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- Departamento de Química, Facultad de Ciencias, Universidad Autónoma de Madrid, 28049 Madrid, Spain (1)
Despite decades of scientific effort, there is still no consensus on the determinants of broad-scale gradients of animal diver-sity. We argue that general drivers of diversity are unlikely to be found among the narrowly defined taxa which are typically analyzed in studies of broad-scale diversity gradients because ecological niches evolve largely conservatively. This causes constraints in the use of available niche space leading to systematic differences in diversity gradients among taxa. We instead advocate studies of phylogenetically diverse animal communities along broad environmental gradients. Such multi-taxa communities are less constrained in resource use and diversification and may be better targets for testing major classical hypotheses on diversity gradients. Besides increasing the spatial scale in analyses, expanding the phylogenetic coverage may be a second way to achieve higher levels of generality in studies of broad-scale diversity gradients
Hydrogels that can mimic mechanical properties and functions of biological tissue have attracted great interest in tissue engineering and biofabrication. In these fields, new materials and approaches to prepare hydrogels without using toxic starting materials or materials that decompose into toxic compounds remain to be sought after. Here, we report the crosslinking of commercial, unfunctionalized hydrophilic poly(2-ethyl-2-oxazoline) using peroxide copolymers in their melt. The influence of temperature, peroxide copolymer concentration, and duration of the crosslinking process has been investigated. The method allows to create hydrogels from unfunctionalized polymers in their melt and to control the mechanical properties of the resulting materials. The design of hydrogels with a suitable mechanical performance is of crucial importance in many existing and potential applications of soft materials, including medical applications.
Intrakranielle Blutungen sind im Säuglingsalter seltene, aber lebensbedrohende Ereignisse. Neben Gefäßmissbildungen, Stoffwechseldefekten sowie Störungen der Blutgerinnung kommen v. a. nichtakzidentielle Traumata, Schütteltrauma in Betracht. Die klinische Diagnostik umfasst hinsichtlich der Blutungsgenese neben Sonographie und MRT als apparatives Verfahren auch eine Fundoskopie sowie laborchemische Analysen, insbesondere der Gerinnungsparameter. Für die Blutgerinnung ist das fettlösliche Vitamin K essenziell: Frühe, klassische und späte Vitamin-K-Mangel-Blutungen werden dabei unterschieden. Um ein gehäuftes Wiederauftreten von Vitamin-K-Mangel-Blutungen bei Neugeborenen und jungen Säuglingen zu verhindern, bedarf es einer hinreichenden Aufklärung der Eltern. Eine Verweigerung der Prophylaxe scheint Folge einer weltanschaulich begründeten Ablehnung der Schulmedizin und ein zunehmendes Phänomen in wohlhabenden Industrieländern zu sein.
Honeybees are very sensitive to their breeding temperature. Even slightly lower temperatures during larval development can significantly affect adult behavior. Several devices which are employed for killing the honeybee ectoparasite Varroa destructor rely on short-term hyperthermia in the honeybee hive. The device used here applies 43.7 °C for 2 h, which is highly effective in killing the mites. We study how short-term hyperthermia affects worker brood and behavior of emerging adult bees. Sucrose responsiveness was strongly reduced after treatment of larvae early or late of larval development. Hyperthermia significantly enhanced life span, particularly in bees receiving treated early in larval development. To ask whether increased life span correlated with foraging performance, we used radio frequency identification (RFID). Onset and offset of foraging behavior as well as foraging trip duration and lifetime foraging effort were unaffected by hyperthermia treatment as prepupa.
Hintergrund
Die Symphysensprengung mit entsprechender Diastase kann durch eine Symphysenplatte stabilisiert werden.
Fragestellung
Welche Beckenverletzungen werden mit einer Symphysenplatte stabilisiert und wie ist das Outcome?
Material und Methoden
Retrospektive Auswertung von 64 Patienten über einen Untersuchungszeitraum von 24 Monaten.
Ergebnisse
Es waren 56 Patienten männlich, 8 weiblich und das mittlere Alter betrug 44 Jahre (SD ± 17). Unfälle im Straßenverkehr waren der führende Grund für die Beckenverletzung. Die Verteilung nach AO-Klassifikation zeigte sich wie folgt: 14-mal B1-, 10-mal B2-, 5‑mal B3-, 23-mal C1-, 9‑mal C2- und 3‑mal C3-Verletzungen. Die Verteilung nach Young und Burgess ergab: 9‑mal APC-I-, 18-mal APC-II-, 13-mal APC-III-, 9‑mal LC-I-, 3‑mal LC-II-, 2‑mal LC-III- und 10-mal VS-Verletzungen. Der mittlere Injury Severity Score (ISS) betrug 32 und die mittlere stationäre Verweildauer 29 Tage (pos. Korrelation p ≤ 0,001). Im Verlauf war eine radiologische Implantatlockerung bei 52 Patienten nachweisbar. Therapierelevante Komplikationen gab es in 14 Fällen. Hierbei war das Implantatversagen (n = 8) der Hauptgrund für eine operative Revision.
