Erste Erfahrungen mit der offen-laparoskopischen Cholezystektomie über ein spezielles Spreizspekulum

In der Arbeit werden die Erfahrungen der ersten 186 über eine Minilaparotomie mit speziellem Spreizspekulum offen-laparoskopisch durchgeführten Cholezystektomien vorgestellt. Das Instrumentarium, die Operationstechnik sowie die klinischen Ergebnisse werden beschrieben. Es wird aufgezeigt, daß das vorstellte Operationsverfahren bezüglich der Indikationsstellung, des Patientenkomforts sowie der Komplikationsraten gleichwertig gegenüber der videoendoskopischen Cholezystektomie ist. Darüber hinaus bestehen allerdings Vorteile in der Möglichkeit zur einfachen intraoperativen Cholangiographie und antegraden Choledochusrevision mit Steinextraktion unter Beibehaltung dieser minimal-invasiven Operationstechnik. Der Verzicht auf ein Pneumoperitoneum ermöglicht auch bei cardio-pulmonalen Risikopatienten ein minimal-invasives Operationsverfahren. Die offen-laparoskopische Gallenchirurgie kann darüber hinaus bei allen Patienten mit Kontraindikation zur videoendoskopischen Technik Anwendung finden

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Formation of an olfactory glomerulus: Morphological aspects of development and organization

We have studied the development of olfactory nerves in the rat from their first contact with the telencephalic vesicle until the formation of glomerular structures in the olfactory bulb at early postnatal period. The study is based on serial semithin and ultrathin sections of material prepared for electron microscopy and antibodies to label radial glial cells, glial fibrillary acidic protein and Rat-401. Beginning on embryonic day 12, developing olfactory axons from the olfactory placode are accompanied by migratory cells, also derived from the olfactory placode, that reach the prospective olfactory bulb by embryonic day 13. The mass of migratory cells accumulate superficial to the telencephalic vesicle. The cells increase in number by mitotic divisions. The majority of these cells represent precursor elements that will later develop into the ensheathing cells of the olfactory nerves and olfactory nerve layer of the adult. Some migratory cells penetrate into the prospective olfactory bulb early during development. The first synaptic contacts of olfactory axons with dendritic processes in the olfactory bulb were observed at embryonic day 18. Glomerular formation is initiated by penetration of cells from the migratory mass into the prospective glomerular layer by embryonic day 20 to postnatal day 0. These cells form walls surrounding zones of high synaptic density forming protoglomeruli. Postnatally, the peripheral processes of radial glial cells branch profusely delimiting glomerular formations and transform into periglomerular astrocytes. Rat-401 stains radial glial cells from embryonic day 14. Immunoreactivity becomes restricted to the olfactory glomeruli during the first postnatal weeks and it virtually disappears by the end of the first postnatal month. We conclude that the early penetration of cells from the migratory mass into the prospective olfactory bulb, observed immediately after the hrst synaptic contacts were established, initiates the formation of olfactory glomeruli which becomes completed by the transformation of radial glial cells into periglomerular astrocytes.Peer Reviewe

Matrix-insensitive protein assays push the limits of biosensors in medicine

Advances in biosensor technologies for in vitro diagnostics have the potential to transform the practice of medicine. Despite considerable work in the biosensor field, there is still no general sensing platform that can be ubiquitously applied to detect the constellation of biomolecules in diverse clinical samples (for example, serum, urine, cell lysates or saliva) with high sensitivity and large linear dynamic range. A major limitation confounding other technologies is signal distortion that occurs in various matrices due to heterogeneity in ionic strength, pH, temperature and autofluorescence. Here we present a magnetic nanosensor technology that is matrix insensitive yet still capable of rapid, multiplex protein detection with resolution down to attomolar concentrations and extensive linear dynamic range. The matrix insensitivity of our platform to various media demonstrates that our magnetic nanosensor technology can be directly applied to a variety of settings such as molecular biology, clinical diagnostics and biodefense

Datensatz Notaufnahme V2015.1

Die Dokumente enthalten die Beschreibung des Datensatzes Notaufnahme in der Version 2015.1. Weiterhin sind die Änderungen gegenüber der Version 2010 dargestellt. Der Datensatz Notaufnahme wurde von den Mitgliedern der Sektion Notaufnahmeprotokoll der DIVI entwickelt. Felix Walcher und Martin Kulla leiteten die Sektion während des Entwicklungsprozesses. Korrespondierender Autor für Fragen und Anmerkungen ist: Dr. Martin Kulla Bundeswehrkrankenhaus Ulm Klinik für Anästhesie und Intensivmedizin Oberer Eselsberg 40 E-Mail: [email protected]

Notaufnahmeprotokoll V2015.1

Die folgenden Dateien sind ein Vorschlag wie der Datensatz Notaufnahme in der Version 2015.1. graphisch als Papierformular umgesetzt werden kann. Der Datensatz Notaufnahme sowie seine graphische Umsetzung wurde von den Mitgliedern der Sektion Notaufnahmeprotokoll der DIVI entwickelt. Für Fragen und Anmerkungen wenden sie sich bitte an den korrespondierenden Autor: Dr. Martin Kulla 2. Sprecher der Sektion Notaufnahmeprotokoll der DIVI Bundeswehrkrankenhaus Ulm Klinik für Anästhesie und Intensivmedizin Oberer Eselsberg 40 89081 Ulm E-Mail: [email protected] Kulla M, Brammen D, Greiner F, Hörster A, Lefering R, Somasundaram R, Wrede C, Röhrig R, Erdmann B, Walcher F: [The development of a national data set, quality indicators and an emergency department registry by the DIVI]. DIVI 7: 12-20 (2016

Das AKTIN-Notaufnahmeregister – kontinuierlich aktuelle Daten aus der Akutmedizin

Background!#!Emergency care in Germany is in transition. Emergency departments (EDs) treat their patients based on symptoms and acuity. However, this perspective is not reflected in claims data. The aim of the AKTIN project was to establish an Emergency Department Data Registry as a data privacy-compliant infrastructure for the use of routine medical data.!##!Methods!#!Data from the respective documentation systems are continuously transmitted to local data warehouses using a standardized interface. They are available for several applications such as internal reports but also multicentre studies, in compliance with data privacy regulations. Based on a 12-months period we evaluate the population with focus on acuity assessment (triage) and vital parameters in combination with presenting complaints.!##!Results!#!For the period April 2018 to March 2019, 436,149 cases from 15 EDs were available. A triage level is documented in 86.0% of cases, and 70.5% were triaged within 10 min of arrival. Ten EDs collected a presenting complaint regularly (82.3%). The respective documentation of vital signs shows plausible patterns.!##!Conclusions!#!The AKTIN registry provides an almost real-time insight into German EDs, regardless of the primary documentation system and health insurance claims data. The Federal Joint Committee's requirements are largely met. Standardized presenting complaints allow for symptom-based analyses as well as health surveillance