Recommendations for the Use of Antibiotics in Primary and Secondary Esthetic Breast Surgery

The use of systemic prophylactic antibiotics to reduce surgical-site infection in esthetic breast surgery remains controversial, although the majority of surgeons prefer to utilize antibiotics to prevent infection. Nonetheless, postoperative acute and subclinical infection and capsular fibrosis are among the most common complications following implant-based breast reconstruction. After esthetic breast augmentation, up to 2.9% of women develop infection, with an incidence rate of 1.7% for acute infections and 0.8% for late infections. After postmastectomy reconstruction (secondary reconstruction), the rates are even higher. The microorganisms seen in acute infections are Gram-positive, whereas subclinical late infections involving microorganisms are typically Gram-negative and from normal skin flora with low virulence. In primary implantation, a weight-based dosing of cefazolin is adequate, an extra duration of antibiotic cover does not provide further reduction in superficial or periprosthetic infections. Clindamycin and vancomycin are recommended alternative for patients with β-lactam allergies. The spectrum of microorganism found in late infections varies (Gram-positive and Gram-negative), and the antibiotic prophylaxis (fluoroquinolones) should be extended by vancomycin and according to the antibiogram when replacing implants and in secondary breast reconstruction, to target microorganisms associated with capsular contracture. All preoperative antibiotics should be administered <60 minutes before incision to guarantee high serum levels during surgical procedure

Severe early onset preeclampsia: short and long term clinical, psychosocial and biochemical aspects

Preeclampsia is a pregnancy specific disorder commonly defined as de novo hypertension and proteinuria after 20 weeks gestational age. It occurs in approximately 3-5% of pregnancies and it is still a major cause of both foetal and maternal morbidity and mortality worldwide1. As extensive research has not yet elucidated the aetiology of preeclampsia, there are no rational preventive or therapeutic interventions available. The only rational treatment is delivery, which benefits the mother but is not in the interest of the foetus, if remote from term. Early onset preeclampsia (<32 weeks’ gestational age) occurs in less than 1% of pregnancies. It is, however often associated with maternal morbidity as the risk of progression to severe maternal disease is inversely related with gestational age at onset2. Resulting prematurity is therefore the main cause of neonatal mortality and morbidity in patients with severe preeclampsia3. Although the discussion is ongoing, perinatal survival is suggested to be increased in patients with preterm preeclampsia by expectant, non-interventional management. This temporising treatment option to lengthen pregnancy includes the use of antihypertensive medication to control hypertension, magnesium sulphate to prevent eclampsia and corticosteroids to enhance foetal lung maturity4. With optimal maternal haemodynamic status and reassuring foetal condition this results on average in an extension of 2 weeks. Prolongation of these pregnancies is a great challenge for clinicians to balance between potential maternal risks on one the eve hand and possible foetal benefits on the other. Clinical controversies regarding prolongation of preterm preeclamptic pregnancies still exist – also taking into account that preeclampsia is the leading cause of maternal mortality in the Netherlands5 - a debate which is even more pronounced in very preterm pregnancies with questionable foetal viability6-9. Do maternal risks of prolongation of these very early pregnancies outweigh the chances of neonatal survival? Counselling of women with very early onset preeclampsia not only comprises of knowledge of the outcome of those particular pregnancies, but also knowledge of outcomes of future pregnancies of these women is of major clinical importance. This thesis opens with a review of the literature on identifiable risk factors of preeclampsia

