Microbial community shifts induced by plastic and zinc as substitutes of tire abrasion.

Aquatic environments serve as a sink for anthropogenic discharges. A significant part of the discharge is tire wear, which is increasingly being released into the environment, causing environmental disasters due to their longevity and the large number of pollutants they contain. Main components of tires are plastic and zinc, which therefore can be used as substitutes for tire abrasion to study the effect on microbial life. We investigate environmentally realistic concentrations of plastic and zinc on a freshwater microeukaryotic community using high-throughput sequencing of the 18S V9 region over a 14-day exposure period. Apart from a generally unchanged diversity upon exposure to zinc and nanoplastics, a change in community structure due to zinc is evident, but not due to nanoplastics. Evidently, nanoplastic particles hardly affect the community, but zinc exposure results in drastic functional abundance shifts concerning the trophic mode. Phototrophic microorganisms were almost completely diminished initially, but photosynthesis recovered. However, the dominant taxa performing photosynthesis changed from bacillariophytes to chlorophytes. While phototrophic organisms are decreasing in the presence of zinc, the mixotrophic fraction initially benefitted and the heterotrophic fraction were benefitting throughout the exposure period. In contrast to lasting changes in taxon composition, the functional community composition is initially strongly imbalanced after application of zinc but returns to the original state.

Delayed and fractional use of enzymatic debridement with nexobrid for extensive burn injury: a case report.

Selective enzymatic debridement is increasingly being used in cases of burn wounds. However, until now the use of Nexobrid has been limited to 15% of total body surface area (TBSA) and immediate use on admission day. A 61-year-old Caucasian male suffered a severe burn injury that affected 95% TBSA. After surgical escharotomy and tracheotomy on admission day, we successfully performed a fractional enzymatic debridement of 54% of the TBSA in three different sessions within four days. This case report reveals that a delayed and fractional application of Nexobrid to more than 15% TBSA is possible.

Le débridement enzymatique sélectif des brûlures est de plus en plus utilisé. Cependant, cette technique était jusqu'ici limitée à 15% de la surface corporelle totale (SCT). Nous rapportons le cas d'un homme de 61 ans brûlé sur 95% SCT. Après une trachéotomie et des incisions de décharge le jour de son entrée, nous avons réalisé un débridement enzymatique sur 54% SCT sur 4 j en 3 séances. Cette observation montre que l'utilisation séquentielle de Nexobrid® permet de traiter plus de 15% SCT.

Experiences with Osteoligamentoplasty According to Weiss for the Treatment of Scapholunate Dissociation.

BACKGROUND: In post-traumatic, dynamic, or static scapholunate (SL) instability, an SL ligament reconstruction is advisable to avoid long-term complications. However, a sufficient primary reconstruction is best achieved in acute injuries. For chronic SL dissociation, there is still no satisfying standard surgical technique. In this context, we evaluated the clinical outcome of Weiss's osteoligamentoplasty as a treatment option. METHODS: Over a three-year period, 16 patients with chronic and symptomatic SL dissociation Grade-II and III, without the signs of osteoarthrosis were, surgically treated using a bone-retinaculum-bone autograft from the distal radius. All patients underwent prior wrist arthroscopy. The clinical outcome was measured using the Mayo-Wrist, Krimmer, and DASH score. In addition, radiological measurements were also performed. RESULTS: The postoperative clinical outcome successfully increased the Mayo-Wrist score: 32 to 64 points, Krimmer score: 30 to 53 points and DASH score: 41 to 30 points. The radiological follow-up demonstrated no evidence of an SL gap or significant loss of reposition in the SL angle in 13 of the 16 cases. Till date, two patients had to be revised to an arthrodesis. CONCLUSIONS: The autogenous osteoligamentary span from the distal radius improves a chronic SL dissociation and, therefore, presents a suitable option to anatomically reconstruct the SL ligament. It leads to a proper realignment of the carpus and could help to prevent arthritic changes of the wrist. Nevertheless, in patients with postoperative high occupational physical strain, the procedure should be performed with reservations. As long as there is no satisfying standard surgical treatment, Weiss's osteoligamentoplasty is a convincing technique.

[Analysis of Diagnosis Related Groups and their Impact on Health Care in Post Massive Weight Loss Surgery]. / Analyse von Fallpauschalen und deren versorgungsrelevante Effekte in der postbariatrischen Wiederherstellungschirurgie.

