ 2 = 929.04, p < 0.001). The second chart review revealed that OPP users had a significantly lower readmission rate than non-OPP users during the intervention phase (2.3% and 10.9%, respectively; χ 2 = 52.5; p < 0.001). Conclusion: Obtaining discharge medications from the OPP was associated with a lower thirty-day readmission rate in children with asthma. Promoting use of the OPP for transitional care should continue to be part of future efforts to decrease hospital readmissions.

The shared metabolism of PPIs and tacrolimus through the CYP enzyme system has been associated with clinically significant drug interactions, especially in patients who are classified as CYP 2C19 PMs. However, existing data are conflicting, indicating that a single mechanism does not account for all interactions. A drug interaction between tacrolimus and omeprazole, esomeprazole, but not lansoprazole, occurred in an 18-yr-old female kidney transplant recipient classified as a CYP 2C19 extensive (normal) metabolizer. This case suggests that further research is needed to establish the definitive mechanism of this potentially serious drug-drug interaction. Physicians prescribing PPIs in organ transplant recipients with tacrolimus immunosuppression should consider close pharmacokinetic monitoring of tacrolimus when starting or switching a PPI.

Background: Medication Therapy Management (MTM) is a vital resource in reducing medication nonadherence, yet many individuals who are eligible for MTM services are unaware of what MTM is and how to enroll. Little is known about how to best educate patients on MTM services and its benefits. Objective: To determine the difference between in-person education community education versus brochure community education on MTM services on perceptions of and enrollment in MTM services. Methods: A pre-post quasi experimental study, where patients were allocated to receive information about MTM through an educational brochure or an in-person education session and completed survey assessments pre- and post-intervention, was conducted at a federally-qualified health center. Patients who were ages 18 years or older, MTM-eligible, and had received no prior MTM service were eligible to participate. Changes in patient perceptions of and enrollment in MTM from pre- to post-intervention were assessed by survey instruments developed for this study. Results: A total of 35 patients (brochure=25, in-person=10) were recruited for this study. Most participants (94.2%) either reported having never heard of MTM or not being sure if they had heard of MTM. There were no significant between-group differences on pre-survey questions or pre-post within-group changes (p>0.05). There were significant between-group differences on 11 post-assessment questions and MTM enrollment (p

Patients who develop hydronephrosis due to an acute cause often have colic-like pain but hydronephrosis secondary to a chronic cause is often asymptomatic. Ureteral obstruction can be due to a variety of intrinsic and extrinsic causes, such as trauma, radiation, iatrogenic injury, urolithiasis, malignancies and congenital causes. Management planning is dictated by the underlying cause, patient comorbidity and life expectancy. Malignant ureteral obstructions can be managed with segmental metal stents with advantages in the quality of life and provide an alternative to long-term treatment with a DJ stent. Endoscopic balloon dilatation and endoureterotomy are options for benign ureteral strictures up to 2 cm in length. For longer benign strictures there are a number of reconstructive techniques, which can also be performed by laparoscopic or robot-assisted approaches at specialized centers.

Hyperkaliamie ist eine haufige und weiter zunehmende Erkrankung. Besonders der schnelle Anstieg der Kaliumkonzentration ist eine potentiell lebensbedrohliche Elektrolytstorung. Die Genese ist meist durch das Zusammentreffen mehrerer Faktoren bedingt. Diese sind nicht selten iatrogen verursacht. Zunehmendes Alter des Patienten, Diabetes mellitus, Storungen des Renin-Angiotensin-Aldosteron-Systems, antibiotische Hochdosistherapie und Immunsuppressiva sind Ursachen einer Hyperkaliamie. Pathophysiologisch stehen vier Mechanismen im Vordergrund: 1. Nierenfunktionsstorung, 2. Hyporeninamischer Hypoaldosteronismus, 3. tubulare Storungen, 4. zellulare Storungen.

The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin syndrome. This article presents a new surgical technique of endoscopic assisted median nerve decompression.Endoscopic scissor decompression of the median nerve is always performed under plexus anaesthesia. It includes 6 key steps documented in this article. We review the indications and limitations of the surgical technique.Since 2011, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We also review the limitations of the technique and its potential for future development.Although clinical results after endoscopic assisted decompression of the median nerve appear excellent they still need to be compared with conventional techniques. Clinical studies are likely to develop primarily due to the mini-invasive nature of this new surgical technique.

