Soil moisture evaluation over the Argentine Pampas using models, satellite estimations and in-situ measurements.

STUDY REGION: The Pampas region is located in the central-east part of Argentina, and is one of the most productive agricultural regions of the world under rainfed conditions. STUDY FOCUS: This study aims at examining how different Land Surface Models (LSMs) and satellite estimations reproduce daily surface and root zone soil moisture variability over 8 in-situ observation sites. The ability of the LSMs to detect dry and wet events is also evaluated. NEW HYDROLOGICAL INSIGHTS FOR THE REGION: The surface and root zone soil moisture of the LSMs and the surface soil moisture of the ESA CCI (European Space Agency Climate Change Initiative, hereafter ESA-SM) show in general a good performance against the in-situ measurements. In particular, the BHOA (Balance Hidrológico Operativo para el Agro) shows the best representation of the soil moisture dynamic range and variability, and the GLDAS (Global Land Data Assimilation System)-Noah, ERA-Interim TESSEL (Tiled ECMWF's Scheme for Surface Exchanges over Land) and Global Drought Observatory (GDO)-LISFLOOD are able to adequately represent the soil moisture anomalies over the Pampas region. In addition to the LSM results, also the ESA-SM satellite estimated anomalies proved to be valuable. However, the LSMs and the ESA-SM have difficulties in reproducing the soil moisture frequency distributions. Based on this study, it is clear that accurate forcing data and soil parameters are critical to substantially improve the ability of LSMs to detect dry and wet events.

Photophysical properties of Na+ -indicator dyes suitable for quantitative two-photon fluorescence-lifetime measurements.

Two-photon microscopy (2PM) offers great potential in fluorescence imaging of intracellular Na+ dynamics of live cells. A severe drawback, however, is that quantitative ratioing of fluorescence intensities at different wavelengths [possible in one-photon imaging with the classical Na+ -indicator dye sodium-binding benzofuran isophtalate (SBFI)] is not practical in 2PM. We aimed at establishing 2PM-based time-correlated fluorescence lifetime measurements as an alternative method for quantifying Na+ dynamics. We compared the photophysical properties of the four Na+ -sensitive fluorescent indicator dyes SBFI, CoroNa Green, Sodium Green and Asante NaTRIUM Green-2 (ANG-2) in cuvette calibrations. All four dyes showed Na+ -dependent intensity changes, with ANG-2 having the most favourable properties for 2PM. All dyes but SBFI showed significant changes in their fluorescence lifetime upon Na+ binding, again with ANG-2 being the most promising dye. We found that, unfortunately, the fluorescence lifetime of ANG-2 is not only affected by Na+ but also by protons, K+ and dye impurities, rendering a quantitative description of the individual lifetime components impractical. However, a simplified calibration procedure, based on a published approach for Ca2+ imaging, allowed relating lifetimes to Na+ concentration. Using ANG-2 and the simplified calibration will allow quantitative two-photon Na+ imaging with millimolar sensitivity. LAY DESCRIPTION: Dynamic changes of ion concentrations, which play crucial roles in cellular physiology, can be monitored with appropriate fluorescent indicator dyes. For intracellular sodium ions (Na+ ), certain dyes even allow quantitative measurements with standard microscopic techniques. However, for two-photon microscopy, which allows resolving cells deep in intact tissue, imaging solutions that are fully quantitative are lacking. For the four commercially available Na+ dyes 'SBFI', 'CoroNa Green', 'Sodium Green', and 'Asante NaTRIUM Green-2' (ANG2) we analyzed whether their fluorescent lifetime (LT), i.e., the nanosecond decay of emission of photons after a pulsed excitation, could serve as a quantitative measure of intracellular Na+ . Pulsed excitation in the femtosecond range is an inherent feature of two-photon microscopy and, in combination with fast, single-photon counting microscopes, allows for easy-to-implement LT microscopy. We found that Sodium Green and ANG2 showed strong Na+ -dependent changes in the fluorescence LT, while SBFI showed no, and CoroNa Green only small changes. ANG2, as the brightest dye, was further characterized regarding effects of protons and potassium ions (K+ ), both also present in cells at significant concentrations, on the fluorescence LT. We found that the LT of ANG2 is affected in a predictable manner by Na+ , K+ , and protons. However, our data reveal that the commercial dye must also contain impurities with unexpected Na+ - and K+ -binding characteristics, rendering a quantitative description of the individual lifetime components impractical. We, therefore, adapted a simplified calibration procedure, based on a published approach for Ca2+ imaging, that allows relating the average lifetime to Na+ concentration. With this simplified calibration procedure, ANG2 is well suited for quantitative two-photon Na+ imaging with millimolar sensitivity.

