Diagnosis and treatment of implant-associated septic arthritis and osteomyelitis

Implant-associated infections are caused by microorganisms growing in biofilms, rendering these infections difficult to diagnose and to eradicate. Delayed-onset low-grade infection is difficult to distinguish from aseptic failure, often presenting without signs of infection, but only with early loosening and persisting pain. A combination of criteria is needed for an accurate diagnosis: clinical signs and symptoms, laboratory signs of infection, microbiology, histology, and imaging. The treatment goals in prosthetic joint-associated infection are eradication of infection and an optimal functional result. The goal in internal fixation device-associated infection is consolidation of the fracture and avoidance of chronic osteomyelitis. Successful treatment requires an adequate surgical procedure combined with long-term antimicrobial therapy, ideally with an agent acting on adhering biofilm microorganisms. This article reviews the epidemiology, pathogenesis, diagnosis, and management of implant-associated infections, and presents pathogenesis and risk of hematogenous infectio

EES 2013 - Energy EcoSystems 2013: Leipzig, Germany, 23 - 24 September 2013; proceedings

Im Kontext der Energiewende durchlebt die Energiewirtschaft in Deutschland gegenwärtig einen tiefgreifenden Strukturwandel. Der Trend zur Fragmentierung und Dezentralisierung von Marktteilnehmern wird sich in den nächsten Jahren fortsetzen und weiter beschleunigen. Die Komplexität des Energiesystems wird weiter steigen. Gleichzeitig ergeben sich im Zuge dieser Entwicklung für energiewirtschaftliche Akteure (Erzeuger, Verbraucher, Netze, Energiemärkte und IuK-Technologien) vielfältige wirtschaftliche Herausforderungen und Entwicklungsperspektiven. Das Konzept 'Ecosystems' eröffnet innovative Perspektiven auf die zu erwartenden energiewirtschaftlichen Entwicklungen. Es strukturiert das komplexe Zusammenspiel der einzelnen Akteure und Teilsysteme mit der Zielsetzung, das Gesamtsystem sicherer, effizienter und umweltverträglicher zu gestalten. Im Fokus der Energy EcoSystems Conference 2013 stehen hierbei vier Betrachtungsebenen – die physikalische Ebene, die IKT-Ebene, die ökonomische Ebene und die soziokulturelle Ebene – sowie deren ebenenübergreifenden Wechselwirkungen. Mit den Sessions 'Energy EcoSystems heute und morgen', 'Technische Informationsbedarfe im Energy EcoSystem', 'Vermarktung und Verbrauch im Energy EcoSystem\\\', \\\'Erneuerbare Energien im Energy EcoSystem', 'Innovationen im Energy EcoSystem' und 'Quo vadis Energy EcoSystems?' liegen die Schwerpunkte der Konferenz in der Systemintegration von Erneuerbare-Energie-Anlagen, der Flexibilisierung des Verbrauchs auf physikalischer und ökonomischer Ebene, der Standardisierung von Datenformaten und Kommunikationsprotokollen, der Umsetzung steigender informationstechnischer Anforderungen sowie in Ansätzen zur Optimierung des Gesamtsystems. Dieser Tagungsband beinhaltet die wissenschaftlichen Beiträge der Scientific Tracks sowie ausgewählte Präsentationen der Industrie Tracks der Konferenz. Dr. Gerd Arnold, Dr. Stefan Kühne, Johannes Schmidt und Dr. Andrej Werner – das Konferenzkomitee – danken den Teilnehmern für die hochwertigen wissenschaftlichen sowie praxisrelevanten Beiträge und Diskussionen. Weiterhin möchte sich das Konferenzkomitee bei den Projektförderern Sächsische Aufbaubank (SAB), Bundesministerium für Bildung und Forschung (BMBF) sowie Bundesministerium für Wirtschaft und Technologie (BMWi) bedanken, welche durch unterschiedliche Förderprogramme