Klinischer Behandlungspfad Carotisstenose : Evaluation im Ländervergleich ; Poster

Poster Einleitung Im Rahmen effizienzsteigernder Maßnahmen sind klinische Behandlungspfade unter DRG- Bedingungen und im Rahmen der Qualitätssicherung wichtige Instrumente. Material und Methoden Aus der Analyse zweier erfahrungsbasierter klinischer Behandlungspfade in Frankfurt/D und Newcastle/GB wurde ein halbstandardisierter clinical pathway Carotisstenose entwickelt, der der heterogenen Befundkonstellation bei Aufnahme, den unterschiedlichen klinischen Stadien der Erkrankung und den individuellen Patientenbedürfnissen Rechnung trägt. Es wurden dazu zwei Gruppen mit je 25 konsekutiv in Frankfurt/D ( Gruppe FrankfurtI) und New Castle/GB ( Gruppe New Castle )operierten Patienten retrospektiv analysiert.Aus den retrospektiv erhobenen Daten wurde ein stadienbezogener und der Zuweisersituation gerecht werdender klinischer Behandlungspfad erstellt, der anhand von 20 konsekutiv operierten Patienten, davon 60 % im Stadium IV der Erkrankung, ( Gruppe FrankfurtII ) analysiert wurde. Ergebnisse In Frankfurt 1 wurde 21 mal eine Eversions-TEA und 4 mal eine TEA/ Patchplastik angewendet, 62 % der Patienten befanden sich im Stadium 1 der Erkrankung, ,65 % erhielten präoperativ eine i.a.DSA der supraaortalen Äste ,100% eine Duplexsonografie und eine CCT; postoperativ fielen insgesamt 12 Intensiv- Pflegetage an sowie eine Revision aufgrund einer Nachblutung. In der Gruppe New Castle befanden sich 68% der Patienten in einem klinischen Stadium 2,es wurde 25 mal offen thrombendarteriektomiert, davon 21 mal mit Direktnaht verschlossen und 4 mal mit Patchplastik, alle Patienten erhielten präoperativ eine CT- Angiografie und eine Duplexsonografie; postoperativ fiel 1 Intensivpflegetag an und eine Revision wegen Nachblutung. Die Morbiditäts-/ Mortalitätsrate betrug in beiden Gruppen 0%. Betriebswirtschaftlich wurden bei einer Liegedauer von durchschnittlich 10 Tagen in Frankfurt 1 tatsächliche Kosten von 2768.96€ pro Patient ermittelt, in New Castle,bei einer Liegedauer von durchschnittlich 5 Tagen und einer differenten Kostenstruktur von 2510.56 €. In der Gruppe Frankfurt 2 wurde 11mal eine TEA mit Patchplastik und 9 mal eine Eversions-TEA durchgeführt, alle Patienten erhielten präoperativ eine Duplexsonografie und eine CCT , postoperativ fielen insgesamt 6 Intensivtage an, es wurde nicht revidiert, die Morbiditäts-/Mortalitätsrate lag ebenfalls bei 0%. Durch Einführung eines klinischen Behandlungspfades wurde also die Liegedauer in Frankfurt um 40 % reduziert sowie die tatsächlichen Kosten auf 2384.41€ pro Fall und damit im Mittel um 14 % gemindert. Schlussfolgerung Unter DRG-Bedingungen trägt daher die Anwendung eines klinischen Behandlungspfades in der Carotischirurgie zu einer Verbesserung der Erlössituation ohne Qualitätseinbuße bei

Observation of sonified movements engages a basal ganglia frontocortical network

Background: Producing sounds by a musical instrument can lead to audiomotor coupling, i.e. the joint activation of the auditory and motor system, even when only one modality is probed. The sonification of otherwise mute movements by sounds based on kinematic parameters of the movement has been shown to improve motor performance and perception of movements.Results: Here we demonstrate in a group of healthy young non-athletes that congruently (sounds match visual movement kinematics) vs. incongruently (no match) sonified breaststroke movements of a human avatar lead to better perceptual judgement of small differences in movement velocity. Moreover, functional magnetic resonance imaging revealed enhanced activity in superior and medial posterior temporal regions including the superior temporal sulcus, known as an important multisensory integration site, as well as the insula bilaterally and the precentral gyrus on the right side. Functional connectivity analysis revealed pronounced connectivity of the STS with the basal ganglia and thalamus as well as frontal motor regions for the congruent stimuli. This was not seen to the same extent for the incongruent stimuli.Conclusions: We conclude that sonification of movements amplifies the activity of the human action observation system including subcortical structures of the motor loop. Sonification may thus be an important method to enhance training and therapy effects in sports science and neurological rehabilitation.DFG/SFB/TR31/EUDFG/TP/A7/E

