Therapie chronischer Wunden mit wassergefiltertem Infrarot A (wIRA)

The central portion of chronic wounds is often hypoxic and relatively hypothermic, representing a deficient energy supply of the tissue, which impedes wound healing or even makes it impossible. Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue penetration and a low thermal load to the skin surface. wIRA produces a therapeutically usable field of heat and increases temperature, oxygen partial pressure and perfusion of the tissue. These three factors are decisive for a sufficient tissue supply with energy and oxygen and consequently as well for wound healing, especially in chronic wounds, and infection defense. wIRA acts both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA can advance wound healing or improve an impaired wound healing process and can especially enable wound healing in non-healing chronic wounds. wIRA can considerably alleviate the pain and diminish wound exudation and inflammation and can show positive immunomodulatory effects. In a prospective, randomized, controlled study of 40 patients with chronic venous stasis ulcers of the lower legs irradiation with wIRA and visible light (VIS) accelerated the wound healing process (on average 18 vs. 42 days until complete wound closure, residual ulcer area after 42 days 0.4 cm² vs. 2.8 cm²) and led to a reduction of the required dose of pain medication in comparison to the control group of patients treated with the same standard care (wound cleansing, wound dressing with antibacterial gauze, and compression garment therapy) without the concomitant irradiation. Another prospective study of 10 patients with non-healing chronic venous stasis ulcers of the lower legs included extensive thermographic investigation. Therapy with wIRA(+VIS) resulted in a complete or almost complete wound healing in 7 patients and a marked reduction of the ulcer size in another 2 of the 10 patients, a clear reduction of pain and required dose of pain medication, and a normalization of the thermographic image. In a current prospective, randomized, controlled, blinded study patients with non-healing chronic venous stasis ulcers of the lower legs are treated with compression garment therapy, wound cleansing, wound dressings and 30 minutes irradiation five times per week over 9 weeks. A preliminary analysis of the first 23 patients of this study has shown in the group with wIRA(+VIS) compared to a control group with VIS an advanced wound healing, an improved granulation and in the later phase of treatment a decrease of the bacterial burden. Some case reports have demonstrated that wIRA can also be used for mixed arterial-venous ulcers or arterial ulcers, if irradiation intensity is chosen appropriately low and if irradiation is monitored carefully. wIRA can be used concerning decubital ulcers both in a preventive and in a therapeutic indication. wIRA can improve the resorption of topically applied substances also on wounds. An irradiation with VIS and wIRA presumably acts with endogenous protoporphyrin IX (or protoporphyrin IX of bacteria) virtually similar as a mild photodynamic therapy (endogenous PDT-like effect). This could lead to improved cell regeneration and wound healing and to antibacterial effects. In conclusion, these results indicate that wIRA generally should be considered for the treatment of chronic wounds.Das Zentrum von chronischen Wunden ist oft hypoxisch und relativ hypotherm. Dies entspricht einer defizitären Energiebereitstellung im Gewebe, die die Wundheilung behindert oder unmöglich macht. Wassergefiltertes Infrarot A (wIRA) ist eine spezielle Form der Wärmestrahlung mit hohem Eindringvermögen in das Gewebe bei geringer thermischer Oberflächenbelastung. wIRA erzeugt ein therapeutisch nutzbares Wärmefeld und steigert Temperatur, Sauerstoffpartialdruck sowie die Durchblutung im Gewebe. Diese drei Faktoren sind entscheidend für eine ausreichende Versorgung des Gewebes mit Energie und Sauerstoff und deshalb auch für die Wundheilung, speziell bei chronischen Wunden, und die Infektionsabwehr. wIRA wirkt sowohl über thermische und temperaturabhängige als auch über nicht-thermische und temperaturunabhängige Effekte. wIRA kann die Wundheilung beschleunigen oder einen stagnierenden Wundheilungsprozess verbessern und insbesondere bei nicht-heilenden chronischen Wunden eine Wundheilung ermöglichen. wIRA vermag Schmerzen deutlich zu mindern und die Wundsekretion sowie Entzündung zu reduzieren sowie positive immunmodulierende Effekte zu zeigen. In einer prospektiven, randomisierten, kontrollierten Studie mit 40 Patienten mit chronischen venösen Unterschenkelulzera führte eine Bestrahlung mit wIRA und sichtbarem Licht (VIS) zu einer schnelleren Wundheilung (im Durchschnitt 18 vs. 42 Tage bis zum kompletten Wundschluss, Restulkusfläche nach 42 Tagen 0,4 cm² vs. 2,8 cm²) und einem geringeren Schmerzmittelverbrauch gegenüber einer in gleicher Form (Wundsäuberung, antibakterielle Wundauflagen und Kompressionstherapie) therapierten, aber nicht bestrahlten Kontrollgruppe. Eine weitere prospektive Studie mit 10 Patienten mit aufwändiger thermographischer Verlaufskontrolle ergab unter Therapie mit wIRA(+VIS) eine vollständige oder fast vollständige Abheilung therapierefraktärer chronischer Unterschenkelulzera bei 7 sowie eine deutliche Ulkusverkleinerung bei 2 weiteren der 10 Patienten, eine ausgeprägte Minderung der Schmerzen und des Schmerzmittelverbrauchs und eine Normalisierung des thermographischen Bildes. In einer laufenden prospektiven, randomisierten, kontrollierten, verblindeten Studie werden Patienten mit nicht-heilenden chronischen venösen Unterschenkelulzera mit Kompressionstherapie, Wundsäuberung und nicht-adhäsiven Wundauflagen sowie 30 Minuten Bestrahlung fünfmal pro Woche über 9 Wochen behandelt. Eine vorläufige Auswertung der ersten 23 Patienten zeigte, dass die Gruppe mit wIRA(+VIS) verglichen mit einer Kontrollgruppe mit VIS eine schnellere Wundheilung, eine bessere Granulation und in der späteren Phase der Behandlung eine Abnahme der bakteriellen Last der Wunden aufwies. Einige Fallberichte haben gezeigt, dass wIRA selbst bei gemischt arteriell-venösen Ulzera oder arteriellen Ulzera eingesetzt werden kann, wenn die Bestrahlungsstärke angemessen niedrig gewählt und die Bestrahlung sorgfältig überwacht wird. wIRA kann bei Dekubitalulzera sowohl präventiv als auch therapeutisch eingesetzt werden. wIRA kann die Resorption topisch applizierter Substanzen auch auf Wunden verbessern. Eine Bestrahlung mit VIS und wIRA wirkt vermutlich in Verbindung mit endogenem Protoporphyrin IX (oder Protoporphyrin IX von Bakterien) quasi ähnlich wie eine milde photodynamische Therapie (endogener PDT-ähnlicher Effekt). Dies kann die Zellregeneration und Wundheilung fördern und antibakteriell wirken. Zusammengefasst zeigen die Ergebnisse, dass wIRA generell für die Behandlung chronischer Wunden erwogen werden sollte

