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  • 1
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    Intrahost Evolution of Methicillin-Resistant Staphylococcus aureus USA300 Among Individuals With Reoccurring Skin and Soft-Tissue Infections (2016)
    Oxford University Press
    Details
    Publication Date: 2016-08-25
    Description: Background.  Methicillin-resistant Staphylococcus aureus (MRSA) USA300 is the leading cause of MRSA infections in the United States and has caused an epidemic of skin and soft-tissue infections. Recurrent infections with USA300 MRSA are common, yet intrahost evolution during persistence on an individual has not been studied. This gap hinders the ability to clinically manage recurrent infections and reconstruct transmission networks. Methods.  To characterize bacterial intrahost evolution, we examined the clinical courses of 4 subjects with 3–6 recurrent USA300 MRSA infections, using patient clinical data, including antibiotic exposure history, and whole-genome sequencing and phylogenetic analysis of all available MRSA isolates (n = 29). Results.  Among sequential isolates, we found variability in diversity, accumulation of mutations, and mobile genetic elements. Selection for antimicrobial-resistant populations was observed through both an increase in the number of plasmids conferring multidrug resistance and strain replacement by a resistant population. Two of 4 subjects had strain replacement with a genetically distinct USA300 MRSA population. Discussions.  During a 5-year period in 4 subjects, we identified development of antimicrobial resistance, intrahost evolution, and strain replacement among isolates from patients with recurrent MRSA infections. This calls into question the efficacy of decolonization to prevent recurrent infections and highlights the adaptive potential of USA300 and the need for effective sampling.
    Print ISSN: 0022-1899
    Electronic ISSN: 1537-6613
    Topics: Medicine
    Published by Oxford University Press on behalf of The Infectious Diseases Society of America (IDSA).
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    PAPER CURRENT
  • 2
    Electronic Resource
    Electronic Resource
    Preparation of superconducting Bi-Sr-Ca-Cu-O thin films by sequential electron beam evaporation and oxygen annealing (1989)
    Woodbury, NY : American Institute of Physics (AIP)
    Applied Physics Letters 54 (1989), S. 466-468 
    Details
    ISSN: 1077-3118
    Source: AIP Digital Archive
    Topics: Physics
    Notes: Superconducting films with nominal composition Bi2Sr2Ca1Cu2Ox have been prepared on 〈100〉 MgO substrates by sequential electron beam evaporation of Cu, Bi, and Sr2/3 Ca1/3 F2, followed by annealing in flowing wet, then dry, O2. X-ray diffraction data show that the films contain the two Bi-Sr-Ca-Cu-O phases that have been identified in the literature as a superconducting phase with c∼31 A(ring) and a semiconducting phase with c∼24 A(ring). Both phases are strongly textured with the c axis perpendicular to the substrate. For the best film, which was annealed at 870 °C for 30 min, zero resistance was observed at 90 K, and the critical current density increased from 0.8×105 A/cm2 at 77 K to 2.3×105 A/cm2 at 4.2 K.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1063/1.101457
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  • 3
    Electronic Resource
    Electronic Resource
    Segregation of impurities in pulsed-laser-melted carbon (1988)
    [S.l.] : American Institute of Physics (AIP)
    Journal of Applied Physics 64 (1988), S. 1802-1809 
    Details
    ISSN: 1089-7550
    Source: AIP Digital Archive
    Topics: Physics
    Notes: The segregation of 73Ge and 75As in pulsed-laser-melted carbon has been investigated. Both 73Ge and 75As were implanted into highly oriented pyrolytic graphite at a fluence of 1.0×1015 cm−2 at several energies. The implanted graphite was subsequently irradiated with a 30-ns pulsed ruby laser with laser pulse energy densities above the melt threshold for graphite. The distribution of impurities was measured before and after laser irradiation using Rutherford backscattering spectrometry to determine the redistribution of impurities resulting from diffusion in liquid carbon and segregation at the liquid-solid interface. Numerical calculations were then used to determine the diffusivity of the impurities in liquid carbon and the nonequilibrium segregation coefficient of Ge and As in carbon.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1063/1.341779
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  • 4
    Electronic Resource
    Electronic Resource
    A model for pulsed laser melting of graphite (1985)
    [S.l.] : American Institute of Physics (AIP)
    Journal of Applied Physics 58 (1985), S. 4374-4382 
    Details
    ISSN: 1089-7550
    Source: AIP Digital Archive
    Topics: Physics
    Notes: A model for laser melting of carbon at high temperatures to form liquid carbon has been developed. This model is solved numerically using experimental data from laser irradiation studies in graphite consistent with a melting temperature for graphite of 4300 K. The parameters for high-temperature graphite are based on the extension of previously measured thermal properties into the high-temperature regime. A simple classical free electron gas model is used to calculate the properties of liquid carbon. There is very good agreement between the model calculation and experimental results for laser pulse fluences below 2.0 J/cm2. Modifications to the model for larger laser pulse fluences are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1063/1.335527
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  • 5
    Electronic Resource
    Electronic Resource
    Stopping power ratios less than unity?