Cardiac protein expression patterns are associated with distinct inborn exercise capacity in non-selectively bred rats.

In the present study, we successfully demonstrated for the first time the existence of cardiac proteomic differences between non-selectively bred rats with distinct intrinsic exercise capacities. A proteomic approach based on two-dimensional gel electrophoresis coupled to mass spectrometry was used to study the left ventricle (LV) tissue proteome of rats with distinct intrinsic exercise capacity. Low running performance (LRP) and high running performance (HRP) rats were categorized by a treadmill exercise test, according to distance run to exhaustion. The running capacity of HRPs was 3.5-fold greater than LRPs. Protein profiling revealed 29 differences between HRP and LRP rats (15 proteins were identified). We detected alterations in components involved in metabolism, antioxidant and stress response, microfibrillar and cytoskeletal proteins. Contractile proteins were upregulated in the LVs of HRP rats (α-myosin heavy chain-6, myosin light chain-1 and creatine kinase), whereas the LVs of LRP rats exhibited upregulation in proteins associated with stress response (aldehyde dehydrogenase 2, α-crystallin B chain and HSPß-2). In addition, the cytoskeletal proteins desmin and α-actin were upregulated in LRPs. Taken together, our results suggest that the increased contractile protein levels in HRP rats partly accounted for their improved exercise capacity, and that proteins considered risk factors to the development of cardiovascular disease were expressed in higher amounts in LRP animals.

[1.5 Years of Bladder Blog: Questions on Incontinence Outside of the Doctor's Office]. / 1,5 Jahre Blasen-Blog: Fragen zur Inkontinenz jenseits der Sprechstunde.

Nowadays to ascertain medical history is not the only way of communication between the person concerned and the physician. Dealing with a complaint or a disease includes gaining information by surfing on the internet too. The internet offers blogs with the possibility to put a question anonymously. One of these blogs is part of the website "die Blase.de" of Dr. R. Pfleger Arzneimittel in Bamberg, Germany. The requests of 20 months have been evaluated. The typical user of this blog is female; thematically - side effects of a current therapy, seeking a solution for complex continence problems or a refractory therapy and capacity building measures were most frequent. The complexity of the particularised continence problems and the extensive searches for a qualified physician support the offer of an internet-based doctor's consultation in due consideration of a taboo topic such as urinary incontinence.

Identification of C-type isolectins in the venom of the scorpionfish Scorpaena plumieri.

Chemical analyses of the hemagglutinating fraction from Scorpaena plumieri venom revealed that it contains five components (Sp-CL 1-5) with similar chromatographic elution profiles (35-38% of acetonitrile), molecular masses (16,800-17,000 Da) and N-terminal sequences, suggesting that they are isoforms of the same protein. The amino acid sequence of Sp-CL4 was determined and shown to have homology with fish C-type lectins. These data demonstrate for the first time the presence of C-type isolectins in a scorpionfish venom.

Evaluation of indication-specific genuine stress urinary incontinence procedures in a pelvic floor center.

