Clinical features and practical diagnosis of bullous pemphigoid

Bullous pemphigoid (BP) represents the most common autoimmune subepidermal blistering disease. BP typically affects the elderly and is associated with significant morbidity. It has usually a chronic course with spontaneous exacerbations. The cutaneous manifestations of BP can be extremely protean. While diagnosis of BP in the bullous stage is straightforward, in the non-bullous stage or in atypical variants of BP signs and symptoms are frequently non-specific with eg, only itchy excoriated, eczematous, papular and/or urticarial lesions that may persist for several weeks or months. Diagnosis of BP critically relies on immunopathologic examinations including direct immunofluorescence microscopy and detection of serum autoantibodies by indirect immunofluorescence microscopy or BP180-ELISA.

Giant coronary artery fistula complicated by cardiac tamponade

A 30 year old female was admitted to the hospital with cardiogenic shock due to cardiac tamponade. A ruptured giant coronary artery fistula (CAF) originating from the left main coronary artery draining into the right atrium was identified as the cause. In this case report we describe the clinical course with emphasis on diagnostic work-up and imaging.

[The SPI implant system: clinical experience and one-year results]

The new Swiss implant system SPI became available three years ago and is used in combination with fixed and removable prosthetic reconstructions. In a pilot study the clinical procedures were evaluated and data of prosthetic complications of maintenance service were collected. 25 patients participated in the study with a total of 79 SPI implants during the time period from 2003-2004. 37 implants were located in the maxilla and 42 implants in the mandible. Two implants failed during the healing period, but no loaded implant was lost. Thus, the survival rate was 97.5% (77/79). 44 implants supported a fixed prosthesis, including nine single crowns and 33 implants were used in combination with removable partial denture. Four implants were used with ball anchor retention, 29 with bar support. The ELEMENT implant with the low implant shoulder allows very good esthetics. Prosthetic complications and maintenance service during the first year of function was comparable with other implant systems. Since the design of the abutment screws, healing caps and screwdriver was changed, the system has become easier in its application.

Great Lakes tributary phosphorus bioavailability

Information on phosphorus bioavailability can provide water quality managers with the support required to target point source and watershed loads contributing most significantly to water quality conditions. This study presents results from a limited sampling program focusing on the five largest sources of total phosphorus to the U.S. waters of the Great Lakes. The work provides validation of the utility of a bioavailability-based approach, confirming that the method is robust and repeatable. Chemical surrogates for bioavailability were shown to hold promise, however further research is needed to address site-to-site and seasonal variability before a universal relationship can be accepted. Recent changes in the relative contribution of P constituents to the total phosphorus analyte and differences in their bioavailability suggest that loading estimates of bioavailable P will need to address all three components (SRP, DOP and PP). A bioavailability approach, taking advantage of chemical surrogate methodologies is recommended as a means of guiding P management in the Great Lakes.

Evaluation of the performance and cost-effectiveness of pavement sections containing open-graded base courses

Moisture induced distresses have been the prevalent distress type affecting the deterioration of both asphalt and concrete pavement sections. While various surface techniques have been employed over the years to minimize the ingress of moisture into the pavement structural sections, subsurface drainage components like open-graded base courses remain the best alternative in minimizing the time the pavement structural sections are exposed to saturated conditions. This research therefore focuses on assessing the performance and cost-effectiveness of pavement sections containing both treated and untreated open-graded aggregate base materials. Three common roadway aggregates comprising of two virgin aggregates and one recycled aggregate were investigated using four open-ended gradations and two binder types. Laboratory tests were conducted to determine the hydraulic, mechanical and durability characteristics of treated and untreated open-graded mixes made from these three aggregate types. Results of the experimental program show that for the same gradation and mix design types, limestone samples have the greatest drainage capacity, stability to traffic loads and resistance to degradation from environmental conditions like freeze-thaw. However, depending on the gradation and mix design used, all three aggregate types namely limestone, natural gravel and recycled concrete can meet the minimum coefficient of hydraulic conductivity required for good drainage in most pavements. Tests results for both asphalt and cement treated open-graded samples indicate that a percent air void content within the range of 15-25 will produce a treated open-graded base course with sufficient drainage capacity and also long term stability under both traffic and environmental loads. Using the new Mechanistic and Empirical Design Guide software, computer simulations of pavement performance were conducted on pavement sections containing these open-graded base aggregate base materials to determine how the MEPDG predicted pavement performance is sensitive to drainage. Using three truck traffic levels and four climatic regions, results of the computer simulations indicate that the predicted performance was not sensitive to the drainage characteristics of the open-graded base course. Based on the result of the MEPDG predicted pavement performance, the cost-effectiveness of the pavement sections with open-graded base was computed on the assumption that the increase service life experienced by these sections was attributed to the positive effects of subsurface drainage. The two cost analyses used gave two contrasting results with the one indicating that the inclusion of open-graded base courses can lead to substantial savings.

