Durchführbarkeit-Sicherheit-Effektivität telemedizinisch initiierter Akutschlaganfallbehandlung im "Telemedical Acute Stroke Care"-Netzwerk TASC

Magdeburg, Univ., Med. Fak., Diss., 2015

Occurrence of Hirudinea species in a post urban reach of a Patagonian mountain stream

Temporal (May 2005 to February 2006) and habitat distribution (pools and riffles) of Hirudinea species was analyzed at a post urban reach from Esquel stream (Chubut province, Patagonia, Argentina). Site was located 5.7 km downstream a Waste Treatment Plant. Mean values of nutrients: ammonia, nitrates and soluble reactive phosphate, as well water conductivity, turbidity and total suspended solids indicated physical and organic pollution. Leeches assemblage was composed by the glossiphonids: Helobdella scutifera Blanchard, 1900, H. michaelseni (Blanchard, 1900), H. simplex (Moore, 1911), Helobdella sp., H. hyalina Ringuelet, 1942, H. obscura Ringuelet, 1942 and the semiscolecid Patagoniobdella variabilis (Blanchard, 1900). From these H. hyalina and H. obscura are new records for Chubut province. Helobdella hyalina (810 ind.m-2) and H. simplex (465 ind. m-2) clearly dominated the assemblage at the reach. Only H. simplex displayed a spatial preference being significantly more abundant in pools than in riffle habitats (p<0.001). Species recruitment occurred mostly at September, December and March when juveniles were very abundant. Although several species of Helobdella were able to live in the disturbed section of the stream, only H. simplex and H. hyalina sustained large populations at the site and can be considered as tolerant to organic enrichment. This information is valuable to future studies on stream condition assessment in mountainous areas in Patagonia, and in other areas in which these species are present.

A pesquisa bacteriológica post-mortem

The A. A. made bacteriological invesigations in 145 cases of autopsy. These investigations were carried out on the blood and spleen. The cultures were positive in 67 cases and in 21 of these there was body contamination. In the other cases the isolated bacteria were the proved or probable cause of the disease. For the Staphylococcus alone (isolated in 9 cases) we cannot give a definite opinion. We think that presence of bacteria in the blood and in the spleem implies bacteriemia at the moment of death, according to the observations of Hunt and co-workers. In our cases such presence was related to that of anatomical lesions of bacterial origin. When the bacteria were present only in the spleen we think that there had been bacteriemia, not present at the moment of the death. We only observed the contamination by contiguity when the bacteria were present in the blood of the heart. The isolated bacteria were always related to the presence of anatomical lesions. In only 4 cases was this not observed. We were impressed by the great number of negative results even in bodies kept for more than 24 hours. In only 21 cases was body contamination present. In rare cases the bacteria were isolated from the lesions and not from the blood and spleen. We think that apart from the interest of invesigaion, the bacteriological examinations in body material will be able to clear up the diagnosis of many obscure and unnoticed infections. In almost all our cases we obtained that result.

The relevance of post-match LTC: why has the Spanish labor market become as volatile as the US one?

We present a Search and Matching model with heterogeneous workers (entrants and incumbents) that replicates the stylized facts characterizing the US and the Spanish labor markets. Under this benchmark, we find the Post-Match Labor Turnover Costs (PMLTC) to be the centerpiece to explain why the Spanish labor market is as volatile as the US one. The two driving forces governing this volatility are the gaps between entrants and incumbents in terms of separation costs and productivity. We use the model to analyze the cyclical implications of changes in labor market institutions affecting these two gaps. The scenario with a low degree of workers’ heterogeneity illustrates its suitability to understand why the Spanish labor market has become as volatile as the US one.

Efectes de la post-descàrrega del plasma en teixits de llana i poliamida6

Els teixits de llana presenten l’inconvenient de feltrar (encongir) degut a la presència d’escates i a les característiques hidrofòbiques de la seva superfície. Els tractaments amb plasma (gas ionitzat) són una alternativa ecològica als tractaments tradicionals d’anti feltratge de la llana. També són una innovació en el camp de les fibres sintètiques ja que incrementen la hidrofìlia i/o la rugositat. Malgrat les seves avantatges, l’elevat cost de la maquinària de plasma de baixa temperatura existent per a la indústria tèxtil ha frenat la seva aplicació. Basant-se en estudis preliminars, s’ha avaluat l’efecte de la post-descàrrega del plasma sobre l’encongiment dels teixits de llana, així com els seus efectes en la modificació de la morfologia superficial de llana i poliamida 6.

PET Molecular Imaging of Hypoxia in Ischemic Stroke: An Update.

