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Dieser Beitrag konzentriert sich auf den Zielkonflikt für Produktionsanlagen und stellt einen ganzheitlichen Rahmen vor, der hilft, die voneinander abhängigen Attribute von Resilienz, Ressourceneffizienz und Leistung anhand eines systemdynamischen Modells zu optimieren. This paper focuses on the different conflicting goals of manufacturing facilities and presents a holistic framework to help optimizing the interdependent attributes of resilience, resource efficiency, and performance, using a system dynamics model.

While glioblastoma (GBM) is still challenging to treat, novel immunotherapeutic approaches have shown promising effects in preclinical settings. However, their clinical breakthrough is hampered by complex interactions of GBM with the tumor microenvironment (TME). Here, we present an analysis of TME composition in a patient-derived organoid model (PDO) as well as in organotypic slice cultures (OSC). To obtain a more realistic model for immunotherapeutic testing, we introduce an enhanced PDO model. We manufactured PDOs and OSCs from fresh tissue of GBM patients and analyzed the TME. Enhanced PDOs (ePDOs) were obtained via co-culture with PBMCs (peripheral blood mononuclear cells) and compared to normal PDOs (nPDOs) and PT (primary tissue). At first, we showed that TME was not sustained in PDOs after a short time of culture. In contrast, TME was largely maintained in OSCs. Unfortunately, OSCs can only be cultured for up to 9 days. Thus, we enhanced the TME in PDOs by co-culturing PDOs and PBMCs from healthy donors. These cellular TME patterns could be preserved until day 21. The ePDO approach could mirror the interaction of GBM, TME and immunotherapeutic agents and may consequently represent a realistic model for individual immunotherapeutic drug testing in the future.

The randomized phase 3 CeTeG/NOA-09 trial assessed whether CCNU plus temozolomide was superior to temozolomide alone in newly diagnosedWe retrospectively collected clinical and radiographic data from adult newly diagnosedSeventy patients were included. Median progression-free survival was 14.4 months and median overall survival 33.8 months. Patients with TTFields treatment for at least 8 weeks and CCNU plus temozolomide (The results from this multicentric trial indicate that-under real-life conditions-toxicity and survival estimates are comparable to the CeTeG/NOA-09 trial. TTFields therapy for at least eight weeks in combination with this regimen was independently associated with prolonged survival.

The omnipresence of smartphones among adolescents and adults gives rise to the questions about excessive use and personality factors which are associated with heavier engagement with these devices. Previous studies have found behavioral similarities between smartphone use and maladaptive behaviors (e.g. drinking, gambling, drug abuse) in the context of intertemporal choice but mostly relied on participants’ self-reports regarding engagement with their phone. In this study, we collected actual usage data by smartphone application from 101 participants and assessed their tendency to discount future rewards, their reward responsiveness, self-control and consideration of future consequences. We found that smartphone screen time was correlated with choosing smaller immediate over larger delayed rewards and that usage of social media and gaming apps predicted delay discounting. Additionally, smartphone use was negatively correlated with self-control but not correlated with consideration of future consequences. Neither psychological variable could mediate the relationship between smartphone usage and delay discounting. Our findings provide further evidence that smartphone use and impulsive decision-making go hand in hand and that engagement with these devices needs to be critically examined by researchers to guide prudent behavior.

