Transoral, retromolar, para-tonsillar approach to the styloid process in 6 patients with Eagle's syndrome

Objectives: Eagle's syndrome is caused by an elongated or mineralised styloid process and characterised by facial and pharyngeal pain, odynophagia and dysphagia. Diagnosis is based on clinical findings. However radiologic imaging, like panoramic radiograph, helps to confirm the diagnosis. There are different treatments of the Eagle's syndrome. Anti-inflammatory medication (carbamazepime, corticosteroids) and/or surgical interventions are established. The aim of the different surgical techniques is to resect the elongated styloid process near the skull base. Study Design: A transoral, retromolar, para-tonsillar approach was performed to expose and resect the elongated calcified styloid process in a consecutive series of six patients. The use of different angled ring curettes, generally used in hypophysis surgery, facilitated the preparation of the styloid process through the surrounding tissue to the skull base, without a compromise to the surrounding tissue. Clinical examinations were performed pre- and postoperatively (3 month and after 1 year after surgery) in all patients. Results: No intra- or postoperative complications were observed. The hypophysis ring curettes facilitated the preparation of the styloid process to the skull base. Conclusions: The transoral, retromolar, para-tonsillar approach is a secure and fast method to resect an elongated symptomatic styloid process. Side effects of the classical transoral trans-tonsillar approach did not occur

Low temperature transport and evidence for nuclear order in GaAs Quantum Wires

In this thesis we focus on low temperature transport through cleaved edge overgrowth (CEO) quantum wires. This thesis is motivated by recent theoretical work on one hand that predicts the formation of a nuclear helimagnet in presence of a Luttinger liquid (LL) below a critical system temperature [1] and previous measurements on CEO wires on the other hand that might indicate the onset of such a phase transition [2]. The first task for this thesis was to create suitable measurement conditions to approach the theoretically predicted strongly correlated state of matter. More precisely,electron sample temperatures much lower than the predicted ordering temperature of 75mK for GaAs CEO wires have to be demonstrated. For this purpose, cryogenic microwave filters with very low cut-off frequency and good thermalization properties were developed and installed for all measurement cables. With that a minimum electron temperature of 7.5mK was reached in metallic coulomb blockade thermometers [3],and furthermore, for the first time in these devices, a deviation from pure electron-phonon cooling is observed [4]. At low refrigerator temperatures T_R, the CEO (double) wires show pronounced and completely reproducible conductance oscillations as a function of density. We show that these oscillations, also present in the zero magnetic field tunneling current between the parallel quantum wires, emerge as 1D Fabry Perot resonances in the ballistic CEO wires [5]. We analyze the maximum transmission (T=1) through these wires, i.e the oscillation maxima, in the single mode regime as a function of temperature. While the quantum wires approach universal conductance quantization of 2e^2/h for a single quantum wire only at quite large T_R>15K, we find that the conductance saturates below T_R=75mK at 1e^2/h [6]. Furthermore, we give strong evidence that the conductance saturation is not related to insuffcient thermalization, i.e.the CEO wires cool far beyond the saturation temperature of 75mK. This seems to indicate lifting of electron spin degeneracy at zero external magnetic field, consistent with the theo- retically predicted low temperature limit for a clean LL in the ordered helicalstate [1]. We can further exclude other potential mechanisms (temperature dependent contact resistance, freeze-out of weakly disordered LL, Wigner crystal formation/incoherent LL), leaving only nuclear spins as candidates for the source of the (possibly) observed lifted spin degeneracy as spin-orbit coupling is rather weak in GaAs, and the saturation at 1e^2/h is observed in absence of an external magnetic field. This might resolve the long-standing mystery of the temperature-dependent (non-universal) conductance quantization in GaAs cleaved edge overgrowth quantum wires, and furthermore might give first experimental evidence for a new, strongly correlated state of matter, namely (helical) nuclear order induced by the strongly interacting electrons via hyperfine coupling. We also measure real-time tunneling in a GaAs few electron double quantum dot (DQD) by means of an adjacent quantum dot as charge sensor. At low temperatures, in the limit of negligible interdot tunneling and low tunnel rates to source and drain, we observe metastable charge state switching. The metastability only occurs within diamond shaped regions that are centered between associated triple points of the charge stability diagram (CSD). We show that these charge fluctuations arise as an intrinsic property in DQDs, and take place via fast intermediate states that include an electron exchange with the leads [7]. Due to the geometrical shape of the diamond (in very good agreement with our model of thermally activated electron exchange with the leads), its large energy scale (>1.7K) and due to its visibility even at charge sensor bias voltages as small as 5µV, we exclude extrinsic effects such as phonon or photon assisted tunneling. Furthermore, the simultaneous observation of the diamond shaped region of metastable charge state switching at various points in the CSD and its pinning to associated triple points upon reshaping the DQD, make charge traps and other defects a very unlikely explanation

