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BACKGROUND
Immunosuppression is often considered as an indication for antibiotic prophylaxis to prevent surgical site infections (SSI) while performing skin surgery. However, the data on the risk of developing SSI after dermatologic surgery in immunosuppressed patients are limited.
PATIENTS AND METHODS
All patients of the Department of Dermatology and Allergology at the University Hospital of RWTH Aachen in Aachen, Germany, who underwent hospitalization for a dermatologic surgery between June 2016 and January 2017 (6 months), were followed up after surgery until completion of the wound healing process. The follow-up addressed the occurrence of SSI and the need for systemic antibiotics after the operative procedure. Immunocompromised patients were compared with immunocompetent patients. The investigation was conducted as a retrospective analysis of patient records.
RESULTS
The authors performed 284 dermatologic surgeries in 177 patients. Nineteen percent (54/284) of the skin surgery was performed on immunocompromised patients. The most common indications for surgical treatment were nonmelanoma skin cancer and malignant melanomas. Surgical site infections occurred in 6.7% (19/284) of the cases. In 95% (18/19), systemic antibiotic treatment was needed. Twenty-one percent of all SSI (4/19) were seen in immunosuppressed patients.
CONCLUSION
According to the authors' data, immunosuppression does not represent a significant risk factor for SSI after dermatologic surgery. However, larger prospective studies are needed to make specific recommendations on the use of antibiotic prophylaxis while performing skin surgery in these patients.
The available data on complications after dermatologic surgery have improved over the past years. Particularly, additional risk factors have been identified for surgical site infections (SSI). Purulent surgical sites, older age, involvement of head, neck, and acral regions, and also the involvement of less experienced surgeons have been reported to increase the risk of the SSI after dermatologic surgeries.1 In general, the incidence of SSI after skin surgery is considered to be low.1,2 However, antibiotics in dermatologic surgeries, especially in the perioperative setting, seem to be overused,3,4 particularly regarding developing antibiotic resistances and side effects.
Immunosuppression has been recommended to be taken into consideration as an additional indication for antibiotic prophylaxis to prevent SSI after skin surgery in special cases.5,6 However, these recommendations do not specify the exact dermatologic surgeries, and were not specifically developed for dermatologic surgery patients and treatments, but adopted from other surgical fields.6 According to the survey conducted on American College of Mohs Surgery members in 2012, 13% to 29% of the surgeons administered antibiotic prophylaxis to immunocompromised patients to prevent SSI while performing dermatologic surgery on noninfected skin,3 although this was not recommended by Journal of the American Academy of Dermatology Advisory Statement. Indeed, the data on the risk of developing SSI after dermatologic surgery in immunosuppressed patients are limited. However, it is possible that due to the insufficient evidence on the risk of SSI occurrence in this patient group, dermatologic surgeons tend to overuse perioperative antibiotic prophylaxis.
To make specific recommendations on the use of antibiotic prophylaxis in immunosuppressed patients in the field of skin surgery, more information about the incidence of SSI after dermatologic surgery in these patients is needed. The aim of this study was to fill this data gap by investigating whether there is an increased risk of SSI after skin surgery in immunocompromised patients compared with immunocompetent patients.
For fuel flexibility enhancement hydrogen represents a possible alternative gas turbine fuel within future low emission power generation, in case of hydrogen production by the use of renewable energy sources such as wind energy or biomass. Kawasaki Heavy Industries, Ltd. (KHI) has research and development projects for future hydrogen society; production of hydrogen gas, refinement and liquefaction for transportation and storage, and utilization with gas turbine / gas engine for the generation of electricity. In the development of hydrogen gas turbines, a key technology is the stable and low NOx hydrogen combustion, especially Dry Low Emission (DLE) or Dry Low NOx (DLN) hydrogen combustion. Due to the large difference in the physical properties of hydrogen compared to other fuels such as natural gas, well established gas turbine combustion systems cannot be directly applied for DLE hydrogen combustion. Thus, the development of DLE hydrogen combustion technologies is an essential and challenging task for the future of hydrogen fueled gas turbines. The DLE Micro-Mix combustion principle for hydrogen fuel has been in development for many years to significantly reduce NOx emissions. This combustion principle is based on cross-flow mixing of air and gaseous hydrogen which reacts in multiple miniaturized “diffusion-type” flames. The major advantages of this combustion principle are the inherent safety against flashback and the low NOx-emissions due to a very short residence time of the reactants in the flame region of the micro-flames.
On the flight performance impact of landing gear drag reduction methods for unmanned air vehicles
(2018)
The flight performance impact of three different landing gear configurations on a small, fixed-wing UAV is analyzed with a combination of RANS CFD calculations and an incremental flight performance algorithm. A standard fixed landing gear configuration is taken as a baseline, while the influence of retracting the landing gear or applying streamlined fairings is investigated. A retraction leads to a significant parasite drag reduction, while also fairings promise large savings. The increase in lift-to-drag ratio is reduced at high lift coefficients due to the influence of induced drag. All configurations are tested on three different design missions with an incremental flight performance algorithm. A trade-off study is performed using the retracted or faired landing gear's weight increase as a variable. The analysis reveals only small mission performance gains as the aerodynamic improvements are negated by weight penalties. A new workflow for decision-making is presented that allows to estimate if a change in landing gear configuration is beneficial for a small UAV.
Background
Impairment of neurovascular coupling (NVC) was recently reported in the context of subarachnoid hemorrhage and may correlate with disease severity and outcome. However, previous techniques to evaluate NVC required invasive procedures. Retinal vessels may represent an alternative option for non-invasive assessment of NVC.
Methods
A prototype of an adapted retinal vessel analyzer was used to assess retinal vessel diameter in mice. Dynamic vessel analysis (DVA) included an application of monochromatic flicker light impulses in predefined frequencies for evaluating NVC. All retinae were harvested after DVA and electroretinograms were performed.
Results
A total of 104 retinal scans were conducted in 21 male mice (90 scans). Quantitative arterial recordings were feasible only in a minority of animals, showing an emphasized reaction to flicker light impulses (8 mice; 14 scans). A characteristic venous response to flicker light, however, could observed in the majority of animals. Repeated measurements resulted in a significant decrease of baseline venous diameter (7 mice; 7 scans, p < 0.05). Ex-vivo electroretinograms, performed after in-vivo DVA, demonstrated a significant reduction of transretinal signaling in animals with repeated DVA (n = 6, p < 0.001).
Conclusions
To the best of our knowledge, this is the first non-invasive study assessing murine retinal vessel response to flicker light with characteristic changes in NVC. The imaging system can be used for basic research and enables the investigation of retinal vessel dimension and function in control mice and genetically modified animals.