Reduktion postoperativer Wundinfektionsraten und Einfluss auf die Entstehung von Narbenhernien unter Verwendung antibiotisch beschichteten Nahtmaterials

Postoperative Wundinfektionen sind weit verbreitet und repräsentieren gerade bei chirurgischen Patienten einen großen Teil aller nosokomialer Infektionen. Sie sind häufig verantwortlich für eine erhöhte Morbidität, Mortalität und hohe Mehrkosten im Gesundheitssystem. Zur Reduktion eines solchen Infektionsrisikos wurden Triclosan-beschichtete, antibiotisch wirksame Nahtmaterialien entwickelt. In dieser Arbeit soll nun das beschichtete Nahtmaterial PDS®PLUS mit dem unbeschichteten PDS®II-Nahtmaterial verglichen werden, die dafür benötigte Datenerhebung erfolgte im Rahmen einer großen klinischen Studie, der sogenannten PDS®PLUS-Studie. Im Zeitraum September 2009 bis zum Januar 2012 wurde eine große Interventionsstudie mit Cluster-randomisierter Patientenzuteilung durchgeführt. Eingeschlossen wurden 856 Patienten, welche über eine mediane oder quere Laparotomie operiert wurden. Die gesamte Behandlung des Patienten erfolgte nach zuvor festgelegten Standards und sollte sich nur in der Verwendung des jeweiligen Nahtmaterials unterscheiden. Die einzelnen Behandlungsschritte wurden unter Verwendung EDV-gestützter sogenannter „klinischer Behandlungspfade“ definiert und zeitlich vorgegeben. Als primäres Studienziel galt es zu ermitteln, ob der Einsatz des mit Triclosan beschichteten Nahtmaterials die Anzahl von Wundinfektionen minimieren kann, außerdem wurde als sekundäres Studienziel der Einfluss auf die Entwicklung von Narbenhernien im Operationsgebiet untersucht. Verschiedene Risikofaktoren für Wundheilungsstörung wurden ebenfalls prospektiv gesammelt. Bei der Verwendung von PDS®Plus-Nahtmaterial betrug der Anteil an postoperativen Wundinfektionen 6,4%, in der PDS®II-Gruppe wurde eine Rate von 11,2% festgestellt (p=0,0132), der Anteil an Narbenhernien lag bei 7,5% in der PDS®Plus-Gruppe und 13,6% bei PDS®II (p=0,0296). Die beiden Gruppen waren bezüglich der weiteren Risikofaktoren von gleicher Struktur. Die Verwendung eines antibiotischen Nahtmaterials beim Bauchdeckenverschluss kann zu einer signifikanten Reduktion der Anzahl von Wundinfektionen und Hernien führen.Surgical site infections are very common and represent a major part of nosocomial infections, especially in surgical patients. They are often responsible for a high morbidity, mortality and also for huge costs in the healthcare system. To reduce a risk of these kind of infections, triclosan-coated suture material with antibiotic activity has been developed. In the PDS®PLUS-study, two different suture materials, on the one hand the triclosan-coated PDS®PLUS suture material and on the other hand the PDS®II suture without antibiotic activity were compared. During a period between September 2009 and January 2012, a large study was conducted. 856 patients who had surgery via median laparotomy or a transverse incision were included. The allocation of patients was performed by cluster randomization. The entire course of treatment was carried out under strictly defined standards. The only difference between the two groups was the suture material that was used. Each treatment step was precisely fixed and the implementation was supported by so-called “Clinical Pathways”, a computer-controlled system that works like checklists. The primary objective was to find out, whether the coated material can prevent surgical site infections, a secondary objective was to investigate the influence on the development of scar hernias. Further risk factors of infections were collected and documented, in order to ensure comparability between both groups. When using PDS®Plus suture material the rate of surgical site infections was 6.4%, in the PDS®II group the proportion was 11.2% (p=0.0132). The rate of scar hernias was 7.5% in the PDS®Plus group and 13.6% in the PDS®II group (p=0.0296). The groups were the same structure based on the risk profile. The use of antibiotic coated suture can significantly reduce the occurrence of surgical site infections and hernias

Vergleichende Untersuchung der posturalen Kontrolle bei 20 - 40-Jährigen und Karate-Kaderathlet:innen mittels eines neuromuskulären Trainingsgerätes

Die Arbeit untersucht zum einen Veränderungen der posturalen Kontrolle im Altersvergleich bei 20 - 40-Jährigen sowie die Auswirkungen von Karate-Leistungssport auf die posturale Kontrolle. Zur Datenerhebung wurde ein neuromuskuläres Trainingsgerät, der Huber 360®, verwendet. Überprüft wurden Körperschwerpunkt(KSP)-Schwankungen im beidbeinigen Stand mit offenen und geschlossenen Augen, KSP-Schwankungen im Einbeinstand, Gangbreite, Stabilitätsareal, Mobilität, Kraft und Koordination

Precise verification of phase and amplitude calibration by means of a debunching experiment in SIS18

Several new rf cavity systems have to be realized for the FAIR synchrotrons and for the upgrade of the existing GSI synchrotron SIS18 [1]. For this purpose, a completely new low-level rf (LLRF) system architecture [2] has been developed, which is now used in SIS18 operation. Closedloop control systems stabilize the amplitude and the phase of the rf gap voltages. Due to component imperfections the transmission and the detection of the actual values lead to systematic errors without countermeasures. These errors prohibit the operation of the rf systems over the whole amplitude and frequency range within the required accuracy. To compensate the inevitable errors, the target values provided by the central control system are modified by socalled calibration electronics (CEL, [3]) modules. The calibration curves can be measured without the beam, but the desired beam behaviour has to be verified by experiments. For this purpose, a debunching scenario was selected as a SIS18 beam experiment that proved to be very sensitive to inaccuracies. In this contribution the results of this experiment are presented, showing for the first time at GSI by beam observation that the accuracy requirements are met based on predefined calibration curves