Psychosocial and socioeconomically aspects of mothers having a child with cleft lip and/or palate (CL/P) : a pilot-study during the first year of life

The emotional impact on parents at the birth of their new-born with cleft lip and/or palate (CL/P) can be traumatic for parents, especially mothers, and affect the sensitive early parent-child relationship. Unlike many other congenital malformations facial deformities are visible to all. The uncommon facial appearance creates feelings and reactions in the mother, families and other people. Only few studies deal with this psychosocial burden of these mothers. This pilot-study deals with mothers? early experiences (n=84) having a child with CL/P. Mothers were asked to complete a questionnaire at diagnosis, birth and after lip surgery. The questions were focused on the social background of the mother (educational degree, marital status, lifestyle and prenatal care), the medical information at diagnosis and the following reaction. The surveys were administrated from 01/2014 ? 12/2016. 84 mothers of affected children (CL/P) replied the completed questionnaire (84/103, 81.5%). At diagnosis 65 mothers (77%) lived in a solid partnership and 44% worked full-time (40h). The diagnosis caused fear among the mothers (60.7%, p?0.01), despair (27.4%, p?0.01), grief (17.9%, p?0.01) and guilt (16.7%, p?0.01). Despite the emotional stress after the diagnosis only 5 mothers asked for psychological support (6.0%). The medical information by the gynecologist (41.6%) or maxillofacial surgeon (32.2%) was rated as ?good? (n=26) or ?very good? (n=26) in 60.2%. A lack of medical information and care was rated with ?insufficient? (11.9%) or ?poor? (14.3%). There are only few studies about mothers? early feelings and emotions having a child with a CL/P. We found high parental stress, physical and emotional strain among the mothers after diagnosis, mostly caused due to insufficient information?s. This stress was not correlated with the educational level and CLP appearance showed no relation about the socioeconomic status

The UN Sustainable Development Goals as innovation drivers for local sustainability governance? Examples from Germany

Local governments are highly relevant for the just-starting socio-ecological transformation. Living up to this role requires new or adapted forms of governance. The German case provides a vivid example of how the UN Sustainable Development Goals (SDGs) provide a useful framework for this transformation. In our policy-oriented contribution, we focus on the question whether the SDGs themselves are innovation drivers in local sustainability governance. We motivate this idea with the theoretical framework of public sector innovation and provide comprehensive examples of the most prevalent current approaches to SDG-related innovations at the German local government level, covering local government sustainability reporting, strategies, budgets, and financing. Our central finding is that a small group of early-innovating German local governments has already begun to govern sustainability with the help of SDG-driven innovations and that this became possible because of publicly funded support projects and accessible pre-defined localised SDGs

Cuff overinflation and endotracheal tube obstruction: case report and experimental study

Background: Initiated by a clinical case of critical endotracheal tube (ETT) obstruction, we aimed to determine factors that potentially contribute to the development of endotracheal tube obstruction by its inflated cuff. Prehospital climate and storage conditions were simulated. Methods: Five different disposable ETTs (6.0, 7.0, and 8.0 mm inner diameter) were exposed to ambient outside temperature for 13 months. In addition, every second of these tubes was mechanically stressed by clamping its cuffed end between the covers of a metal emergency case for 10 min. Then, all tubes were heated up to normal body temperature, placed within the cock of a syringe, followed by stepwise inflation of their cuffs to pressures of 3 kPa and >=12 kPa, respectively. The inner lumen of the ETT was checked with the naked eye for any obstruction caused by the external cuff pressure. Results: Neither in tubes that were exposed to ambient temperature (range: -12°C to +44°C) nor in those that were also clamped, visible obstruction by inflated cuffs was detected at any of the two cuff pressure levels. Conclusions: We could not demonstrate a critical obstruction of an ETT by its inflated cuff, neither when the cuff was over-inflated to a pressure of 12 kPa or higher, nor in ETTs that had been exposed to unfavorable storage conditions and significant mechanical stress