Background The randomized phase 3 CeTeG/NOA-09 trial assessed whether CCNU plus temozolomide was superior to temozolomide alone in newly diagnosed MGMT promoter methylated glioblastoma patients. Survival was significantly improved from 31.4 months (temozolomide) to 48.1 months (CCNU plus temozolomide). In view of this encouraging data, we assessed safety and efficacy of this regimen under real-life conditions. Methods We retrospectively collected clinical and radiographic data from adult newly diagnosed MGMT promoter methylated IDH wildtype glioblastoma patients from five neuro-oncology centers in Germany. For inclusion in our analysis, treatment with CCNU and temozolomide had to be performed for at least six weeks (one course). Results Seventy patients were included. Median progression-free survival was 14.4 months and median overall survival 33.8 months. Patients with TTFields treatment for at least 8 weeks and CCNU plus temozolomide (n = 22, 31%) had a prolonged progression-free survival compared to those with TTFields treatment for less than eight weeks (n = 48, 69%) (21.5 versus 11.2 months; P = .0105). In a multivariable Cox regression analysis, TTFields treatment for eight weeks or longer together with CCNU plus temozolomide and a Karnofsky performance score ≥ 90% were independent prognostic factors for progression-free and overall survival. Pseudoprogression occurred in n = 16 (33%) of investigated n = 49 (70%) patients. In n = 31 (44%) patients high-grade hematotoxicity was observed. Conclusions The results from this multicentric trial indicate that—under real-life conditions—toxicity and survival estimates are comparable to the CeTeG/NOA-09 trial. TTFields therapy for at least eight weeks in combination with this regimen was independently associated with prolonged survival.

Humans discount rewards as a function of the delay to their receipt. This tendency is referred to as delay discounting and has been extensively researched in the last decades. The magnitude effect (i.e., smaller rewards are discounted more steeply than larger rewards) and the trait effect (i.e., delay discounting of one reward type is predictive of delay discounting of other reward types) are two phenomena which have been consistently observed for a variety of reward types. Here, we wanted to investigate if these effects also occur in the context of the novel but widespread reward types of Instagram followers and likes and if delay discounting of these outcomes is related to self-control and Instagram screen time. In a within-subject online experiment, 214 Instagram users chose between smaller, immediate and larger, delayed amounts of hypothetical money, Instagram followers and likes. First, we found that the magnitude effect also applies to Instagram followers and likes. Second, delay discounting of all three reward types was correlated, providing further evidence for a trait influence of delay discounting. Third, no relationships were found between delay discounting and self-control as well as Instagram screen time, respectively. However, a user's average like count was related to delay discounting of Instagram likes.

BACKGROUND The randomized phase 3 CeTeG/NOA-09 trial assessed whether CCNU plus temozolomide was superior to temozolomide alone in newly diagnosed MGMT promoter methylated glioblastoma patients. Survival was significantly improved from 31.4 months (temozolomide) to 48.1 months (CCNU plus temozolomide). In view of this encouraging data, we assessed safety and efficacy of this regimen under real-life conditions. METHODS We retrospectively collected clinical and radiographic data from adult newly diagnosed MGMT promoter methylated IDH wildtype glioblastoma patients from five neuro-oncology centers in Germany. For inclusion in our analysis, treatment with CCNU and temozolomide had to be performed for at least six weeks (one course). RESULTS Seventy patients were included. Median progression-free survival was 14.4 months and median overall survival 33.8 months. Patients with TTFields treatment for at least eight weeks and CCNU plus temozolomide (n = 22, 31%) had a prolonged progression-free survival compared to those with TTFields treatment for less than eight weeks (n = 48, 69%) (21.5 versus 11.2 months; p = 0.0105). In a multivariable Cox regression analysis, TTFields treatment for eight weeks or longer together with CCNU plus temozolomide and a Karnofsky performance score ≥ 90% were independent prognostic factors for progression-free and overall survival. Pseudoprogression occurred in n = 16 (33%) of investigated n = 49 (70%) patients. In n = 31 (44%) patients high-grade hematotoxicity was observed. CONCLUSIONS The results from this multicentric trial indicate - under real-life conditions - toxicity and survival estimates comparable to the CeTeG/NOA-09 trial. TTFields therapy for at least eight weeks in combination with this regimen was independently associated with prolonged survival.

The reaction of carbon monoxide with the acyclic diaminocarbene iPr2N–C–TMP (TMP=2,2,6,6-tetramethylpiperidino), generated in situ from the formamidinium salt [(iPr2N)CH(TMP)][PF6] and NaN(SiMe3)2, unexpectedly afforded a mixture of β- and γ-lactams.

