Supportive treatment using a compression garment vest of painful sternal instability following deep surgical wound infection: a case report

<p>Abstract</p> <p>Introduction</p> <p>Sternal dehiscence and instability poses a significant cause of persistent pain and limited quality of life following hospital discharge for 0.2% to 5% of patients who have undergone median sternotomy for open heart surgery. We report a successful, conservative, supportive long-term therapy of painful sternal non-union using a customized compression garment vest.</p> <p>Case presentation</p> <p>We report a case of painful sternal instability following open heart surgery in a 74-year-old Caucasian man. The complicating factors of obesity (body mass index of 40), renal failure, insulin-dependent diabetes mellitus and absolute arrhythmia with atrial fibrillation were present.</p> <p>Conclusion</p> <p>A number of studies have demonstrated the efficacy of surgical interventions for secondary sternal stabilization, but individual patients may reject this option or may be, for other reasons, no longer operable. The task of primary care physicians and other health care providers is to offer this group of patients an alternative option for pragmatic, inexpensive and effective supportive therapy, of which compression garments are an example.</p

"Wanderer, kommst du nach Deutschland..."

Immer wieder stößt man bei der Beschäftigung mit totalitärer und militaristischer Erziehung auf die Behauptung, dass die spartanische Erziehung in der Erziehungspraxis des Dritten Reichs seine moderne Adaption gefunden hätte. Die Untersuchung, die im Rahmen dieser Arbeit vorgenommen wurde, geht davon aus, dass die nationalsozialistische Geschichtsrezeption und Erziehungstheorie grundsätzlich ein positives Bild von der spartanischen Erziehung zeichnen, wenn nicht gar ein antikes Vorbild in ihr erkennen. In der Folge geht die Arbeit den Fragen nach, wie das spartanische Erziehungssystem von der nationalsozialistischen Geschichtsschreibung, Erziehungstheorie und Propaganda rezipiert, kontextualisiert, eingeschätzt und bewertet wurde, ob es gewisse Aspekte an der Agoge gab, welche besonders hervorgehoben bzw. dem eigenen Nutzen angepasst wurden und ob es eine einheitliche Rezeptionslinie gab oder ob inhaltliche Abweichungen unter den einzelnen Autoren bestanden. Als Annäherung an die Untersuchung werden vorweg der spartanische Kosmos, das nationalsozialistische Erziehungssystem und die Grundzüge der deutschen Rezeptionsgeschichte zu Sparta dargestellt, um das notwendige Grundlagenwissen zu vermitteln. Kern der Arbeit ist eine qualitative Textanalyse zeitgenössischer, repräsentativer, nationalsozialistischer schriftlicher Quellen, welche sich mit der Agoge beschäftigen. Zudem wird in einem gesonderten Teil auf die spezielle Funktion des schulischen Geschichtsunterrichts in der NS-Zeit eingegangen und anhand einer Analyse zeitgenössischer Schulbücher die Darstellung der spartanischen Erziehung für den Schulunterricht erörtert

In-situ TEM annealing of amorphous Fe-24at.%W coatings and the effect of crystallization on hardness

This paper describes the crystallization which occurs upon annealing of an amorphous Fe-24at.%W coatings, electrodeposited from a glycolate-citrate plating bath. A combination of Differential Scanning Calorimetry and in-situ Transmission Electron Microscopy annealing is used to study the onset of crystallization of the amorphous coating. The in-situ TEM analyses reveal the formation of first crystallites after annealing at 400\ua0\ub0C for 30\ua0min. Upon a temperature increase to 500–600\ua0\ub0C, the crystallites develop into Fe-rich nanocrystals with ~ 40\ua0nm grain size. The nanocrystals are dispersed in the remaining amorphous Fe-W matrix, which results in the formation of a mixed nanocrystalline-amorphous structure. The observed crystallization can be held responsible for the increase in the hardness obtained upon annealing of Fe-24at.%W coatings. In fact, the hardness of the as-deposited material increases from 11 to 13\ua0GPa after annealing at 400\ua0\ub0C, and it reaches the maximum value of 16.5\ua0GPa after annealing at 600\ua0\ub0C

Gaining information about home visits in primary care: methodological issues from a feasibility study

