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PJI with Sepsis, a Complex Emergency Situation with Prodromal Stage

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Open Journal of Orthopedics 2020年第9期10卷 203-220页

作者： nils Haustedt Jorge Armando González Chapa Moritz Hentschke Clinic of Septic Bone and Soft-Tissue Surgery Sch&#246 n-Klinik Hamburg Eilbek Hamburg Germany Departamento de Inmunología Facultad de Medicina UANL Monterrey Mexico Departement of Microbiology and Virology Labor Fenner Hamburg Germany

Introduction: With a considerable morbidity, mortality and a high financial impact, PJI has been considered as one of the most serious complications after arthroplasty. Special awareness must be given to these patients due to a life threatening systemic PJI related complication, sepsis. A prompt detection and adequate medical management of this situation is crucial for avoiding unfavorable outcomes. Methods: Between January 2011 and December 2012, we retrospectively examined adult patients who met PJI-SIRS criteria. Medical history search for patients’ anamnesis, surgical times, laboratory-microbiological findings and success rates was performed. Results: Twenty patients were enrolled in this study with a mean age of 71.35 years. Men population was more commonly affected with 55% of the cases. The knee was mainly the affected joint with 52%. A severe systemic disease was present in 80% of the cases. A sickness sensation and pain were the most common prodromal symptoms found 4.9 days before the admission to the hospital. In 85.7% of the cases the etiological agent was identified, with Staphylococcus aureus as the most common. Two-

Nonun ions of the humerus-Treatment concepts and results of the last five years

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Chinese Journal of Traumatology 2019年第4期22卷 187-195页

作者： Maximilian Leiblein Rene Verboket Ingo Marzi nils Wagner christoph Nau Department of Trauma Hand and Reconstructive Surgery University Hospital Goethe University Frankfurt D-60590 Frankfurt am Main Germany

Puqjose: Fractures of the humerus account for 5%—8% of all fractures. Non union is Found with an incidence of up to 15%, depending on the location of the fracture. In case of a manifest nonunion the surgeon faces a challenging problem and has to conceive a therapy based on the underlying pathology. The aim of this study was to describe our treatment concepts for this entity and present our results of the last five years. Methods: Twenty-six patients were treated for nonunion of the humerus between January 2013 and December 2017. Their charts were reviewed retrospectively and demographic data, pathology, surgical treatment and outcome were assessed. Results: The most frequent location for a nonunion was the humeral shaft, with the most common trauma mechanism being multiple falls. Most often atrophic nonunion (n = 14), followed by hypertrophic and infection-caused nonunion (each n = 4), were found. Our treatment concept could be applied in 19 patients, of which in 90% of those who were available for follow-up consolidation could be achieved. Conclusion: Humeral non union is a heterogeneous entity that has to be analyzed precisely and be treated correspondingly. We therefore present a treatment concept based on the underlying pathology.

关键词： Humerus Nonunion Delayed union Humeral fractures

ERTMS/ETCS Level 3:Development,assumptions,and what it means for the future

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Journal of Intelligent and Connected Vehicles

Journal of Intelligent and Connected Vehicles 2023年第1期6卷 34-45页

作者： Daniel Knutsen nils O.E.Olsson Jiali Fu Department of Mechanical and Industrial Engineering Norwegian University of Science and TechnologyTrondheim 7491Norway Swedish National Road and Transport Research Institute Linkoping 58195Sweden

The purpose of this paper is to categorize the research on Level 3 and Hybrid Level 3;map how the research focus on ERTMS Level 3 has developed over time;summarize key assumptions in research on Level 3 and Hybrid Level *** study uses a scoping review *** review method provides a comprehensive overview of the literature in a selected *** literature searches in this study were primarily conducted in Scopus and Web of Science and were complemented with a follow-up search in Google *** topics are divided into two thematic areas:Effects on the Railway System and Technical *** thematic area Technical Requirements is further divided into the following subcategories:train,trackside,and *** effects on the railway system are measured using performance indicators:capacity,stability/robustness,and *** Level 3 has developed from a pure Level 3 to Hybrid Level *** Level 3 represents a pragmatic solution,but it may emerge as a threat to the long-term objective of the Level 3 moving *** of Level 3 are based on a moving block solution,while studies of Hybrid Level 3 are mainly based on virtual *** Level 3 and Hybrid Level 3 studies tend to make assumptions that risk missing wider aspects of the railway *** is also a need to correctly represent different ERTMS Level 3 configurations to ensure expected capacity *** a better understanding of the development and future path of ERTMS Level 3,it is interesting to study the following aspects:the historical development of ERTMS Level 3 research,the assumptions made about ERTMS Level 3,and the conditions and restrictions under which ERTMS Level 3 will be *** and simplifications are necessary for modeling work,but there is also a need to highlight underlying assumptions in analyses of different ERTMS Level 3 configurations.

