[Endoprostheses of the distal radioulnar joint]. / Endoprothetik am distalen Radioulnargelenk.

BACKGROUND: A stable distal radioulnar joint (DRUJ) is mandatory for the rotation and load transmission in the forearm and wrist. Salvage procedures such as the Darrach operation, Bowers arthroplasty, and the Kapandji-Sauvé procedure include the potential risk of dynamic radioulnar instability and impingement, despite stabilizing techniques addressing the soft tissues. PROSTHESES: In an attempt to stabilize the distal forearm mechanically following ulnar head resection, various endoprostheses have been developed to replace the ulnar head. These prostheses can be used for secondary treatment of persistent complaints and unsatisfactory results after ulnar head resection, but also in the primary treatment of osteoarthritis of the DRUJ. Based on promising results concerning improvement in pain, range of motion, and grip strength, with proper indications ulnar head prostheses should be considered as a valuable treatment option for osteoarthritis of the DRUJ.

[Percentile Values for the Anthropometric Dimensions of Triplet Neonates - Analysis of German Perinatal Survey Data of 2007-2011 from all States of Germany]. / Perzentilwerte für die Körpermaße neugeborener Drillinge - Ergebnisse der deutschen Perinatalerhebung der Jahre 2007-2011 unter Beteiligung aller Bundesländer.

AIM: We aimed to develop national reference values for birth weight, length, head circumference, and weight for length for newborn triplets based on data from the German perinatal survey of 2007-2011. MATERIAL AND METHODS: Perinatal survey data of 3,690 newborn triplets from all the states of Germany were kindly provided to us by the AQUA Institute in Göttingen, Germany. Data of 3,567 newborn triplets were included in the analyses. Sex-specific percentile values were calculated using cumulative frequencies. Percentile values at birth were computed for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles for 21-36 completed weeks of gestation. RESULTS AND CONCLUSIONS: We present the first German reference values (tables and curves) for the anthropometric dimensions of triplet neonates and compare selected birth weight and length percentiles of triplets (after 32 and 34 completed weeks of gestation) to those of singletons and twins. The differences in the 50th birth weight percentiles between singletons and triplets after 32 completed weeks of gestation were 180 g for girls and 210 g for boys; after 34 weeks of gestation the differences were 320 and 325 g, respectively. The differences between twins and triplets after 32 weeks of gestation were 100 g for girls and 120 g for boys; after 34 weeks of gestation they were 130 and 135 g, respectively. The data presented here enable the classification of newborn triplets according to somatic parameters making reference to German perinatal data.

[Pneumomediastinum related to the second stage of labour - a report on 2 cases]. / Mediastinal- und Subkutan-Emphysem in Folge einer Vaginalgeburt - ein Bericht über 2 Fälle.

We report on 2 primigravidae developing pneumomediastinum and subcutaneous emphysema associated with the second stage of labor. Both of the newborns had a comparatively high birth-weight (3,855 g and 4,245 g, respectively). In the first case, the patient felt a sudden chest pain during expulsion followed by dyspnea and swelling of the face. The birth was terminated by vacuum extraction. In the second case, a mild shoulder dystocia occurred, which could be resolved by McRoberts maneuver. The patient exhibited a swollen face and shortness of breath on the first postpartum day. Physical examination revealed crackly skin over the lower face, both sides of the neck and the front of the chest. In both cases, CT scan of the chest revealed pneumomediastinum and a subcutaneous emphysema of the upper thorax, however without showing a pneumothorax. The first patient underwent bronchoscopy and esophagogastroduodenoscopy; there were no abnormalities detected. The pneumomediastinum and subcutaneous emphysema gradually diminished spontaneously in both cases. Appropriate pain management and empirical antibiotics were applied. Pneumomediastinum during labor and birth, typically with subcutaneous emphysema in the face and neck, is a rare condition, but there are reported cases in the literature. Based on the limited available evidence, it seems to have a benign, self-limiting course. A conservative management appears -appropriate and sufficient.

[Pregnant women with COVID-19 ARDS on the intensive care unit]. / Die Schwangere mit COVID-19-ARDS auf der Intensivstation.

BACKGROUND: Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19 patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues. OBJECTIVE: Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS). MATERIAL AND METHODS: We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of a German university hospital between March and November 2021. RESULTS: The cohort included 9 patients with a mean age of 30.3 years (range 26-40 years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV­2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had a PaO2/FiO2 index < 150 mm Hg despite escalated invasive ventilation (FiO2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, a total of 47 prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV­2 at birth. CONCLUSION: High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia a more viable alternative, especially in severe disease.