Metal-oxide film and photonic structures for integrated device applications

The application of photonic crystal technology on metal-oxide film is a very promising field for future optical telecommunication systems. Band gap and polarization effects in lithium niobate (LiNbO3) photonic crystals and bismuth-substituted iron garnets (BiYIG) photonic crystals are investigated in this work reported here. The design and fabrication process are similar for these two materials while the applications are different, involving Bragg filtering in lithium niobate and polarization rotation in nonreciprocal iron garnets. The research of photonic structures in LiNbO3 is of high interest for integrated device application due to its remarkable electro-optical characteristics. This work investigated the photonic band gap in high quality LiNbO3 single crystalline thin film by ion implantation to realize high efficiency narrow bandwidth filters. LiNbO3 thin film detachment by bonding is also demonstrated for optical device integration. One-dimensional Bragg BiYIG waveguides in gyrotropic system are found to have multiple stopbands and evince enhancement of polarization rotation efficiency. Previous photon trapping theory cannot explain the phenomena because of the presence of linear birefringence. This work is aimed at investigating the mechanism with the support of experiments. The results we obtained show that selective suppression of Bloch states in gyrotropic bandgaps is the key mechanism for the observed phenomena. Finally, the research of ferroelectric single crystal PMN-PT with ultra high piezoelectric coefficient as a biosensor is also reported. This work presents an investigation and results on higher sensitivity effects than conventional materials such as quartz and lithium niobate.

ABO blood group incompatible haematopoietic stem cell transplantation and xenograft rejection

The current organ shortage in transplantation medicine stimulates the exploration of new strategies to expand the donor pool including the utilisation of living donors, ABO-incompatible grafts, and xenotransplantation. Preformed natural antibodies (Ab) such as anti-Gal or anti-A/B Ab mediate hyperacute graft rejection and thus represent a major hurdle to the employment of such strategies. In contrast to solid organ transplantation (SOT), ABO blood group incompatibilities are of minor importance in haematopoietic stem cell transplantation (HSCT). Thus, ABO incompatible HSCT may serve as an in vivo model to study carbohydrate antigen (Ag)-mismatched transplantations such as ABO-incompatible SOT or the effect of preformed Ab against Gal in xenotransplantation. This mini-review summarises our clinical and experimental studies performed with the support of the Swiss National Science Foundation program on Implants and Transplants (NFP-46). Part 1 describes data on the clinical outcome of ABO-incompatible HSCT, in particular the incidence of several immunohaematological complications, acute graft-versus-host-disease (GvHD), and the overall survival. Part 2 summarises the measurements of anti-A/B Ab in healthy blood donors and ABO-incompatible HSCT using a novel flow cytometry based method and the potential mechanisms responsible for the loss of anti-A/B Ab observed following minor ABO-incompatible HSCT, ie the occurrence of humoral tolerance. Part 3 analyses the potential of eliminating Gal expression as well as specific complement inhibitors such as dextran sulfate and synthetic tyrosine analogues to protect porcine endothelial cells from xenoreactive Ab-mediated damage in vitro and in a hamster-to-rat heart transplantation model. In conclusion, due to similarities of the immunological hurdles of ABO incompatible transplantations and xenotransplantation, the knowledge obtained from both fields might lead to new strategies to overcome humoral rejection in transplantation.