    Amsterdam : Elsevier
    Nuclear Inst. and Methods in Physics Research, B 48 (1990), S. 51-53 
    Details
    ISSN: 0168-583X
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Physics
    Type of Medium: Electronic Resource
    URL: http://linkinghub.elsevier.com/retrieve/pii/0168-583X(90)90071-2
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  • 6
    Electronic Resource
    Electronic Resource
    Results of posteroinferior capsular shift in patients with posterior shoulder instability (1998)
    Springer
    Der Unfallchirurg 101 (1998), S. 755-761 
    Details
    ISSN: 1433-044X
    Keywords: Key words Posterior shoulder instability • Operative therapy • Posteroinferior shift ; Schlüsselwörter Posteriore Schulterinstabilität • Operative Therapie • Posteroinferior Shift
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Ziel der vorliegenden Untersuchung ist die Darstellung der eigenen Ergebnisse nach postinferiorem Kapselshift bei Patienten mit dorsalen Schulterinstabilitäten. In einer prospektiven Untersuchung wurde bei 12 Patienten (14 Schultergelenke) mit dorsal rezidivierender Schulterluxation ein posteroinferiorer Kapselshift durchgeführt. Für die klinische Dokumentation wurden der Rowe- und der ASES-Score (American Shoulder and Elbow-Score) sowie der SF-36 verwendet. Zusätzlich erfolgten standardisierte EMG-, isokinetische und Propriozeptionsuntersuchungen. Nach einem mittleren Nachuntersuchungszeitraum von 22,2 Monaten zeigten sich 2 Rezidive, die alle innerhalb des ersten postoperativen Jahres auftraten. Der Rowe-Score stieg von 46,25 Punkte auf 76,34 Punkte zum Zeitpunkt der Nachuntersuchung. Der ASES-Score betrug präoperativ 42,43 Punkte und erreichte zum Zeitpunkt der Nachuntersuchung 78,86 Punkte. Hierbei zeigten die meisten Parameter des ASES-Scores eine gleichbleibend positive Tendenz wie der Gesamtscore. Lediglich bei der subjektiven Stabilitätsbewertung kam es aufgrund der beiden Rezidive zu einer leichten Verschlechterung nach den ersten 6 Monaten. Es fand sich jedoch auch bei den stabilen Schultergelenken nach wie vor eine Einschränkung beim Werfen eines Balles. Der SF-36 zeigte einen Zugewinn der allgemeinen Lebensqualität. Die EMG-Untersuchung zum Zeitpunkt der Nachuntersuchung ergab deutliche Defizite im Vergleich zu einem Kontrollkollektiv, die bei den weiblichen Patientinnen ausgeprägter waren als bei den männlichen. Ähnliche Tendenzen fanden sich bei isokinetischen Kraftmessungen zum Zeitpunkt der Nachuntersuchung. Die Propriozeptionsmessungen ergaben keinen Unterschied der Patienten im Vergleich zu einem Normalkollektiv. Bei adäquater Patientenselektion und nach Ausschöpfung aller konservativen therapeutischen Möglichkeiten ist der posteroinferiore Kapselshift eine therapeutische Option bei rezidivierender dorsaler Schulterinstabilität.
