Therapie chronischer Wunden mit wassergefiltertem Infrarot A (wIRA)

The central portion of chronic wounds is often hypoxic and relatively hypothermic, representing a deficient energy supply of the tissue, which impedes wound healing or even makes it impossible. Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue penetration and a low thermal load to the skin surface. wIRA produces a therapeutically usable field of heat and increases temperature, oxygen partial pressure and perfusion of the tissue. These three factors are decisive for a sufficient tissue supply with energy and oxygen and consequently as well for wound healing, especially in chronic wounds, and infection defense. wIRA acts both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA can advance wound healing or improve an impaired wound healing process and can especially enable wound healing in non-healing chronic wounds. wIRA can considerably alleviate the pain and diminish wound exudation and inflammation and can show positive immunomodulatory effects. In a prospective, randomized, controlled study of 40 patients with chronic venous stasis ulcers of the lower legs irradiation with wIRA and visible light (VIS) accelerated the wound healing process (on average 18 vs. 42 days until complete wound closure, residual ulcer area after 42 days 0.4 cm² vs. 2.8 cm²) and led to a reduction of the required dose of pain medication in comparison to the control group of patients treated with the same standard care (wound cleansing, wound dressing with antibacterial gauze, and compression garment therapy) without the concomitant irradiation. Another prospective study of 10 patients with non-healing chronic venous stasis ulcers of the lower legs included extensive thermographic investigation. Therapy with wIRA(+VIS) resulted in a complete or almost complete wound healing in 7 patients and a marked reduction of the ulcer size in another 2 of the 10 patients, a clear reduction of pain and required dose of pain medication, and a normalization of the thermographic image. In a current prospective, randomized, controlled, blinded study patients with non-healing chronic venous stasis ulcers of the lower legs are treated with compression garment therapy, wound cleansing, wound dressings and 30 minutes irradiation five times per week over 9 weeks. A preliminary analysis of the first 23 patients of this study has shown in the group with wIRA(+VIS) compared to a control group with VIS an advanced wound healing, an improved granulation and in the later phase of treatment a decrease of the bacterial burden. Some case reports have demonstrated that wIRA can also be used for mixed arterial-venous ulcers or arterial ulcers, if irradiation intensity is chosen appropriately low and if irradiation is monitored carefully. wIRA can be used concerning decubital ulcers both in a preventive and in a therapeutic indication. wIRA can improve the resorption of topically applied substances also on wounds. An irradiation with VIS and wIRA presumably acts with endogenous protoporphyrin IX (or protoporphyrin IX of bacteria) virtually similar as a mild photodynamic therapy (endogenous PDT-like effect). This could lead to improved cell regeneration and wound healing and to antibacterial effects. In conclusion, these results indicate that wIRA generally should be considered for the treatment of chronic wounds.Das Zentrum von chronischen Wunden ist oft hypoxisch und relativ hypotherm. Dies entspricht einer defizitären Energiebereitstellung im Gewebe, die die Wundheilung behindert oder unmöglich macht. Wassergefiltertes Infrarot A (wIRA) ist eine spezielle Form der Wärmestrahlung mit hohem Eindringvermögen in das Gewebe bei geringer thermischer Oberflächenbelastung. wIRA erzeugt ein therapeutisch nutzbares Wärmefeld und steigert Temperatur, Sauerstoffpartialdruck sowie die Durchblutung im Gewebe. Diese drei Faktoren sind entscheidend für eine ausreichende Versorgung des Gewebes mit Energie und Sauerstoff und deshalb auch für die Wundheilung, speziell bei chronischen Wunden, und die Infektionsabwehr. wIRA wirkt sowohl über thermische und temperaturabhängige als auch über nicht-thermische und temperaturunabhängige Effekte. wIRA kann die Wundheilung beschleunigen oder einen stagnierenden Wundheilungsprozess verbessern und insbesondere bei nicht-heilenden chronischen Wunden eine Wundheilung ermöglichen. wIRA vermag Schmerzen deutlich zu mindern und die Wundsekretion sowie Entzündung zu reduzieren sowie positive immunmodulierende Effekte zu zeigen. In einer prospektiven, randomisierten, kontrollierten Studie mit 40 Patienten mit chronischen venösen Unterschenkelulzera führte eine Bestrahlung mit wIRA und sichtbarem Licht (VIS) zu einer schnelleren Wundheilung (im Durchschnitt 18 vs. 42 Tage bis zum kompletten Wundschluss, Restulkusfläche nach 42 Tagen 0,4 cm² vs. 2,8 cm²) und einem geringeren Schmerzmittelverbrauch gegenüber einer in gleicher Form (Wundsäuberung, antibakterielle Wundauflagen und Kompressionstherapie) therapierten, aber nicht bestrahlten Kontrollgruppe. Eine weitere prospektive Studie mit 10 Patienten mit aufwändiger thermographischer Verlaufskontrolle ergab unter Therapie mit wIRA(+VIS) eine vollständige oder fast vollständige Abheilung therapierefraktärer chronischer Unterschenkelulzera bei 7 sowie eine deutliche Ulkusverkleinerung bei 2 weiteren der 10 Patienten, eine ausgeprägte Minderung der Schmerzen und des Schmerzmittelverbrauchs und eine Normalisierung des thermographischen Bildes. In einer laufenden prospektiven, randomisierten, kontrollierten, verblindeten Studie werden Patienten mit nicht-heilenden chronischen venösen Unterschenkelulzera mit Kompressionstherapie, Wundsäuberung und nicht-adhäsiven Wundauflagen sowie 30 Minuten Bestrahlung fünfmal pro Woche über 9 Wochen behandelt. Eine vorläufige Auswertung der ersten 23 Patienten zeigte, dass die Gruppe mit wIRA(+VIS) verglichen mit einer Kontrollgruppe mit VIS eine schnellere Wundheilung, eine bessere Granulation und in der späteren Phase der Behandlung eine Abnahme der bakteriellen Last der Wunden aufwies. Einige Fallberichte haben gezeigt, dass wIRA selbst bei gemischt arteriell-venösen Ulzera oder arteriellen Ulzera eingesetzt werden kann, wenn die Bestrahlungsstärke angemessen niedrig gewählt und die Bestrahlung sorgfältig überwacht wird. wIRA kann bei Dekubitalulzera sowohl präventiv als auch therapeutisch eingesetzt werden. wIRA kann die Resorption topisch applizierter Substanzen auch auf Wunden verbessern. Eine Bestrahlung mit VIS und wIRA wirkt vermutlich in Verbindung mit endogenem Protoporphyrin IX (oder Protoporphyrin IX von Bakterien) quasi ähnlich wie eine milde photodynamische Therapie (endogener PDT-ähnlicher Effekt). Dies kann die Zellregeneration und Wundheilung fördern und antibakteriell wirken. Zusammengefasst zeigen die Ergebnisse, dass wIRA generell für die Behandlung chronischer Wunden erwogen werden sollte