关键词： ERTMS ETCS Level 3 Hybrid Level 3 moving block virtual sub-section

Lymph Fistulas after Inguinal Lymph Node Dissection—Assessment of Risk Factors and Future Treatment Strategies

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Surgical Science 2014年第4期5卷 193-199页

作者： nils Habbe Alexander Reinisch Wolf Otto Bechstein Sabine Hannes Department of General and Visceral Surgery University Hospital Frankfurt Frankfurt Germany

Background: Inguinal lymph node dissections (ILND) have been commonly associated with postoperative complications such as lymphedema, lymph fistula and wound infections. The reported complication rates after ILND range from 14% - 77%, and a rationale for these large differences is the use of a variety of different definitions of complications. Patients and Methods: Files of patients that underwent inguinal lymph node dissection for lymph node metastases at the Department of General and Visceral Surgery of the University Hospital Frankfurt between February 2005 and March 2012 were retrospectively reviewed. Results: 47 patients (65%) developed a lymphatic fistula in the course of the operation, of which 6 patients (8%) underwent reoperations. Surgical side infections (SSI) were seen in 15 patients (21%), all of them harbouring fistulas. Patients presenting with a BMI ≥ 30 kg/m2 did not develop more fistulas than those with a BMI 2 (p = 0.30). Patients who suffered from a lymph fistula had significantly more visits in the outpatient clinic (p =< 0.0001). There was no difference in the complication rate if the procedure was performed by a resident under supervision or a senior surgeon (p = 0.79). Conclusion: In this study, we demonstrated that lymph fistulas are to date a common complication after ILND and lead to reoperations and significantly more outpatient visits. The number of lymph nodes affected and resected, and prior sentinel lymph node dissection, was not associated with a higher complication rate.

关键词： Lymph Fistula Inguinal Lymph Node Lymphadenectomy Wound Infection

A Mega-Tsunami in the Baltic Sea 1171 BC: Geological Records with Special Reference to the Lake Mälaren Area in Sweden

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International Journal of Geosciences 2020年第10期11卷 667-707页

作者： nils-Axel Mörner Björn Ambrosiani Phyllis Anderson Ambrosiani Paleogeophysics & Geodynamics Stockholm Sweden Swedish National Heritage Board Stockholm Sweden Department of Archaeology and Ancient History Uppsala University Uppsala Sweden

At about 3000 C14-year BP or 1200 cal. yrs BC, the Baltic Sea experienced a mega-tsunami with a wave-height of 10 m or more, and a run-up height of up to 16.5 m. This event had significant geological and archaeological effects. We explore the records from the Lake M?laren area in Sweden. The tsunami event is linked to seismic ground shaking and methane venting tectonics at several sites. The triggering factor is proposed to be the Kaali meteor impact in Estonia of the same age. The documentation of a mega-tsunami in the middle of the Bronze Age has wide implications both in geology and in archaeology. The archaeological key sites at Annelund and Apalle are reinterpreted in terms of tsunami wave actions remodelling stratigraphy. By extensive coring, we are able to trace the tsunami effects in both off-shore and on-shore environment. At the time of the event, sea level was at +15 m (due to isostatic uplift). The tsunami wave erosion is traced 13.5 m below sea level. The tsunami run-up over land is traced to +29.5 m to +31.5 m (occasionally even higher), implying a run-up of 14.5 - 16.5 m. In ?ngermanland, the tsunami event was absolutely dated at 1171 varve years BC. Archaeologically, the tsunami event coincides well with the transition between Periods II and III of the South Scandinavian Bronze Age. Period III has traditionally been difficult to identify in the cultural materials of the Lake M?laren region.