Walter Lorenz – Wegbegleiter und Orientierungspunkt in der interkulturellen Sozialen Arbeit

First meeting, common interests and ways together The European Centre for Social Welfare, Training and Research situated in Vienna, was our first meeting place. W. Lorenz was interested in the international comparison of the different concepts and perspectives of social welfare problems in the European countries and the different developments in the training of social professions in Europe. The challenge of intercultural, antiracist social work in the context of Erasmus-Intensive Seminars To organize an intensive seminar with the aim to train students and colleagues for intercultural and antiracist competence in social professions, we formed an European network of European universities and schools of s.w. in Vienna (VIENNET), with the support of ECCE (European Centre of Community Education) in Koblenz. “The group discovered that working on these issues in an international context raises issues of ‘difference’ with renewed acuteness”(cit. W. Lorenz). We learned to cope with a variety of differences: biographical, language, theoretical and institutional backgrounds and discourse traditions. A Venue for an Intensive Seminar In choosing a venue for an Intensive Seminar we were relatively free. We locked for a place, “one dream about”, to support in the best way our seminar aims, to promote a base built on knowledge, skills and values particularly in the area of inner/outer borders, disadvantage, ignorance, minorities, majorities, vulnerable groups, racism and xenophobia. In a small village in Burgenland (Austria), very close to the Hungarian border, we thought to have found it. Future Prospect Are we only representatives of our background institutions or did we act and exposed ourselves as persons with a very specific biography and training experience. Can we sustain this created network, as a network of experts and friends in the field of intercultural, antiracist social work? This question is still open.

The European League for Non-Western Studies and E-learning

Leiden’s Faculty of Arts invited on May 20th the members of the ELNWS for a workshop on e-learning for Non-Western studies. The aim of the workshop was to take a closer look at the possibilities of e-learning as a means of realizing co-operation between our universities. During our discussions, and looking back on the past academic years, we attempted to position our own academic community on the Internet, in the sense of 'looking for, finding and putting it on, or giving it a location' in the omnipresent Internet. In order to investigate the ways in which e-learning can be used as a tool to stimulate European co-operation within the field of Non-Western studies, Leiden’s Faculty of Arts rewards one initiative between two or more European universities of the ELNWS with financial support.

Implementing Swedish Models of Social Work in a Russian Context

The economic and social changes taking place in Russia in recent decades have implied a restructuring of the Russian society. Among other things, Russian leaders have expressed a need for the reorientation of social development. In the 1990’s, cooperation was initiated on a number of social work and social welfare projects with international support, a process further speeded up during President Jeltsin’s state visit to Sweden in 1997. Discussions between the Swedish International Development Cooperation Agency (Sida) and the Russian authorities dealing with welfare issues started from the assumption that Russian professional social work was weak and needed to be strengthened. In the 1990's Sida was also given a stronger general mandate to work with other former Soviet countries in Eastern Europe, for example the Baltic States. The Russian-Swedish discussions resulted in projects aiming to raise social work competencies in public authorities, managements and among social workers in Russia. One of the areas chosen for these projects was Saint Petersburg, where several projects aiming to develop new models for social work were launched. The point of departure has been to transfer and adjust Swedish models of social work to the Russian context. The Stockholm University Department of Social Work became responsible for a number of such projects and besides using academic teachers also involved a number of practitioners, such as social workers in disablement services and reformatory staff who could meet and match Russian authorities and partners.

Percutaneous cement augmentation techniques for osteoporotic spinal fractures

Minimally invasive vertebral augmentation-based techniques have been used for the treatment of spinal fractures (osteoporotic and malignant) for approximately 25 years. In this review, we try to give an overview of the current spectrum of percutaneous augmentation techniques, safety aspects and indications. Crucial factors for success are careful patient selection, proper technique and choice of the ideal cement augmentation option. Most compression fractures present a favourable natural course, with reduction of pain and regainment of mobility after a few days to several weeks, whereas other patients experience a progressive collapse and persisting pain. In this situation, percutaneous cement augmentation is an effective treatment option with regards to pain and disability reduction, improvement of quality of life and ambulatory and pulmonary function.

