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In der mehr als einhundertjährigen Debatte über die Gründe und die Verantwortung für den Ausbruch des Ersten Weltkrieges blieb ein wesentlicher Faktor bislang unberücksichtigt: die französische Detailkenntnis des Schlieffenplans. Der Beitrag entwickelt die These, dass dieses Wissen um das seit 1913 alternativlose militärische Vorgehen des Deutschen Reiches sowie die sich hieraus ergebenden Handlungszwänge für Berlin zum Kompassbuch der Außen- und Militärpolitik Frankreichs vor dem Kriegsbeginn wurde. Als Ministerpräsident und als Staatspräsident verfolgte Poincaré eine Kriegsvorbereitungs- und Erpressungspolitik gegenüber Berlin. Sie sollte nicht nur die Sicherheit Frankreichs vor Deutschland verbürgen. Ihr Ziel und ihre Perspektive waren vielmehr die einer Revanche für 1870/71, um, analog zu Bismarcks Vorgehen in der „Hohenzollernkrise“, die Berliner Reichsleitung in eine Situation zu manövrieren, in der sich diese zur Flucht nach vorne in die Kriegsauslösung entschloss. Deshalb wurde die Entente Cordiale mit England zu einem de facto-Militärbündnis ausgebaut; deshalb agierte Poincaré als Geburtshelfer der Unterhandlungen für eine Marinekonvention zwischen London und Petersburg; und deshalb gab er der Pariser Balkanpolitik eine neue Ausrichtung, indem er die seit 1893/94 bestehende Beistandsautomatik gegenüber Rußland grundlegend modifizierte. Jetzt wurden die russischen Expansionsziele auf dem Balkan als handlungsleitendes Motiv der Pariser Politik adoptiert; jetzt wurde Petersburg angespornt, gegen Wien offensiv aufzutreten; jetzt bekamen die russischen Entscheidungsträger, anders als noch in der „bosnischen Annexionskrise“, die Versicherung uneingeschränkten französischen Beistands auf dem Balkan; und jetzt wurde mit Petersburg ein mit Anleihen unterfüttertes Kompensationsgeschäft abgeschlossen, das sich sowohl diplomatisch wie vor allem militärisch gegen Deutschland richtete und die Prämissen des Schlieffenplans zunehmend aushebelte. All diese Vorkehrungen dienten dazu, die Unzulänglichkeiten der eigenen militärstrategischen Aufstellung gemäß „Plan XVII“ auszubalancieren, die offene belgische Flanke abzudichten, die eminenten Bedenken der eigenen Generalität zu zerstreuen und Frankreich in einem Krieg an der Seite Russlands und Englands eine Siegchance zu verschaffen. Vor allem aber erfüllten sie den Zweck, Deutschland herauszufordern und unter enormen Handlungsdruck zu setzen. Die von Poincaré angeheizten Einkreisungsphobien in der deutschen Führungsspitze ebneten somit Berlin den Weg in die hochriskante und nicht beherrschbare Konfrontations- und Risikopolitik der „Julikrise“. Poincarés Kalkül erfüllt den Tatbestand einer indirekten Kriegsentfesselung.
Background
Barbed suture material offers the possibility of knotless flexor tendon repair, as suggested in an increasing number of biomechanical studies. There are currently two different absorbable barbed suture products available, V-Loc™ and Stratafix™, and both have not been compared to each other with regard to flexor tendon repair. The purpose of this study was to evaluate both suture materials for primary stability under static and cyclic loading in a biomechanical ex vivo model.
Methods
Forty fresh porcine flexor digitorum profundus tendons were randomized in two groups. A four-strand modified Kessler suture technique was used to repair the tendon either with a 3–0 V-Loc™ or 3–0 Stratafix™ without a knot. Parameters of interest were mode of failure, 2-mm gap formation force, displacement, stiffness and maximum load under static and cyclic testing.
Results
The maximum load was 42.3 ± 7.2 for the Stratafix™ group and 50.7 ± 8.8 N for the V-Loc™ group. Thus, the ultimate tensile strength was significantly higher for V-Loc™ (p < 0.05). The 2-mm gap occurred at 24.8 ± 2.04 N in the Stratafix™ group in comparison to 26.5 ± 2.12 N in the V-Loc™ group (n.s.). Displacement was 2.65 ± 0.56 mm in the V-Loc™ group and 2.71 ± 0.59 mm in the Stratafix™ group (n.s.). Stiffness was 4.24 ± 0.68 (N/mm) in the V-Loc™ group and 3.85 ± 0.55 (N/mm) the Stratafix™ group (n.s.). Those measured differences were not significant.
Conclusion
V-Loc™ demonstrates a higher maximum load in tendon reconstruction. The differences in 2-mm gap formation force, displacement and stiffness were not significant. Hereby, the V-Loc™ has an advantage when used as unidirectional barbed suture for knotless flexor tendon repair.
In der Arbeit geht es um die Ausmessung von knochenverankerten Hörgeräten, sogenannten BAHAs und um die Messung eines künstlichen Mastoids. Unter anderem wurden die Geräte auf Resonanzen und Nichtlinearitäten untersucht sowie die wirkenden Kräfte der BAHAs. Ein einfacher Versuchsaufbau für Impulsmessung und Vibrationsmessung wurde eigens hierfür erstellt. Das künstliche Mastoid Tu-1000 zeigte einwandfreie Funktionsweise in den Frequenzen 125 Hz bis 6 kHz, die BAHAs Cordelle 2 und Compact wurden miteinander in den Frequenzen 125 Hz bis 8 kHZ verglichen und die filigranen Kräfte ausgemessen, mit denen die BAHAs arbeiten.
