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Background
For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances on postoperative complications such as cerebrospinal fluid leakage or impaired wound healing overall remains largely unclear. With this study, we are reporting our experiences and the impact of our clinical routines on outcome in a prospectively collected data set.
Method
We prospectively observed 150 consecutive patients undergoing supratentorial craniotomy and recorded technical variables (type/length of incision, size of craniotomy, technique of dural and skin closure, type of dressing, and placement of subgaleal drains). Outcome variables (subgaleal hematoma/CSF collection, periorbital edema, impairment of wound healing, infection, and need for operative revision) were recorded at time of discharge and at late follow-up.
Results
Early subgaleal fluid collection was observed in 36.7% (2.8% at the late follow-up), and impaired wound healing was recorded in 3.3% of all cases, with an overall need for operative revision of 6.7%. Neither usage of dural sealants, lack of watertight dural closure, and presence of subgaleal drains, nor type of skin closure or dressing influenced outcome. Curved incisions, larger craniotomy, and tumor size, however, were associated with an increase in early CSF or hematoma collection (p < 0.0001, p = 0.001, p < 0.01 resp.), and larger craniotomy size was associated with longer persistence of subgaleal fluid collections (p < 0.05).
Conclusions
Based on our setting, individual surgical nuances such as the type of dural closure and the use of subgaleal drains resulted in a comparable complication rate and outcome. Subgaleal fluid collections were frequently observed after supratentorial procedures, irrespective of the closing technique employed, and resolve spontaneously in the majority of cases without significant sequelae. Our results are limited due to the observational nature in our single-center study and need to be validated by supportive prospective randomized design.
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.
Particularly multiparous elderly women may suffer from vaginal vault prolapse after hysterectomy due to weak support from lax apical ligaments. A decreased amount of estrogen and progesterone in older age is assumed to remodel the collagen thereby reducing tissue stiffness. Sacrocolpopexy is either performed as open or laparoscopic surgery using prosthetic mesh implants to substitute lax ligaments. Y-shaped mesh models (DynaMesh, Gynemesh, and Ultrapro) are implanted in a 3D female pelvic floor finite element model in the extraperitoneal space from the vaginal cuff to the first sacral (S1) bone below promontory. Numerical simulations are conducted during Valsalva maneuver with weakened tissues modeled by reduced tissue stiffness. Tissues are modeled as incompressible, isotropic hyperelastic materials whereas the meshes are modeled either as orthotropic linear elastic or as isotropic hyperlastic materials. The positions of the vaginal cuff and the bladder base are calculated from the pubococcygeal line for female pelvic floor at rest, for prolapse and after repair using the three meshes. Due to mesh mechanics and mesh pore deformation along the loaded direction, the DynaMesh with regular rectangular mesh pores is found to provide better mechanical support to the organs than the Gynemesh and the Ultrapro with irregular hexagonal mesh pores.
Insbesondere ältere, mehrgebährende Frauen leiden häufiger an einem Scheidenvorfall nach einer Hysterektomie aufgrund der schwachen Unterstützung durch laxe apikale Bänder. Es wird angenommen, dass eine verringerte Menge an Östrogen und Progesteron im höheren Alter das Kollagen umformt, wodurch die Gewebesteifigkeit reduziert wird. Die Sakrokolpopexie ist eine offene oder laparoskopische Operation, die mit prothetischen Netzimplantaten durchgeführt wird, um laxe Bänder zu ersetzen. Y-förmige Netzmodelle (DynaMesh, Gynemesh und Ultrapro) werden in einem 3D-Modell des weiblichen Beckenbodens im extraperitonealen Raum vom Vaginalstumpf bis zum Promontorium implantiert. Numerische Simulationen werden während des Valsalva-Manövers mit geschwächtem Gewebe durchgeführt, das durch eine reduzierte Gewebesteifigkeit modelliert wird. Die Gewebe werden als inkompressible, isotrop hyperelastische Materialien modelliert, während die Netze entweder als orthotrope linear elastische oder als isotrope hyperlastische Materialien modelliert werden. Die Positionen des Vaginalstumpfs, der Blase und der Harnröhrenachse werden anhand der Pubococcygeallinie aus der Ruhelage, für den Prolaps und nach der Reparatur unter Verwendung der drei Netze berechnet. Aufgrund der Netzmechanik und der Netzporenverformung bietet das DynaMesh mit regelmäßigen rechteckigen Netzporen eine bessere mechanische Unterstützung und eine Neupositionierung des Scheidengewölbes, der Blase und der Urethraachse als Gynemesh und Ultrapro mit unregelmäßigen hexagonalen Netzporen.
