Exome Sequencing of 5 Families with Severe Early-Onset Periodontitis.

Periodontitis is characterized by alveolar bone loss leading to tooth loss. A small proportion of patients develop severe periodontitis at the juvenile or adolescent age without exposure to the main risk factors of the disease. It is considered that these cases carry rare variants with large causal effects, but the specific variants are largely unknown. In this study, we performed exome sequencing of 5 families with children who developed stage IV, grade C, periodontitis between 3 and 18 y of age. In 1 family, we found compound heterozygous variants in the gene CTSC (p.R272H, p.G139R), 1 of which was previously identified in a family with prepubertal periodontitis. Subsequent targeted resequencing of the CTSC gene in 24 patients <25 y of age (stage IV, grade C) identified the known mutation p.I453V (odds ratio = 4.06, 95% CI = 1.6 to 10.3, P = 0.001), which was previously reported to increase the risk for adolescent periodontitis. An affected sibling of another family carried a homozygous deleterious mutation in the gene TUT7 (p.R560Q, CADD score >30 [Combined Annotation Dependent Depletion]), which is implicated in regulation of interleukin 6 expression. Two other affected siblings shared heterozygous deleterious mutations in the interacting genes PADI1 and FLG (both CADD = 36), which contribute to the integrity of the environment-tissue barrier interface. Additionally, we found predicted deleterious mutations in the periodontitis risk genes ABCA1, GLT6D1, and SIGLEC5. We conclude that the CTSC variants p.R272H and p.I453V have different expressivity and diagnostic relevance for prepubertal and adolescent periodontitis, respectively. We propose additional causal variants for early-onset periodontitis, which also locate within genes that carry known susceptibility variants for common forms. However, the genetic architecture of juvenile periodontitis is complex and differs among the affected siblings of the sequenced families.

Radiological management of postoperative lymphorrhea.

PURPOSE: Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated. METHOD: A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI. RESULTS: Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100-4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2-330 days and 0-5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97-100% and 89-100%, respectively. The clinical success rate of CL and PLI was 73-95%. CL-associated and PLI-associated major complication rates were 0-3% and 0-5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated. CONCLUSION: The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.

Energy-dispersive X-ray micro Laue diffraction on a bent gold nanowire.

This article reports on energy-dispersive micro Laue (µLaue) diffraction of an individual gold nanowire that was mechanically deformed in three-point bending geometry using an atomic force microscope. The nanowire deformation was investigated by scanning the focused polychromatic X-ray beam along the nanowire and recording µLaue diffraction patterns using an energy-sensitive pnCCD detector that permits measurement of the angular positions of the Laue spots and the energies of the diffracted X-rays simultaneously. The plastic deformation of the nanowire was shown by a bending of up to 3.0 ± 0.1°, a torsion of up to 0.3 ± 0.1° and a maximum deformation depth of 80 ± 5 nm close to the position where the mechanical load was applied. In addition, extended Laue spots in the vicinity of one of the clamping points indicated the storage of geometrically necessary dislocations with a density of 7.5 × 1013 m-2. While µLaue diffraction with a non-energy-sensitive detector only gives access to the deviatoric strain, the energy sensitivity of the employed pnCCD offers absolute strain measurements with a resolution of 1%. Here, the residual strain after complete unloading of the nanowire amounted to maximum tensile and compressive strains of the order of +1.2 and -3%, which is comparable to the actual resolution limit. The combination of white-beam µLaue diffraction using an energy-sensitive pixel detector with nano-mechanical testing opens up new possibilities for the study of mechanical behavior at the nanoscale.

Normal Load and Counter Body Size Influence the Initiation of Microstructural Discontinuities in Copper during Sliding.