PI3K/p110α inhibition selectively interferes with arterial thrombosis and neointima formation, but not re-endothelialization: potential implications for drug-eluting stent design

Background Impaired re-endothelialization and stent thrombosis are a safety concern associated with drug-eluting stents (DES). PI3K/p110α controls cellular wound healing pathways, thereby representing an emerging drug target to modulate vascular homoeostasis after injury. Methods and results PI3K/p110α was inhibited by treatment with the small molecule inhibitor PIK75 or a specific siRNA. Arterial thrombosis, neointima formation, and re-endothelialization were studied in a murine carotid artery injury model. Proliferation and migration of human vascular smooth muscle cell (VSMC) and endothelial cell (EC) were assessed by cell number and Boyden chamber, respectively. Endothelial senescence was evaluated by the β-galactosidase assay, endothelial dysfunction by organ chambers for isometric tension. Arterial thrombus formation was delayed in mice treated with PIK75 when compared with controls. PIK75 impaired arterial expression and activity of tissue factor (TF) and plasminogen activator inhibitor-1 (PAI-1); in contrast, plasma clotting and platelet aggregation did not differ. In VSMC and EC, PIK75 inhibited expression and activity of TF and PAI-1. These effects occurred at the transcriptional level via the RhoA signalling cascade and the transcription factor NFkB. Furthermore, inhibition of PI3K/p110α with PIK75 or a specific siRNA selectively impaired proliferation and migration of VSMC while sparing EC completely. Treatment with PIK75 did not induce endothelial senescence nor inhibit endothelium-dependent relaxations. In line with this observation, treatment with PIK75 selectively inhibited neointima formation without affecting re-endothelialization following vascular injury. Conclusion Following vascular injury, PI3K/p110α inhibition selectively interferes with arterial thrombosis and neointima formation, but not re-endothelialization. Hence, PI3K/p110α represents an attractive new target in DES desig

Kinetic and morphological differentiation of Ettringites in plain and blended Portland cements using Metakaolin and the ASTM C 452-68 test. Part I: kinetic differentiation.

22 pages, 3 figures, 5 tables.[ES] En esta Parte I de la investigación, se han logrado verifi- car mediante el ensayo ASTM C 452-68, los resultados obtenidos en anteriores investigaciones realizadas con DRX y SEM y el ensayo Le Chatelier-Ansttet. Para ello, a 10 cementos Portland –6 CPO y 4 CPRS– se les añadió 20%, 30% y 40% de metakaolín (MK). Tanto los 10 CP como los 30 de sus mezclas con metakaolín (MK), se ensayaron durante 2 años, mediante dicho método ASTM C 452-68, y a sus probetas no sólo se les determinó su incremento porcentual de longitud, ∆L(%), sino además, el contenido de sulfatos de sus aguas de conservación. Otras determinaciones complementarias fueron: análisis químico de los materiales cementiceos utilizados y pro- piedades específicas de algunos cementos ensayados. Los resultados experimentales, ∆L(%) frente al tiempo, han confirmado de nuevo que la velocidad de formación de la ettringita de origen alúmina reactiva, Al2O3 r-, de las puzolanas, tiene que ser considerablemente mayor que la velocidad de formación de la ettringita de origen C3A de los CP, lo que ha sido verificado por la evolución durante todo el ensayo, del contenido de sulfatos de las aguas de conservación de las probetas. Debido a ello, se ha pro- puesto denominar a ambos tipos de ettringitas, ettringita de rápida formación, ett-rf, y ettringita de lenta forma- ción, ett-lf, respectivamente.[EN] In this first part of the study, the results obtained in prior research with XRD and SEM, as well as the Le Chatelier- Ansttet test were confirmed with the ASTM C 452-68 test. To this end, 20%, 30% and 40% metakaolin (MK) was added to ten Portland cements, six OPCs and four SRPCs. Both the ten plain PCs and the 30 metakaolin (MK) blends were tested for two years under ASTM C 452-68 specifications, determining not only the percentage increase in length, ΔL(%), of the specimens, but also the sulphate content in the curing water. Other parameters studied included: chemical analysis of the cementitious materials used and specific properties of some of the cements tested. The experimental results, ΔL(%) versus time, re-confirmed that the formation rate of ettringite from the reactive alumina, Al2O3 r-, present in the pozzolan must be substantially higher than the formation rate of ettringite from the C3A present in the PC. This was verified by the variation of the sulphate content in the specimen curing water throughout the test. In light of those findings, in this article these two types of ettringite are denominated rapid forming ettringite or ett-rf, and slow forming ettringite or ett-lf.Peer reviewe

