Operative Verfahren bei hohen kryptoglandulären Analfisteln: Systematische Übersicht und Metaanalyse

Purpose: Perianal fistulas, and specifically high perianal fistulas, remain a challenge for surgical treatment. Many techniques have been and are still being developed to improve the outcome after surgery. A systematic review and meta-analysis was performed for surgical treatment of high cryptoglandular perianal fistulas. Methods: Medline (Pubmed, Ovid), Embase and The Cochrane Library databases were searched for relevant randomized controlled trials on surgical treatments for high cryptoglandular perianal fistulas. Two independent reviewers selected articles for inclusion based on title, abstract and outcomes described. The main outcome measurement was the recurrence/healing rate. Secondary outcomes were continence status, quality of life and complications. Results: The number of randomized trials available was low. Fourteen studies could be included in the review. A meta-analysis could only be performed for the mucosal advancement flap versus the fistula plug, and did not show a result in favour of either technique in recurrence or complication rate. The mucosal advancement flap was the most investigated technique but did not show any advantage over any other technique. Other techniques identified in randomized studies were seton treatment, medicated seton treatment, fibrin glue, autologous stem cells, island flap anoplasty, rectal wall advancement flap, ligation of the intersphincteric fistula tract, sphincter reconstruction, sphincter-preserving seton and techniques combined with antibiotics. None of these techniques seemed superior to each other. Conclusions: The best surgical treatment for high cryptoglandular perianal fistulas could not be identified. More randomized controlled trials are needed to find the best treatment. The mucosal advancement flap is the most investigated technique available

High precision beam momentum determination in a synchrotron using a spin resonance method

In order to measure the mass of the eta meson with high accuracy using the d+p -> 3He+eta reaction, the momentum of the circulating deuteron beam in the Cooler Synchrotron COSY of the Forschungszentrum Juelich has to be determined with unprecedented precision. This has been achieved by studying the spin dynamics of the polarized deuteron beam. By depolarizing the beam through the use of an artificially induced spin resonance, it was possible to evaluate its momentum p with a precision of dp/p < 10-4 for a momentum of roughly 3 GeV/c. Different possible sources of error in the application of the spin resonance method are discussed in detail and its possible use during a standard experiment is considered.Comment: 10 pages, 6 figures, 2 tables, published versio

THE ACCUSED IS ENTERING THE COURTROOM: THE LIVE-TWEETING OF A MURDER TRIAL.

© 2017 Informa UK Limited, trading as Taylor & Francis GroupThe use of social media is now widely accepted within journalism as an outlet for news information. Live tweeting of unfolding events is standard practice. In March 2014, Oscar Pistorius went on trial in the Gauteng High Court for murder. Hundreds of journalists present began live-tweeting coverage, an unprecedented combination of international interest, permission to use technology and access which resulted in massive streams of consciousness reports of events as they unfolded. Based on a corpus of Twitter feeds of twenty-four journalists covering the trial, this study analyses the content and strategies of these feeds in order to present an understanding of how microblogging is used as a live reporting tool. This study shows the development of standardised language and strategies in reporting on Twitter, concluding that journalists adopt a narrow range of approaches, with no significant variation in terms of gender, location, or medium. This is in contrast to earlier studies in the field (Awad, 2006, Hedman, 2015; Kothari, 2010; Lariscy, Avery, Sweetser, & Howes, 2009 Lasorsa, 2012; Lasorsa, Lewis, & Holton, 2011; Sigal, 1999, Vis, 2013).Peer reviewe

Nurse-led follow-up of patients after oesophageal or gastric cardia cancer surgery: a randomised trial