Background: Home visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs’ care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs’ home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible. Methods: We used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study. Results: Our study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits. Conclusions: The results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent

Feasibility of low-dose digital pulsed video-fluoroscopic swallow exams (VFSE): effects on radiation dose and image quality

Background: Fluoroscopy is a frequently used examination in clinical routine without appropriate research evaluation latest hardware and software equipment. Purpose: To evaluate the feasibility of low-dose pulsed video-fluoroscopic swallowing exams (pVFSE) to reduce dose exposure in patients with swallowing disorders compared to high-resolution radiograph examinations (hrVFSE) serving as standard of reference. Material and Methods: A phantom study (Alderson-Rando Phantom, 60 thermoluminescent dosimeters [TLD]) was performed for dose measurements. Acquisition parameters were as follows: (i) pVFSE: 76.7 kV, 57 mA, 0.9 Cu mm, pulse rate/s 30;(ii) hrVFSE: 68.0 kV, 362 mA, 0.2 Cu mm, pictures 30/s. The dose area product (DAP) indicated by the detector system and the radiation dose derived from the TLD measurements were analyzed. In a patient study, image quality was assessed qualitatively (5-point Likert scale, 5 = hrVFSE;two independent readers) and quantitatively (SNR) in 35 patients who subsequently underwent contrast-enhanced pVFSE and hrVFSE. Results: Phantom measurements showed a dose reduction per picture of factor 25 for pVFSE versus hrVFSE images (0.0025 mGy versus 0.062 mGy). The DAP (mu Gym 2) was 28.0 versus 810.5 (pVFSE versus hrVFSE) for an average examination time of 30 s. Direct and scattered organ doses were significantly lower for pVFSE as compared to hrVFSE (P< 0.05). Image quality was rated 3.9 +/- 0.5 for pVFSE versus the hrVFSE standard;depiction of the contrast agent 4.8 +/- 0.3;noise 3.6 +/- 0.5 (P< 0.05);SNR calculations revealed a relative decreased of 43.9% for pVFSE as compared to hrVFSE. Conclusion: Pulsed VFSE is feasible, providing diagnostic image quality at a significant dose reduction as compared to hrVFSE

Prevention and health promotion in undergraduate medical education: Preferences, attitudes and previous knowledge of medical students - a cross-sectional study

Objective: The interdisciplinary topic "prevention and health promotion" (Q10) was introduced into the medical training in Germany by the new medical licensing regulations in 2004. For the conception of an effective curriculum, it is helpful to know student preferences concerning teaching-formats, attitudes and self-estimated previous knowledge. Little is known concerning student perception of “prevention and health promotion” in Germany. Thus, this explorative cross-sectional study aims to provide a first step for closing this gap

Differential phosphorylation of the N - terminal extension regulates phytochrome B signaling

Viczián, András. Institute of Plant Biology. Biological Research Centre. Szeged, Hungary.Ádám, Éva. Institute of Plant Biology. Biological Research Centre. Szeged, Hungary.Staudt, Anne Marie. University of Freiburg. Institute of Biology II. Freiburg, Germany.Lambert, Dorothee. University of Freiburg. Institute of Biology II. Freiburg, Germany.Klement, Eva. Biological Research Centre. Laboratory of Proteomics Research. Szeged, Hungary.Romero Montepaone, Sofia. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura (IFEVA). Buenos Aires, Argentina.Hiltbrunner, Andreas. University of Freiburg. Institute of Biology II. Freiburg, Germany.Casal, Jorge José. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura (IFEVA). Buenos Aires, Argentina.1635–1650Phytochrome B (phyB) is an excellent light quality and quantity sensor that can detect subtle changes in the light environment. The relative amounts of the biologically active photoreceptor (phyB Pfr) are determined by the light conditions and light independent thermal relaxation of Pfr into the inactive phyB Pr, termed thermal reversion. Little is known about the regulation of thermal reversion and how it affects plants’ light sensitivity. In this study we identified several serine/threonine residues on the N-terminal extension (NTE) of Arabidopsis thaliana phyB that are differentially phosphorylated in response to light and temperature, and examined transgenic plants expressing nonphosphorylatable and phosphomimic phyB mutants. The NTE of phyB is essential for thermal stability of the Pfr form, and phosphorylation of S86 particularly enhances the thermal reversion rate of the phyB Pfr–Pr heterodimer in vivo. We demonstrate that S86 phosphorylation is especially critical for phyB signaling compared with phosphorylation of the more N terminal residues. Interestingly, S86 phosphorylation is reduced in light, paralleled by a progressive Pfr stabilization under prolonged irradiation. By investigating other phytochromes (phyD and phyE) we provide evidence that acceleration of thermal reversion by phosphorylation represents a general mechanism for attenuating phytochrome signaling