Development and screening of selective catalysts for the synthesis of clean liquid fuels

This article is a compilation of the research carried out under EEC contract EN3V-0400-D at the Institut für Energieverfahrenstechnik in Jülich and at the Faculty of Chemical Technology and Materials Science, Delft, concerning the development and screening of copper/cobalt-based catalysts for the synthesis of alcohol mixtures from syngas. Analogous work, based on copper/zinc oxide/alumina catalysts, has been performed at the Faculty of Chemical Technology in Twente University at Enschede. This work is described in a companion paper. Comparative tests of several catalysts in a pressure micropulse reactor and in a plug flow tubular reactor, carried out at the Institut für Technische Chemie, TU Braunschweig, are presented in a second companion paper. \ud In the discussion section of the present article the results obtained by the joint groups are compared with the initial objectives of the programme

Ultraviolet photoelectron spectroscopy of Nb − 4 to Nb − 200

Abstract. We present UV (hν = 6.42 eV) photoelectron spectra of niobium cluster anions Nb − n in the size range from n = 4 to n = 200. The spectra exhibit a variety of patterns, which can be related to the geometrical structures of the clusters. The charging energies of the larger clusters are in very good agreement with the metallic sphere model. Nevertheless a strong size dependence of the work function is observed, which underlines the special properties of this transition metal. PACS. 33.60.Cv Ultraviolet and vacuum ultraviolet photoelectron spectra -36.40.Cg Electronic and magnetic properties of clusters -73.22.-f Electronic structure of nanoscale materials