Between January 2004 and February 2006, 109 patients after intentionally curative surgery for oesophageal or gastric cardia cancer were randomised to standard follow-up of surgeons at the outpatient clinic (standard follow-up; n=55) or by regular home visits of a specialist nurse (nurse-led follow-up; n=54). Longitudinal data on generic (EuroQuol-5D, European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30) and disease-specific quality of life (EORTC QLQ-OES18), patient satisfaction and costs were collected at baseline and at 6 weeks and 4, 7 and 13 months afterwards. We found largely similar quality-of-life scores in the two follow-up groups over time. At 4 and 7 months, slightly more improvement on the EQ-VAS was noted in the nurse-led compared with the standard follow-up group (P=0.13 and 0.12, respectively). Small differences were also found in patient satisfaction between the two groups (P=0.14), with spouses being more satisfied with nurse-led follow-up (P=0.03). No differences were found in most medical outcomes. However, body weight of patients of the standard follow-up group deteriorated slightly (P=0.04), whereas body weight of patients of the nurse-led follow-up group remained stable. Medical costs were lower in the nurse-led follow-up group (€2600 vs €3800), however, due to the large variation between patients, this was not statistically significant (P=0.11). A cost effectiveness acceptability curve showed that the probability of being cost effective for costs per one point gain in general quality-of-life exceeded 90 and 75% after 4 and 13 months of follow-up, respectively. Nurse-led follow-up at home does not adversely affect quality of life or satisfaction of patients compared with standard follow-up by clinicians at the outpatient clinic. This type of care is very likely to be more cost effective than physician-led follow-up

Canine NAPEPLD-associated models of human myelin disorders

Canine leukoencephalomyelopathy (LEMP) is a juvenile-onset neurodegenerative disorder of the CNS white matter currently described in Rottweiler and Leonberger dogs. Genome-wide association study (GWAS) allowed us to map LEMP in a Leonberger cohort to dog chromosome 18. Subsequent whole genome re-sequencing of a Leonberger case enabled the identification of a single private homozygous non-synonymous missense variant located in the highly conserved metallo-beta-lactamase domain of the N-acyl phosphatidylethanolamine phospholipase D (NAPEPLD) gene, encoding an enzyme of the endocannabinoid system. We then sequenced this gene in LEMP-affected Rottweilers and identified a different frameshift variant, which is predicted to replace the C-terminal metallo-beta-lactamase domain of the wild type protein. Haplotype analysis of SNP array genotypes revealed that the frameshift variant was present in diverse haplotypes in Rottweilers, and also in Great Danes, indicating an old origin of this second NAPEPLD variant. The identification of different NAPEPLD variants in dog breeds affected by leukoencephalopathies with heterogeneous pathological features, implicates the NAPEPLD enzyme as important in myelin homeostasis, and suggests a novel candidate gene for myelination disorders in people

Measurement of the absolute differential cross section of proton-proton elastic scattering at small angles

The differential cross section for proton-proton elastic scattering has been measured at a beam energy of 1.0 GeV and in 200 MeV steps from 1.6 to 2.8 GeV for centre-of-mass angles in the range from 12-16 degrees to 25-30 degrees, depending on the energy. Absolute normalisations of typically 3% were achieved by studying the energy losses of the circulating beam of the COSY storage ring as it passed repeatedly through the windowless hydrogen target of the ANKE magnetic spectrometer. It is shown that the data have a significant impact upon a partial wave analysis. After extrapolating the differential cross sections to the forward direction, the results are broadly compatible with the predictions of forward dispersion relations

What factors influence training opportunities for older workers? Three factorial surveys exploring the attitudes of HR professionals

The core research questions addressed in this paper are: what factors influence HR professionals in deciding whether to approve training proposals for older workers? What kind of training are they more likely to recommend for older employees and in which organizational contexts? We administered three factorial surveys to 66 HR professionals in Italy. Participants made specific training decisions based on profiles of hypothetical older workers. Multilevel analyses indicated that access to training decreases strongly with age, while highly-skilled older employees with low absenteeism rates are more likely to enjoy training opportunities. In addition, older workers displaying positive performance are more likely to receive training than older workers who perform poorly, suggesting that training late in working life may serve as a reward for good performance rather than as a means of enhancing productivity. The older the HR professional evaluating training proposals, the higher the probability that older workers will be recommended for training. keywords: training; older workers; HR professionals; factorial survey; multilevel model