PURPOSE: The aim of this study was to assess the indication-related safety, feasibility, and efficacy of laparoscopic Burch colposuspension (LBC), open Burch colposuspension (OB), and midurethral sling (MUS), retropubic vaginal tape (TVT) and transobturator vaginal tape (TOT) procedures for surgical treatment of female stress urinary incontinence (SUI). METHODS: Perioperative outcome was assessed in 321 patients treated for SUI by a single surgeon (LBC, n = 120; OB, n = 23; TVT, n = 129; TOT, n = 49) between April 2001 and December 2007 at a single center. Follow-up was available for 115 patients at 30, 40, and 26 months for LBC, OB, and MUS, respectively. The primary outcome was the objective continence measured by a negative cough stress test. The secondary outcome was the subjective continence measured by subjective perception of cure, the King's Health Questionnaire (KHQ), and visual analog score (VAS). RESULTS: The LBC group had one (0.8%) intra-operative complication (bladder injury) and a mean operation time of 56.5 min. The objective and subjective cure rate associated with LBC was 90.3 and 71%, respectively. The OB group had three (13%) intra-operative complications and a mean procedure time of 44.6 min. The objective and subjective cure rate was 69.2 and 61.5%, respectively. MUS had 7 (TVT, n = 2; retropubic I-STOP, n = 5) procedure-related complications (5.4%) and an operation time of 19.8 min. The objective and subjective efficacy rate for MUS was 84.5 and 62%, respectively. CONCLUSIONS: LBC was shown to be safe and feasible with a high objective and subjective success rate. Use of this minimally invasive procedure should be considered in patients with concomitant intra-abdominal pathology.

[Keratoplasty in children--still a dilemma]. / Die perforierende Keratoplastik im Kindesalter--das ewige Dilemma.

BACKGROUND: Penetrating keratoplasty (PKP) in children is associated with specific age-related problems. In contrast to adults, children can be examined less easily and they are not readily complaining about symptoms. Thus, the rate of intra- and postoperative complications is higher than in adults. In addition, amblyopia is a major issue before the age of seven years potentially resulting in irreversible reduction of visual acuity. PATIENTS AND METHODS: Potential indications for surgery are classified as follows: (i) congenital cloudiness (e.g., congenital hereditary endothelial dystrophy--CHED), (ii) acquired traumatic scars, (iii) acquired non-traumatic scars (e.g., infections, keratoconus) and (iv) irreversible graft failure. Our experience concerning 126 paediatric PKPs between 1980 and 2002 in children under age 16 is reported. Five case reports of PKPs performed in Homburg/Saar from 2006 are added. RESULTS: To minimise the risk of immunological graft rejection and chronic endothelial cell loss, we prefer PTK, lamellar keratoplasty or ipsilateral autologous rotational keratoplasty whenever possible. In cases of sclerocornea we feel that PKP should be avoided in view of the histopathology, in cases of Peters' anomaly an optical sector iridectomy may be considered as a valid alternative to high-risk PKP. In cases of buphthalmos the IOP must be controlled before PKP (e.g., previous trabeculotomy). In cases of central penetrating cornea and lens injuries we advocate simultaneous PKP and IOL implantation in the quiet interval after primary wound closure to achieve quick optical rehabilitation. We prefer smaller grafts and interrupted sutures in children. In addition, early suture removal is attempted, especially in cases of progressive corneal neovascularisation threatening the graft. If in doubt, examinations are performed in general anaesthesia readily. CONCLUSIONS: Corneal grafting in children should be performed as soon as necessary (less amblyopia!), but as late as possible (better cooperation!). In children, critical indication, repeated in-depth counselling of the parents, good cooperation with the anaesthetist and excellent cooperation with the paediatric ophthalmologist are indispensable in order to achieve good morphological and functional results after PKP.

[Current developments and perspectives on the diagnosis and treatment of urinary incontinence and genital prolapse in women]. / Aktuelle Entwicklungen und Perspektiven in der Diagnostik und Therapie von Harninkontinenz und Genitalsenkung der Frau.

As a key area of gynaecology, urogynaecology has undergone impressive changes in the past few years. Together with the high prevalence of functional pelvic floor disorders, modern anaesthesia procedures and the introduction of new, innovative minimally invasive operation techniques have led to a dramatic increase in the number of operations for incontinence and prolapses. The increasingly subtle diagnostic options, such as, e. g., 2D and 3D sonography of the pelvic floor provide unambiguous findings and facilitate decision making. Tension-free vaginal slings in retro-pubic, trans-obturator or single-incision techniques show a high success rate with few complications and have almost completely replaced the more invasive abdominal surgical techniques for the operative management of stress incontinence. Especially for recurrent prolapse the use of alloplastic nets leads to a markedly improved anatomic and functional outcome. In spite of the euphoria about modern operation techniques and novel net materials, in-depth knowledge of pelvic floor anatomy, sufficient surgical experience and unequivocal guideline-conform indications are mandatory for satisfactory treatment outcomes. The afflicted women must be informed in detail about alternative procedures and more emphasis should be placed on conservative therapy. Novel surgical techniques should be monitored by registers or clinical trials. The professional society is called upon to improve the training curricula for pelvic floor surgery.