Simulation of Claylike Colloids

We investigate properties of dense suspensions and sediments of small spherical silt particles by means of a combined Molecular Dynamics (MD) and Stochastic Rotation Dynamics (SRD) simulation. We include van der Waals and effective electrostatic interactions between the colloidal particles, as well as Brownian motion and hydrodynamic interactions which are calculated in the SRD-part. We present the simulation technique and first results. We have measured velocity distributions, diffusion coefficients, sedimentation velocity, spatial correlation functions and we have explored the phase diagram depending on the parameters of the potentials and on the volume fraction.Comment: 20 pages, 14 figure

Развитие альтернативной энергетики Германии

В данной статье рассмотрены последние тенденции развития альтернативной энергетики Германии. Приведены некоторые причины выбора политики, направленной на столь стремительную интеграцию технологий, использующих возобновляемые источники энергии. Проведено сравнение Германии с другими странами Евросоюза по динамике использования возобновляемой энергии

Анализ осветительной установки центра спортивной подготовки "Заря"

In the work provided an analysis of the lighting system UIA Sports Training Centre "Dawn", Novosibirsk and calculation of payback lighting installation when replacing an existing system on led light sources

Development of a Novel Valve-Controlled Drug-Elutable Microstent for Microinvasive Glaucoma Surgery: In Vitro and Preclinical In Vivo Studies

Purpose: Microinvasive glaucoma surgery (MIGS) has become an important treatment approach for primary open-angle glaucoma, although the safe and long-term effective lowering of intraocular pressure with currently available implants for MIGS is not yet achieved to a satisfactory extent. The study focusses on the development and in vitro and in vivo testing of a novel microstent for MIGS. Methods: A silicone elastomer-based microstent was developed. Implants were manufactured using dip coating, fs-laser cutting, and spray coating. Within the current study no antifibrotic drug was loaded into the device. Sterilized microstents were analyzed in vitro regarding pressure–flow characteristics and biocompatibility. Six New Zealand white rabbits were implanted with a microstent draining the aqueous humor from the anterior chamber into the subconjunctival space. Drainage efficacy was evaluated using oculopressure tonometry as a transient glaucoma model. Noninvasive imaging was performed. Results: Microstents were manufactured successfully and characterized in vitro. Implantation in vivo was successful for four animals with additional device fixation. Without additional fixation, dislocation of microstents was found in two animals. Safe and effective intraocular pressure reduction was observed for the four eyes with correctly implanted microstent during the 6-month trial period. Conclusions: The described microstent represents an innovative treatment approach for MIGS. The incorporation of a selectively antifibrotic drug into the microstent drugelutable coating will be addressed in future investigations. Translational Relevance: The current preclinical study successfully provided proof of concept for our microstent for MIGS which is suitable for safe and effective intraocular pressure reduction and offers promising perspectives for the clinical management of glaucoma

The Source of Three-minute Magneto-acoustic Oscillations in Coronal Fans

We use images of high spatial, spectral and temporal resolution, obtained using both ground- and space-based instrumentation, to investigate the coupling between wave phenomena observed at numerous heights in the solar atmosphere. Intensity oscillations of 3 minutes are observed to encompass photospheric umbral dot structures, with power at least three orders-of-magnitude higher than the surrounding umbra. Simultaneous chromospheric velocity and intensity time series reveal an 87 \pm 8 degree out-of-phase behavior, implying the presence of standing modes created as a result of partial wave reflection at the transition region boundary. An average blue-shifted Doppler velocity of ~1.5 km/s, in addition to a time lag between photospheric and chromospheric oscillatory phenomena, confirms the presence of upwardly-propagating slow-mode waves in the lower solar atmosphere. Propagating oscillations in EUV intensity are detected in simultaneous coronal fan structures, with a periodicity of 172 \pm 17 s and a propagation velocity of 45 \pm 7 km/s. Numerical simulations reveal that the damping of the magneto-acoustic wave trains is dominated by thermal conduction. The coronal fans are seen to anchor into the photosphere in locations where large-amplitude umbral dot oscillations manifest. Derived kinetic temperature and emission measure time-series display prominent out-of-phase characteristics, and when combined with the previously established sub-sonic wave speeds, we conclude that the observed EUV waves are the coronal counterparts of the upwardly-propagating magneto-acoustic slow-modes detected in the lower solar atmosphere. Thus, for the first time, we reveal how the propagation of 3 minute magneto-acoustic waves in solar coronal structures is a direct result of amplitude enhancements occurring in photospheric umbral dots.Comment: Accepted into ApJ (13 pages and 10 figures