The increasing digitalization brings new opportunities but also puts new challenges to modern industrial systems. Software agents are one of the key technologies towards self-optimizing factories and are currently used to address the needs of cyber-physical production systems (CPPS). However their interplay in industrial settings needs to be understood better.This paper focusses on securing a cloud infrastructure for multi-agent systems for industrial sites. An industrial site contains multiple production processes that need to communicate with each other and each physical resource is abstracted with a software agent. This volatile architecture needs to be managed and protected from manipulation. The proposed infrastructure presents a security concept for TCP/IP communication between agents, machines, and external networks. It is based on open-source software and tested on a three-node edge cloud controlling a model-plant.
Suspension depletion approach for exemption of infected Solanum jasminoides cells from pospiviroids
(2018)
Despite numerous studies, viroid elimination from infected plants remains a very challenging task. This study introduces for the first time a novel ‘suspension depletion’ approach for exemption of Solanum jasminoides plants from viroids. The proposed method implies initial establishment of suspension cultures of the infected plant cells. The suspended cells were then physically treated (mild thermotherapy, 33 °C), which presumably delayed the replication of the viroid. The viroid concentration in the treated biomass was monitored weekly using pospiviroid-specific PCR. After 10–12 weeks of continuous treatment, a sufficient decrease in viroid concentration was observed such that the infection became undetectable by PCR. The treated single cells then gave rise to microcolonies on a solid culture medium and the obtained viroid-negative clones were further promoted to regenerate into viroid-free plants. Three years of accumulated experimental data suggests feasibility, broad applicability, and good efficacy of the proposed approach.
The course Physics for Electrical Engineering is part of the curriculum of the bachelor program Electrical Engineering at University of Applied Science Aachen.
Before covid-19 the course was conducted in a rather traditional way with all parts (lecture, exercise and lab) face-to-face. This teaching approach changed fundamentally within a week when the covid-19 limitations forced all courses to distance learning. All parts of the course were transformed to pure distance learning including synchronous and asynchronous parts for the lecture, live online-sessions for the exercises and self-paced labs at home. Using these methods, the course was able to impart the required knowledge and competencies. Taking the teacher’s observations of the student’s learning behaviour and engagement, the formal and informal feedback of the students and the results of the exams into account, the new methods are evaluated with respect to effectiveness, sustainability and suitability for competence transfer. Based on this analysis strong and weak points of the concept and countermeasures to solve the weak points were identified. The analysis further leads to a sustainable teaching approach combining synchronous and asynchronous parts with self-paced learning times that can be used in a very flexible manner for different learning scenarios, pure online, hybrid (mixture of online and presence times) and pure presence teaching.