Diskussion
Obwohl die radiologische Implantatlockerung häufig beobachtet wird, ist sie nur selten Grund für einen Revisionseingriff. Kommt es hingegen zum vollständigen Implantatversagen, tritt dies meist innerhalb der ersten postoperativen Wochen auf und ist revisionsbedürftig. Eine frühzeitige Abklärung durch Röntgenbildgebung sollte bei Verdacht erfolgen.
The fruit fly Drosophila is a prime model in circadian research, but still little is known about its circadian regulation of metabolism. Daily rhythmicity in levels of several metabolites has been found, but knowledge about hydrophobic metabolites is limited. We here compared metabolite levels including lipids between period\(^{01}\) (per\(^{01}\)) clock mutants and Canton-S wildtype (WT\(_{CS}\)) flies in an isogenic and non-isogenic background using LC–MS. In the non-isogenic background, metabo-lites with differing levels comprised essential amino acids, kynurenines, pterinates, glycero(phospho)lipids, and fatty acid esters. Notably, detectable diacylglycerols (DAG) and acylcarnitines (AC), involved in lipid metabolism, showed lower levels in per\(^{01}\) mutants. Most of these differences disappeared in the isogenic background, yet the level differences for AC as well as DAG were consistent for fly bodies. AC levels were dependent on the time of day in WTCS in phase with food consumption under LD conditions, while DAGs showed weak daily oscillations. Two short-chain ACs continued to cycle even in constant darkness. per\(^{01}\) mutants in LD showed no or very weak diel AC oscillations out of phase with feeding activity. The low levels of DAGs and ACs in per\(^{01}\) did not correlate with lower total food consumption, body mass or weight. Clock mutant flies showed higher sensitivity to starvation independent of their background-dependent activity level. Our results suggest that neither feeding, energy storage nor mobilisation is significantly affected in per\(^{01}\) mutants, but point towards impaired mitochondrial activity, supported by upregulation of the mitochondrial stress marker 4EBP in the clock mutants
Hintergrund
Die Fotodokumentation von offenen Frakturen, Wunden, Dekubitalulzera, Tumoren oder Infektionen ist ein wichtiger Bestandteil der digitalen Patientenakte. Bisher ist unklar, welchen Stellenwert diese Fotodokumentation bei der Abrechnungsprüfung durch den Medizinischen Dienst der Krankenkassen (MDK) hat.
Fragestellung
Kann eine Smartphone-basierte Fotodokumentation die Verteidigung von erlösrelevanten Diagnosen und Prozeduren sowie der Verweildauer verbessern?
Material und Methoden
Ausstattung der Mitarbeiter mit digitalen Endgeräten (Smartphone/Tablet) in den Bereichen Notaufnahme, Schockraum, OP, Sprechstunden sowie auf den Stationen. Retrospektive Auswertung der Abrechnungsprüfung im Jahr 2019 und Identifikation aller Fallbesprechungen, in denen die Fotodokumentation eine Erlösveränderung bewirkt hat.
Ergebnisse
Von insgesamt 372 Fallbesprechungen half die Fotodokumentation in 27 Fällen (7,2 %) zur Bestätigung eines Operationen- und Prozedurenschlüssels (OPS) (n = 5; 1,3 %), einer Hauptdiagnose (n = 10; 2,7 %), einer Nebendiagnose (n = 3; 0,8 %) oder der Krankenhausverweildauer (n = 9; 2,4 %). Pro oben genanntem Fall mit Fotodokumentation ergab sich eine durchschnittliche Erlössteigerung von 2119 €. Inklusive Aufwandpauschale für die Verhandlungen wurde somit ein Gesamtbetrag von 65.328 € verteidigt.
Diskussion
Der Einsatz einer Smartphone-basierten Fotodokumentation kann die Qualität der Dokumentation verbessern und Erlöseinbußen bei der Abrechnungsprüfung verhindern. Die Implementierung digitaler Endgeräte mit entsprechender Software ist ein wichtiger Teil des digitalen Strukturwandels in Kliniken.