Near the interface of two contacting metallic bodies in relative motion, the microstructure changes. This modified microstructure leads to changes in material properties and thereby influences the tribological behavior of the entire contact. Tribological properties such as the friction coefficient and wear rate are controlled by the microstructure, while the elementary mechanisms for microstructural changes are not sufficiently understood. In this paper, the influence of the normal load and the size of the counter body on the initiation of a tribologically induced microstructure in copper after a single sliding pass is revealed. A systematic variation in the normal load and sphere diameter resulted in maximum Hertzian contact pressures between 530 MPa and 1953 MPa. Scanning electron microscopy, focused ion beam, and transmission electron microscopy were used to probe the subsurface deformation. Irrespective of the normal load and the sphere diameter, a sharp line-like feature consisting of dislocations, the so-called dislocation trace line, was identified in the subsurface area at depths between 100 nm and 400 nm. For normal loads below 6.75 N, dislocation features are formed below this line. For higher normal loads, the microstructure evolution directly underneath the surface is mainly confined to the area between the sample surface and the dislocation trace line, which itself is located at increasing depth. Transmission Kikuchi diffraction and transmission electron microscopy demonstrate that the misorientation is predominantly concentrated at the dislocation trace line. The results disclose a material rotation around axes roughly parallel to the transverse direction. This study demonstrates the generality of the trace line phenomena over a wide range of loads and contact pressures and the complexity of subsurface processes under a sliding contact and provides the basis for modeling the early stages in the microstructure evolution.

Percutaneous afferent lymphatic vessel sclerotherapy for postoperative lymphatic leakage after previous ineffective therapeutic transpedal lymphangiography.

BACKGROUND: To demonstrate the efficacy of percutaneous computed tomography (CT)-guided afferent lymphatic vessel sclerotherapy (ALVS) in the treatment of postoperative lymphatic leakage (LL) after ineffective therapeutic transpedal lymphangiography (TL). METHODS: A retrospective review in this institute involving 201 patients was conducted from May 2011 to September 2018. Patients diagnosed with postoperative LL undergoing ineffective therapeutical TL before the performance of percutaneous CT-guided ALVS were involved. Technical success and clinical success of TL and ALVS were established. The technical success and efficacy of ALVS in the treatment of postoperative LL after ineffective therapeutic TL were assessed. The clinical success rate of ALVS is also assessed, and the complications are reviewed. RESULTS: In total, nine patients were involved including three patients (33.3%) presented with chylothorax, three patients (33.3%) presented with inguinal lymphatic fistula/lymphocele, and three patients (33.3%) presented with lymphatic fistula in the thigh; 27 ± 18 days (mean ± standard deviation) after surgery, therapeutic TL was successfully performed and showed definite afferent lymphatic vessel and leakage site in all the patients. Due to clinical failure after TLs, the following ALVS was performed with a mean interval of 12 ± 8 days after TL. The technical success rate was 9/9 (100.0%, 95% confidence interval [CI] 63.1-100.0%). An average of 2.7 ± 1.3 mL 95% ethanol as sclerosant agent was injected during the procedure. The clinical success was observed in 8 of the 9 patients (88.9%, 95% CI 51.8-99.7%) with a time between ALVS and the LL cure of 8 ± 6 days. No complications were reported. CONCLUSIONS: Our results showed the role of percutaneous CT-guided ALVS as a safe, feasible, and effective salvage treatment for postoperative LL after ineffective TL.

The roles of iodized oil-based lymphangiography and post-lymphangiographic computed tomography for specific lymphatic intervention planning in patients with postoperative lymphatic fistula: a literature review and case series.

In the management of patients with postoperative lymphatic fistula (LF) in different locations, iodized oil-based lymphangiography (LAG) from trans-pedal or intranodal route is an established diagnostic approach with the potential to plan further interventional treatments. However, specific lymphatic interventions are indicated depending on different locations and morphologies of the LF. After a systematic literature review, four types of interventions can be considered, including direct leakage embolization/sclerotherapy (DLE/DLS), percutaneous afferent lymphatic vessel embolization (ALVE), percutaneous afferent lymphatic vessels disruption/sclerotherapy (ALVD/ALVS), and trans-afferent nodal embolization (TNE). In the iodized oil-based LAG, three potential lymphatic targets including confined leakage, definite afferent LVs, and definite closest afferent LNs should be comprehensively assessed. For optimal prospective treatment planning for LF, iodized oil-based post-lymphangiographic computed tomography (post-LAG CT) is a useful complement to the conventional iodized oil-based LAG, which can be performed easily after LAG. This review article summarized the current evidence of the specific lymphatic interventions in patients with postoperative LF and explored the potential benefits of post-LAG CT in the intervention planning from a case series.

Matter-wave interference of a native polypeptide.