This paper uses a quantitative analysis to examine the interdependence and impact of resource rents on socio-economic development from 2002 to 2017. Nigeria and Norway have been chosen as reference countries due to their abundance of natural resources by similar economic performance, while the ranking in the Human Development Index differs dramatically. As the Human Development Index provides insight into a country’s cultural and socio-economic characteristics and development in addition to economic indicators, it allows a comparison of the two countries. The hypothesis presented and discussed in this paper was researched before. A qualitative research approach was used in the author’s master’s thesis “The Human Development Index (HDI) as a Reflection of Resource Abundance (using Nigeria and Norway as a case study)” in 2018. The management of scarce resources is an important aspect in the development of modern countries and those on the threshold of becoming industrialised nations. The effects of a mistaken resource management are not only of a purely economic nature but also of a social and socio-economic nature. In order to present a partial aspect of these dependencies and influences this paper uses a quantitative analysis to examine the interdependence and impact of resource rents on socio-economic development from 2002 to 2017. Nigeria and Norway have been chosen as reference countries due to their abundance of natural resources by similar economic performance, while the ranking in the Human Development Index differs significantly. As the Human Development Index provides insight into a country’s cultural and socio-economic characteristics and development in addition to economic indicators, it allows a comparison of the two countries. This paper found out in a holistic perspective that (not or poorly managed) resource wealth in itself has a negative impact on socio-economic development and significantly reduces the productivity of the citizens of a state. This is expressed in particular for the years 2002 till 2017 in a negative correlation of GDP per capita and HDI value with the share respectively the size of resources in the GDP of a country.
Drought and water shortage are serious problems in many arid and semi-arid regions. This problem is getting worse and even continues in temperate climatic regions due to climate change. To address this problem, the use of biodegradable hydrogels is increasingly important for the application as water-retaining additives in soil. Furthermore, efficient (micro-)nutrient supply can be provided by the use of tailored hydrogels. Biodegradable polyaspartic acid (PASP) hydrogels with different available (1,6-hexamethylene diamine (HMD) and L-lysine (LYS)) and newly developed crosslinkers based on diesters of glycine (GLY) and (di-)ethylene glycol (DEG and EG, respectively) were synthesized and characterized using Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM) and regarding their swelling properties (kinetic, absorbency under load (AUL)) as well as biodegradability of PASP hydrogel. Copper (II) and zinc (II), respectively, were loaded as micronutrients in two different approaches: in situ with crosslinking and subsequent loading of prepared hydrogels. The results showed successful syntheses of di-glycine-ester-based crosslinkers. Hydrogels with good water-absorbing properties were formed. Moreover, the developed crosslinking agents in combination with the specific reaction conditions resulted in higher water absorbency with increased crosslinker content used in synthesis (10% vs. 20%). The prepared hydrogels are candidates for water-storing soil additives due to the biodegradability of PASP, which is shown in an exemple. The incorporation of Cu(II) and Zn(II) ions can provide these micronutrients for plant growth.
The transition within transportation towards battery electric vehicles can lead to a more sustainable future. To account for the development goal ‘climate action’ stated by the United Nations, it is mandatory, within the conceptual design phase, to derive energy-efficient system designs. One barrier is the uncertainty of the driving behaviour within the usage phase. This uncertainty is often addressed by using a stochastic synthesis process to derive representative driving cycles and by using cycle-based optimization. To deal with this uncertainty, a new approach based on a stochastic optimization program is presented. This leads to an optimization model that is solved with an exact solver. It is compared to a system design approach based on driving cycles and a genetic algorithm solver. Both approaches are applied to find efficient electric powertrains with fixed-speed and multi-speed transmissions. Hence, the similarities, differences and respective advantages of each optimization procedure are discussed.
Chelate stabilization of a titanium(IV)–salan alkoxide by ligand exchange with 2,6-pyridinedicarboxylic acid (dipic) resulted in heptacoordinate complex 3 which is not redox-active, stable on silica gel and has increased aqueous stability. 3 is highly toxic in HeLa S3 and Hep G2 and has enhanced antitumor efficacy in a mouse cervical-cancer model.