[Importance of sonography in the diagnostics of functional disorders of the female pelvic floor]. / Stellenwert der Sonographie bei der Diagnostik von Funktionsstörungen des weiblichen Beckenbodens.

Ultrasound now plays an indispensible role in urogynecological diagnostics. Sonographic imaging of the female pelvic floor allows depiction of the urethra, bladder neck, bladder, anorectum and the levator ani muscle and is currently an important clinical component for the diagnostics of functional disorders in the region of the female pelvic floor. Essential aspects in sonography of the female pelvic floor are the dynamic depiction and direct imaging of alloplastic implants. For these reasons sonographic imaging is of great clinical importance especially for the diagnostics of recurrent or postoperative complications. A further important factor which supports the success of ultrasound in the diagnostics of functional disorders of the female pelvic floor is the wide availability of ultrasound devices in patient care. Furthermore, the method is noninvasive, comparatively inexpensive and does not involve radiation.

Different surgical approaches for stress urinary incontinence in women.

Stress urinary incontinence (SUI) constitutes involuntary voiding as a consequence of rising intra-abdominal pressure caused by sphincter weakness. In recent years studies were published according to surgical SUI management evaluating and comparing therapy options and outcomes. Therapy options were evaluated using a Medline search, including only publications in English between 2000-2012. Key words used were: SUI, conservative and surgical treatment, midurethral sling, colposuspension. Surgical treatment options demonstrate significantly better results than conservative treatment. MUS demonstrate better subjective and objective cure rates than colposuspension; it is less invasive and more cost-effective. First line SUI therapy such as RP MUS and TVT seem to be favored when compared to transobturator techniques. Retropubic and transobturator MUS showed equivalent objective and subjective success rates. Open colposuspension is an effective treatment possibility for recurrent SUI after failed MUS. TVT, compared with other MUS, seems to show slightly better cure rates. but perioperative complications appear to be similar. Long-term results (>10 years) of repeated SUI surgery showed that the Burch procedure had the lowest 9-year cumulative incidence of repeat SUI surgery. Mini-sling techniques may be underestimated but long-time results are pending and closer monitoring of the adverse event profile must be carried out. MUS are first choice in the treatment of SUI, of which TVT, has the best cure rate. Colpussupension continues to have its place in recurrent SUI. The new mini-MUS needs a longer follow-up for final evaluation.

[Measurement of the infrapubic angle using 3D perineal ultrasound and its relationship to obstetrical parameters]. / Die Messung des infrapubischen Winkels in der 3-D-Perineal-Sonografie und seine Beziehung zu geburtshilflichen Parametern.

PURPOSE: Ultrasound has achieved an indispensable role in urogynecology. The introduction of 3 D technology has enabled sonographers to visualize structures in the axial plane. The angle of the infrapubic arc may enable us to presume the shape of the pelvis. Our aim was to describe a method for measuring the infrapubic angle and the interpubic space with 3 D perineal ultrasound through 3 D rotation, correlating them with the length of the 2nd stage of labor and the rate of levator defects. MATERIALS AND METHODS: Women after vaginal delivery were recruited and underwent a 3 D perineal ultrasound on 2nd - 3 rd day postpartum. Volume datasets were analyzed to measure the infrapubic angle and the interpubic space independently by 2 urogynecologists. The interobserver reliability and the correlation between infrapubic arc angle and the length of the 2nd stage of labor and the occurrence of levator defects were calculated. RESULTS: 110 women were enrolled. With a correlation coefficient of 0.76, the relationship between the infrapubic angle measurements of the two observers was very good. A moderate to good correlation was found for the assessment of the interpubic gap, with r = 0.69. Between the infrapubic angle and length of the 2nd stage of labor, no statistical correlation for both observer measurements (p = 0.31; p = 0.78, respectively) was found. Also the correlation between the infrapubic arc angle and the occurrence of levator avulsions was not significant (p = 0.59; p = 0.39, respectively). CONCLUSION: 3 D ultrasound technology enables us to identify and evaluate the interpubic gap and the infrapubic arc with a high inter-observer reproducibility. However, from our data, the infrapubic angle does not seem to influence the length of the 2nd stage of labor and the occurrence of levator defects.

