Chirurgische und interventionelle Behandlung der chronisch-kritischen Beinischämie

Zusammenfassung: Die chronisch-kritische Beinischämie (CLI) ist die schwerste Form der peripher-arteriellen Verschlusskrankheit und geht mit einem erhöhten Risiko für letale kardiovaskuläre Ereignisse einher. Die meisten Patienten überleben aber die ersten Jahre nach Diagnosestellung und sind für den Erhalt ihrer Selbständigkeit auf eine nachhaltige Verbesserung der Beindurchblutung angewiesen. Dieser CME-Artikel fasst die chirurgischen und endovaskulären Optionen zur Revaskularisierung zusammen und geht auf deren Nachhaltigkeit bei CLI ein. Grenzen der verfügbaren Evidenz werden aufgezeigt. Sie beruhen vor allem auf dem Fehlen einer einheitlichen Definition des Behandlungserfolges. Ein klinisch orientierter Lösungsvorschlag wird diskutiert, der helfen könnte, die verschiedenen Behandlungsindikationen zu schärfen. Da sich aber nur die wenigsten Patienten gleich gut für verschiedene Verfahren eignen, werden CLI-Patienten auch in Zukunft am besten in einem interdisziplinär arbeitenden Team betreut sei

In Situ Investigations of Simultaneous Two-Layer Slot Die Coating of Component-Graded Anodes for Improved High-Energy Li-Ion Batteries

The use of thicker electrodes can contribute to a reduction in cell costs. However, the properties of the electrode must be kept in view to be able to meet the performance requirements. Herein, the possibility of simultaneous multilayer slot die coating is investigated to improve the electrode properties of medium- and high-capacity anodes. The stable coating window of the two-layer slot die coating process is investigated to produce property-graded multilayer electrodes. Electrodes with different styrene–butadiene rubber (SBR) gradients are investigated with regard to adhesive force and electrochemical performance. An increase in the adhesive force of up to 43.5% and an increase in the discharge capacity is observed

High-Speed Coating of Primer Layer for Li-Ion Battery Electrodes by Using Slot-Die Coating

A reduction of the inactive components can increase the energy density and reduce production cost of Li‐ion batteries. But an effective reduction of the binder amount also negatively affects the adhesion of the electrode. Herein, slot‐die coating of a primer layer for Li‐ion anodes is investigated. It is shown that the use of a primer layer with only 0.3 g m$^{-2}$ can increase the adhesive force by the factor of 5 as well as the cell performance for anodes with low binder content. The process limits for a stable, defect‐free primer coating are investigated at coating speeds of up to 550 m min$^{-1}$. The limits coincide both for a setup without vacuum box and with vacuum box with theory‐based equations. By using a vacuum box, the minimum wet film thickness can be reduced by half

Entwicklung von Verkapselungsmethoden für Pflanzenextrakte

Organic farming is reliant on alternative active substances like plant extracts for plant protection. Limited stability of plant extracts complicates their use and storage. Consequently, there is a need for the development of novel formulations like encapsulation that stabilize the active substances, control their release and provide an appropriate handling. In the project DevelOPAR (Development of a plant avian repellent) we illustrate how a repellent plant extract is formulated in order to be applied as seed-coating protecting seeds not to be eaten by birds. Testing the methods of ionic gelation and complex coacervation we managed to encapsulate the plant extract and produce homogenous particles that can be applied on corn seeds using a spin coating process

Profound influence of different methods for determination of the ankle brachial index on the prevalence estimate of peripheral arterial disease