Meitner-Auger-electron emitters have a promising potential for targeted radionuclide therapy of cancer because of their short range and the high linear energy transfer of Meitner-Auger-electrons (MAE). One promising MAE candidate is 197m/gHg with its half-life of 23.8 h and 64.1 h, respectively, and high MAE yield. Gold nanoparticles (AuNPs) that are labelled with 197m/gHg could be a helpful tool for radiation treatment of glioblastoma multiforme when infused into the surgical cavity after resection to prevent recurrence. To produce such AuNPs, 197m/gHg was embedded into pristine AuNPs. Two different syntheses were tested starting from irradiated gold containing trace amounts of 197m/gHg. When sodium citrate was used as reducing agent, no 197m/gHg labelled AuNPs were formed, but with tannic acid, 197m/gHg labeled AuNPs were produced. The method was optimized by neutralizing the pH (pH = 7) of the Au/197m/gHg solution, which led to labelled AuNPs with a size of 12.3 ± 2.0 nm as measured by transmission electron microscopy. The labelled AuNPs had a concentration of 50 μg (gold)/mL with an activity of 151 ± 93 kBq/mL (197gHg, time corrected to the end of bombardment).
Synthesis of derivatives of the peptide sequence L-pyroglutamyl-L-phenylalanyl-L-aspartyl-glycyl-L-lysyl-glycyl-glycyl-glycine as the antigenic determinant representing the N-terminal non-helical region of the α-2-chain of rabbit skin collagen, and conjugation to two different polypeptide carriers, are described.
Poly(vinyl acetate), PVAc, with a degree of polymerization Xn = 10 was prepared by chain-transfer radical polymerization using carbon tetrachloride and used as oligomeric plasticizer for commercial PVAc. However, the chlorinated chain ends cause a low thermal stability requiring mild Cl/H substitution. The product exhibits high thermal stability and excellent melt-compounding properties. Blends of oligomeric and commercial PVAc show single glass transition temperatures which decrease with higher oligomer content and exhibit small negative deviations from Fox' linear additivity rule. This indicates plasticization and miscibility being mainly due to entropic effects. Injection-moulded thick specimens show ductile behaviour at oligomer contents >10 wt %, while sheets with a thickness of 0.2–0.5 mm appear flexible already at 7.5 wt %. The oxygen permeability coefficients are an order of magnitude lower than those of low-density polyethylene. Due to the sum of their properties, the plasticized sheets present a promising alternative in the preparation of barrier materials.
α-hydroxy ketones (HK) and 1,2-diols are important building blocks for fine chemical synthesis. Here, we describe the R-selective 2,3-butanediol dehydrogenase from B. clausii DSM 8716ᵀ (BcBDH) that belongs to the metal-dependent medium chain dehydrogenases/reductases family (MDR) and catalyzes the selective asymmetric reduction of prochiral 1,2-diketones to the corresponding HK and, in some cases, the reduction of the same to the corresponding 1,2-diols. Aliphatic diketones, like 2,3-pentanedione, 2,3-hexanedione, 5-methyl-2,3-hexanedione, 3,4-hexanedione and 2,3-heptanedione are well transformed. In addition, surprisingly alkyl phenyl dicarbonyls, like 2-hydroxy-1-phenylpropan-1-one and phenylglyoxal are accepted, whereas their derivatives with two phenyl groups are not substrates. Supplementation of Mn²⁺ (1 mM) increases BcBDH's activity in biotransformations. Furthermore, the biocatalytic reduction of 5-methyl-2,3-hexanedione to mainly 5-methyl-3-hydroxy-2-hexanone with only small amounts of 5-methyl-2-hydroxy-3-hexanone within an enzyme membrane reactor is demonstrated.
The enantioselective synthesis of α-hydroxy ketones and vicinal diols is an intriguing field because of the broad applicability of these molecules. Although, butandiol dehydrogenases are known to play a key role in the production of 2,3-butandiol, their potential as biocatalysts is still not well studied. Here, we investigate the biocatalytic properties of the meso-butanediol dehydrogenase from Bacillus licheniformis DSM 13T (BlBDH). The encoding gene was cloned with an N-terminal StrepII-tag and recombinantly overexpressed in E. coli. BlBDH is highly active towards several non-physiological diketones and α-hydroxyketones with varying aliphatic chain lengths or even containing phenyl moieties. By adjusting the reaction parameters in biotransformations the formation of either the α-hydroxyketone intermediate or the diol can be controlled.