A digital beam-phase control system for a heavy-ion synchrotron with a double-harmonic cavity system

For the new Facility for Antiproton and Ion Research (FAIR) at GSI Helmholtzzentrum für Schwerionenforschung GmbH (http://www.gsi.de), the heavy ion synchrotron SIS18 will be operated with a double harmonic cavity system. The second cavity, running at twice the fundamental frequency, is used to create a lengthened bucket which introduces nonlinearities to the control system. To damp longitudinal rigid dipole oscillations a digital feedback system consisting of a filter and an integrator is used. For the existing single-harmonic setup an FIR-filter is implemented which realizes a multiple bandpass filter with the first passband centre frequency close to the synchrotron frequency. Both, the feedback gain and the passband frequency of the filter depend on the actual value of the synchrotron frequency. It was shown by simulations and in an experiment that this setup can be transferred to a double-harmonic cavity system obtaining similar results for the region of stabilizing feedback parameters, if the oscillation frequency of the bunch barycenter is considered instead of the synchrotron frequency of a linearized bucket

Generation of RF Frequency and Phase References on the FAIR Site

Based on the Bunch Phase Timing System (BuTiS) local analog radio frequency reference signals (RF references) like the particle revolution frequency and their multiple harmonics will be generated. These references are used to control the phase of the accelerator cavities to altering harmonics of the bunch revolution frequency. Delay or phase shifts from the FAIR-Center to references at the BuTiS endpoints are already compensated by the BuTiS receivers. Phase shifts from the RF reference generators to LLRF electronics can be compensated by controlling the output phases of the DDS modules of the RF references. However phase shift delays of multiple harmonics at the same interconnecting electrical path are not identical at the same time. Configurable electronics manage phase calibration of the RF references to their endpoints. Calibration may depend on frequency and harmonic of the RF reference, aging as well as on thermal effects. The electrical length and impedance of interconnecting cables for phase control loops can be compensated. This is an important feature, in particular if control loops are switched between different harmonic frequencies

Elle a des airs bleus, roses, gris et verts. Das Farbenspiel in Debussys La mer est plus belle

Die folgende Analyse von La mer est plus belle verfolgt eine multiperspektivische Strategie, um vorrangig die einheitsstiftenden Elemente der Komposition aufzuzeigen. Zentral hierbei erscheinen die Analyseparadigmen des ›klanglichen Dreitakts‹, der ›Zentralklangkomposition‹, der Tonnetzanalyse und der Funktionsharmonik

Análisis y desarrollo de soluciones de conexión alternativas para colectores de corriente de tercer rail en vehículos ferroviarios con suspensión primaria

[EN] A third rail system is a method of providing electric power to a rail vehicle. Nowadays, the third rail current collector of rail vehicles with big primary suspension is attached to the axle bearing box on either side of the bogie. However, this solution has several disadvantages. The axle bearing box is an unsprung area exposed to lots of vibrations. Fatigue failure caused by these vibrations is difficult to predict. Moreover, the attachment on the axle bearing box, especially of in-board bearing bogie designs, leads to heavy and expensive solutions. This master thesis investigates alternative solutions for the attachment of the current collector without these disadvantages. For the development of concepts, a methodological approach is applied. Based on a detailed analysis of different attachment possibilities and a tolerance and movement analysis of the current collector, attachment requirements are determined. According to the product development process the overall function of the attachment is first structured into subfunctions. Then partial solutions are combined to various concepts. The most promising concepts are designed and evaluated in their strength by using a finite element (FE) simulation. During a final assessment, a mathematically validated solution is identified which attaches the current collector with a bent sheet metal directly to the bogie frame in a simple and economical way.[ES] Los sistemas de tránsito rápido con alimentación eléctrica de un tercer riel se desarrollan en Stadler Rail Valencia. Aquí, sin embargo, surgen problemas en el acoplamiento de los colectores de corriente del tercer carril. En este momento, el accesorio de colector actual conduce a soluciones pesadas y caras. Además, está expuesto a muchas vibraciones. En el contexto de este trabajo, se deben investigar posibles soluciones alternativas para el apego, evitando estas desventajas. Las tareas incluyen: Análisis de los diseños de accesorios existentes de los colectores del tercer riel con sus ventajas y desventajas. Análisis de la tolerancia y el movimiento de los movimientos relativos que se producen entre el tercer riel, la zapata colectora y el marco del bogie. Encontrar nuevas ideas y soluciones con métodos de creatividad. Selección de las mejores soluciones con uso de métodos de desarrollo. Desarrollo detallado adicional de soluciones elegidas, incluido el modelado y cálculo CAD Evaluación de soluciones y proceso de desarrollo.Ningel, E. (2019). Análisis y desarrollo de soluciones de conexión alternativas para colectores de corriente de tercer rail en vehículos ferroviarios con suspensión primaria. http://hdl.handle.net/10251/12526

Nanofibras de aplicación farmacológica para el tratamiento de lesiones cutáneas

Tesis (Maestría en Tecnología Avanzada). Ciudad de México, Instituto Politécnico Nacional, PTA, CICATA, Unidad Legaria. 2017. 1 archivo PDF, (89 pàginas). tesis.ipn.m