Hernias are a common occurrence with a correspondingly huge clinical and economic impact on the healthcare system. Parastomal and trocar hernias are rare in routine urological work. The therapy of parastomal hernias remains problematic but basically the surgeon is able to use conventional techniques with suture repair or procedures with mesh implantation. The conventional parastomal hernia repair with mesh can be classified into sublay, onlay and intraperitoneal techniques. Furthermore, a relocation of the stoma is possible. Trocar hernias represent a rare but hazardous complication. Due to the increase in keyhole surgery there is also the danger of a rise in their occurrence. Incisional hernias occur frequently in patients who have undergone laparotomy and for repair different surgical techniques and types of meshes are available. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostic and therapy of parastomal, trocar and incisional hernias.

Hernias are a common occurrence with correspondingly huge clinical and economic impacts on the healthcare system. The most common forms of hernia which need to be diagnosed and treated in routine urological work are inguinal and umbilical hernias. With the objective of reconstructing and stabilizing the inguinal canal there are the possibilities of open and minimally invasive surgery and both methods can be performed with suture or mesh repair. Indications for surgery of umbilical hernias are infrequent although this is possible with little effort under local anesthesia. This article presents an overview of the epidemiology, pathogenesis, clinical symptoms, diagnostics and therapy of inguinal, femoral and umbilical hernias.

Myocardial infarction is an increasing health problem worldwide. Because of an under-supply of blood, the cardiomyocytes in the affected region permanently lose their ability to contract. This in turn gradually weakens the overall heart function. A new therapeutic approach based on the injection of a gel into the infarcted area aims to support the healing and to inhibit adverse remodelling that can lead to heart failure. A computational model is the basis for obtaining a better understanding of the heart mechanics, in particular, how myocardial infarction and gel injections affect its pumping performance. A strain invariant-based stored energy function is proposed to account for the passive mechanical behaviour of the model, which also makes provision for active contraction. To incorporate injections an additive homogenization approach is introduced. The numerical framework is developed using an in-house code based on the element-free Galerkin method. The main focus of this contribution is to investigate the influence of gel injections on the mechanics of the left ventricle during the diastolic filling and systolic isovolumetric (isochoric) contraction phases. It is found that gel injections are able to reduce the elevated fibre stresses caused by an infarct.

Different approaches for the simultaneous determination of arsenic, antimony, bismuth, selenium and tellurium by furnace atomic nonthermal excitation spectrometry (FANES) are described. In the direct analysis of microvolumes of solutions, the results could be improved by working with Pd or Ir as chemical modifiers for the stabilization of the analytes during the thermal pre-treatment. Using Ir as a modifier, absolute detection limits of 0.116 ng (As), 0.062 ng (Bi), 0.044 ng (Sb), 0.316 ng (Se) and 0.016 ng (Te) could be realized. The combination of hydride generation and in situ enrichment of the analytes onto a permanent Ir-treated inner surface of the graphite tube of the FANES source has been used as pre-concentration technique. The conditions for all steps, hydride generation, pre-reduction, in situ enrichment, atomization and excitation have been studied. Using compromise conditions for the simultaneous determination of all the elements using a sample volume of 20 ml, relative detection limits of 0.032 μg l −1 As 3+ , 0.015 μg l −1 Bi 3+ , 0.012 μg l −1 Sb 3+ , 0.047 μg l −1 Se 4+ and 0.009 μg l −1 Te 4+ are obtained. The influence of hydride forming elements on the determination of each of the elements by the technique of vapour generation and in situ enrichment is studied. The results are validated using standard reference materials.

Traditionally, Curie temperature measurements have been performed using a vibrating sample magnetometer, an expensive piece of equipment not readily available to all undergraduate physics laboratories. This article describes an alternative measurement technique requiring only equipment stocked in most undergraduate physics departments. The device was originally constructed for data collection as part of a graduate‐level research program in radiation damage effects in amorphous Fe–Ni–P–B ferromagnetic alloys, but can be used for lecture demonstration purposes or as an undergraduate laboratory experiment.