The distribution, metabolism, excretion and hepatic effects of the human hepatotoxin fenclozic acid were investigated following single oral doses of 10 mg/kg to normal and bile duct-cannulated male C57BL/6J mice. Whole body autoradiography showed distribution into all tissues except the brain, with radioactivity still detectable in blood, kidney and liver at 72 h post-dose. Mice dosed with [14C]-fenclozic acid showed acute centrilobular hepatocellular necrosis, but no other regions of the liver were affected. The majority of the [14C]-fenclozic acid-related material recovered was found in the urine/aqueous cage wash, (49%) whilst a smaller portion (13%) was eliminated via the faeces. Metabolic profiles for urine, bile and faecal extracts, obtained using liquid chromatography and a combination of mass spectrometric and radioactivity detection, revealed extensive metabolism of fenclozic acid in mice that involved biotransformations via both oxidation and conjugation. These profiling studies also revealed the presence of glutathione-derived metabolites providing evidence for the production of reactive species by mice administered fenclozic acid. Covalent binding to proteins from liver, kidney and plasma was also demonstrated, although this binding was relatively low (less than 50 pmol eq./mg protein).

Patient: Female, 59 Final Diagnosis: Delayed kidney graft function Symptoms: — Medication: — Clinical Procedure: Living donor kidney transplantation Specialty: Transplantology Objective: Unusual clinical course Background: Delayed graft function is a clinical term to describe the failure of the transplanted kidney to function immediately after transplantation. Case Report: A 59-year-old woman suffered from a rare case of delayed graft function lasting 148 days after unrelated living donor kidney transplantation. Until now, 15 years after transplantation, organ function is still good, with serum creatinine levels about 1.4 to 2.0 mg/dl. Conclusions: Even after prolonged graft dysfunction, good graft function can be achieved.

Endoscopy and laparoscopy are used for the assessment of disorders of sex development (DSD) and therapeutic interventions. Endoscopy (urethra-cystoscopy, vaginoscopy) is especially useful when vaginal or urethral surgery is planned. It is also valuable for the assessment of complications. Laparoscopy is used to identify sex ducts and gonads and to perform minimally invasive abdominal and pelvic surgery. This article reviews clinical indications, limitations, findings, and their reporting. It further discusses the impact of these findings on care in typical clinical situations.

The portfolio of acyclic diaminocarbenes (ADACs) has been substantially expanded, owing to the synthesis of eleven new formamidinium salts, mostly of the type [(iPr2N)CH(NRR')][PF6], for use as immediate carbene precursors. The corresponding ADACs (iPr2N)C(NRR') were sufficiently stable for isolation in the case of NRR' = 2-methylpiperidino (13), 3-methylpiperidino (14), 4-methylpiperidino (15), morpholino (17) and NiPrPh (20), but had to be trapped in situ in the case of NRR' = 2,2,6,6-tetramethylpiperidino (12) and NiPrMe (19). The tetraaryl-substituted ADACs (Ph2N)2C (22) and (Ph2N)C[N(C6F5)2] (24) also could only be generated and trapped in situ. Trapping with elemental selenium was particularly efficient, affording the corresponding selenourea derivative in all cases, whereas trapping with [{Rh(μ-Cl)(cod)}2] did not work for 12 and 24. The (77)Se NMR chemical shifts, δ((77)Se), of the selenourea compounds derived from the new ADACs lie in the range 450-760 ppm, which indicates a much higher electrophilicity and π-accepting capability of ADACs in comparison with NHCs, which typically exhibit δ((77)Se)

BACKGROUND Simultaneous pancreas-kidney transplantation has been established as the treatment of choice for type 1 diabetes patients with renal dysfunction. Patient 1-year survival better than 95% has been achieved using this kind of transplantation. According to the postoperative complication rate (5% mortality), recipients appear to have a survival benefit not earlier than 2 years after transplantation. This study evaluates the long-term benefit of simultaneous pancreas-kidney recipients with functioning grafts after 1 year. MATERIAL/METHODS A retrospective analysis of 176 patients after first transplantation with functioning grafts 1 year after simultaneous pancreas-kidney transplantation was performed. RESULTS During the follow-up period starting 1 year after successful transplantation, 7 patients died due to various causes, 13 pancreas grafts (7.4%) and 13 kidney transplants (7.4%) lost their function during the 10-year follow-up period. Chronic graft failure was the most common reason for transplant loss. CONCLUSIONS Our data support the excellent long-term prognosis of simultaneous pancreas-kidney transplantation recipients with functioning graft 1 year after transplantation.