1420 MHz Continuum Absorption Towards Extragalactic Sources in the Galactic Plane

We present a 21-cm emission-absorption study towards extragalactic sources in the Canadian Galactic Plane Survey (CGPS). We have analyzed HI spectra towards 437 sources with S > 150 mJy, giving us a source density of 0.6 sources per square degree at arcminute resolution. We present the results of a first analysis of the HI temperatures, densities, and feature statistics. Particular emphasis is placed on 5 features with observed spin temperatures below 40 K. We find most spin temperatures in the range from 40 K to 300 K. A simple HI two-component model constrains the bulk of the cold component to temperatures (T_c) between 40 K and 100 K. T_c peaks in the Perseus arm region and clearly drops off with Galactocentric radius, R, beyond that. The HI density follows this trend, ranging from a local value of 0.4 cm^{-3} to less than 0.1 cm^{-3} at R = 20 kpc. We find that HI emission alone on average traces about 75% of the total HI column density, as compared to the total inferred by the emission and absorption. Comparing the neutral hydrogen absorption to CO emission no correlation is found in general, but all strong CO emission is accompanied by a visible HI spectral feature. Finally, the number of spectral HI absorption features per kpc drop off exponentially with increasing R.Comment: 13 pages, 13 figures, Accepted for March 2004 Ap

A mapping approach to synchronization in the "Zajfman trap": stability conditions and the synchronization mechanism

We present a two particle model to explain the mechanism that stabilizes a bunch of positively charged ions in an "ion trap resonator" [Pedersen etal, Phys. Rev. Lett. 87 (2001) 055001]. The model decomposes the motion of the two ions into two mappings for the free motion in different parts of the trap and one for a compressing momentum kick. The ions' interaction is modelled by a time delay, which then changes the balance between adjacent momentum kicks. Through these mappings we identify the microscopic process that is responsible for synchronization and give the conditions for that regime.Comment: 12 pages, 9 figures; submitted to Phys Rev

Historical-institutionalist perspectives on the development of the EU budget system

The EU budget has only recently started to feature in theories of European integration. Studies typically adopt a historical-institutionalist framework, exploring notions such as path dependency. They have, however, generally been rather aggregated, or coarse-grained, in their approach. The EU budget has thus been treated as a single entity rather than a series of inter-linked institutions. This paper seeks to address these lacunae by adopting a fine-grained approach. This enables us to emphasize the connections that exist between EU budgetary institutions, in both time and space. We show that the initial set of budgetary institutions was unable, over time, to achieve consistently their treaty-based objectives. In response, rather than reform these institutions at potentially high political cost, additional institutions were layered on top of the extant structures. We thus demonstrate how some EU budgetary institutions have remained unchanged, whilst others have been added or changed over time

The effects of lifestyle and diet on gut microbiota composition, inflammation and muscle performance in our aging society