Transcriptomic response of bioengineered human cartilage to parabolic flight microgravity is sex-dependent.

Spaceflight and simulated spaceflight microgravity induced osteoarthritic-like alterations at the transcriptomic and proteomic levels in the articular and meniscal cartilages of rodents. But little is known about the effect of spaceflight or simulated spaceflight microgravity on the transcriptome of tissue-engineered cartilage developed from human cells. In this study, we investigate the effect of simulated spaceflight microgravity facilitated by parabolic flights on tissue-engineered cartilage developed from in vitro chondrogenesis of human bone marrow mesenchymal stem cells obtained from age-matched female and male donors. The successful induction of cartilage-like tissue was confirmed by the expression of well-demonstrated chondrogenic markers. Our bulk transcriptome data via RNA sequencing demonstrated that parabolic flight altered mostly fundamental biological processes, and the modulation of the transcriptome profile showed sex-dependent differences. The secretome profile analysis revealed that two genes (WNT7B and WNT9A) from the Wnt-signaling pathway, which is implicated in osteoarthritis development, were only up-regulated for female donors. The results of this study showed that the engineered cartilage tissues responded to microgravity in a sex-dependent manner, and the reported data offers a strong foundation to further explore the underlying mechanisms.

Prevention of group B streptococcal neonatal disease revisited. The DEVANI European project.

The purpose of this paper was to present the current knowledge on the prevention of group B streptococcus (GBS) neonatal infections and the status of prevention policies in European countries and to present the DEVANI pan-European program, launched in 2008. The aim of this program was to assess the GBS neonatal infection burden in Europe, to design a new vaccine to immunize neonates against GBS infections, to improve the laboratory performance for the diagnosis of GBS colonization and infection, and to improve the methods for the typing of GBS strains. The current guidelines for GBS prevention in different countries were ascertained and a picture of the burden before and after the instauration of prevention policies has been drawn. After the issue of the Centers for Disease Control and Prevention (CDC) guidelines, many European countries have adopted universal screening for the GBS colonization of pregnant women and intrapartum prophylaxis to colonized mothers. Nevertheless, some European countries continue advocating the risk factor approach to GBS prevention. Most European countries have implemented policies to prevent GBS neonatal infections and the burden of the disease has decreased during the last several years. Nevertheless, further steps are necessary in order to develop new strategies of prevention, to improve microbiological techniques to detect GBS colonization and infection, and to coordinate the prevention policies in the EU.

NMR relaxometry as a versatile tool to study Li ion dynamics in potential battery materials.

NMR spin relaxometry is known to be a powerful tool for the investigation of Li(+) dynamics in (non-paramagnetic) crystalline and amorphous solids. As long as significant structural changes are absent in a relatively wide temperature range, with NMR spin-lattice (as well as spin-spin) relaxation measurements information on Li self-diffusion parameters such as jump rates and activation energies are accessible. Diffusion-induced NMR relaxation rates are governed by a motional correlation function describing the ion dynamics present. Besides the mean correlation rate of the dynamic process, the motional correlation function (i) reflects deviations from random motion (so-called correlation effects) and (ii) gives insights into the dimensionality of the hopping process. In favorable cases, i.e., when temperature- and frequency-dependent NMR relaxation rates are available over a large dynamic range, NMR spin relaxometry is able to provide a comprehensive picture of the relevant Li dynamic processes. In the present contribution, we exemplarily present two recent variable-temperature (7)Li NMR spin-lattice relaxation studies focussing on Li(+) dynamics in crystalline ion conductors which are of relevance for battery applications, viz. Li(7) La(3)Zr(2)O(12) and Li(12)Si(7).

[Idiopathic facial palsy during pregnancy]. / Periphere Fazialisparese in der Schwangerschaft.

BACKGROUND: Idiopathic facial (Bell's) palsy occurring during pregnancy or post partum is a rare disease. Reports regarding incidence, prognosis and associated risk factors are still inconsistent. MATERIAL AND METHODS: We performed a retrospective analysis of patients presenting with idiopathic facial palsy who had been treated in cooperation between obstetric and otorhinolaryngological departments (tertiary referral centers). The time of onset of paralysis, grading according to House and Brackman, treatment modalities and results were analyzed for the years 1999-2010. RESULTS: The incidence of Bell's palsy in pregnancy was 56 in 100,000 live births. Preeclampsia was reported in one case only. Therapy included prednisolone, methylprednisolone and/or pentoxifylline (up to 2005). All results were favorable (House-Brackman 1-2). CONCLUSION: The incidence of Bell's palsy in pregnancy within our cohort is not increased with regard to the international reports. Early treatment with corticosteroids in consultation with the treating obstetrician is indicated in both pregnant and post-partum patients to achieve optimal results.