The distribution, metabolism, excretion and hepatic effects of the human hepatotoxin fenclozic acid were investigated following single oral doses of 10 mg/kg to normal and bile duct-cannulated male C57BL/6J mice. Whole body autoradiography showed distribution into all tissues except the brain, with radioactivity still detectable in blood, kidney and liver at 72 h post-dose. Mice dosed with [14C]-fenclozic acid showed acute centrilobular hepatocellular necrosis, but no other regions of the liver were affected. The majority of the [14C]-fenclozic acid-related material recovered was found in the urine/aqueous cage wash, (49%) whilst a smaller portion (13%) was eliminated via the faeces. Metabolic profiles for urine, bile and faecal extracts, obtained using liquid chromatography and a combination of mass spectrometric and radioactivity detection, revealed extensive metabolism of fenclozic acid in mice that involved biotransformations via both oxidation and conjugation. These profiling studies also revealed the presence of glutathione-derived metabolites providing evidence for the production of reactive species by mice administered fenclozic acid. Covalent binding to proteins from liver, kidney and plasma was also demonstrated, although this binding was relatively low (less than 50 pmol eq./mg protein). Electronic supplementary material The online version of this article (doi:10.1007/s00204-016-1894-5) contains supplementary material, which is available to authorized users.

This paper focuses on complexes of the N-heterocyclic carbene (NHC) 1-Np, which contains a 1,1′-ferrocenediyl backbone and neopentyl substituents at the N atoms flanking the divalent C atom. 1-Np is a ring-expanded NHC with a ring size of six atoms. The square-planar group 10 metal complexes [{PdCl(μ-Cl)(1-Np)}2], cis-[PdCl2(1-Np)(PPh3)], trans-[PdCl2(1-Np)2] and trans-[NiCl2(1-Np)(PPh3)] have been prepared by the reaction of 1-Np with trans-[PdCl2(PhCN)2], [PdCl2(PPh3)2], cis-[PdCl2(COD)] (COD = cycloocta-1,5-diene) and [NiCl2(PPh3)2], respectively. In addition, the carbene–borane adduct 1-Np–BF3 has been obtained by serendipity. All new compounds have been structurally characterised by single-crystal X-ray diffraction, which demonstrates the pronounced trans influence of 1-Np. 1-Np has been compared with the ring-expanded NHC 1,3-diisopropyltetrahydropyrimid-2-ylidene (THP-iPr) in the context of homogeneous catalysis, which utilises analogous palladium NHC complexes known to be particularly effective in the case of NHC = THP-iPr. The catalytic performance of cis-[PdCl2(1-Np)(PPh3)] in Suzuki–Miyaura cross-coupling reactions of PhB(OH)2 with aryl bromides Br–p-C6H4–R is similar to that reported for cis-[PdCl2(THP-iPr)(PPh3)]. With aryl chlorides, however, the latter complex is superior to its 1-Np analogue. The catalytic performance reported for trans-[PdCl2(THP-iPr)2] in Mizoroki–Heck reactions of n-butyl acrylate with aryl bromides Br–p-C6H4–R is equal to (R = H) or moderately better than that of trans-[PdCl2(1-Np)2] [R = C(O)Me, OMe].