The de Broglie wave nature of matter is a paradigmatic example of quantum physics and it has been exploited in precision measurements of forces and fundamental constants. However, matter-wave interferometry has remained an outstanding challenge for natural polypeptides, building blocks of life, which are fragile and difficult to handle. Here, we demonstrate the wave nature of gramicidin, a natural antibiotic composed of 15 amino acids. Its center of mass is delocalized over more than 20 times the molecular size in our time-domain Talbot-Lau interferometer. We compare the observed interference fringes with a model that includes both a rigorous treatment of the peptide's quantum wave nature as well as a quantum chemical assessment of its optical properties to distinguish our result from classical predictions. The realization of quantum optics with this prototypical biomolecule paves the way for quantum-assisted measurements on a large class of biologically relevant molecules.

Ionic conductivity of melt-frozen LiBH4 films.

The fast Li conductivity of LiBH4 envisages its use in all-solid-state batteries. Powders are commonly applied. But here, we study the formation of dense micrometer films by melting, spinning and subsequent solidifying. Characterized by electron microscopy, and spectroscopy (EDX/XPS/impedance), a reversible phase transformation is confirmed as well as a maximum conductivity of 103 S cm-1.

Development of an international core outcome set for peripheral vascular malformations: the OVAMA project.

BACKGROUND: An important limitation in vascular malformation research is the heterogeneity in outcome measures used for the evaluation of treatment outcome. OBJECTIVES: To reach international consensus on a core outcome set (COS) for clinical research on peripheral vascular malformations: lymphatic (LM), venous (VM) and arteriovenous malformations (AVM). In this consensus study, we determined what domains should constitute the COS. METHODS: Thirty-six possibly relevant outcome domains were proposed to an international group of physicians, patients and the parents of patients. In a three-round e-Delphi process using online surveys, participants repeatedly rated the importance of these domains on a five-point Likert scale. Participants could also propose other relevant domains. This process was performed for LM, VM and AVM separately. Consensus was predefined as 80% agreement on the importance of a domain among both the physician group and the patient/parent group. Outcomes were then re-evaluated in an online consensus meeting. RESULTS: 167 physicians and 134 patients and parents of patients with LM (n = 50), VM (n = 71) and AVM (n = 29) participated in the study. After three rounds and a consensus meeting, consensus was reached for all three types of vascular malformations on the core domains of radiological assessment, physician-reported location-specific signs, patient-reported severity of symptoms, pain, quality of life, satisfaction and adverse events. Vascular malformation type-specific signs and symptoms were included for LM, VM and AVM, separately. CONCLUSIONS: Our recommendation is that therapeutic-efficacy studies on peripheral vascular malformations should measure at least these core outcome domains.

The PF4/PPBP/CXCL5 Gene Cluster Is Associated with Periodontitis.

Periodontitis is a common dysbiotic inflammatory disease with an estimated heritability of 50%. Due to the limited sample size of available periodontitis cohorts and the underlying trait heterogeneity, genome-wide association studies (GWAS) of chronic periodontitis (CP) have been unsuccessful in discovering susceptibility factors. A strategy that combines agnostic GWAS with a well-powered candidate-gene approach has the potential to discover novel loci. We combined RNA-seq data from gingival tissues with quantitative trait loci (QTLs) that were identified in a F2-cross of mice resistant and susceptible to infection with oral bacterial pathogens. Four genes, which were located within the mapped QTLs, showed differential expression. The chromosomal regions across the human orthologous were interrogated for putative periodontitis-associated variants using existing GWAS data from a German case-control sample of aggressive periodontitis (AgP; 651 cases, 4,001 controls), the most severe and early onset form of periodontitis. Two haplotype blocks, one upstream to the coding region of UGT2A1 (rs146712414, P = 9.1 × 10-5; odds ratio [OR], 1.34; 95% confidence interval [CI], 1.16-1.56) and one downstream of the genes PF4/PPBP/CXCL5 (rs1595009, P = 1.3 × 10-4; OR, 1.32; 95% CI, 1.15-1.52), were associated with AgP. The association of rs1595009 was validated in an independent cohort of CP of European Americans (1,961 cases and 1,864 controls; P = 0.03; OR, 1.45; 95% CI, 1.01-1.29). This association was further replicated in another sample of 399 German CP cases (disease onset <60 y of age) and 1,633 controls ( P = 0.03; OR, 1.75; 95% CI, 1.06-2.90). The combined estimates of association from all samples were P = 2.9 × 10-5 (OR, 1.2; 95% CI, 1.1-1.3). This study shows the strength of combining QTL mapping and RNA-Seq data from a mouse model with association studies in human case-control samples to identify genetic risk variants of periodontitis.