Hintergrund
Die Diagnose Krebs und ihre Behandlung kann eine große Belastung für die Betroffenen darstellen. Neben körperlichen Beschwerden kann auch die Psyche in Mitleidenschaft gezogen werden. Fehlt es an entsprechenden Bewältigungsstrategien, kann der selbstbestimmte Tod als einziger Ausweg erscheinen.
Ziel und Fragestellung
Die vorliegende Übersichtsarbeit zur Suizidalität bei Krebspatienten befasst sich mit einem Thema, das in der Forschung und Praxis in Deutschland nur wenig Aufmerksamkeit findet.
Material und Methoden
Eine themenbezogene Literaturrecherche stellt die Basis der Arbeit dar.
Ergebnisse
Todeswünsche unter Krebspatienten sind nicht selten und können Suizidgedanken/-absichten beinhalten. Psychische Beschwerden, insbesondere Hoffnungslosigkeit und Depression, sind ernstzunehmende Risikofaktoren. Das Erkennen einer hohen psychischen Belastung/von Todeswünschen ist ein wichtiger Aspekt für die Suizidprävention. Für die Praxis empfiehlt sich zunächst die Verwendung von Fragebögen. Bei auffälligen Werten muss die Suizidalität proaktiv in einem persönlichen Gespräch exploriert werden. Betroffene sind meist ambivalent bezüglich ihrer Entscheidung für oder gegen das Leben. Dies stellt eine große Chance für Interventionen dar.
Schlussfolgerungen
Suizidalität kann verhindert werden, wenn die hohe Belastung erkannt wird. Bereits das Gespräch zwischen Arzt und Patient über Todeswünsche kann eine erste Entlastung darstellen.
Purpose
The trauma centre of the Wuerzburg University Hospital has integrated a pioneering dual-room twin-CT scanner in a multiple trauma pathway. For concurrent treatment of two trauma patients, two carbon CT examination and intervention tables are positioned head to head with one sliding CT-Gantry in the middle. The focus of this study is the process of trauma care with the time to CT (tCT) and the time to operation (tOR) as quality indicator.
Methods
All patients with suspected multiple trauma, who required emergency surgery and who were initially diagnosed by the CT trauma protocol between 05/2018 and 12/2018 were included. Data relating to time spans (tCT and tOR), severity of injury and outcome was obtained.
Results
110 of the 589 screened trauma patients had surgery immediately after finishing primary assessment in the ER. The ISS was 17 (9–34) (median and interquartile range, IQR). tCT was 15 (11–19) minutes (median and IQR) and tOR was 96.5 (75–119) minutes (median and IQR). In the first 30 days, seven patients died (6.4%) including two within the first 24 h (2%). There were two ICU days (1–6) (median and IQR) and one (0–1) (median and IQR) ventilator day.
Conclusion
The twin-CT technology is a fascinating tool to organize high-quality trauma care for two multiple trauma patients simultaneously
Anxiety disorders are the most common mental disorders. The etiology is complex involving genetic and environmental factors. The first genome-wide association studies so far implicate a number of genetic loci, genome-wide epigenetic and therapy response related genetic studies are emerging. Genetic studies of anxiety disorders — as the most recent Psychiatric Genomics Consortium (PGC) group of disorders — are at the threshold of providing findings comparable to other mental disorders.
Purpose
Sacral nerve stimulation is an effective treatment for patients suffering from fecal incontinence. However, less is knownabout predictors of success before stimulation. The purpose of this study was to identify predictors of successful sacral nervestimulation in patients with idiopathic fecal incontinence.
Methods
Consecutive female patients, receiving peripheral nerve evaluation and sacral nerve stimulation between September2008 and October 2014, suffering from idiopathic fecal incontinence were included in this study. Preoperative patient’scharac-teristics, anal manometry, and defecography results were collected prospectively and investigated by retrospective analysis. Mainoutcome measures were independent predictors of treatment success after sacral nerve stimulation.
Results
From, all in all, 54 patients suffering from idiopathic fecal incontinence receiving peripheral nerve evaluation, favorableoutcome was achieved in 23 of 30 patients after sacral nerve stimulation (per protocol 76.7%; intention to treat 42.6%). From allanalyzed characteristics, wide anorectal angle at rest in preoperative defecography was the only independent predictor offavorable outcome in multivariate analysis (favorable 134.1 ± 13.9° versus unfavorable 118.6 ± 17.1°).