Background:
In recent years attention has focused on \(\gamma\)H2AX as a very sensitive double strand break indicator. It has been suggested that \(\gamma\)H2AX might be able to predict individual radiosensitivity. Our aim was to study the induction and repair of DNA double strand breaks labelled by \(\gamma\)H2AX in a large cohort.
Methods:
In a prospective study lymphocytes of 136 rectal cancer (RC) patients and 59 healthy individuals were ex vivo irradiated (IR) and initial DNA damage was compared to remaining DNA damage after 2 Gy and 24 hours repair time and preexisting DNA damage in unirradiated lymphocytes. Lymphocytes were immunostained with anti-\(\gamma\)H2AX antibodies and microscopic images with an extended depth of field were acquired. \(\gamma\)H2AX foci counting was performed using a semi-automatic image analysis software.
Results:
Distinct increased values of preexisting and remaining \(\gamma\)H2AX foci in the group of RC patients were found compared to the healthy individuals. Additionally there are clear differences within the groups and there are outliers in about 12% of the RC patients after ex vivo IR.
Conclusions:
The \(\gamma\)H2AX assay has the capability to identify a group of outliers which are most probably patients with increased radiosensitivity having the highest risk of suffering radiotherapy-related late sequelae.
Bioprinting offers the opportunity to fabricate precise 3D tumor models to study tumor pathophysiology and progression. However, the choice of the bioink used is important. In this study, cell behavior was studied in three mechanically and biologically different hydrogels (alginate, alginate dialdehyde crosslinked with gelatin (ADA–GEL), and thiol-modified hyaluronan (HA-SH crosslinked with PEGDA)) with cells from breast cancer (MDA-MB-231 and MCF-7) and melanoma (Mel Im and MV3), by analyzing survival, growth, and the amount of metabolically active, living cells via WST-8 labeling. Material characteristics were analyzed by dynamic mechanical analysis. Cell lines revealed significantly increased cell numbers in low-percentage alginate and HA-SH from day 1 to 14, while only Mel Im also revealed an increase in ADA–GEL. MCF-7 showed a preference for 1% alginate. Melanoma cells tended to proliferate better in ADA–GEL and HA-SH than mammary carcinoma cells. In 1% alginate, breast cancer cells showed equally good proliferation compared to melanoma cell lines. A smaller area was colonized in high-percentage alginate-based hydrogels. Moreover, 3% alginate was the stiffest material, and 2.5% ADA–GEL was the softest material. The other hydrogels were in the same range in between. Therefore, cellular responses were not only stiffness-dependent. With 1% alginate and HA-SH, we identified matrices that enable proliferation of all tested tumor cell lines while maintaining expected tumor heterogeneity. By adapting hydrogels, differences could be accentuated. This opens up the possibility of understanding and analyzing tumor heterogeneity by biofabrication.
Background:
Flap reconstruction of the distal lower extremity is challenging. Especially, the concept of perforator surgery has increased available surgical options. Although results are generally judged in terms of objective facts, patients-perceived quality of life has largely remained unexamined. The aim of the study was to compare quality of life after lower extremity reconstruction with pedicled and free flaps.
Methods:
Patients were evaluated retrospectively after reconstruction of defects of the distal lower extremity either with distally based adipofascial sural flap (pedicled reverse sural flap) or an anterior lateral thigh (ALT) flap. A specific questionnaire was developed to measure the patient’s quality of life, based on short form health survey-12, Dresden Body Image Score-35, Patient Health Questionnaire-4, and XSMFA questionnaires with additional specific questions. Furthermore, results, secondary surgeries, and complications were analyzed.
Results:
Thirty-seven patients with reconstruction of lower limb defects treated with a pedicled reverse sural flap and 34 patients treated with an ALT flap were included in the study. There was no statistical significant difference in the overall satisfaction with the procedure in the long-term follow-up between both groups, but patients with ALT showed a higher satisfaction with the treatment in the initial postoperative period. Both groups demonstrated approximately similar results in the long term for self-acceptance and vitality.
Conclusions:
Although anatomic situation may dictate flap choice coverage with free flaps, a less-complicated flap is by no means regarded as an inferior treatment option in patient’s estimation. Despite the intuitive speculation that patients with more advanced reconstruction methods should have better function and subsequently higher quality of life, this assumption was clearly not supported by data in this study.
Background:
Although indocyanine-green fluorescence angiography (ICG-FA) has been established as a useful tool to assess perfusion in free tissue transfer, only few studies have applied this modality to pedicled perforator flaps. As both volume and reach of pedicled perforator flaps are limited and tip necrosis often equals complete flap failure, ICG-FA may help to detect hypoperfusion in pedicled flaps.
Methods:
In 5 patients, soft tissue reconstruction was achieved with pedicled perforator flaps. ICG-FA was utilized intraoperatively to visualize flap perfusion.
Results:
Three pedicled anterolateral thigh flap flaps and 2 propeller flaps were transferred. ICG-FA detected hypoperfusion in 2 flaps. No flap loss occurred; in 2 cases, prolonged wound healing was encountered.
Conclusions:
ICG-FA confirmed clinical findings and reliably detected tissue areas with hypoperfusion. A clear cut-off point between nonvital tissue and such that stabilized in the following clinical course could not be found. ICG-FA is a promising technology which could also be used in pedicled perforator flaps.