[What can/should be treated in kidney tumors and when]. / Was kann/soll bei Nierentumoren wann behandelt werden.

CLINICAL/METHODICAL ISSUE: In the treatment of localized renal cell carcinoma, the lack of randomization in controlled trials on thermal ablation is a major limitation. The latter leads to significant study bias and it ultimately remains unclear whether the improved overall survival in favor of partial nephrectomy can actually be attributed to the treatment method. STANDARD RADIOLOGICAL METHODS: For T1a (≤4 cm) renal cell carcinoma without lymph node and distant metastases, excellent technical and clinical results have been described after imaging-guided radiofrequency ablation and cryoablation. METHODICAL INNOVATIONS: Low major complication rates, preservation of renal function and three-dimensional confirmation of negative ablation margins (A0 ablation) are the advantages of computed tomography (CT)-guided thermal ablation. PERFORMANCE: According to the results of controlled (non-randomized) trials on T1a renal cell cancer, the cancer-specific survival rates are comparable between ablative and surgical techniques. ACHIEVEMENTS: It is high time for prospective randomized controlled trials to define the actual value of percutaneous thermal ablation and partial nephrectomy in the treatment of T1a renal cell carcinoma. PRACTICAL RECOMMENDATIONS: Apart from localized renal cell carcinoma, angiomyolipoma and oncocytoma can be treated by thermal ablation. Transarterial embolization extends the radiological spectrum for the treatment of renal tumors, either as complementary embolization (e. g. before thermal ablation of T1a and T1b renal cell carcinoma), prophylactic embolization (e. g. angiomyolipoma >6 cm), preoperative embolization (e. g. before laparoscopic partial nephrectomy) or palliative embolization (e. g. in patients with symptomatic macrohematuria due to renal cell carcinoma).

Transarterial embolization (TAE) as add-on to percutaneous radiofrequency ablation (RFA) for the treatment of renal tumors: Review of the literature, overview of state-of-the-art embolization materials and further perspective of advanced image-guided tumor ablation.

Percutaneous radiofrequency ablation (RFA) for the treatment of stage I renal cell carcinoma has recently gained significant attention as the now available long-term and controlled data demonstrate that RFA can result in disease-free and cancer-specific survival comparable with partial and/or radical nephrectomy. In the non-controlled single center trials, however, the rates of treatment failure vary. Operator experience and ablation technique may explain some of the different outcomes. In the controlled trials, a major limitation is the lack of adequate randomization. In case reports, original series and overview articles, transarterial embolization (TAE) before percutaneous RFA was promising to increase tumor control and to reduce complications. The purpose of this study was to systematically review the literature on TAE as add-on to percutaneous RFA for renal tumors. Specific data regarding technique, tumor and patient characteristics as well as technical, clinical and oncologic outcomes have been analyzed. Additionally, an overview of state-of-the-art embolization materials and the radiological perspective of advanced image-guided tumor ablation (TA) will be discussed. In conclusion, TAE as add-on to percutaneous RFA is feasible and very effective and safe for the treatment of T1a tumors in difficult locations and T1b tumors. Advanced radiological techniques and technologies such as microwave ablation, innovative embolization materials and software-based solutions are now available, or will be available in the near future, to reduce the limitations of bland RFA. Clinical implementation is extremely important for performing image-guided TA as a highly standardized effective procedure even in the most challenging cases of localized renal tumors.

KB scanning of X-ray beam for Laue microdiffraction on accelero-phobic samples: application to in situ mechanically loaded nanowires.