[Care of infectious diseases in underage refugees exemplified by Ukraine]. / Infektiologische Versorgung minderjähriger Flüchtlinge am Beispiel der Ukraine: Vorgehen in Deutschland gemäß der S1-Leitlinine (AWMF-Register Nr. 048-017).

Background: By early June 2022, around 300,000 children and adolescents from Ukraine were registered in the German central registry for foreigners.The updated recommendations for action should provide the foundations for an evidence-based and targeted care for the diagnosis and prevention of infectious diseases in underage refugees and asylum seekers, exemplified by Ukraine. Objective: The recommendations for action are intended to support medical personnel in the care of minor refugees in order to1) ensure early recognition and completion of an incomplete vaccination status,2) diagnose and treat common infectious diseases,3) ensure early recognition and treatment of infectious diseases that are rare in the German healthcare system. Material and methods: The recommendations for action were drafted as level 1 (S1) guidelines coordinated by the Association of the Scientific Medical Societies in Germany (AWMF) and were adapted to the situation of refugees from Ukraine.The recommendations were compiled by a representative expert panel appointed by the participating professional societies in an informal consensus and finally officially adopted by the board of directors of all societies concerned. Results: Recommendations are given for the extent of the medical evaluation of minor refugees, including the medical history and physical examination, adapted to the situation of refugees from Ukraine. A blood count and screening for tuberculosis, hepatitis B and C as well as human immunodeficiency virus (HIV) infections are recommended for all minor refugees.For a rapid completion of the vaccination status, an age-related and indications-related prioritization of individual vaccinations will be undertaken. Conclusion: In view of the continuing high numbers of refugees not only from Ukraine, a further professionalization of medical health care is necessary. For this purpose, the necessary structural and personnel framework conditions need to be accomplished.

Foreign-ion and self-ion diffusion in a crosslinked salt-in-polyether electrolyte.

We present an extensive study of ionic transport in PolyG(30)LiPF(6), which is a crosslinked poly(ethylene oxide)-poly(propylene oxide(PEO-PPO) random copolymer complexed with LiPF(6) to an oxygen-to-cation ratio of 30 : 1. Self-diffusion coefficients of the constituent ions were measured by pulsed field gradient nuclear magnetic resonance (PFG-NMR) as a function of temperature using the signals of (7)Li and (19)F. These data were compared with the charge diffusivity as derived with the Nernst-Einstein equation from the ion conductivity obtained by impedance spectroscopy. In addition, the diffusion behaviour of a foreign cation (sodium) and that of a foreign anion (iodine) in PolyG(30)LiPF(6) were investigated by means of the radiotracers (22)Na and (125)I. All different types of diffusivities were evaluated in a comprehensive ion transport model which allows for the occurrence of charged single ions and neutral ion pairs. Simultaneous fitting of all data within this model yields best values of the model parameters which include Vogel-Tammann-Fulcher parameters and enthalpies/entropies of pair formation. Two distinct variants of the same general model reproduce the experimental data equally well, i.e., with closely similar results for the pair contribution to the migration of each ionic species. In the first variant, this pair contribution is due to a small fraction of ion pairs with a high mobility. By contrast, the second variant results in a very large fraction of pairs characterized by a relatively low mobility. The assumptions and implications connected with both model variants are discussed in detail.

[Fractures in neonates as a result of birth trauma caused by caesarean section]. / Geburtstraumatische Frakturen nach Kaiserschnitt.

BACKGROUND: The occurrence of 4 bone fractures associated with birth by Caesarean section (CS) prompted us to examine the incidence and predisposing factors of bone injuries sustained during birth. CASE REPORT AND METHOD: The 4 cases with fractures were evaluated retrospectively and discussed in combination with a short review of the literature. CONCLUSIONS: With the increasing number of Caesarean sections the incidence of birth trauma has decreased. Nevertheless, when performing a CS there is still a risk of serious trauma to the neonate, including bone fractures. A Caesarean section for breech presentation constitutes a predisposition for femoral fractures. When diagnosed early and treated properly, the prognosis for these fractures is good without sequelae and one can expect a satisfactory clinical outcome for the child. We suggest that the possibility of this complication be mentioned when counselling the mother and getting informed consent.

Preoperative selective embolization with vascular coiling of giant sacrococcygeal teratoma.