关键词： Tsunami Deposits Mega-Tsunami Wave Height and Run-Up Kaali Impact Archaeological Reinterpretations The Bronze Age Lake Mälaren Area Sweden

A Study of the Deformation Derivatives for a Ti-6Al-4V Inertia Friction Weld

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Advances in Aerospace Science and Technology 2021年第2期6卷 114-121页

作者： Richard P. Turner nils Warnken Jeffery W. Brooks School of Metallurgy & Materials University of Birmingham Birmingham UK

The velocity–versus-time rundown curves from two experimental Ti-6Al-4V inertia friction welds were analysed and differentiated several times, to produce rotational acceleration, jerk, jounce (or snap), crackle and pop versus-times curves for each weld. Titanium alloys and their mechanical properties are known to be highly sensitive to strain rate as the material is deformed, though nothing has ever been considered in terms of the higher-order time-derivatives of position. These curves have been studied and analysed further, for a more complete understanding of the derivative trends. Rotational acceleration and jerk traces both display behavior patterns across the two welds as the part rotates under action from the flywheel. The rotational snap also displays a pattern in this derivative during the final approximately 0.5 s of welding, as the energy dissipates. Evidence of a distinct oscillatory pattern in the rotational crackle and pop terms was noted for one weld when differentiating over a larger time-base, though could not be replicated in the 2nd weld. The higher derivative curves allow distinction of different process regimes, indicating that inertial energy mostly influences the time-base of dynamically steady-state phase. Qualitative differences between initial energies are evident in higher derivatives.

关键词： Rotation Acceleration Jerk Snap Crackle Pop

Industrial minerals and rocks, aggregates and natural stones in the Nordic countries

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Episodes 2008年第1期31卷 133-139页

作者： Kurt Johansson Rune B. Larsen Markku J. Lehtinen Lars Persson Mika Raeisaenen Stig A. Schack Pedersen Paer Weihed nils-Gunnar Wik Swedish Stone Industries Federation Industrigatan 6 SE-291 36 Kristianstad Sweden. NTNU NO-7491 Trondheim. Norway. Nordkalk Oyj Abp Poikkitie 1 FI-53500 Lappeenranta Finland. Geological Survey of Sweden SE-751 87 Uppsala Sweden. Geological Survey of Finland PO Box 96 FI-02151 Espoo Finland. Geological Survey of Denmark and Greenland Ф. Voldgade 10 DK-1350 Cph. Denmark. Division of Ore Geology and Applied Geophysics Lulea University of Technology SE-971 87 Lulea Sweden. Geological Survey of Sweden SE-223 50 Lund Sweden.

The Nordic countries, including Greenland, have a long tradition in mining. The industrial minerals sector is expanding in most Nordic countries and extensive development has taken place during the last few years. The main commodities mined are carbonate rocks, quartz, feldspar, apatite, olivine and talc. A number of diferent types of dimension stones are quarried in all countries. Rock aggregates are increasingly important, replacing sand and gravel aggregate as construction materials in some countries due to the need to protect ground water supplies.

关键词：工业矿产岩石集合体天然石材北欧地区

Feedstock choice,pyrolysis temperature and type influence biochar characteristics:a comprehensive meta-data analysis review

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Biochar 2020年第4期2卷 421-438页

作者： James A.Ippolito Liqiang Cui Claudia Kammann Nicole Wrage‑Mönnig Jose MEstavillo Teresa Fuertes‑Mendizabal Maria Luz Cayuela Gilbert Sigua Jeff Novak Kurt Spokas nils Borchard Department of Soil and Crop Sciences Colorado State UniversityFort Collins 80523USA School of Environmental Science and Engineering Yancheng Institute of Technology9 Yingbin AvenueYancheng 224051China Department of Applied Ecology Geisenheim UniversityVon‑Lade‑Straße 165366 GeisenheimGermany Faculty of Agricultural and Environmental Sciences Grassland and Fodder SciencesUniversity of RostockJustus‑von‑Liebig‑Weg 618059 RostockGermany Department of Plant Biology and Ecology University of the Basque Country(UPV/EHU)Apdo.64448080 BilbaoSpain Department of Soil and Water Conservation and Waste Management CEBAS-CSICCampus Universitario de Espinardo30100 MurciaSpain United States Department of Agriculture Agriculture Research ServiceCoastal Plains Research Center2611 West Lucas StreetFlorenceSC 29501USA United States Department of Agriculture Agriculture Research ServiceSoil and Water Management Research UnitUniversity of Minnesota439 Borlaug Hall1991 Buford CircleSt.PaulMN 29501USA Natural Resources Institute Finland(Luke) Latokartanonkaari 900790 HelsinkiFinland