A mapping technique has been developed where a sub-micrometer focused polychromatic X-ray beam is scanned across a stationary sample instead of scanning the sample in front of the X-ray microbeam. This method is applied to a gold nanowire during its mechanical loading using the tip of an atomic force microscope. During the loading process, such a sample is `accelero-phobic', i.e. the sample scanning stages must not to be moved to avoid parasitic additional load. Without beam scanning, only one single position within the sample can be probed during the test. The probed material point may even change because of drifts or movements induced by the test itself. The new scanning approach facilitates the in situ mapping of the entire wire giving access to the evolution of the wire shape as well as to the boundary conditions. This novel scanning technique opens promising perspectives for studies where sample motion is forbidden because of the sample environment.

A flexible method for the preparation of thin film samples for in situ TEM characterization combining shadow-FIB milling and electron-beam-assisted etching.

A new method for the preparation of freestanding thin film samples for mechanical testing in transmission electron microscopes is presented. It is based on a combination of focused ion beam (FIB) milling and electron-beam-assisted etching with xenon difluoride (XeF2) precursor gas. The use of the FIB allows for the target preparation of microstructural defects and enables well-defined sample geometries which can be easily adapted in order to meet the requirements of various testing setups. In contrast to existing FIB-based preparation approaches, the area of interest is never exposed to ion beam irradiation which preserves a pristine microstructure. The method can be applied to a wide range of thin film material systems compatible with XeF2 etching. Its feasibility is demonstrated for gold and alloyed copper thin films and its practical application is discussed.

Influence of Calcium Phosphate and Apatite Containing Products on Enamel Erosion.

For the purpose of erosion prevention the present study aimed to compare the efficacy of two biomimetic products and a fluoride solution to optimize the protective properties of the pellicle. After 1 min of in situ pellicle formation on bovine enamel slabs, 8 subjects adopted CPP-ACP (GC Tooth Mousse), a mouthwash with hydroxyapatite microclusters (Biorepair), or a fluoride based mouthwash (elmex Kariesschutz) for 1 min each. Afterwards, samples were exposed in the oral cavity for 28 min. Native enamel slabs and slabs exposed to the oral cavity for 30 min without any rinse served as controls. After oral exposure, slabs were incubated in HCl (pH values 2, 2.3, and 3) for 120 s and kinetics of calcium and phosphate release were measured photometrically; representative samples were evaluated by SEM and TEM. The physiological pellicle reduced demineralization at all pH values; the protective effect was enhanced by fluoride. The biomimetic materials also reduced ion release but their effect was less pronounced. SEM indicated no layer formation after use of the different products. However, TEM confirmed the potential accumulation of mineral components at the pellicle surface. The tested products improve the protective properties of the in situ pellicle but not as effectively as fluorides.

The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm.

PURPOSE: The aim of this study was to evaluate the technical feasibility and short-time patency rate of iliac side branch devices based on the authors' institution's experience. MATERIALS AND METHODS: Data of 17 patients (all men) with an aortoiliac aneurysm (median age 72.5 years) who underwent endovascular repair between October 2013 and June 2015 (20 months) at our institution was analyzed retrospectively. Primary endpoint was primary technical success, defined as adequate implantation of the iliac branch device with patency of the hypogastric side branch without the need of further re-interventions within 30 days. Mean follow-up was 8.2 ±â€Š5.4 months. RESULTS: Eighteen iliac side branch devices were implanted with a branch patency of 100 % and a primary technical success rate of 94.4 % (n = 17). Perioperative 30 days mortality was 0 %. The mean diameter of treated abdominal aorta and common iliac artery was 41 ±â€Š14 and 30 ±â€Š8 mm. In one case partial dislocation of the iliac side branch device occurred due to severe kinking of iliac arteries with development of an iliac endoleak type Ib that had to be treated in a second intervention. Three patients (15 %) showed an endoleak type II from the inferior mesenteric artery without the need of re-intervention. After three months one patient suffered from subtotal thrombotic occlusion of the bridging stent that was successfully resolved through intra-arterial fibrinolytic therapy and additional stent graft implantation. CONCLUSION: Summarized, implantation of iliac side branch devices is a feasible technique with favourable short-term results in patients with aortoiliac aneurysm. KEY POINTS: • Implantation of iliac side branch devices is a feasible technique.• Distinguish short-term results of side branch endografting in patients with aortoiliac aneurysm.• Carefully patient selection is necessary to avoid complications and re-interventions. Citation Format: • Maus V, Kurz P, Sommer CM et al. The Use of Iliac Side Branch Devices in Patients with Aortoiliac Aneurysm.. Fortschr Röntgenstr 2016; 188: 746 - 752.