Differential phosphorylation of the N‐terminal extension regulates phytochrome B signaling

Phytochrome B (phyB) is an excellent light quality and quantity sensor that can detect subtle changes in the light environment. The relative amounts of the biologically active photoreceptor (phyB Pfr) are determined by the light conditions and light independent thermal relaxation of Pfr into the inactive phyB Pr, termed thermal reversion. Little is known about the regulation of thermal reversion and how it affects plants’ light sensitivity. In this study we identified several serine/threonine residues on the N-terminal extension (NTE) of Arabidopsis thaliana phyB that are differentially phosphorylated in response to light and temperature, and examined transgenic plants expressing nonphosphorylatable and phosphomimic phyB mutants. The NTE of phyB is essential for thermal stability of the Pfr form, and phosphorylation of S86 particularly enhances the thermal reversion rate of the phyB Pfr–Pr heterodimer in vivo. We demonstrate that S86 phosphorylation is especially critical for phyB signaling compared with phosphorylation of the more N-terminal residues. Interestingly, S86 phosphorylation is reduced in light, paralleled by a progressive Pfr stabilization under prolonged irradiation. By investigating other phytochromes (phyD and phyE) we provide evidence that acceleration of thermal reversion by phosphorylation represents a general mechanism for attenuating phytochrome signaling.Fil: Viczián, András. Institute of Plant Biology; HungríaFil: Ádám, Éva. Institute of Plant Biology; Hungría. University of Szeged; HungríaFil: Staudt, Anne Marie. Albert Ludwigs University of Freiburg; AlemaniaFil: Lambert, Dorothee. Albert Ludwigs University of Freiburg; AlemaniaFil: Klement, Eva. Biological Research Centre; HungríaFil: Romero Montepaone, Sofía Iara. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; ArgentinaFil: Hiltbrunner, Andreas. Albert Ludwigs University of Freiburg; AlemaniaFil: Casal, Jorge José. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Bioquímicas de Buenos Aires. Fundación Instituto Leloir. Instituto de Investigaciones Bioquímicas de Buenos Aires; ArgentinaFil: Schäfer, Eberhard. Albert Ludwigs University of Freiburg; AlemaniaFil: Nagy, Ferenc. Institute of Plant Biology; HungríaFil: Klose, Cornelia. Albert Ludwigs University of Freiburg; Alemani

Opposing roles for 53BP1 during homologous recombination

Although DNA non-homologous end-joining repairs most DNA double-strand breaks (DSBs) in G2 phase, late repairing DSBs undergo resection and repair by homologous recombination (HR). Based on parallels to the situation in G1 cells, previous work has suggested that DSBs that undergo repair by HR predominantly localize to regions of heterochromatin (HC). By using H3K9me3 and H4K20me3 to identify HC regions, we substantiate and extend previous evidence, suggesting that HC-DSBs undergo repair by HR. Next, we examine roles for 53BP1 and BRCA1 in this process. Previous studies have shown that 53BP1 is pro-non-homologous end-joining and anti-HR. Surprisingly, we demonstrate that in G2 phase, 53BP1 is required for HR at HC-DSBs with its role being to promote phosphorylated KAP-1 foci formation. BRCA1, in contrast, is dispensable for pKAP-1 foci formation but relieves the barrier caused by 53BP1. As 53BP1 is retained at irradiation-induced foci during HR, we propose that BRCA1 promotes displacement but retention of 53BP1 to allow resection and any necessary HC modifications to complete HR. In contrast to this role for 53BP1 in HR in G2 phase, we show that it is dispensable for HR in S phase, where HC regions are likely relaxed during replication