die anstehenden Herausforderungen in der Energiewirtschaft und die Entwicklung hin zu einer erfolgreichen und exportierbaren Energiewende unterstützen. Besonderer Dank gilt den Sponsoren perdata Gesellschaft für Informationsverarbeitung mbH und GETEC net AG, durch deren Unterstützung viele Teilnehmer ihre Ergebnisse und Erkenntnisse auf der EcoSystems Conference 2013 vorstellen konnten. Das Konferenzkomitee dankt auch den Mitgliedern des Organisationskomitees –- Axel Hummel, Stefan Sprick und Robert Wehlitz –- für ihr persönliches Engagement und ihre tatkräftige operative Unterstützung. Weitere Informationen zur Energy EcoSystems Conference 2013 sowie die Folien der ReferentInnen finden Sie unter http://ees2013.infai.org. Alle Informationen zur nächsten Energy EcoSystems Conference werden unter http://ees.infai.org bekannt gegeben.:Sabine Wieland: Informationsarchitektur im Smart Meter Umfeld unter Berücksichtigung der aktuellen Netzsituation; Stefan Saatmann und Sandra Maeding: Energiewende und Regulierung — Wie werden Sonne und Wind im Stromnetz integriert und reguliert; Stefan Sprick, Tino Ryll, Kerstin Wurdinger, Andrej Werner, Bogdan Franczyk, Marcus Grieger, Jan Pfeifer und Robert Wehlitz: Regenerative Energien Management-Cockpit (REMC): Informationstransparenz in Energiewertschöpfungsnetzwerken; Hendrik Kondziella und Thomas Bruckner: Modellbasierte Investitionsentscheidungen in dezentralen Energiesystemen; Diana Böttger, Philipp Hanemann und Thomas Bruckner: Wirtschaftlichkeitsanalyse eines virtuellen Kraftwerks in Delitzsch innerhalb des EU-Projektes VIS NOVA; Robert Wehlitz, Andrej Werner, Marcus Grieger, Jan Pfeifer, Bogdan Franczyk, Stefan Sprick und Tino Ryll: Smart Meter Installation Management — Prototypgestützte Digitalisierung von Smart Meter Montageprozessen; Marcus Grieger, Andrej Werner, Robert Wehlitz, Jan Pfeifer, Stefan Sprick, Tino Ryll und Bogdan Franczyk: How ICT Could Accelerate the Smart Meter Installation Process — An Assessment of Rollout Experiences; Heiko Mevert: Smart-Metering: Theorie und Praxis; Hartmut Entrup: Anforderungen an IT-Systeme im Zuge der Einführung intelligenter Messsysteme; Martin Winter: Dynamische Anbindung dezentraler Energieanlagen mit IEC 61850; Olaf Krietsch: Verbindungen zwischen SRL-Anbieter und Übertragungsnetzbetreibern gemäß 'Mindestanforderungen an die Informationstechnik für die Erbringung von Sekundärregelleistung'; Sabrina Schlammerl: Innovative Services in der Windenergie: Der Einsatz von RDS-PP und dessen Bedeutung für das Life Cycle Management; Christian Schweitzer: Lebenslaufakte: Ganzheitlicher Ansatz für einen gesicherten Anlagenbetrieb; Rene Baumann: Vermarktungskonzepte für dezentrale Anlagen; Heike Diebler und Lutz Maicher: Energiekosten sparen durch Energetische Transparenz in der verarbeitenden Industrie – ein Praxisbericht; Philipp Guttenberg, Heinrich Hördegen: Betriebsoptimierung für Energiespeicher durch Energieflussmodellierung; Winfried Damm: Regenerative Energieversorgung einer Großstadt, Stadtwerke Leipzig; Uwe Härling: Herausforderungen der Energiewende für das Verteilnetz der MITNETZ STROM; Matthias Müller-Mienack: Integration Erneuerbarer Energien — Notwendige Werkzeuge für den ÜNB; Martin Jarosch-Mitko: Eine Integrationsplattform für Erneuerbare-Energie-Anlagen; Stephan Witt: Energiesysteme als Business Ecosystems – Bedeutung für die strategische Planung und das Innovationsmanagement am Beispiel dezentraler Netzsteuerungsparadigmen; Thomas Bruckner: Die Energiewende in Deutschland – Technologische Lösungen und energiewirtschaftliche Herausforderunge