Measurement of associated W plus charm production in pp collisions at √s=7 TeV

Peer reviewe

Peptidmimetika an Zellulosemembranen

Die SPOT-Synthese an Zellulosemembranen wurde 1992 als eine hocheffiziente Methode zur parallelen Synthese von Peptiden beschrieben. Die wichtigste Anwendung der so synthetisierten Verbindungen ist das direkte Festphasen-Screening. Im Rahmen dieser Arbeit ist es gelungen, das Anwendungsgebiet der SPOT-Methode von Peptiden auf verschiedene Peptidmimetika auszudehnen und durch Screening entsprechender Bibliotheken bioaktive Substanzen zu identifizieren. (1) Peptoid-Synthese an Zellulosemembranen Die Ähnlichkeit von Oligo-N-alkylglycinen (Peptoiden) zu Peptiden sowie die Vereinbarkeit ihrer Synthese mit den Bedingungen der SPOT-Technik ließen sie als besonders geeignete Kandidaten für eine Erweiterung der SPOT-Synthese von Peptiden auf Peptidmimetika erscheinen. Die Peptoide wurden nach der 1992 für die Synthese am Harz beschriebenen Sub-Monomer-Methode synthetisiert, bei der die N-Alkylglycin-Monomere zweistufig durch Bromacetylierung und nachfolgende Bromsubstitution durch ein primäres Amin aufgebaut werden. Die Kernaufgabe bei der Anpassung der Synthesebedingungen an Zellulosemembranen war dabei die Entwicklung einer N/O-selektiven Bromacetylierungsmethode, da die Anwesenheit freier Membran-Hydroxyfunktionalitäten ein Reagenz erfordert, welches eine N-Acylierung in Anwesenheit von O-Nukleophilen zuläßt. Durch Untersuchung mehrerer Aktivester der Bromessigsäure konnte gezeigt werden, daß der kristalline Bromessigsäure-2,4-dinitrophenylester im Hinblick auf Ausbeute und N/O-Selektivität optimale Eigenschaften besitzt. Im Anschluß an die Bromacetylierungsmittel wurden 46 primäre Amine auf ihre Anwendbarkeit bei der Synthese von Modell-Tripeptoiden untersucht. Aus den Ergebnissen konnten Gesetzmäßigkeiten abgeleitet werden, die eine Abschätzung der Verwendbarkeit von Aminen für die Peptoidsynthese im Hinblick auf Flüchtigkeit, sterischen Anspruch, Nukleophilie des Stickstoffatoms sowie vorhandene funktionelle Gruppen in Seitenketten ermöglichen. (2) Synthese und Screening von Peptoid-Bibliotheken Unter den optimierten Synthesebedingungen wurden zwei Bibliotheken mit jeweils 8000 Tri- bzw. Hexapeptoiden synthetisiert. Die Trimeren-Bibliothek beinhaltete dabei den gesamten Sequenzraum basierend auf 20 Bausteinen, während die Verbindungen der Hexameren-Bibliothek aus einem wesentlich größeren, auf 40 Bausteinen basierenden Sequenzraum statistisch ausgewählt wurden. Um zu überprüfen, ob sich die Bibliotheken zur "de novo" Auffindung von Protein-Liganden eignen, wurden sie auf Bindung zum monoklonalen Antikörper Tab-2 untersucht. Es konnten in beiden Fällen bioaktive Oligomere identifiziert werden (Trimere: KD >= 87 µM, Hexamere: KD >= 2.7 µM), die sich vom Peptid-Epitop des Antikörpers [VVSHFND] deutlich unterschieden. (3) Rückgratmodifizierte Peptoide Mit dem Ziel, Rückgratmodifikationen in Peptoide einzufügen, wurden neun Biselektrophile im Rahmen eines "chemischen Screenings" zur Synthese eines Modell-Trimers verwendet. Vier der Bausteine waren geeignet und ermöglichten damit die Einführung von beta-Peptoid-, m- und p-Aminomethylbenzoesäure- sowie Carbamat-Einheiten in Peptoide. Beim Versuch, in analoger Weise auch Harnstoffe zugänglich zu machen, wurde unter den Linker-Spaltungsbedingungen eine Cyclisierung zu Hydantoinen beobachtet. Diese interessante Reaktion wurde näher untersucht, um die SPOT-Methode auf die Synthese von Hydantoinen als heterocyclische Struktur zu erweitern. (4) Synthese von Hydantoinen an Zellulosemembranen Die Bildung von Hydantoinen in einer Cyclisierungsreaktion, bei der Ammoniak aus einem Amid freigesetzt wird, wurde an fester Phase noch nicht genutzt, während dieser Reaktionstyp in Lösung bereits intensiv untersucht wurde. Durch eine Optimierung der Cyclisierungsbedingungen ließ sich die zunächst unvollständige Reaktion zur Vollständigkeit bringen. Auch C-substituierte Hydantoine konnten durch Verwendung von alpha-Aminosäureamiden bzw. -tert.-butylestern enantiomerenrein zugänglich gemacht werden.SPOT-synthesis on cellulose membranes was introduced as a highly efficient method for the parallel synthesis of peptides in 1992. The most important applications of libraries synthesized by SPOT-synthesis are solid phase binding assays. Within this work the extension of the SPOT-method to the synthesis of various peptidomimetics and the identification of bioactive substances by screening of corresponding libraries is described. (1) peptoid synthesis on cellulose membranes The similarity of oligo-N-alkylglycines (peptoids) and peptides as well as the compatibility of their synthesis with the conditions of the SPOT-technique made them ideally suited for the extension of the SPOT-synthesis from peptides to peptidomimetics. The peptoids were synthesized by the sub-monomer approach originally developed for the synthesis on standard resins in 1992. N-alkylglycine monomers are hereby synthesized in a stepwise manner by bromoacetylation and subsequent substitution of the bromine atom by a primary amine. The most critical point in the adaptation of the synthesis conditions was the development of an N/O-selective reagent for bromoacetylation due to the presence of free hydroxyl functionalities of the membrane support requiring a reagent suitable for N-acylation in the presence of O-nucleophiles. Several active esters of bromoacetic acid were synthesized and tested whereby crystalline 2,4-dinitrophenylbromoacetate gave the best results with respect to yield and N/O-selectivity. After optimization of bromoacetylation 46 primary amines were applied to the synthesis of model tripeptoids. Rules for the applicability of amines in peptoid synthesis with respect to volatility, sterical demand, nucleophilicity of the nitrogen atom and compatibility with sidechain functional groups were derived from the results. (2) synthesis and screening of peptoid libraries Two libraries consisting of 8000 tri- and hexapeptoids respectively were synthesized under optimized conditions. The library of trimers displayed the entire sequence space based on 20 building blocks, whereas the sequences of the hexamers were selected statistically from the sequence space based on 40 building blocks. In order to examine the suitability of the libraries for the "de novo" identification of protein ligands they were screened for binding to the monoclonal antibody Tab-2. Bioactive peptoids could be identified in both cases (trimers: KD >= 87 µM, hexamers: KD >= 2.7 µM) both differing significantly from the peptide epitope [VVSHFND]. (3) backbone modified peptoids In order to introduce backbone modifications into peptoids nine biselectrophiles were applied in the synthesis of model trimers in a chemical screening. Four of the building blocks were well suited allowing the incorporation of beta-peptoid, m- and p-aminomethylbenzoic acid and carbamate units into peptoids. When the introduction of urea-units in a similar approach was attempted hydantoins were formed during cleavage from the solid support. This interesting reaction was examined in detail in order to extend SPOT-synthesis to the synthesis of heterocycles. (4) synthesis of hydantoins on cellulose membranes The formation of hydantoins from terminal amides was not yet described in a solid phase synthesis, whereas it was examined intensively in solution. By optimizing the conditions of cyclization the reaction could be driven to completion. C-substituted hydantoins were obtained as single enantiomers, when alpha-amino acid-amides or -tert. butylesters were used in the synthesis