Hypoxia, a condition of insufficient oxygen availability to support metabolism, occurs when the vascular supply is interrupted, as in stroke. The identification of the hypoxic and viable tissue in stroke as compared with irreversible lesions (necrosis) has relevant implications for the treatment of ischemic stroke. Traditionally, imaging by positron emission tomography (PET), using 15O-based radiotracers, allowed the measurement of perfusion and oxygen extraction in stroke, providing important insights in its pathophysiology. However, these multitracer evaluations are of limited applicability in clinical settings. More recently, specific tracers have been developed, which accumulate with an inverse relationship to oxygen concentration and thus allow visualizing the hypoxic tissue non invasively. These belong to two main groups: nitroimidazoles, and among these the 18F-Fluoroimidazole (18F-FMISO) is the most widely used, and the copper-based tracers, represented mainly by Cu-ATSM. While these tracers have been at first developed and tested in order to image hypoxia in tumors, they have also shown promising results in stroke models and preliminary clinical studies in patients with cardiovascular disorders, allowing the detection of hypoxic tissue and the prediction of the extent of subsequent ischemia and clinical outcome. These tracers have therefore the potential to select an appropriate subgroup of patients who could benefit from a hypoxia-directed treatment and provide prognosis relevant imaging. The molecular imaging of hypoxia made important progress over the last decade and has a potential for integration into the diagnostic and therapeutic workup of patients with ischemic stroke.

Multi-phase post-mortem CT angiography: development of a standardized protocol.

The objective of this work was to develop an easily applicable technique and a standardized protocol for high-quality post-mortem angiography. This protocol should (1) increase the radiological interpretation by decreasing artifacts due to the perfusion and by reaching a complete filling of the vascular system and (2) ease and standardize the execution of the examination. To this aim, 45 human corpses were investigated by post-mortem computed tomography (CT) angiography using different perfusion protocols, a modified heart-lung machine and a new contrast agent mixture, specifically developed for post-mortem investigations. The quality of the CT angiographies was evaluated radiologically by observing the filling of the vascular system and assessing the interpretability of the resulting images and by comparing radiological diagnoses to conventional autopsy conclusions. Post-mortem angiography yielded satisfactory results provided that the volumes of the injected contrast agent mixture were high enough to completely fill the vascular system. In order to avoid artifacts due to the post-mortem perfusion, a minimum of three angiographic phases and one native scan had to be performed. These findings were taken into account to develop a protocol for quality post-mortem CT angiography that minimizes the risk of radiological misinterpretation. The proposed protocol is easy applicable in a standardized way and yields high-quality radiologically interpretable visualization of the vascular system in post-mortem investigations.

Primary isolated aortic valve surgery in octogenarians.

We reviewed our surgery registry, to identify predictive risk factors for operative results, and to analyse the long-term survival outcome in octogenarians operated for primary isolated aortic valve replacement (AVR). A total of 124 consecutive octogenarians underwent open AVR from January 1990 to December 2005. Combined procedures and redo surgery were excluded. Selected variables were studied as risk factors for hospital mortality and early neurological events. A follow-up (FU; mean FU time: 77 months) was obtained (90% complete), and Kaplan-Meier plots were used to determine survival rates. The mean age was 82+/-2.2 (range: 80-90 years; 63% females). Of the group, four patients (3%) required urgent procedures, 10 (8%) had a previous myocardial infarction, six (5%) had a previous coronary angioplasty and stenting, 13 patients (10%) suffered from angina and 59 (48%) were in the New York Heart Association (NYHA) class III-IV. We identified 114 (92%) degenerative stenosis, six (5%) post-rheumatic stenosis and four (3%) active endocarditis. The predicted mortality calculated by logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 12.6+/-5.7%, and the observed hospital mortality was 5.6%. Causes of death included severe cardiac failure (four patients), multi-organ failure (two) and sepsis (one). Complications were transitory neurological events in three patients (2%), short-term haemodialysis in three (2%), atrial fibrillation in 60 (48%) and six patients were re-operated for bleeding. Atrio-ventricular block, myocardial infarction or permanent stroke was not detected. The age at surgery and the postoperative renal failure were predictors for hospital mortality (p value <0.05), whereas we did not find predictors for neurological events. The mean FU time was 77 months (6.5 years) and the mean age of surviving patients was 87+/-4 years (81-95 years). The actuarial survival estimates at 5 and 10 years were 88% and 50%, respectively. Our experience shows good short-term results after primary isolated standard AVR in patients more than 80 years of age. The FU suggests that aortic valve surgery in octogenarians guarantees satisfactory long-term survival rates and a good quality of life, free from cardiac re-operations. In the era of catheter-based aortic valve implantation, open-heart surgery for AVR remains the standard of care for healthy octogenarians.

The generic Hanna Neumann conjecture and post correspondence problem

"Vegeu el resum a l'inici del document del fitxer adjunt."

Pelvic floor dysfunction 6 years post-anal sphincter tear at the time of vaginal delivery.

INTRODUCTION AND HYPOTHESIS: This study aims to estimate fecal, urinary incontinence, and sexual function 6 years after an obstetrical anal sphincter tear. METHODS: Among 13,213 women who had a vaginal delivery of a cephalic singleton at term, 196 women sustained an anal sphincter tear. They were matched to 588 controls. Validated questionnaires grading fecal and urinary incontinence, and sexual dysfunction were completed by the participants. RESULTS: Severe fecal incontinence was more frequently reported by women who had sustained an anal sphincter tear compared to the controls. Women with an anal sphincter tear had no increased risk of urinary incontinence, but reported significantly more pain, difficulty with vaginal lubrication, and difficulty achieving orgasm compared to the controls. A fetal occiput posterior position during childbirth was an independent risk factor for both severe urinary incontinence and severe sexual dysfunction. CONCLUSIONS: Fecal incontinence is strongly associated with an anal sphincter tear. A fetal occiput posterior position represents a risk factor for urinary incontinence and sexual dysfunction.