Various studies have established that feedstock choice,pyrolysis temperature,and pyrolysis type influence final biochar physicochemical ***,overarching analyses of pre-biochar creation choices and correlations to biochar characteristics are severely ***,the objective of this work was to help researchers,biochar-stakeholders,and practitioners make more well-informed choices in terms of how these three major parameters influence the final biochar *** approximately 5400 peer-reviewed journal articles and over 50,800 individual data points,herein we elucidate the selections that influence final biochar physical and chemical properties,total nutrient content,and perhaps more importantly tools one can use to predict biochar’s nutrient *** on the large dataset collected,it appears that pyrolysis type(fast or slow)plays a minor role in biochar physico-(inorganic)chemical characteristics;few differences were evident between production *** temperature,however,affects biochar’s longevity,with pyrolysis temperatures>500℃ generally leading to longer-term(i.e.,>1000 years)*** pyrolysis temperatures also led to biochars containing greater overall C and specific surface area(SSA),which could promote soil physico-chemical ***,based on the collected data,it appears that feedstock selection has the largest influence on biochar *** surface area is greatest in wood-based biochars,which in combination with pyrolysis temperature could likely promote greater changes in soil physical characteristics over other feedstock-based ***-and other grass-based biochars appear to have cation exchange capacities greater than other biochars,which in combination with pyrolysis temperature could potentially lead to longer-term changes in soil nutrient *** collected data also suggest that one can reasonably predict the availability of various biochar nutrients(e.g.,N,P

关键词： Biochar Total elemental analysis Plant-available elemental analysis Physico-chemical characteristics·Meta-analysis

Residents Achieve a High Patient Satisfaction in Pre-Anesthetic Patient Assessment. An Observational Study

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Open Journal of Anesthesiology 2014年第11期4卷 263-275页

作者： Ulrike Reuter Babette Jurack nils Engelmann Thilo Busch Joerg Schnoor Department of Anesthesiology and Intensive Care Medicine University Hospital Leipzig Leipzig Germany Department of Anaesthesiology King’s College Hospital Clinics Abu Dhabi UAE

A physician’s empathetic attitude is regarded as an important influencing factor towards patient satisfaction. However, physicians’ self-assessed empathy declines during medical school and through residency, which may limit patient satisfaction in the doctor-patient contact. In conse-quence, we hypothesized that residents might fail in generating high levels of patient satisfaction. We conducted an observational study in the setting of a pre-anesthetic assessment center, Univer-sity Hospital Leipzig, Germany. Patient satisfaction was measured using the overall ZUF-8 score (8 - 32 points;increasing with patient satisfaction). Data were collected by questionnaires (ZUF-8 items, additional satisfaction items, and items of organizational and logistical processes). Key items for patient satisfaction as primary endpoints were defined. Statistical evaluation was performed in dependency of the anesthesiologists’ level of training (residents vs. consultants) by using the Mann-Whitney-U test or the chi square test, as required. Statistical significance was accepted for p < 0.05. In total, 2565 patients were assessed for eligibility. 986 patients met the criteria of inclusion. 978 questionnaires were submitted with 517 questionnaires being excluded because of missing values. Finally, 461 questionnaires could be analysed. Both residents and consultants achieved a high level of patient satisfaction. The ZUF-8-scores were comparable between the groups (p = 0.91), whilst the quality of consultation was rated slightly better by patients being assessed by residents (p = 0.047). The results in additional satisfaction items were comparable between the groups. We found a trend in residents assessing to be rated more friendly. Residents are able to generate a high level of patient satisfaction which is comparable to that of consultants with scores ranging between “good” and “very good”. Small albeit significant differences in favor of residents underline the quality of their performance

关键词： Patient Satisfaction Pre-Anesthetic Patient Education ZUF-8 Questionnaire Physicians’ Educational Level