We report the case of a 57-year-old patient with a huge, retrovesical, aggressive desmoid fibromatosis detected incidentally during preoperative staging for radical prostatectomy. The tumor was locally invasive consisting of monoclonal and fibroblastic proliferations. The etiology of such tumors is not well known but they are mostly sporadic and aggressive fibromatosis is sometimes associated with familial adenomatous polyposis (FAP) or Gardner's syndrome. Such desmoid tumors are slow growing and locally invasive but lack metastatic potential. Complete resection with wide margins is the therapy of choice and the tendency to recur is high. Radiotherapy following surgery is controversial. We discuss the pathogenesis, clinical manifestations and therapy of such rare tumors.

Organ-confined prostate cancer can be treated with curative intent by different types of radiotherapy or by radical surgery. Regardless of improvements in radiotherapy about 60% of patients with prostate cancer develop biochemical recurrence (BCR) which is defined by the progressive increase in serum prostate-specific antigen (PSA) and necessitates further diagnostic procedures. If non-organ-confined cancer and metastasis are categorically excluded by cross-sectional imaging using computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography CT (PET-CT) and bone scintigraphy, a prostate biopsy should be performed. Biopsy proven detection of recurrent or persisting prostate cancer after irradiation is essential prior to a salvage prostatectomy. The function of the lower urinary tract should be evaluated prior to surgery. Preoperative PSA measurement is the best prognostic indicator prior to surgery. Salvage prostatectomy in irradiated patients is more challenging and requires extensive skill. The most common complications are incontinence, rectal injury and anastomotic strictures. Both functional and oncologic outcome have improved due to better irradiation techniques and surgical skills. Provided post-radiotherapy recurrence of prostate cancer is diagnosed early enough, curing is possible by salvage prostatectomy.

Obtaining a biowaiver for topical drugs used in veterinary species faces many of the same challenges associated with human topicals. However, the skin of domestic animals varies anatomically and biochemically and experimental approaches to assess bioequivalence (BE) in veterinary species have challenges that are not often encountered with human skin. This is especially the situation with locally acting drugs. The focus of this paper is to address several of the challenges associated with (i) determining the BE of these locally acting drugs and (ii) critically examine the current technological advances that can act as a surrogate for clinical trials.

This paper shows the results of performance improvement, which have been achieved in benchmarking projects in the wastewater industry in Germany over the last 15 years. A huge number of changes in operational practice and also in achieved annual savings can be shown, induced in particular by benchmarking at process level. Investigation of this question produces some general findings for the inclusion of performance improvement in a benchmarking project and for the communication of its results. Thus, we elaborate on the concept of benchmarking at both utility and process level, which is still a necessary distinction for the integration of performance improvement into our benchmarking approach. To achieve performance improvement via benchmarking it should be made quite clear that this outcome depends, on one hand, on a well conducted benchmarking programme and, on the other, on the individual situation within each participating utility.

The determination of Hg using different variants of the Furnace Atomic Nonthermal Excitation Spectrometry (FANES) is described. In the direct analysis of micro volumes of solutions, the results could be improved by working with chemical modifiers for the stabilization of Hg during the thermal pretreatment. The best results were obtained using Ir and Pd as modifiers, with absolute detection limits of 4 and 12 pg, respectively. The determination of mercury in sample volumes up to 10 ml could be achieved by coupling a cold vapour generation system and an amalgam attachment to the FANES source. A detection limit of 22 ng l was obtained with this technique. The best results were obtained by using the cold vapour generation technique and in situ enrichment of Hg onto the modified inner surface of the graphite tube of the FANES source. Using Ir for permanent impregnation of the tube a detection limit of 0.0009 μ;g l was found. The influence of hydride forming elements on the determination of mercury by the technique of vapour generation and in situ enrichment was studied. A reduction of the concentration of NaBH 4 to 0.002% m/v made it possible to determine traces of mercury in presence of a high excess of hydride forming elements without any depression of the Hg emission intensity. The results were validated using standard reference materials.

Laparoscopic (transperitoneal) radical prostatectomy is a standard procedure for surgical management of locally advanced prostate cancer. Disagreement still prevails over how long the catheter should remain in place and whether cystography is indicated before catheter removal. Until recovery, the urine is drained through a transurethral indwelling catheter. Serious complications due to anastomotic leakage could be avoided in our patient cohort by applying the algorithm presented.