    Notes: Purpose: The purpose of this study was the evaluation of our results after posteroinferior capsular shift in patients with a posterior shoulder instability. Materials and methods: In a prospective study we evaluated 12 patients (14 shoulder joints) with recurrent posterior shoulder dislocations who were stabilized by a posteroinferior capsular shift procedure. For the clinical documentation the Rowe-Score, the ASES-Score and the SF-36 were used. Furthermore the patients were submitted to standardized EMG-, isokinetic and proprioceptive tests. Results: After an average follow-up of 22.2 months there were two recurrences which occurred during the first postoperative year. The Rowe-Score improved from 46.25 to 76.34 points. The ASES-Score showed an average of 42.43 points preoperatively and at the time of follow-up an average of 78.86 points. Most parameters of the ASES-Score as well as the score in total had a constant positive tendency. Only the subjective rating of stability showed a slight decrease after the first six months due to the two redislocations. But even the stable shoulder joints demonstrated limitations when throwing a ball. The SF-36 showed a definite gain in the overall quality of living as well. The EMG-tests at follow-up showed a deficit for the patients compared with a control group; even more for the female than for the male patients. Similar tendencies were found with the isokinetic strength. The proprioception did not show any differences between the patients and the control group. Conclusion: With adequate patient selection and after failure of all possible conservative treatments the posteroinferior capsular shift is a therapeutical option in recurrent posterior shoulder instability.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050334
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  • 7
    Electronic Resource
    Electronic Resource
    The open Bankart repair using suture anchors in posttraumatic shoulder instability: 2- to 5-year results (1997)
    Springer
    Der Unfallchirurg 100 (1997), S. 938-942 
    Details
    ISSN: 1433-044X
    Keywords: Key words Shoulder instability • Bankart repair • Suture anchors ; Schlüsselwörter Schulterinstabilität • Bankart-Operation • Nahtanker
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Ziel dieser prospektiven Studie war die Darstellung der Ergebnisse der offenen Bankart-Operation unter Einsatz von Nahtankern bei der rezidivierenden posttraumatischen vorderen Schulterinstabilität. Es wird über 32 Patienten, die in der oben beschriebenen Weise operiert wurden, berichtet. Der Mindestnachuntersuchungszeitraum betrug 2 Jahre, der durchschnittliche Nachuntersuchungszeitraum 40 Monate. Das Durchschnittsalter der 28 Männer und 4 Frauen war 29,7 Jahre. Alle Patienten wurden postoperativ 3 Wochen immobilisiert. Die Nachuntersuchungen erfolgten durch einen unabhängigen Beobachter anhand des Rowe-Scores. Nach 40 Monaten beklagten 2 Patienten (6,3 %) eine oder mehrere Reluxationen. Die Reluxationen traten zwischen dem 6. und 24. postoperativen Monat auf. Insgesamt hatten 90,6 % ein gutes oder sehr gutes Ergebnis; 93,7 % der Operierten berichteten über keine oder nur eine leichte Einschränkung der Sportfähigkeit. Die offene Bankart-Operation unter dem Einsatz von Nahtankern ist ein sicheres und geeignetes Verfahren zur Therapie der posttraumatischen rezidivierenden Schulterinstabilität mit vergleichbaren Ergebnissen zur traditionellen Nahttechnik.
    Notes: Summary The aim of this study was to evaluate the results after open Bankart repair using suture anchors in patients with recurrent posttraumatic anterior shoulder instability. Some 32 patients were prospectively observed for a mean of 40 months (24–60) after stabilization. The mean age at the time of operation was 29.7 years. All patients were postoperatively immobilized in a sling for 3 weeks. According to the criteria of Rowe, 29 patients (90.6 %) had good or excellent results. Two patients (6.3 %) developed recurrent instability 6–24 months postoperatively; 93.7 % were not or only slights limited in sports activities. Bankart repair is an excellent treatment for recurrent posttraumatic anterior shoulder instability. The use of suture anchors is an appropriate way of reattaching the capsuloligamentous complex to the glenoid to restore stability to an unstable joint.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050215
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  • 8
    Electronic Resource
    Electronic Resource
    Radiologische Beurteilbarkeit von Pfannendefekten bei Pfannenlockerungen von Hüftalloarthroplastiken (1996)
    Springer
    Der Unfallchirurg 99 (1996), S. 727-733 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Pfannendefekt ; Pfannenlockerung ; Hüftalloarthroplastik ; Radiologische Beurteilung ; Key words Acetabular bone defect ; Hip arthroplasty ; Radiological classification
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: In 18 human pelvis specimens we produced different acetabular defects according to Paprosky. Standardized X-rays of these specimens were taken, and these X-rays were evaluated by six orthopaedic surgeons with different levels of surgical experience. A total of 350 evaluation sheets were analyzed. The X-rays of the acetabular rim were correctly interpreted in only 66% of cases. The interpretation of plates showing bone loss was even worse. A medial wall defect was correctly assessed in just 49% of cases, giving a correlation (r) or 0.60 between the real defect and the radiological estimation. While massive defects were recognized in most cases, moderate defects were correctly estimated in about 50%. Moderate defects included migration of the cup, which was overlooked in between 46% and 69% of cases. Similar results were achieved in the judgement of bone loss. Only in 25% was direct classification according to Paprosky successful; it was better in small defects and worse in massive defects, with 16%. The interobserver correlation was only 0.54. In general, in most cases the defects were unterestimated. This study raises the question of whether classification systems can provide the information needed for clinical useful therapeutic algorithms. The fact that the real bone loss is generally underestimated must receive due considerations when operations are being planned.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050048
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  • 9
    Electronic Resource
    Electronic Resource
    Halm-Zielke-Instrumentation als primärstabile Weiterentwicklung der Zielke-VDS bei idiopathischen Skoliosen (2000)
    Springer
    Der Orthopäde 29 (2000), S. 563-570 
    Details
    ISSN: 1433-0431
    Keywords: Schlüsselwörter Halm-Zielke-Instrumentation • VDS • Skoliose ; Keywords Halm-Zielke instrumentation • VDS • Scoliosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Halm-Zielke Instrumentation (HZI) was developed to eliminate the disadvantage of ventral derotation spondylodesis (VDS)- Zielke in terms of lack of primary stability and in order to simplify sagittal plane control. Within a prospective clinical trial started in 1993, we have studied whether HZI fulfills these demands. HZI is an anterior double-rod system with a two screw per vertebral body fixation. The longitudinal components consist of a threaded VDS rod and a solid rod, which are attached to a hinge-conducted lid plate. Twenty-nine consecutive patients with idiopathic scoliosis and curves ranging from 36 ° to 92 ° were treated with HZI. The follow-up period ranged from 1 to 4 years. Correction of the frontal plane within the instrumented levels averaged 71.6 % and 70.5 % postoperatively and at follow-up, respectively. Derotation averaged 53.7 % and mean correction of the tilt of the lowest instrumented vertebra was 69.5 % at final follow-up. Thoracolumbar kyphosis was present in eight patients and was always completely corrected from + 18.8 ° to 3.3 ° on average. One implant-related complication involved a screw breakage 18 months postoperatively without adverse effects . There was no case of pseudoarthrosis. All patients were mobilized without any additional external immobilization in terms of a brace or cast, and were allowed to go swimming for physiotherapeutical purposes immediately after wound healing. This study proves that HZI is a primary stable implant to perform VDS. Implant-related disadvantages typical of VDS are eliminated. Thereby, the period of rehabilitation is shortened by many months due to avoidance of cast and brace treatment.