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

Background: Although colorectal surgery is long established as the mainstay treatment for colon cancer, certain topics regarding technical fine-tuning to increase postsurgical recurrence-free survival have remained a matter of debate throughout the past years. These include complete mesocolic excision (CME), treatment strategies for metastatic disease, significance of hyperthermic intraperitoneal chemotherapy (HIPEC), and surgical techniques for the treatment of colorectal cancer recurrence. In addition, new surgical techniques have been introduced in oncologic colorectal surgery, and their potential to provide sufficiently radical resection has yet to be proven. Methods: A structured review of the literature was performed to identify the current state of the art with regard to the mentioned key issues in colorectal surgery. Results: This article provides a comprehensive review of the current literature addressing the above-mentioned current challenges in colorectal surgery. The focus lies on the impact of CME and, in relation to this, on lymph node dissection, as well as on treatment of metastatic disease including peritoneal spread, and finally on the treatment of recurrent disease. Conclusion: Uniformly, the current literature reveals that surgery aiming at complete malignancy elimination within multimodal treatment approaches represents the fundamental quantum leap for the achievement of long-term tumor-free survival. (C) 2016 S. Karger GmbH, Freibur

Trusting versus monitoring: an experiment of endogenous institutional choices

We investigate the problem of deciding between trusting and monitoring, and how this decision affects subsequent behavior, using a laboratory experiment where subjects choose between the Ultimatum and the Yes-No Game. Despite the similarity of the two games in Ultimatum Games responders monitor the allocation proposal, while in Yes-No games responders react without monitoring, i.e. have to rely on trust. We permit either the proposer or responder to make the game choice and analyze how both roles choose between trusting and monitoring, what the ensuing effects of their choices are, and how they vary depending on who has chosen the game. We, also, experimentally vary the cost of monitoring and the responder’s conflict payoff. Since monitoring is usually costly, the amount to share in Yes-No Games (YNG) can exceed that in Ultimatum Games (UG). Regarding the conflict payoff, it can be positive or negative with the former rendering Yes-No interaction a social dilemma. According to our results, proposers (responders) opt for trusting significantly more (less) often than for monitoring. Average offers are higher in Ultimatum than in Yes-No games, but neither UG nor YNG offers depend on who has chosen between games

Large Converter-Fed Adjustable Speed AC Drives For Turbomachines.

LecturePg. 103-112Converter-fed adjustable speed electric motors are now finding increasing use for driving turbomachinery in the power range from 1.0 to 20 (50) MW. The most important properties of these drives are explained, with the main emphasis on the frequency converter, the motor, and especially the shaft line

Steel silos for particulate solid materials. Part 1, Actions at filling and discharge.

V članku podajamo izraze za membranske sile v osno-simetričnem jeklenem silosu med procesoma polnjenja in praznjenja s sipkim materialom. Izrazi so predstavljeni tudi v grafični obliki, kar omogoča hitro in enostavno oceno velikosti in razporeditve membranskih sil v posameznih delih silosa. Grafi veljajo za poljubno geometrijo silosa in za poljuben material, ki se hrani. Na podlagi teh grafov lahko preverimo, kakšen je vpliv geometrije silosa in shranjenega materiala na razporeditev in velikost membranskih sil. Na koncu podajamo ilustrativen primer izračuna vplivov (pritiskov) in membranskih sil pri polnjenju in praznjenju silosa.In the paper, the expressions for membrane forces in an axisymmetric steel silo structure at filling and discharge with a particulate solid material are presented. Graphical plots of these expressions are given. They can be used for a quick and easy estimate of membrane forces distribution in all parts of a silo structure. The plots are valid for any silo geometry and for any material stored. The influence of silo geometry and stored material properties on the size and distribution of membrane forces can be thus checked. The paper completes with an illustrative example where actions (pressure loads) at filling and discharge on the walls of a silo are computed and the corresponding membrane forces are evaluated

Effect of two different neuroprotection systems on microembolization during carotid artery stenting