BACKGROUND: The ankle brachial index (ABI) is an efficient tool for objectively documenting the presence of lower extremity peripheral arterial disease (PAD). However, different methods exist for ABI calculation, which might result in varying PAD prevalence estimates. To address this question, we compared five different methods of ABI calculation using Doppler ultrasound in 6,880 consecutive, unselected primary care patients ≥65 years in the observational getABI study. METHODS: In all calculations, the average systolic pressure of the right and left brachial artery was used as the denominator (however, in case of discrepancies of ≥10 mmHg, the higher reading was used). As nominators, the following pressures were used: the highest arterial ankle pressure of each leg (method #1), the lowest pressure (#2), only the systolic pressure of the tibial posterior artery (#3), only the systolic pressure of the tibial anterior artery (#4), and the systolic pressure of the tibial posterior artery after exercise (#5). An ABI < 0.9 was regarded as evidence of PAD. RESULTS: The estimated prevalence of PAD was lowest using method #1 (18.0%) and highest using method #2 (34.5%), while the differences in methods #3–#5 were less pronounced. Method #1 resulted in the most accurate estimation of PAD prevalence in the general population. Using the different approaches, the odds ratio for the association of PAD and cardiovascular (CV) events varied between 1.7 and 2.2. CONCLUSION: The data demonstrate that different methods for ABI determination clearly affect the estimation of PAD prevalence, but not substantially the strength of the associations between PAD and CV events. Nonetheless, to achieve improved comparability among different studies, one mode of calculation should be universally applied, preferentially method #1

Lifeworld Inc. : and what to do about it

Can we detect changes in the way that the world turns up as they turn up? This paper makes such an attempt. The first part of the paper argues that a wide-ranging change is occurring in the ontological preconditions of Euro-American cultures, based in reworking what and how an event is produced. Driven by the security – entertainment complex, the aim is to mass produce phenomenological encounter: Lifeworld Inc as I call it. Swimming in a sea of data, such an aim requires the construction of just enough authenticity over and over again. In the second part of the paper, I go on to argue that this new world requires a different kind of social science, one that is experimental in its orientation—just as Lifeworld Inc is—but with a mission to provoke awareness in untoward ways in order to produce new means of association. Only thus, or so I argue, can social science add to the world we are now beginning to live in

Assessment of fetal kidney growth and birth weight in an Indigenous Australian cohort

Introduction: Indigenous Australians experience higher rates of renal disease and hypertension than non-Indigenous Australians. Low birth weight is recognized as a contributing factor in chronic disease and has been shown to increase the risk of renal failure in adulthood. A smaller kidney volume with fewer nephrons places an individual at risk of hypertension and renal failure. Indigenous Australians have fewer nephrons than non-Indigenous Australians. In this study, intrauterine fetal and kidney growth were evaluated in 174 Indigenous Australian babies throughout gestation in order to record and evaluate fetal growth and kidney size, within a population that is at high risk for chronic illness. Methods: Pregnant women that identified as Indigenous, or non-Indigenous women that were pregnant with a partner who identified as an Indigenous Australian were eligible to participate. Maternal history, smoking status, blood and urine samples and fetal ultrasounds were collected throughout pregnancy. Fetal kidney measurements were collected using ultrasound. Statistical analysis was performed using the Stata 14.1 software package. Results: 15.2% of babies were born prematurely. 44% of the mothers reported smoking in pregnancy. The median birth weight of this cohort was 3,240 g. Male fetuses had higher kidney to body weight ratios than female fetuses (P = 0.02). The birth weights of term neonates whose mothers smoked during pregnancy were lower (327 g, P < 0.001) than the birth weights of term babies from non-smoking mothers. The kidney volumes of babies whose mothers smoked were also smaller (P = 0.02), but were in proportion to body weight. Conclusion: In this cohort of Indigenous women smoking was associated with both increased number of preterm births and with a reduction in birth weights, even of term infants. Since kidney volume is a surrogate measure of nephron number and nephrogenesis is complete at birth, babies whose mothers smoked during pregnancy must have fewer nephrons than those from non-smoking mothers. Previous studies have shown that glomerular filtration rate is not related to birth weight, thus infants with smaller kidney volumes are hyperfiltering from birth and therefore are likely to be more susceptible to early onset renal disease in later life.Christopher J. Diehm, Eugenie R. Lumbers, Loretta Weatherall, Lyniece Keogh, Sandra Eades, Alex Brown, Roger Smith, Vanessa Johnson, Kirsty G. Pringle and Kym M. Ra