    Notes: Zusammenfassung Die Halm-Zielke-Instrumentation (HZI) wurde entwickelt, um die Nachteile der geringen internen Stabilisierungseigenschaften der Zielke-VDS zu eliminieren und um die Kontrolle des Profils der Wirbelsäule im Instrumentationsbereich vereinfachen zu können. Im Rahmen einer prospektiven Studie wird seit 1993 überprüft, ob die HZI diesem Anspruch genügt. Bei der HZI handelt es sich um ein ventrales Doppelstabsystem mit Doppelverschraubung einer scharniergeführten Bügelplatte am Wirbelkörper. Die Längsträgerkomponente besteht aus einem VDS-Gewindestab und einem soliden Rundstab; 29 konsekutive Patienten mit idiopathischer Skoliose und Winkelgraden zwischen 36 ° und 92 ° wurden einer HZI unterzogen. Der Nachbeobachtungszeitraum betrug zwischen 1 und 4 Jahren. Die durchschnittliche Korrektur der frontalen Ebene im Instrumentationsbereich betrug postoperativ 71,6 % und zum Follow-up 70,5 %. Die Schrägstellung des untersten instrumentierten Wirbels ließ sich damit um 69,5 % korrigieren. Die mittlere Derotation betrug 53,7 %. Pathologische Kyphosen lagen präoperativ im Instrumentationsbereich bei 8 Patienten vor und konnten ausnahmslos von im Mittel 18,8 ° auf 3,3 ° korrigiert werden. An implantatbezogenen Komplikationen trat 1 Schraubenbruch 18 Monate postoperativ auf. Pseudarthrosen wurden nicht beobachtet. Alle Patienten wurden rumpfgips- und korsettfrei nachbehandelt und durften bereits nach Wundheilung zu krankengymnastischen Zwecken schwimmen gehen. Bei der HZI handelt es sich um ein primärstabiles Implantat zur Durchführung der ventralen Derotationsspondylodese. Die systemimmanenten Nachteile der VDS im Sinne geringer interner Stabilisierungseigenschaften werden vermieden. Dadurch wird die Rehabilitationsphase durch Vermeiden einer Rumpfgips- und Korsettnachbehandlung um viele Monate abgekürzt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001320050494
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  • 10
    Electronic Resource
    Electronic Resource
    Influence of a high hip center on abductor muscle function (1997)
    Springer
    Archives of orthopaedic and trauma surgery 116 (1997), S. 385-389 
    Details
    ISSN: 1434-3916
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 20 anatomic specimens with an acetabular defect (type Paprosky 3b), an acetabular component was implanted in the position of a high hip center. The vertical migration of the hip center ranged between 13 and 35 mm. It was accompanied by a lateralization and ventral migration of between 5 and 25 mm. The influence on the different abductor muscles was calculated through computer model comparing muscle force and muscle length before and after implantation of a high hip center. The increase in length of the gluteus maximus muscle and the posterior part of the gluteus minimus muscle ranged between 1% and 6%, while all other evaluated abductor muscles were shortened from 3% to 16%. The effect of the simultaneous changes of the lever arms was an increase in necessary muscle strength for pelvic stabilization from 140% to 250% compared with the original estimated strength prior to implantation. This may lead to insufficiency of the abductor muscles after placement of a high hip center. On the basis of these findings, we do not recommend the implantation of an acetabular component in the position of a high hip center.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00433996
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