Conclusions
Anorectal angle at rest in preoperative defecography might present a predictor of outcome after sacral nervestimulation in patients with idiopathic fecal incontinence.
Biological systems are dynamic and three-dimensional but many techniques allow only static and two-dimensional observation of cells. We used three-dimensional (3D) lattice light-sheet single-molecule localization microscopy (dSTORM) to investigate the complex interactions and distribution of single molecules in the plasma membrane of whole cells. Different receptor densities of the adhesion receptor CD56 at different parts of the cell highlight the importance and need of three-dimensional observation and analysis techniques.
We present a non-Hermitian Floquet model with topological edge states in real and imaginaryband gaps. The model utilizes two stacked honeycomb lattices which can be related via four different typesof non-Hermitian time-reversal symmetry. Implementing the correct time-reversal symmetry provides uswith either two counterpropagating edge states in a real gap, or a single edge state in an imaginary gap.The counterpropagating edge states allow for either helical or chiral transport along the lattice perimeter.In stark contrast, we find that the edge state in the imaginary gap does not propagate. Instead, it remainsspatially localized while its amplitude continuously increases. Our model is well-suited for realizing theseedge states in photonic waveguide lattices
Mature dendritic cells (DCs) represent cellular adjuvants for optimal antigen presentation in cancer vaccines. Recently, a combination of prostaglandin E\(_2\) (PGE\(_2\)) with Toll-like receptor agonists (TLR-P) was proposed as a new standard to generate superior cytokine-producing DCs with high migratory capacity. Here, we compare TLR-P DCs with conventional DCs matured only with the proinflammatory cytokines TNFα and IL-1ß (CDCs), focussing on the interaction of resulting DCs with CD8\(^+\) T-cells. TLR-P matured DCs showed elevated expression of activation markers such as CD80 and CD83 compared to CDCs, together with a significantly higher migration capacity. Secretion of IL-6, IL-8, IL-10, and IL-12 was highest after 16 h in TLR-P DCs, and only TLR-P DCs secreted active IL-12p70. TLR-P DCs as well as CDCs successfully primed multifunctional CD8\(^+\) T-cells from naïve precursors specific for the peptide antigens Melan-A, NLGN4X, and PTP with comparable priming efficacy and T-cell receptor avidity. CD8\(^+\) T-cells primed by TLR-P DCs showed significantly elevated expression of the integrin VLA-4 and a trend for higher T-cell numbers after expansion. In contrast, TLR-P DCs displayed a substantially reduced capability to cross-present CMVpp65 protein antigen to pp65-specific T cells, an effect that was dose-dependent on PGE2 during DC maturation and reproducible with several responder T-cell lines. In conclu-sion, TLR-P matured DCs might be optimal presenters of antigens not requiring processing such as short peptides. However, PGE\(_2\) seems less favorable for maturation of DCs intended to process and cross-present more complex vaccine antigens such as lysates, proteins or long peptides.
In this paper we introduce a theoretical framework concerned with fostering functional thinking in Grade 8 students by utilizing digital technologies. This framework is meant to be used to guide the systematic variation of tasks for implementation in the classroom while using digital technologies. Examples of problems and tasks illustrate this process. Additionally, results of an empirical investigation with Grade 8 students, which focusses on the students’ skills with digital technologies, how they utilize these tools when engaging with the developed tasks, and how they influence their functional thinking, are presented. The research aim is to investigate in which way tasks designed according to the theoretical framework could promote functional thinking while using digital technologies in the sense of the operative principle. The results show that the developed framework — Function-Operation-Matrix — is a sound basis for initiating students’ actions in the sense of the operative principle, to foster the development of functional thinking in its three aspects, namely, assignment, co-variation and object, and that digital technologies can support this process in a meaningful way.
Action planning can be construed as the temporary binding of features of perceptual action effects. While previous research demonstrated binding for task-relevant, body-related effect features, the role of task-irrelevant or environment-related effect features in action planning is less clear. Here, we studied whether task-relevance or body-relatedness determines feature binding in action planning. Participants planned an action A, but before executing it initiated an intermediate action B. Each action relied on a body-related effect feature (index vs. middle finger movement) and an environment-related effect feature (cursor movement towards vs. away from a reference object). In Experiments 1 and 2, both effects were task-relevant. Performance in action B suffered from partial feature overlap with action A compared to full feature repetition or alternation, which is in line with binding of both features while planning action A. Importantly, this cost disappeared when all features were available but only body-related features were task-relevant (Experiment 3). When only the environment-related effect of action A was known in advance, action B benefitted when it aimed at the same (vs. a different) environment-related effect (Experiment 4). Consequently, the present results support the idea that task relevance determines whether binding of body-related and environment-related effect features takes place while the pre-activation of environment-related features without binding them primes feature-overlapping actions.