Patient goals after incontinence procedures: does the single-incision sling satisfy them?

OBJECTIVE: This study was undertaken to describe short-term postoperative achievement of subjective preoperative goals for single-incision MiniArc slings, in comparison with tension-free vaginal tape (TVT). METHOD: Patients submitted to mid-urethral sling (TVT and MiniArc) procedures for stress urinary incontinence (SUI) in two centers were included in this prospective study. Before surgery, the patients completed a preoperative open-ended questionnaire, in which they described their personal outcomes goals for SUI surgery and the degree of severity of their symptoms. At the first postoperative check, they were asked to assess the degree to which their goals had been met and the degree of postoperative incontinence symptoms; their grade of satisfaction was evaluated with IIQ-7, UDI-6 and a 0-10 visual analog scale. RESULTS: One hundred and eight patients (TVT n=51, MiniArc n=57) were included in this study. Incontinence symptom relief and improvement of quality of life were the most commonly described preoperative goals. Six to eight weeks after surgery, 47 patients (92.1%) after TVT and 53 (92.9%) women after single-incision slings were objectively cured (P=1). After surgery, more than 90% of the patients in both groups achieved their preoperative goals. Symptom scores improved significantly and were comparable in both groups. CONCLUSION: Our results show that self-reported achievement of preoperative goals of patients submitted to single-incision slings are comparable at the first follow-up with patients who have undergone the classic mid-urethral sling.

Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period.

OBJECTIVE: To evaluate morphology and integrity of the levator ani muscle (LAM) with three-dimensional ultrasound early in the postpartum period. DESIGN: Prospective cross-sectional observational study. SETTING: University hospital in Germany. POPULATION: Women after vaginal delivery and caesarean section with no previous vaginal delivery. METHODS: Three-dimensional perineal ultrasound was performed between 48 and 72 hours postpartum. The axial plane at the level of minimal hiatal dimension and tomographic ultrasound imaging were used to determine LAM biometry and defect. MAIN OUTCOME MEASURES: Primary outcome was to compare hiatal dimensions and levator defect following vaginal delivery or caesarean section. For secondary outcomes, we evaluated the role of caesarean section in protecting levator integrity, and the possible involvement of the first stage of labour in LAM changes. RESULTS: In all, 157 women participated: 81 (51.6%) following vaginal delivery (70 spontaneous and 11 operative deliveries) and 76 (48.4%) following caesarean section (55 elective and 21 emergency caesarean sections). All biometric indices of the levator were higher after vaginal delivery (P<0.001), except for LAM thickness. LAM defects were found to be significantly associated with vaginal delivery, with relative risk 7.5 (P<0.001). Following vaginal delivery, 32 (39.5%) levator defects were found: 27 (38.5%) after spontaneous delivery and five (45.4%) after operative delivery. Four (5.2%) women had a levator defect following emergency caesarean section. CONCLUSION: Vaginal delivery modifies and damages the LAM: the risk of levator defect after vaginal delivery is more than seven times higher than after caesarean section. Despite this, emergency caesarean section seems to have no complete preventive effect on LAM trauma.

Single-Incision Slings (SIS) - a New Option for the Surgical Treatment of Female Stress Urinary Incontinence.

The new development of single-incision slings (SIS) for the treatment of female stress urinary incontinence offers comparable results with only minimal side effects and will find wide acceptance in modern incontinence surgery. This mini-sling is inserted over a single vaginal incision and fixed on both sides to the pelvic wall tissue with special anchors, without passing through the groin and avoiding a blind tape passage. Compared with the established sub-urethral tapes, there are comparable success rates with fewer complications. Randomised prospective studies are needed to evaluate whether, in the long run, the benefits of the single incision technique can be correlated with satisfying continence results.

Current Developments and Perspectives on the Diagnosis and Treatment of Urinary Incontinence and Genital Prolapse in Women.