ObjectivesThis study sought to compare the efficacy of two different cerebral protection systems for the prevention of embolization during carotid artery stenting (CAS) using a transcranial Doppler (TCD) monitoring with the detection of microembolic signals (MES).BackgroundDespite the introduction of cerebral protection systems, neurologic complications during CAS cannot completely be prevented. Transcranial Doppler and detection of MES may aid in assessing the efficacy of different neuroprotection systems.MethodsA total of 42 patients with internal carotid artery stenoses were treated by CAS using either a filter (E.P.I. FilterWire, Boston Scientific Corp., Santa Clara, California) (n = 21) or a proximal endovascular clamping device (MO.MA system, Invatec s.r.l., Roncadelle, Italy) (n = 21). Microembolic signal counts were compared during five phases: placement of the protection device, passage of the stenosis, stent deployment, balloon dilation, and retrieval of the protection device.ResultsThere were no significant differences in clinical or angiographic outcomes between the two groups. Compared to the filter device, the MO.MA system significantly reduced MES counts during the procedural phases of wire passage of the stenosis, stent deployment, balloon dilation, and in total (MES counts for the filter device were 25 ± 22, 73 ± 49, 70 ± 31, and 196 ± 84 during the three phases and in total, MES counts for the MO.MA system were 1.8 ± 3.2, 11 ± 19, 12 ± 21, and 57 ± 41, respectively; p < 0.0001).ConclusionsIn comparison to a filter device the MO.MA system led to significantly lower MES counts during CAS. The detection of MES by TCD may facilitate the evaluation and comparison of different neuroprotection systems

Telling the other what one knows? Strategic lying in a modified acquiring-a-company experiment with two-sided private information

Lying for a strategic advantage is to be expected in commercial interactions. But would this be more or less obvious when lying could come from either party and question mutually profitable exchange? To explore this, we modify the acquiring-a-company game (Samuelson and Bazerman in Res Exp Econ 3:105–138, 1985) by letting both, buyer and seller, be privately informed. Specifically, the value of the company for the buyer is known only by the seller; whereas, only the buyer is aware by which proportion the sellers evaluation is lower than that of the buyer. Before bargaining, both parties can reveal what they know via cheap-talk numerical messages. Game theoretically, the pooling equilibrium may or may not allow for trade depending on the commonly known expected evaluation discrepancy. By mutually revealing what one knows, one could boost trade and efficiency. Although strategic misreporting prevails quite generally, it is higher for sellers throughout the experiment. Regarding gender, women misreport less, especially as sellers, and offer higher prices

Behavioral spillovers in local public good provision: an experimental study

In a circular neighborhood, each member has a left and a right neighbor with whom(s) he interacts repeatedly. From their two separate endowment amounts individuals can contribute to each of their two structurally independent public goods, either shared only with their left, respectively right, neighbor. If most group members are discrimination averse and conditionally cooperating with their neighbors, this implies intra- as well as inter personal spillovers which link all neighbors. Investigating individual adaptations in one’s two games with differing freeriding incentives confirms, through behavioral spillovers, that both individual contributions anchor on the local public good with the smaller free-riding incentive. Therefore asymmetry in gaining from local public goods allows to establish a higher level of voluntary cooperation

Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role?

Background Postoperative complications of Clavien-Dindo grade 3 or more are of prognostic significance in patients who undergo liver resection for hepatocellular carcinoma (HCC). However, perioperative mortality and patient comorbidities represent relevant factors that interfere with postoperative long-term survival. To clarify this, a retrospective single-center study was carried out. Patients and methods Patient data were prospectively collected in a continuously updated liver resection database. Overall, 184 consecutive patients who underwent liver resection for HCC with a curative intent between March 2003 and December 2013 were selected for the study. The patients were assigned to two groups according to the presence or absence of postoperative complications. Pre-existing comorbidities, perioperative mortality, surgical outcome, and long-term survival data were analyzed. Results Postoperative complications requiring revision surgery were identified in 17.4% of the patients. The in-house mortality rate was 4.8%. Compared with patients without complications, patients with complications were older and had significantly more pre-existing comorbidities, more advanced tumors, more intrahepatic metastasis, longer operation times, greater blood loss, and more extensive resections. The overall 5-year survival rates were 40.1 and 52.5% in patients with or without postoperative complications, respectively. The corresponding 5-year recurrence-free survival rates were 46.3 and 46.7% (perioperative mortality excluded). Multivariate analysis showed that elevation of the Charlson Comorbidity Index was associated independently with decreased overall and recurrence-free survival. Conclusion In patients with HCC, posthepatectomy complications are confirmed to have predictive value. However, closer analysis and exclusion of perioperative mortality effects show an independent impact of pre-existing comorbidities on long-term overall und recurrence-free survival