Design and Impact of Awareness Functions – A Study about Social Media in Virtual Teams

The usage of social media in leisure time settings has become a prominent research topic. However, less research has been done on the design of social media in collaboration settings. In this study, we investigate how social media can support asynchronous collaboration in virtual teams and specifically how they can increase activity awareness. On the basis of an open source social networking platform, we present two prototype designs: a standard platform with basic support for information processing, communication and process – as suggested by Zigurs and Buckland (1998) – and an advanced platform with additional support for activity awareness via specialfeed functions. We argue that the standard platform already conveys activity awareness to a certain extent, however, that this awareness can be increased even more by the feeds in the advanced platform. Both prototypes are tested in a field experiment and evaluated with respect to their impact on perceived activity awareness, coordination and satisfaction. We show that the advanced design increases coordination and satisfaction through increased perceived activity awareness.

Antimyelin antibodies as predictors of disability after clinically isolated syndrome

There is controversy whether determination of antibodies against myelin, myelin oligodendrocyte glycoprotein, and myelin basic protein in serum from patients with a first episode suggestive of multiple sclerosis is of prognostic value. We evaluated whether detection of antimyelin antibodies in serum indicates a worse course with earlier time to a second relapse and increased progression of disability. We conducted a prospective study at the Department of Neurology, Inselspital Bern, Switzerland from 2004 to 2008 in patients presenting with a clinically isolated syndrome (CIS) and a follow-up of at least 4 months. Antimyelin antibodies were assessed by Western blot. Results were correlated with clinical course and sex. Among 93 consecutive patients with a CIS, 74 (80%) were positive for either one or both antimyelin antibodies. A relapse occurred in 49 (53%) and the median EDSS was 2 (range 1-3.5) after a mean observation period of 20 months. Presence of antimyelin antibodies at CIS neither increased the risk for a second relapse nor for progression of disability. Stratification for gender did not reveal differences for any of the clinical surrogates. The sole determination of antimyelin antibodies in serum is of limited prognostic value for the identification of patients with different short-term course.

Assessment of a robust opportunistic routing for video transmission in dynamic topologies

Mobile multimedia ad hoc services run on dynamic topologies due to node mobility or failures and wireless channel impairments. A robust routing service must adapt to topology changes with the aim of recovering or maintaining the video quality level and reducing the impact of the user's experience. In those scenarios, beacon-less Opportunistic Routing (OR) increases the robustness by supporting routing decisions in a completely distributed manner based on protocol-specific characteristics. However, the existing beacon-less OR approaches do not efficiently combine multiple metrics for forwarding selection, which cause higher packet loss rate, and consequently reduce the video quality level. In this paper, we assess the robustness and reliability of our recently developed OR protocol under node failures, called cross-layer Link quality and Geographical-aware OR protocol (LinGO). Simulation results show that LinGO achieves multimedia dissemination with QoE support and robustness in scenarios with dynamic topologies.

A Link Quality and Geographical-aware Routing Protocol for Video Transmission in Mobile IoT

Wireless mobile sensor networks are enlarging the Internet of Things (IoT) portfolio with a huge number of multimedia services for smart cities. Safety and environmental monitoring multimedia applications will be part of the Smart IoT systems, which aim to reduce emergency response time, while also predicting hazardous events. In these mobile and dynamic (possible disaster) scenarios, opportunistic routing allows routing decisions in a completely distributed manner, by using a hop- by-hop route decision based on protocol-specific characteristics, and a predefined end-to-end path is not a reliable solution. This enables the transmission of video flows of a monitored area/object with Quality of Experience (QoE) support to users, headquarters or IoT platforms. However, existing approaches rely on a single metric to make the candidate selection rule, including link quality or geographic information, which causes a high packet loss rate, and reduces the video perception from the human standpoint. This article proposes a cross-layer Link quality and Geographical-aware Opportunistic routing protocol (LinGO), which is designed for video dissemination in mobile multimedia IoT environments. LinGO improves routing decisions using multiple metrics, including link quality, geographic loca- tion, and energy. The simulation results show the benefits of LinGO compared with well-known routing solutions for video transmission with QoE support in mobile scenarios.