Kinetics of isothermal and non-isothermal precipitation in an Al-6at%Si alloy

A novel theory which describes the progress of a thermally activated reaction under isothermal and linear heating conditions is presented. It incorporates nucleation, growth and impingement and takes account of temperaturedependent solubility. The model generally fits very well to isothermal calorimetry and differential scanning calorimetry data on precipitation in an Al-6 at.% Si alloy. Analysis of the data shows that two processes occur in this precipitation reaction: growth of large Si particles and growth of pre-existing small nuclei. Determination of the sizes of Si precipitates by transmission electron microscopy indicates that interfacial energy contributions are small and have a negligible influence on solubilit

Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy (PRADA): a 2 x 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol

Aims: Contemporary adjuvant treatment for early breast cancer is associated with improved survival but at the cost of increased risk of cardiotoxicity and cardiac dysfunction. We tested the hypothesis that concomitant therapy with the angiotensin receptor blocker candesartan or the {beta}-blocker metoprolol will alleviate the decline in left ventricular ejection fraction (LVEF) associated with adjuvant, anthracycline-containing regimens with or without trastuzumab and radiation. Methods and results: In a 2 x 2 factorial, randomized, placebo-controlled, double-blind trial, we assigned 130 adult women with early breast cancer and no serious co-morbidity to the angiotensin receptor blocker candesartan cilexetil, the {beta}-blocker metoprolol succinate, or matching placebos in parallel with adjuvant anticancer therapy. The primary outcome measure was change in LVEF by cardiac magnetic resonance imaging. A priori, a change of 5 percentage points was considered clinically important. There was no interaction between candesartan and metoprolol treatments (P = 0.530). The overall decline in LVEF was 2.6 (95% CI 1.5, 3.8) percentage points in the placebo group and 0.8 (95% CI −0.4, 1.9) in the candesartan group in the intention-to-treat analysis (P-value for between-group difference: 0.026). No effect of metoprolol on the overall decline in LVEF was observed. Conclusion: In patients treated for early breast cancer with adjuvant anthracycline-containing regimens with or without trastuzumab and radiation, concomitant treatment with candesartan provides protection against early decline in global left ventricular function

Exotic fluids and crystals of soft polymeric colloids

We discuss recent developments and present new findings in the colloidal description of soft polymeric macromolecular aggregates. For various macromolecular architectures, such as linear chains, star polymers, dendrimers and polyelectrolyte stars, the effective interactions between suitably chosen coordinates are shown to be ultrasoft, i.e., they either remain finite or diverge very slowly at zero separation. As a consequence, the fluid phases have unusual characteristics, including anomalous pair correlations and mean-field like thermodynamic behaviour. The solid phases can exhibit exotic, strongly anisotropic as well as open crystal structures. For example, the diamond and the A15-phase are shown to be stable at sufficiently high concentrations. Reentrant melting and clustering transitions are additional features displayed by such systems, resulting in phase diagrams with a very rich topology. We emphasise that many of these effects are fundamentally different from the usual archetypal hard sphere paradigm. Instead, we propose that these fluids fall into the class of mean-field fluids.Comment: 22 pages, uses iopart.cls and iopart10.clo; submitted to Journal of Physics Condensed Matter, special issue in honour of professor Peter Puse

An updated analysis of NN elastic scattering data to 1.6 GeV

An energy-dependent and set of single-energy partial-wave analyses of $NN$ elastic scattering data have been completed. The fit to 1.6~GeV has been supplemented with a low-energy analysis to 400 MeV. Using the low-energy fit, we study the sensitivity of our analysis to the choice of $\pi NN$ coupling constant. We also comment on the possibility of fitting $np$ data alone. These results are compared with those found in the recent Nijmegen analyses. (Figures may be obtained from the authors upon request.)Comment: 17 pages of text, VPI-CAPS-7/

A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018

Necrotising fasciitis is a rapidly progressing soft-tissue infection with a low incidence that carries a relevant risk of morbidity and mortality. Although necrotising fasciitis is often fatal in adults, its case fatality rate seems to be lower in children. A highly variable clinical presentation makes the diagnosis challenging, which often results in misdiagnosis and time-delay to therapy