Sacrococcygeal teratoma is one of the most common congenital tumors. Its optimal management requires interdisciplinary care by obstetricians, radiologists, pediatric surgeons, and neonatologists. Early surgery entailing complete tumor excision is the main therapy aim, but a substantial risk of life-threatening complications remains, especially uncontrollable intraoperative hemorrhage. To reduce the risk of bleeding in a female neonate with a giant sacrococcygeal teratoma, we successfully coil-embolized the tumor's main feeding arteries. Her subsequent complete surgical resection was uneventful, and the child is well with favorable reconstructive and functional status of all involved and adjacent organ systems.

Enhanced lithium transference numbers in ionic liquid electrolytes.

Ion transport processes in mixtures of N-butyl- N-methyl-pyrrolidinium bis(trifluoromethanesulfonyl)imide (BMP-TFSI) and lithium bis(trifluoromethanesulfonyl)imide (Li-TFSI) were characterized by ac impedance spectroscopy and pulsed field gradient NMR. Molar ratios x = n Li-TFSI/( n Li-TFSI + n BMP-TFSI) up to 0.377 could be achieved without crystallization. From the bulk ionic conductivity and the individual diffusion coefficients of cations and anions we calculate the Haven ratio and the apparent lithium transference number. Although the Haven ratio exhibits typical values for ionic liquid electrolytes, the maximal apparent lithium transference number is higher than found in other recent studies on ionic liquid electrolytes containing lithium ions. On the basis of these results we discuss strategies for further improving the lithium transference number of such electrolytes.

The role of public health officers in preparedness planning and management of health crises.

The contribution of public health officers is of crucial importance in both the preparedness planning process and the response to health threats since the implementation of public health measures lies within the competence of the public health system. Thus, public health officers on regional and district level have to be involved in every stage of the planning process for crisis management. Federal structures of health systems as equivalent to the political structure of a country pose specific challenges for both the planning process and the response itself. The most important instrument for the evaluation of crisis plans, including the assessment of the public health officers' preparedness, is the performance of exercises. The success of a simulation exercise depends mainly on careful planning process, clear evaluation criteria and a work plan, that allows for necessary improvements of crisis plans of all involved organisations. Simulation exercises are an integrated element of preparedness activities on all administrative levels of the public health system. Depending on the nature of the exercise public health officers on regional and district level are involved as planners or as players

Treatment of very preterm preeclampsia via heparin-mediated extracorporeal LDL-precipitation (H.E.L.P.) apheresis: The Freiburg preeclampsia H.E.L.P.-Apheresis study.

OBJECTIVE: Soluble Fms-like tyrosine kinase-1 (sFlt-1) is thought to be causative in the pathogenesis of preeclampsia (PE) and specific removal of sFlt-1 via dextran sulfate cellulose (DSC)-apheresis was suggested as cure to allow prolongation of pregnancy in preterm PE. However, in addition a deranged lipoprotein metabolism may impact endothelial and placental function in PE. Lipoprotein-apheresis by heparin-mediated extracorporeal LDL-precipitation (H.E.L.P.) was previously applied and has been shown to alleviate symptoms in PE. This clinical trial reevaluates the clinical efficacy of H.E.L.P.-apheresis in PE considering sFlt-1. STUDY DESIGN: Open pilot study assessing the prolongation by H.E.L.P.-apheresis in 6 women (30-41 years) with very preterm PE (24+4 to 27+0 gestational weeks (GW)) (NCT01967355) compared to a historic control-group matched for GW at admission (<28 GW; n = 6). Clinical outcome of mothers and babies, and pre- and post H.E.L.P.-apheresis levels of sFlt-1 and PlGF were monitored. MAIN OUTCOME MEASURES: In apheresis patients (2-6 treatments), average time from admission to birth was 15.0 days (6.3 days in controls; p = 0.027). Lung maturation was induced in all treated cases, and all children were released in healthy condition. Apheresis reduced triglycerides and LDL-cholesterol by more than 40%. Although H.E.L.P.-apheresis induced a transient peak baseline levels did not change and rather stabilized sFlt-1 levels at pre-apheresis levels throughout treatments, with sFlt-1/PLGF ratio remaining unaffected. CONCLUSIONS: H.E.L.P.-apheresis proved again to be safe and prolongs pregnancies in PE. However, without changing sFlt-1 levels below baseline lowering lipids or other yet undefined factors appear to be of more relevance than reducing sFlt-1.

Insertional activation of a promoterless thymidine kinase gene.