Shear bond strength of different types of adhesive systems to dentin and enamel of deciduous teeth in vitro.

OBJECTIVES: The present study aimed to evaluate the suitability of self-etch adhesives for restoration of deciduous teeth compared with etch and rinse approaches. MATERIALS AND METHODS: One hundred twenty primary teeth were divided into five groups, each being assigned to an adhesive system. Self-etch adhesives XenoV (XV) and Clearfil S(3) Bond (CB), Prime&Bond NT with (PBE)/without preliminary etching (PBN), and Optibond FL (OBFL) as an etch and rinse system were included. Enamel and dentin specimens were prepared (n = 36/group), adhesives applied, and compomer cylinders polymerized. After 24-h storage in 37 °C distilled water and thermo-cycling (1440 cycles, 5/55 °C, 27 s), shear bond tests and fracture mode classification based on SEM investigation were performed. Statistical analysis involved ANOVA and Scheffé procedure with Bonferroni-Holm correction (p ≤ 0.005). RESULTS: High shear bond strengths to primary enamel were determined for PBE (mean [M] = 22.48 ± 7.7 MPa) > OBFL (M = 19.06 ± 5.62 MPa) > CB (M = 17.6 ± 6.55 MPa), and XV (M = 16.85 ± 5.38 MPa) and PBN (M = 8.26 ± 4.46 MPa) formed significantly less reliable enamel-resin interfaces (p ≤ 0.005). PBE generated the highest bond strength on primary dentin (M = 21.97 ± 8.02 MPa); significantly lower values were measured for XV (M = 13.44 ± 5.43 MPa) and OBFL (M = 12.92 ± 4.31 MPa) (p ≤ 0.005). CONCLUSIONS: Adhesives requiring preliminary etching ensure optimal bond strength to primary enamel. If separate etching is to be avoided, selected self-etch adhesives obtain acceptable shear bond values on primary enamel and dentin. CLINICAL RELEVANCE: The treatment of pediatric patients presents a great challenge in dental practice, and optimization of treatment processes is important.

Medical Liability and Patient Law in Germany: Main Features with Particular Focus on Treatments in the Field of Interventional Radiology.

UNLABELLED: On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology--with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient's health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient's consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liablity of malpractice law. KEY POINTS: •On February 26th, 2013 the new patient law came into effect. Materially, there was no fundamental remodeling of the German liability for medical malpractice. •Regarding a physician's liability for medical malpractice two different elements of an offence come into consideration: for one the liability for malpractice and, in turn, liability for errors made during medical consultation in the process of obtaining informed consent. •Forensic practice shows that patients frequently enforce both offences concurrently.

Development of a sink-source interaction model for the growth of short-rotation coppice willow and in silico exploration of genotype×environment effects.

Identifying key performance traits is essential for elucidating crop growth processes and breeding. In Salix spp., genotypic diversity is being exploited to tailor new varieties to overcome environmental yield constraints. Process-based models can assist these efforts by identifying key parameters of yield formation for different genotype×environment (G×E) combinations. Here, four commercial willow varieties grown in contrasting environments (west and south-east UK) were intensively sampled for growth traits over two 2-year rotations. A sink-source interaction model was developed to parameterize the balance of source (carbon capture/mobilization) and sink formation (morphogenesis, carbon allocation) during growth. Global sensitivity analysis consistently identified day length for the onset of stem elongation as most important factor for yield formation, followed by various 'sink>source' controlling parameters. In coastal climates, the chilling control of budburst ranked higher compared with the more eastern climate. Sensitivity to drought, including canopy size and rooting depth, was potentially growth limiting in the south-east and west of the UK. Potential yields increased from the first to the second rotation, but less so for broad- than for narrow-leaved varieties (20 and 47%, respectively), which had established less well initially (-19%). The establishment was confounded by drought during the first rotation, affecting broad- more than narrow-leaved canopy phenotypes (-29%). The analysis emphasized quantum efficiency at low light intensity as key to assimilation; however, on average, sink parameters were more important than source parameters. The G×E pairings described with this new process model will help to identify parameters of sink-source control for future willow breeding.