AgTcO4 reacts with R3ECl compounds (E = C, Si, Ge, Sn, Pb; R = Me, iPr, tBu, Ph), tBu2SnCl2, or PhMgCl under formation of novel trioxotechnetium(VII) derivatives. The carbon and silicon derivatives readily undergo decomposition, which was proven by 99Tc NMR spectroscopy and the isolation of decomposition products such as [TcOCl3(THF)(OH2)]. Compounds [Ph3GeOTcO3], [(THF)Ph3SnOTcO3], [(O3TcO)SntBu2(OH)]2, and [(THF)4Mg(OTcO3)2] are more stable and were isolated in crystalline form and characterized by X-ray diffraction.
This paper describes the realization of a novel neurocomputer which is based on the concepts of a coprocessor. In contrast to existing neurocomputers the main interest was the realization of a scalable, flexible system, which is capable of computing neural networks of arbitrary topology and scale, with full independence of special hardware from the software's point of view. On the other hand, computational power should be added, whenever needed and flexibly adapted to the requirements of the application. Hardware independence is achieved by a run time system which is capable of using all available computing power, including multiple host CPUs and an arbitrary number of neural coprocessors autonomously. The realization of arbitrary neural topologies is provided through the implementation of the elementary operations which can be found in most neural topologies.
This chapter introduces performance and acceptance testing and describes state-of-the-art tools, methods, and instruments to assess the plant performance or realize plant acceptance testing. The status of the development of standards for performance assessment is given.
We generalize our work on Carlitz prime power torsion extension to torsion extensions of Drinfeld modules of arbitrary rank. As in the Carlitz case, we give a description of these extensions in terms of evaluations of Anderson generating functions and their hyperderivatives at roots of unity. We also give a direct proof that the image of the Galois representation attached to the p-adic Tate module lies in the p-adic points of the motivic Galois group. This is a generalization of the corresponding result of Chang and Papanikolas for the t-adic case.
Control engineering theory is hard to grasp for undergraduates during the first semesters, as it deals with the dynamical behavior of systems also in combination with control strategies on an abstract level. Therefore, operational amplifier (OpAmp) processes are reasonable and very effective systems to connect mathematical description with actual system’s behavior. In this paper, we present an experiment for a laboratory session in which an embedded system, driven by a LabVIEW human machine interface (HMI) via USB, controls the analog circuits.With this setup we want to show the possibility of firstly, analyzing a first order process and secondly, designing a P-and PI-controller. Thereby, the theory of control engineering is always applied to the empirical results in order to break down the abstract level for the students.
This paper describes two courses on
simulation methods for graduate students:
“Simulation Methods” and “Simulation and
Optimization in Virtual Engineering” The
courses were planned to teach young engineers
how to work with simulation software as well as
to understand the necessary mathematical background.
As simulation software COMSOL is
used. The main philosophy was to combine
theory and praxis in a way that motivates the
students. In addition “soft skills” should be
improved. This was achieved by project work as
final examination. As underlying didactical principle
the ideas of Bloom’s revised taxonomy
were followed. The paper basically focusses on
educational aspects, e.g. how to structure the
course, plan the exercises, organize the project
work and include practical COMSOL examples.
Due to the increasing complexity of software projects, software development is becoming more and more dependent on teams. The quality of this teamwork can vary depending on the team composition, as teams are always a combination of different skills and personality types. This paper aims to answer the question of how to describe a software development team and what influence the personality of the team members has on the team dynamics. For this purpose, a systematic literature review (n=48) and a literature search with the AI research assistant Elicit (n=20) were conducted. Result: A person’s personality significantly shapes his or her thinking and actions, which in turn influences his or her behavior in software development teams. It has been shown that team performance and satisfaction can be strongly influenced by personality. The quality of communication and the likelihood of conflict can also be attributed to personality.