As a key area of gynaecology, urogynaecology has undergone impressive changes in the past few years. Together with the high prevalence of functional pelvic floor disorders, modern anaesthesia procedures and the introduction of new, innovative minimally invasive operation techniques have led to a dramatic increase in the number of operations for incontinence and prolapses. The increasingly subtle diagnostic options, such as, e. g., 2D and 3D sonography of the pelvic floor provide unambiguous findings and facilitate decision making. Tension-free vaginal slings in retro-pubic, trans-obturator or single-incision techniques show a high success rate with few complications and have almost completely replaced the more invasive abdominal surgical techniques for the operative management of stress incontinence. Especially for recurrent prolapse the use of alloplastic nets leads to a markedly improved anatomic and functional outcome. In spite of the euphoria about modern operation techniques and novel net materials, in-depth knowledge of pelvic floor anatomy, sufficient surgical experience and unequivocal guideline-conform indications are mandatory for satisfactory treatment outcomes. The afflicted women must be informed in detail about alternative procedures and more emphasis should be placed on conservative therapy. Novel surgical techniques should be monitored by registers or clinical trials. The professional society is called upon to improve the training curricula for pelvic floor surgery.

[Perspectives of excimer laser-assisted keratoplasty]. / Perspektiven der Excimerlaser-Trepanation für die Keratoplastik.

BACKGROUND AND PURPOSE: The purpose of this paper is to demonstrate the evolution of laser keratoplasty and to outline the potential future perspectives of this technique. METHODS: For non-contact donor trephination from the epithelial side an artificial anterior chamber has been used. Since 1989 more than 3,300 penetrating keratoplasty operations (PKP) have been performed successfully with the Zeiss-Meditec MEL60® excimer laser in Erlangen and Homburg/Saar. RESULTS: Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient decentration, reduces vertical tilt and horizontal torsion of the graft in the recipient bed, thus resulting in significantly less all-sutures-out keratometric astigmatism, higher regularity of the topography and better visual acuity. Besides less blood-aqueous barrier breakdown during the early postoperative course after PKP, excimer laser trephination does not induce cataract formation and does not impair the graft endothelium. Likewise, the rate of immunological graft rejections is not adversely affected by the excimer laser. In addition, trephination of an instable cornea is facilitated. CONCLUSIONS: Because of undisputed clinical advantages, especially in eyes with keratoconus, excimer laser trephination with orientation teeth/notches is still favored in Homburg/Saar in daily practice. The femtosecond laser (FSL)-assisted keratoplasty technique is very exciting but a prospective randomized study is required to determine potential benefits over excimer laser PKP.

The IUGA/ICS classification of complications of prosthesis and graft insertion: a comparative experience in incontinence and prolapse surgery.

INTRODUCTION AND HYPOTHESIS: This is a presentation of case series after the use of alloplasic material in urogynaecology. METHODS: From 2004 to 2010, a total 179 patients with complications have been referred directly after the use of alloplastic material in incontinence and prolapse surgery. Of this total, 125 patients had a previous vaginal sling plasty because of urinary stress incontinence, while 54 patients underwent a prolapse surgery with mesh use. Symptoms and findings are expressed by the recently introduced International Urogynecological Association/International Continence Society (IUGA/ICS) terminology. RESULTS: The most frequent findings after vaginal sling plasty were bladder outlet obstruction, pain and tape exposure. The most frequent findings after prolapse surgery were pain and mesh erosion. The IUGA/ICS classification does not give the possibility to express functional disorders. Most revisions were done more than 2 months after surgery. After incontinence surgery, mostly the vaginal area of suture line was affected; after prolapse surgery, the vagina and the trocar passage were affected. CONCLUSIONS: Mesh complication and affected site after prolapse surgery do differ from those after incontinence surgery. The IUGA/ICS classification of mesh complication facilitates the comparison of mesh complication.

["War of the slings": when do I do what and which concept will endure?]. / Krieg der Bänder : Wann mache ich was und welches Konzept hat Bestand?

The number of incontinence surgeries has drastically increased for female stress urinary incontinence requiring treatment. On the one hand, public perception of the problem has become widespread, increasingly removing the stigma of the condition, and on the other hand, newer surgical techniques and materials have been continually developed in the last 15 years. The use of tension-free vaginal slings for the treatment of stress incontinence is associated with high continence rates and minimal side effects and has meanwhile become the gold standard in the management of incontinence.