The new ellipsocephaloid trilobite species Kingaspidoides spinirecurvatus has a spectacular morphology because of a unique set of two long and anteriorly recurved spines on the occipital ring and the axial ring of thoracic segment 8. Together with the long genal spines this whimsical dorsally directed spine arrangement is thought to act as a non-standard protective device against predators. This is illustrated by the body posture during different stages of enrolment, contrasting with the more sophisticated spinosities seen in later trilobites, which are discussed in brief. Kingaspidoides spinirecurvatus from the lower–middle Cambrian boundary interval of the eastern Anti-Atlas in Morocco has been known for about two decades, with specimens handled as precious objects on the fossil market. Similar, but far less spectacular, spine arrangements on the thoracic axial rings are known from other ellipsocephaloid trilobites from the Anti-Atlas of Morocco and the Franconian Forest region of Germany. This suggests that an experimental phase of spine development took place within the Kingaspi-doides clade during the early–middle Cambrian boundary interval.
Purpose
To characterize the effects of netarsudil on the aqueous humor outflow tract distal to the trabecular meshwork (TM). Wehypothesized that netarsudil increases outflow facility in eyes with and without circumferential ab interno trabeculectomy (AIT)that removes the TM.
Methods
Sixty-four porcine anterior segment cultures were randomly assigned to groups with (n= 32) and without circumferential AIT (n= 32). Cultures were exposed to 0.1, 1, and 10μM netarsudil (N= 8 eyes per concentration). For each concentration,IOP and vessel diameters were compared with their respective pretreatment baselines. Outflow tract vessel diameters wereassessed by spectral-domain optical coherence tomography (SDOCT) and rendered in 4D (XYZ time series).
Results
Netarsudil at 1μM reduced IOP both in eyes with TM (−0.60 ± 0.24 mmHg,p= 0.01) and in eyes without TM (−1.79 ±0.42 mmHg,p< 0.01). At this concentration, vessels of the distal outflow tract dilated by 72%. However, at 0.1μMnetarsudilelevated IOP in eyes with TM (1.59 ± 0.36 mmHg,p< 0.001) as well as in eyes without TM (0.23 ± 0.32 mmHg,p<0.001). Vessels of the distal outflow tract constricted by 31%. Similarly, netarsudil at a concentration of 10μM elevated IOP both in eyeswith TM (1.91 ± 0.193,p< 0.001) and in eyes without TM (3.65 ± 0.86 mmHg,p< 0.001). At this concentration, outflow tractvessels constricted by 27%.
Conclusion
In the porcine anterior segment culture, the dose-dependent IOP changes caused by netarsudil matched the diameterchanges of distal outflow tract vessels. Hyper- and hypotensive properties of netarsudil persisted after TM removal
Purpose
Rescue missions during terrorist attacks are extremely challenging for all rescue forces (police as well as non-police forces) involved. To improve the quality and safety of the rescue missions during an active killing event, it is obligatory to adapt common rescue mission goals and strategies.
Methods
After the recent attacks in Europe, the Federal Office of Civil Protection and Disaster Assistance started an evaluation process on behalf of the Federal Ministry of the Interior and the Federal Ministry of Health. This was done to identify weaknesses, lessons learned and to formulate new adapted guidelines.
Results
The presented bullet point recommendations summarise the basic and most important results of the ongoing evaluation process for the Federal Republic of Germany. The safety of all the rescue forces and survival of the greatest possible number of casualties are the priority goals. Furthermore, the preservation and re-establishment of the socio-political integrity are the overarching goals of the management of active killing events. Strategic incident priorities are to stop the killing and to save as much lives as possible. The early identification and prioritised transportation of casualties with life-threatening non-controllable bleeding are major tasks and the shortest possible on-scene time is an important requirement with respect to safety issues.
Conclusion
With respect to hazard prevention tactics within Germany, we attributed the highest priority impact to the bullet points. The focus of the process has now shifted to intense work about possible solutions for the identified deficits and implementation strategies of such solutions during mass killing incidents.
Background
The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeonshave had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards.
Purpose
To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safelyaccommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergencysurgery and oncological patients or jeopardizing the well-being of hospital staff.
Conclusions
The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life whilemaintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards andoperating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidentlyand successfully undertake their respective clinical duties.