Living longer is associated with an increased risk of chronic diseases, including impairments of the musculoskeletal and immune system as well as metabolic disorders and certain cancers, each of which can negatively affect the relationship between host and microbiota up to the occurrence of dysbiosis. On the other hand, lifestyle factors, including regular physical exercise and a healthy diet, can affect skeletal muscle and immune aging positively at all ages. Accordingly, health benefits could partly depend on the effect of such interventions that influence the biodiversity and functionality of intestinal microbiota. In the present review, we first discuss the physiological effects of aging on the gut microbiota, immune system, and skeletal muscle. Secondly, we describe human epidemiological evidence about the associations between physical activity and fitness and the gut microbiota composition in older adults. The third part highlights the relevance and restorative mechanisms of immune protection through physical activity and specific exercise interventions during aging. Fourth, we present important research findings on the effects of exercise and protein as well as other nutrients on skeletal muscle performance in older adults. Finally, we provide nutritional recommendations to prevent malnutrition and support healthy active aging with a focus on gut microbiota. Key nutrition‐related concerns include the need for adequate energy and protein intake for preventing low muscle mass and a higher demand for specific nutrients (e.g., dietary fiber, polyphenols and polyunsaturated fatty acids) that can modify the composition, diversity, and metabolic capacity of the gut microbiota, and may thus provide a practical means of enhancing gut and systemic immune function

Evaluation of the G8 Screening Tool in Older Patients with Cancer: A Retrospective Analysis

Aim: The aims of this study were to evaluate the results of the Geriatric 8 (G8) screening in patients aged 75 years and over. Findings: Of 2,294 patients screened, 177 were ≥ 75 years. 120 patients (68%) were vulnerable as defined by a G8 score ≤ 14. Vulnerable patients showed worse outcomes than fit patients did. In binary logistic regression modeling, the G8 domains of nutritional intake and health status were predictive of hospitalization and of death, when controlling for all other variables. Message: The G8 screening is applicable and can discriminate between fit and vulnerable patients in oncology. Prospective use in treatment decisions might improve care for geriatric cancer patients Purpose: To evaluate the results of the Geriatric 8 (G8) screening in patients aged 75 years and over. Methods: In this retrospective single-center study, we screened the medical records of 2294 patients referred to the Department for Medical Oncology in St. Gallen, a tertiary hospital in Switzerland, over a period of 29 days. For each patient aged 75 and older, the responsible oncologist completed the G8 questionnaire. The cohort was followed to obtain data on patient outcomes for the 4 months following the completion of the G8 assessment. Patients' charts were reviewed following a standardized approach. Information regarding given anticancer treatment, anticancer toxicity, date and reason for inpatient admission, date of inpatient discharge, and date of death was documented. Data were analyzed using the Χ2 test and binary logistic regression. Results: Of 2,294 patients screened, 177 were ≥75 years. 176 G8 assessments were completed on patients with various tumor types. 152 (86%) were outpatients and 112 (64%) males. Mean age was 79.9 years (SD 4.3). 120 patients (68%) were vulnerable as defined by a G8 score ≤ 14. Vulnerable patients showed worse outcomes than fit patients did. In binary logistic regression modeling, the G8 domains of nutritional intake and health status were predictive of hospitalization and of death, when controlling for all other variables. Conclusion: The G8 screening is applicable and can discriminate between fit and vulnerable patients in oncology. Prospective use in treatment decisions might improve care for geriatric cancer patients. Keywords: Geriatric assessment; Clinical oncology; Palliative medicine; Hospitalization; Deat

Frequency-adaptive control of a three-phase single-stage grid-connected photovoltaic system under grid voltage sags

The low-voltage ride-through service is carried out in this paper according to the voltage profile described by the IEC 61400-21 European normative when short-duration voltage sags happen, and some instantaneous reactive power is delivered to the grid in accordance with the Spanish grid code; the mandatory limitation of the amplitude of the three-phase inverter currents to its nominal value is carried out with a novel control strategy, in which a certain amount of instantaneous constant active power can also be delivered to the grid when small or moderate voltage sags happen. A Multiple second order generalized integrator frequency-locked loop synchronization algorithm is employed in order to estimate the system frequency without harmonic distortions, as well as to output the positive- and the negative- sequence of the {\alpha}\b{eta} quantities of the three-phase grid voltages when balanced and unbalanced voltage sags happen in a frequency-adaptive scheme. The current control is carried out in the stationary reference frame, which guarantees the cancellation of the harmonic distortions in the utility grid currents using a Harmonic compensation structure, and the implementation of a constant active power control in order to protect the DC link capacitor from thermal stresses avoiding the appearance of large harmonic distortions at twice the fundamental frequency in the DC link voltage. A case study of a three-phase single-stage grid-connected PV system with a maximum apparent power about 500 kVA is tested with several simulations using MATLAB/SIMULINK firstly, and secondly, with some experiments using the Controller hardware-in-the-loop (CHIL) simulation technique for several types of voltage sags in order to do the final validation of the control algorithms