Surface-Treated versus Untreated Large-Bore Catheters as Vascular Access in Hemodialysis and Apheresis Treatments

Background. Catheter-related infections, thrombosis, and stenosis are among the most frequent complications associated with catheters, which are inserted in vessels. Surface treatment processes of the outer surface, such as ion-beam-assisted deposition, can be used to mitigate such complications. Methods. This retrospective study (1992–2007) evaluated silver-coated (54 patients) and noncoated (105 patients) implanted large-bore catheters used for extracorporeal detoxification. The catheters were inserted into the internal jugular or subclavian veins. After removal, the catheters were cultured for bacterial colonization using standard microbiologic assays. They also were examined using scanning electron microscope. Results. The silver coated catheters showed a tendency towards longer in situ time. The microbiologic examinations of the catheter tips were in both catheter types high positive, but not significant. Conclusion. The silver-coated catheters showed no significantly reduction in infection rate by evaluation of all collected data in this retrospective study. There was no association between both catheters in significantly reducing savings in treatment costs and in reducing patient discomfort. Other new developed catheter materials such as the microdomain-structured inner and outer surface are considered more biocompatible because they mimic the structure of natural biological surface

LDL-Apheresis: Technical and Clinical Aspects

The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are five different LDL-apheresis systems available: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. There is a strong correlation between hyperlipidemia and atherosclerosis. Besides the elimination of other risk factors, in severe hyperlipidemia therapeutic strategies should focus on a drastic reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. Hence, in such patients, treatment with LDL-apheresis is indicated. Technical and clinical aspects of these five different LDL-apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or triglycerides observed. With respect to elevated lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term application

Integrated archaeological and engineering geophysical investigation of the castle ruin Mödling (Austria)

An extensive multi-method investigation of a castle ruin has been conducted that extends the spectrum of geophysical methods used in archaeological prospection. For complex sites like a castle ruin, the incorporation of seismic and geoelectrical methods can facilitate the interpretation of ground penetrating radargrams, particularly in the existence of bedrock

Bridges to the past - the Roman settlement of Emmersdorf/Rosegg, Austria

A large-area archaeological prospection of a roman bridgehead settlement using aerial photography, magnetics and GPR was conducted. The roman bridgehead settlement of Emmerdorf/Rosegg is one of the best preserved Roman settlements in Austria

Psychological care in children and adolescents with type 1 diabetes in a real‐world setting and associations with metabolic control

Background: International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. Objective: To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome. Methods: Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. Results: Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P<.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, P<.001) compared with children without psychological care. In age-, sex-, diabetes duration-, and migratory background-matched children, HbA1c stayed stable in children supported by CPC during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009). Conclusions: In this real-world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow-up

Large-scale motorised prospection along the “SuedLink” route in Lower Franconia

Large-scale archaeological prospection has proven itself as an essential tool in advance of a linear infrastructure project. The non-destructive survey is a basis for infrastructural planning and the protection of archaeological sites. More than 410 ha of high-resolution motorized geomagnetics were surveyed within six weeks. Such infrastructure projects can also be seen as an opportunity for archaeological research

Buried, forgotten and rediscovered - prospecting the Roman villae rusticae in the area of Flachgau in Salzburg, Austria

At six different villae rusticae sites in the Salzburger Flachgau high resolution motorized and non motorized magnetic and radar data was gained. The sites are well preserved due to sustainable agricultural use

Protected by shooting at it - the Öde Kloster and an associated Roman settlement within the military training area Bruckneudorf, Austria

The archaeological prospection focused on a multiphase fortified settlement. It was conducted as an integrated survey using airborne laserscanning (ALS) data, aerial photography, magnetics and GPR. The results show among other things that restricted military areas provide outstanding conditions for the preservation of archaeological sites

Smartwatch und -phone als Therapie- und Monitoringgerät für Diabetes und Adipositas

Volltext: Einleitung: Die Häufigkeit von lebensstilbedingten Risikofaktoren und manifeste Stoffwechsel- und kardiovaskuläre Krankheiten (z.B. Diabetes mellitus) sind massiv ansteigend. Daher müssen verbesserte Behandlungsmodelle und Methoden zum Selfempowerment systematisch beforscht und implementiert werden. Hierbei zeigt sich ein mobiles Assistenzsystem auf Basis von Smartwatch und -phone, das eine permanente Aktivitätserfassung und damit verbundene Feedbackfunktion ermöglicht, als besonders vielversprechend. Ein Modell, das in der Chronikerversorgung von Risikopersonen und Patienten mit Stoffwechsel- und/oder kardiovaskulären Erkrankungen eingesetzt werden kann, wird derzeit betrieben vom Fraunhofer-Institut für Graphische Datenverarbeitung in Kooperation mit der MEDIGREIF Inselklinik Heringsdorf. Methoden: Damit der Chroniker ein situatives Feedback zur objektiv erfassten Bewegung erhalten kann, werden Smartphones und Smartwatches mit integrierten Beschleunigungssensoren genutzt. Smartwatches sind intelligente Uhren, die mit Sensoren, einer integrierten Funkeinheit sowie einem Display und Vibrationsgeber ausgestattet sind. Mittels Analyse und Klassifizierung der Bewegungsmuster von Körper oder den Extremitäten wird auf die Ausführungart und -dauer der Aktivitäten zurückgeschlossen. Die erfassten Daten werden mit Sollvorgaben verglichen und ermöglichen ein direktes, multimediales Feedback. Dieses System, DiaTrace, stellt daher situativ elektronische Motivationselemente und Begleitinformationen zur Verfügung. Ergebnisse: Das System wurde bisher im Rahmen von Feasibility-Studien bei Kindern und Jugendlichen mit Übergewicht, Adipositas und Diabetes eingesetzt und validiert (Schiel R et al. Appetite 2012; 58: 432 – 7; Schiel R et al. Exp Clin Endocrinol Diabetes 2011;119: 565 – 8). Alle Untersuchungen ergaben eine hohe Akzeptanz der Technologie bei Patienten, Angehöringen und Therapeuten, eine hohe Validität sowie die Reduktion entsprechender pathologischer klinischer Ereignisse. Bei Kindern und Jugendlichen mit Übergewicht und Adipostas (n = 124, Alter = 13,5 +-2,8 Jahre, BMI = 31,3 ± 5,2 kg/m(2), BMI-SDS = 2,50 ± 0,5) konnte durch die kontinuierliche Bewegungserfassung beispielsweise nicht nur die im Vergleich zur herkömmlichen Therapie bessere Gewichtsreduktion (7,1 ± 3,0 kg, BMI/BMI-SDS Reduktion p Schlussfolgerungen: Während zusätzlich zu tragende Geräte zur Aktivitätserfassung bereits eine Therapieunterstützung ermöglichen, so bieten unaufdringliche zu tragende Systeme einen erheblichen Mehrwert. Besonders die Smartwatch wird als kontinuierliches und auch im Schlaf zu tragendes, multimediales Interaktionsgerät besonders für die Diabetes- und Adipositasbehandlung Einsatz finden