Incisional hernias after laparotomy are a large financial burden for society as well as for the patients suffering from pain and limitations of activity over time. The introduction of alloplastic materials such as polypropylene seems to improve the results. The question of whether to apply open or laparoscopic implantation of the mesh is of ongoing interest. We compare the available alloplastic materials and try to clarify the question of whether the laparoscopic procedure is superior to the conventional (open) technique based on the available randomized studies. All available meshes for intraperitoneal and extraperitoneal implantation were described regarding their handling and their pros and cons. A database search (PubMed, Medline, Ovid, and in the secondary literature) was carried out to retrieve all randomized studies comparing laparoscopic and open hernia repair. Data were reviewed by two independent scientists for surgical and statistical design. The ideal mesh for a laparoscopic maintenance of abdominal wall hernias as well as the optimal fixation of the mesh has not been found yet. Recent available literature shows no evidence demonstrating the superiority of one of these meshes. The available studies found a lower infection rate, but higher occurrence of seroma for the laparoscopic procedure. The value of the different studies is reduced due to deficiency in study design and power. Guidelines for further studies are discussed to avoid surgical and statistical pitfalls. Laparoscopic incisional hernia repair shows, in some (randomized) studies as well as a large number of retrospective analyses and in case control studies, superiority compared to conventional hernia repair. Long-term results with a high level of evidence are not available. Additional well-designed randomized trials including long-term observation of patients are required in order to clarify a number of interesting questions.

The use of alloplastic materials such as polypropylene and polyester has reduced the recurrence of abdominal wall hernias. Concomitantly, new problems have arisen such as inflammatory response against the implanted material and the development of enteric fistulas in case of direct contact of the bowel to polypropylene and polyester. A precoating of the PP with collagen and other absorbable materials seems to reduce the incidence of adhesions and fistulas. The aim of this study was to show the technical feasibility of a precoating of polypropylene with living human fibroblasts and to investigate the growth properties of the cells under these conditions in vitro.The textile structure of three different alloplastic materials is described (SurgiPro), TycoHealthcare; Parietene3 PP1510, Dallhausen; VIPRO II, Ethicon Endosurgery). Enhanced Green Fluorescence Protein (EGFP) transduced human foreskin fibroblasts (KiF5) were seeded onto these different alloplastic materials. Proliferation was analyzed by FACS analysis of Ki67 expression. The coating process of the whole mesh area was observed over time with UV-light microscopy, immunostaining, and scanning electron microscopy (SEM). The expression of collagen type I and III was investigated by immunostaining.The three alloplastic materials used were knitted fabrics with different textile structures. KiF5 colonized the entire alloplastic material within 4-6 weeks. Cells were proliferating, as detected by Ki67 expression. SEM showed surface ruffles and long cellular extensions, indicating an active cell metabolism. Light microscopy and SEM suggested that the cells modify the apolar surface by deposition of extracellular matrix components before colonization.Our study shows the feasibility of precoating of polypropylene meshes with living human fibroblasts and opens the possibility for clinical use in the future.

Self-induced injuries of the bowel have various accidental mechanisms. This is a report of a 35-year-old patient with disruption of the recto-sigmoid junction caused by carbon dioxide (CO2) originating from a bottle of sparkling wine, which was introduced transanally for sexual stimulation. The patient underwent resection of the recto-sigmoid junction and primary anastomosis. The postoperative course was uneventful except for wound infection. The patient was discharged 12 days later. The physical backgrounds, the pathological pathways for perforation and diagnostic modalities including diagnostic pitfalls are critically discussed.

Tacrolimus, used in organ transplantation, inhibits cellular immune function. Little is known about the effect on dermal and colonic healing. Groups of 10 rats underwent dorsal skin incision, and polyvinyl alcohol sponges were implanted subcutaneously. Beginning at the day of wounding, rats were treated intraperitoneal with 1.0 or 2.0 mg tacrolimus/kg/day. Animals were sacrificed 10 d later to determine wound breaking strength and reparative collagen deposition. Expression of transforming growth factor (TGF)-beta, tumor necrosis factor (TNF)-alpha, and interferon (IFN)-gamma was studied in wounds. Groups of 8 rats underwent laparotomy and left colonic anastomosis. These rats were treated by subcutaneous injections with 2.0 or 5.0 mg tacrolimus/kg. Animals were sacrificed 5 d later to test colonic bursting pressure and reparative collagen deposition. Expression of TGF-beta, TNF-alpha, IFN-gamma, and CD4 and CD8 in the anastomosis was investigated. Tacrolimus impaired dermal healing (p < .05). This was paralleled by decreased expression of TGF-beta (stimulates healing) and increased expression of IFN-gamma and TNF-alpha (both inhibit healing) (p < .05). In contrast, tacrolimus did not inhibit healing of colonic anastomoses. No effect was seen on the expression of TGF-beta, TNF-alpha, IFN-gamma, and CD4 and CD8 in colonic anastomoses. We concluded that tacrolimus differentially effects tissue healing and expression of cellular mediators in dermal and intestinal wounds.