The vacuum permeability method provides a new approach to assessment of permeability in the near-field of rock excavations. The method, which resembles leak testing of vacuum lines, is based on the measurement and interpretation of the pneumatic response to evacuation of a rock mass. As the induced drainage area is in order of meters, the method is particularly suitable on the scale of the excavation damaged zone. The data can be evaluated either analytically or numerically. The evaluation is similar to the approach used in the analysis of drill stem tests in gas wells. Experiments on large scale laboratory models corroborated the validity of the method and the evaluation procedure. Field tests were conducted at a wide range of geomechanical conditions. The collected data indicate that there are three characteristic types of permeability distribution in the excavation damaged zone.

Background The purpose of this study was to review the management of lower extremity arterial injuries to determine incidence, assess the current management strategy, and evaluate hospital outcome. Methods This was a retrospective review, including trauma database query, and medical records review set in an urban level I trauma center. Sixty-five patients with 75 lower extremity arterial injuries were admitted between April 2005 and April 2010. The interventions were primary amputation, medical management, vascular surgical intervention, and subsequent amputation. The main outcome measures were age, gender, race, mechanism of injury, type of injury, associated lower extremity injuries, concomitant injuries, Injury Severity Score, Abbreviated Injury Scale, surgical procedures and interventions, limb salvage rate, mortality, length of stay, and discharge disposition. Results During a 5-year period, 65 patients with 75 lower extremity arterial injuries were admitted to the hospital, yielding an incidence of 0.39% among trauma admissions. The study population was comprised primarily of young men, with a mean Injury Severity Score of 15.2 and a mean Abbreviated Injury Scale of 2.7 (moderate to severe injuries). The majority of patients (78.4%) suffered concomitant lower extremity injuries, most frequently bony or venous injuries, whereas 35.4% experienced associated injuries to other body regions. The most common injury mechanism was a gunshot wound (46.7%). Arterial injuries were categorized into 42 penetrating (56.0%) and 33 blunt mechanisms (44.0%). Involved arterial distribution was as follows: 4 common femoral (5.3%), 4 profunda femoris (5.3%), 24 superficial femoral (32.0%), 16 popliteal (21.3%), and 27 tibial (36.0%) arteries. The types of arterial injuries were as follows: 28 occlusion (37.3%), 23 transection (30.7%), 16 laceration (21.3%), and 8 dissection (10.7%). Orthopedic surgeons performed amputations as primary procedures in 3 patients (4.6%). The majority (76.8%) of injuries receiving vascular management underwent surgical intervention, with procedure distribution as follows: 26 bypass (49.1%); 13 primary repair (24.5%); 7 ligation (13.2%); 4 endovascular (7.5%); and 3 isolated thrombectomy (5.7%) procedures. Concomitant venous repair and fasciotomy were performed in 22.4% and 38.2% of cases, respectively. Medication was the primary strategy for 16 arterial injuries (23.2%). Subsequent major amputation was required for 3 patients (4.8%) who initially received vascular management. Three patients (4.6%) died during hospitalization. Conclusion The current multidisciplinary team management approach, including use of computed tomographic or conventional angiography and prompt surgical management, resulted in successful outcomes after lower extremity arterial injuries and will continue to be utilized.

We present a kinetic Monte Carlo simulation based on ab initio calculations for the thermal desorption of oxygen from a Rh(111) surface. Several models have been used for the parametrization of the interaction between the adsorbed atoms. We find that models based on a parametrization with only pairwise interactions have a relatively large error in the predicted adsorption energies. This error can be significantly reduced by including three- and four-body interactions. In addition, we find that a significant amount of atoms adsorb in a second adsorption site — the hcp-hollow site — at an elevated temperature. Consequently, only a many-body multisite model of the oxygen interactions yields appropriate desorption spectra for the full coverage range, while more simple models only capture the correct shape in the low-coverage case. Our parametrization allows us to predict the adsorption energies of an arbitrary configuration of adsorbates with a mean average error of less than 6 meV/atom.

Ultra precise figure error correction of optics whether down to the sub-nm RMS level or time-saving with nm-RMS accuracy by using three axes IBF-plants.