Radical Difluoromethylation of Thiols with (Difluoromethyl)triphenylphosphonium Bromide

A method for facile difluoromethylation of various thiols using (difluoromethyl)­triphenyl­phosphonium bromide under mild reaction conditions is presented. The transformation proceeds in the absence of any transition metal using a bench-stable and readily accessible phosphonium salt. Deuterium labeling experiments and cyclic voltammetry measurements reveal that the difluoromethylation occurs via a S_RN1-type mechanism. Substrate scope is broad, and various functional groups are tolerated (OH, NH₂, amide, ester)

Synthesis and properties of photochromic furofurans

476-484The deep blue-violet bis-o-quinonemethide 3 cyclizes thermally in a [4s+4a]cycloaddition reaction, yielding the colourless [3,2- b]furofurane 1a. The latter is re-opened by irradiation with UV light back to the methide in its Z,Z- configuration 2a. By metallation of 1a, the highly photoreactive acetylene 8a is obtained which again forms a methide under irradiation, but now in its E,E-configuration 3. The properties of this unique new photochromic system and related furofurans and alkyneshave been investigated

Light-induced modular ligation of conventional RAFT polymers

Making light work of RAFT conjugation: A non-activated RAFT agent at the end of RAFT polymers can readily be coupled with ortho-quinodimethanes (photoenols) in a photo-triggered Diels-Alder reaction under mild conditions without catalyst (see scheme). The method is universal and opens the door for the conjugation of a large number of RAFT-prepared polymers with photoenol-functionalized (macro)molecules. (RAFT=reversible addition- fragmentation chain transfer.) Copyright © 2013 WILEY-VCH Verlag GmbH &amp; Co. KGaA, Weinheim

Separation of presynaptic Cav2 and Cav1 channel function in synaptic vesicle exo- and endocytosis by the membrane anchored Ca2+ pump PMCA

Synaptic vesicle (SV) release, recycling, and plastic changes of release probability co-occur side by side within nerve terminals and rely on local Ca2+ signals with different temporal and spatial profiles. The mechanisms that guarantee separate regulation of these vital presynaptic functions during action potential (AP)–triggered presynaptic Ca2+ entry remain unclear. Combining Drosophila genetics with electrophysiology and imaging reveals the localization of two different voltage-gated calcium channels at the presynaptic terminals of glutamatergic neuromuscular synapses (the Drosophila Cav2 homolog, Dmca1A or cacophony, and the Cav1 homolog, Dmca1D) but with spatial and functional separation. Cav2 within active zones is required for AP-triggered neurotransmitter release. By contrast, Cav1 localizes predominantly around active zones and contributes substantially to AP-evoked Ca2+ influx but has a small impact on release. Instead, L-type calcium currents through Cav1 fine-tune short-term plasticity and facilitate SV recycling. Separate control of SV exo- and endocytosis by AP-triggered presynaptic Ca2+ influx through different channels demands efficient measures to protect the neurotransmitter release machinery against Cav1-mediated Ca2+ influx. We show that the plasma membrane Ca2+ ATPase (PMCA) resides in between active zones and isolates Cav2-triggered release from Cav1-mediated dynamic regulation of recycling and short-term plasticity, two processes which Cav2 may also contribute to. As L-type Cav1 channels also localize next to PQ-type Cav2 channels within axon terminals of some central mammalian synapses, we propose that Cav2, Cav1, and PMCA act as a conserved functional triad that enables separate control of SV release and recycling rates in presynaptic terminals