INTRODUCTION Laparoscopic therapy of complicated appendicitis is still discussed controversially. This retrospective study compared the clinical results of open and laparoscopic appendectomy in a single centre. PATIENTS AND METHODS Within a period of three years (1999 to 2001) 493 patients with suspected acute appendicitis were operated prospectively at a German district hospital (250 open appendectomies, 243 laparoscopic appendectomies). Twenty percent of the patients in every group had a complicated appendicitis (48 open, 44 laparoscopic appendectomies) and were analysed retrospectively considering demographic data, operative time, body mass index, preoperative inflammatory parameters (white blood cell count, C-reactive protein and body temperature) and postoperative complication rate. RESULTS Both groups were comparable with regard to demographic data. One patient of the laparoscopic group needed an open operation (conversion rate 2.3 %). The body mass index of the laparoscopic group was significantly higher (26.3 vs. 24.1 kg/m(2)). Preoperative white blood cell count, C-reactive protein, body temperature as well as postoperative antibiotic therapy and analgesics requirement were comparable in both groups. There was no significant difference between the length of operative time (open 48 min, laparoscopic 53.5 min). The postoperative hospital stay was significantly shorter in the laparoscopic group (8 vs. 9 days, p = 0.032). Complication rate was significantly lower in the laparoscopic group (11.5 vs. 35 %, p = 0.014). CONCLUSION Laparoscopic appendectomy is a safe procedure for the treatment of complicated appendicitis with a significantly decreased complication rate and shorter postoperative stay.

Diisopropylamino-cis-2,6-dimethylpiperidinocarbene reacts regio- and diastereoselectively with CO to afford a bicyclic β-lactam with 100% atom efficiency, whose spectrum of activity resembles that of penicillin G or amoxicillin.

The reactions of the acyclic diaminocarbenes (Me2N)2C and (Ph2N)(iPr2N)C with CO proceed in a 2 : 1 stoichiometric ratio, affording unprecedented betainic oxyallyl species of type [(R2N)2C]2CO.

The "Alder carbene" (iPr(2)N)(2)C undergoes a β-fragmentation in solution already at room temperature, affording propene and N,N,N'-triisopropylformamidine. This stands in sharp contrast to the indefinite stability previously claimed for this iconic compound.

In spite of the widespread use of laparoscopic appendectomy, there is an ongoing debate on the advantages of this method when compared to open appendectomy. In the evaluation of a postoperative procedure, long-term quality of life is essential. From 1999 to 2001, 493 patients diagnosed with acute appendicitis were operated in a German general district hospital and included in an observational study. In a median postoperative interval of 7 years, these patients were re-evaluated regarding their quality of life after surgery. A Short-Form 36 Health Survey (SF-36) questionnaire was applied to evaluate the general parameters of quality of life after surgery. This questionnaire was supplemented by an additional self-developed module referring to the appendectomy. The primary outcome was the recommendation of the experienced operating procedure to relatives and friends. A total of 243 patients underwent a laparoscopic procedure: 132 patients were re-evaluated (recovery rate 54%). In the open group, 250 patients were operated: 121 patients were re-evaluated (recovery rate 48%). The median interval from operation to evaluation was 7 years in the laparoscopic group and 7.7 years in the open group. For the primary outcome, patients with laparoscopic appendectomy would significantly more often recommend the procedure than patients with the open operation method. For secondary outcomes, the cosmetic results were judged significantly more favourably in the laparoscopic group. The eight scaled scores of the SF-36 questionnaire did not differ significantly between the two groups. Four patients of the open group and nine patients of the laparoscopic group (including one converted procedure) needed a reoperation because of incisional hernia, adhesions and late infections. Patients after laparoscopic appendectomy show a higher degree of satisfaction with their body and their scar than patients after open appendectomy.