A plasmid carrying a promoterless herpes simplex virus thymidine kinase gene was transfected via calcium phosphate precipitation into LM (tk-) mouse fibroblast cells. The transfected gene was efficiently expressed, as the transfected cells grew perfectly well in selective hypoxanthine-aminopterin-thymidine medium, suggesting that the thymidine kinase-coding region became linked to a promoterlike element on integration into the recipient genome. To investigate the structure of the surrogate promoter, we first isolated the integrated gene from a genomic library. The nucleotide sequence of the DNA adjacent to the thymidine kinase-coding sequence was then determined. We found, first, that the integration of the transfected DNA apparently occurred by a blunt end ligation mechanism involving no obvious sequence similarities between integrated and recipient DNA and, second, that the 5'-flanking region included a TATA box, two CCAAT boxes, and a GC box element. However, the TATA box motif and the most proximal CCAAT box appeared to be sufficient for full promoter activity, as determined by the transfection efficiencies of appropriate plasmid constructs. Except for these canonical promoter elements, the surrogate promoter had no obvious similarities to known thymidine kinase gene promoters.

[Epidemiology, diagnostics, therapy, prevention and management of uncomplicated bacterial outpatient acquired urinary tract infections in adult patients : Update 2017 of the interdisciplinary AWMF S3 guideline]. / Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten : Aktualisierung 2017 der interdisziplinären AWMF S3­Leitlinie.

BACKGROUND: Update of the 2010 published evidence-based S3 guideline on epidemiology, diagnostics, therapy and management of uncomplicated, bacterial, outpatient-acquired urinary tract infections in adult patients. The guideline contains current evidence for the rational use of antimicrobial substances, avoidance of inappropriate use of certain antibiotic classes and development of resistance. METHODOLOGY: The update was created under the leadership of the German Association of Urology (DGU). A systematic literature search was conducted for the period 01 January 2008 to 31 December 2015. International guidelines have also been taken into account. Evidence level and risk of bias were used for quality review. RESULTS: Updated information on bacterial susceptibility, success, collateral damage and safety of first- and second-line antibiotics was given. For the treatment of uncomplicated cystitis the first line antibiotics are fosfomycin trometamol, nitrofurantoin, nitroxoline, pivmecillinam, trimethoprim (with consideration of the local resistance rates). Fluoroquinolones and cephalosporins should not be used as first choice antibiotics. In the case of uncomplicated pyelonephritis of mild to moderate forms, preferably cefpodoxime, ceftibuten, ciprofloxacin or levofloxacin should be used as oral antibiotics. CONCLUSION: The updated German S3 guideline provides comprehensive evidence- and consensus-based recommendations on epidemiology, diagnostics, therapy, prevention and management of uncomplicated bacterial outpatient acquired urinary tract infections in adult patients. Antibiotic stewardship aspects have significantly influenced the therapeutic recommendations. A broad implementation in all clinical practice settings is necessary to ensure a foresighted antibiotic policy and thus t improve clinical care.

Tar yields of cigarettes and male lung cancer risk.

Of 252 male lung cancer patients, 248 or 98% were cigarette smokers, significantly (P less than .001) more than in the control group (526 = 64% of 839). In relation to the relative risks (RR) of never-smokers, the adjusted (for age, total years smoked, and average number of cigarettes smoked per day) lung cancer RR for smokers who had exclusively smoked cigarettes belonging to group II (15-24 mg tar/cigarette) was 10.4 (P less than .001); for smokers who had exclusively smoked cigarettes belonging to group III (greater than 24 mg tar/cigarette), it was 25.1 (P less than .001). The respective RR of smokers who had mainly smoked cigarettes belonging to group I (less than 15 mg tar/cigarette), group II, or group III were 10.9 (P less than .001), 20.6 (P less than .001), and 36.7 (P less than .001). After the differences in daily consumption were taken into account, the adjusted (for age and total years smoked) lung cancer RR for smokers who had consumed mainly cigarettes belonging to the various groups were the following: group II (11-20 cigarettes/day) compared to group III (11-20 cigarettes/day), RR = 0.6 (P less than .05); group II (greater than 20 cigarettes/day) compared to group III (greater than 20 cigarettes/day), RR = 0.8; group II (greater than 20 cigarettes/day) compared to group III (11-20 cigarettes/day), RR = 1.3 (P less than .001); group II (greater than 20 cigarettes/day) compared to group III (less than 10 cigarettes/day), RR = 7.8 (P less than .001); and group II (11-20 cigarettes/day) compared to group III (less than 10 cigarettes/day), RR = 2.5 (P less than .001).