The benefit of laparoscopic appendicectomy remains unclear. We have analysed available randomised studies comparing laparoscopic and open appendicectomy regarding their clinical pitfalls and statistical relevance.Thirty eight studies were analysed in terms of the following aspects: A. clinical problems (e.g., expertise of the surgeons, pre- and postoperative antibiotic treatment, definition of complications, blinding of outcomes) and B. statistical problems (e.g., definition of primary and secondary outcomes, power and sample size, statistical methods, confidence intervals, comparability of groups and studies).Most of the studies have clinical and statistical pitfalls. The most important pitfalls are the uncertain expertise of the operating surgeons, blinding, and the exploratory nature of the studies. Our analysis aims at giving useful information for the appraisal of existing studies and the conduct of further studies. It also gives some preliminary results.More than twenty years after Semm performed the first laparoscopic appendicectomy, it is necessary to clarify the superiority of laparoscopic or open appendectomy with well-defined, carefully designed randomised studies.

A variety of alloplastic materials are used for hernia repair. We discuss the long-term stability and possible shrinkage of these materials. In the past, measurement of pore sizes was used to study the physical properties of alloplastic meshes. The aim of this study was to evaluate the measurement of pore sizes with regard to its correlation to possible mesh alteration. The water absorption of different polypropylene (PP) and polyester (PE) mesh materials under defined conditions was studied. For shrinkage studies, meshes were stored in formaldehyde, distilled water, saline solution, trypsin solution, urea solution, and hydrogen peroxide. The measurement of the relation between material and pore was evaluated to investigate the potential shrinking and enlargement processes. This material–pore index (MPI) before as well as 1, 7, and 14 days after incubation was measured. In comparison to measuring single pore sizes, MPI determination is the more efficient method to evaluate the possible shrinking or enlargement processes of alloplastic materials. With this technique, incorrect determination of pore sizes due to the dynamic textile structure of meshes and to shrinkage or enlargement, is excluded. All tested alloplastic materials showed an insignificant increase in water absorption under the condition of rehydration up to 0.4%. We did not observe variances in the material in shrinking or enlargement. MPI was found to be more reliable than measuring single pores to investigate possible external influences on polymer materials. Biomaterials such as PP and PE proved to be absolutely inert under various in vitro conditions.

Die kombinierte Pankreas-/Nierentransplantation (PNTX) ist inzwischen als Therapie bei niereninsuffizienten Typ I Diabetiker akzeptiert [1]. Nach Angaben des IPTR werden 1-Jahres-Funktionsraten von 81% (Pankreas) bzw. 86% (Niere) erreicht [2]. Hierzu haben ganz wesentlich Weiterentwicklungen der chirurgischen Technik und des perioperativen Managements beigetragen. Organverluste auf Grund lokaler Komplikationen (Thrombose, Pankreatitis) sind erheblich zuruck gegangen. Trotz einer Induktionstherapie mit polyklonalen oder monoklonalen Antikorpern (AK) wurde nach PNTX Abstosunginzidenzen von 55% bis 83,5% beschrieben [3]. Durch die Modifikation der Quadruple-Induktionstherapie mit bereits praoperativem Beginn der Immunsuppression konnten wir in unserem Zentrum die Inzidenz akuter Abstosungsreaktionen (RE) auf 33% reduzieren [4]. Erste Erfahrungen mit TAC, MMF, Prednisolon und single shot ATG nach PNTX sind ebenfalls vielversprechend. Daher wird in einer Studie nach PNTX untersucht, ob vergleichbare Ergebnisse mit CsA (Neoral®), MMF, Prednisolon und single shot ATG erreicht werden konnen.

This case report deals with a patient who was readmitted with a bilateral submandibular swelling after having received primary surgery due to gastric adenocarcinoma 6 months before. After bilateral submandibulectomy both glands were diagnosed histopathologically as metastasis of adenocarcinoma. This is the rare case of a submandibular gland metastasis and the first case of a bilateral synchronous submandibular gland metastasis from gastric carcinoma.