BACKGROUND: Diagnosis Related Groups (DRG) were introduced in Germany as a medico-economic classification system in 2004. In this analysis, we looked at restorative surgery after massive weight loss, focusing on reimbursement of this fee-per-case system in comparison to costs to deduce possible effects on health care over time. MATERIAL AND METHODS: First we analysed the algorithms for the relevant DRGs including data about length of stay and reimbursement. Furthermore, we integrated cost data from German reference hospitals of the last 5 years as well as single-centre data from a university hospital. RESULTS: Due to a diagnosis-related algorithm, coding will constantly lead to DRG K07Z. In 2016, a new diagnosis code specific to massive weight loss was introduced, which now leads to DRG J10B. As a result, reimbursement is reduced by more than half. In the cost matrix, staff, general ward, operation theatre and anaesthesia were identified as the main cost drivers. As expected, there was a statistically significant correlation between general ward costs and time of stay in hospital as well as operation theatre costs and incision-suture time. Considering the cost data of the reference hospitals, there was an average excess of EUR 781 per case whereas our own cost data revealed a deficit of EUR 1 700 to 2 700 per case. This is mainly due to the fact that approximately one third of our patient cohort underwent highly elaborate circular body lifts. CONCLUSION: It has to be questioned whether a newly introduced main diagnosis code can be applied as such without any underlying cost data having been collected in previous years. Given unchanged treatment measures, the main cost drivers identified by us remain the same, which means that there is no rationale for a drop in revenue. In addition to providing incentives for an efficient use of resources and quality optimisation, this system should offer medical service providers a sustainable and realistic possibility to break even.

Alteration of biomechanical properties of burned skin.

BACKGROUND: The prevalence of burns in the general population is high. Despite new research findings, skin burns and its resulting tissue damage are still not entirely understood. In particular, little is known about the depth-dependent alteration of skin biomechanical properties of these wounds. METHODS: Thirty-six burn wounds with six different depths were generated on the abdomen of six Göttingen minipigs. The alteration of skin biomechanical properties was evaluated objectively after 15 and 360 min using a Cutometer device. Biopsies for histological evaluation were taken and the depth of burn was correlated with biomechanical properties. RESULTS: Firmness of skin (R0), overall elasticity (R8) and calculated elasticity (Ue) demonstrated a continuous decrease with an increasing depth of burn 15 min after wound generation. Gross elasticity (R2), net elasticity (R5) and amount of elasticity of the whole curve (R7), however, showed an increase of values with increasing depth of injury. A further decrease of elasticity was demonstrated 360 min after wound generation. CONCLUSION: The alteration of skin biomechanical properties is a function of damaged tissue structures. The presented results demonstrate a depth-dependent decrease of principal elastic parameters with an increasing depth of burn and the results indicate progressive tissue damage over the time.

Alteration of biomechanical properties of skin in acute cold contact injury.

BACKGROUND: The prevalence of acute cold injury has increased recently. Despite new research findings, these injuries and their resulting tissue damage are still not entirely understood. Especially, little is known about alteration of skin biomechanical properties. METHODS: A total of 36 acute cold contact wounds with different depths were generated on the abdomen of six Göttingen minipigs. Alteration of biomechanical properties of skin was evaluated objectively after 15 and 360 min using a Cutometer device. Biopsies for histological evaluation were taken, and the depth of injury was correlated with biomechanical properties. RESULTS: Calculated elasticity (Ue), firmness of skin (R0) and overall elasticity (R8) demonstrated a continuous decrease, whereas other parameters demonstrated an initial increase with increasing depth of injury 15 min after wound generation. All parameters showed an increase compared to healthy skin, 360 min after wound generation. Furthermore, an alteration of values over time was detected. CONCLUSION: Alteration of biomechanical properties of skin is a function of damaged tissue structures. The presented results demonstrate a decrease of main elastic parameters with increasing depth of injury and indicate progressive tissue damage over time. Skin elasticity measurements are a valuable tool in acute cold contact injury depth assessment and may act as an influencing factor in management decisions.

[Benign subcutaneous emphysema caused by a bellows mechanism of the first interdigital space]. / Benigne subkutane Emphysembildung durch einen Falten-Blasebalg-Mechanismus der ersten Zwischenfingerfalte.

We report 2 cases of subcutaneous emphysema after stab wounds of the first interdigital space. The first diagnosis of a gas gangrene was not confirmed. We hypothese an air incorporation caused by a bellows mechanism. An escape of the air may not be possible due to an one-way valve mechanism. The aim of this report is to describe criteria to distinguish benign emphysema from emphysema caused by infection.

College health needs to participate in the national STD debate.

We have a window of opportunity in which events are coming together, and we in ACHA can make a significant impact on STDs/STIs. College health professionals can choose to become actively involved or we can be bystanders. Our population, our tradition, and our moral imperatives all urge us to become engaged at all levels. We work with one of the most highly educated of all groups--a group that also shows some of the highest rates of risky behaviour--and we should be able to demonstrate the highest levels of successful intervention.

Truth or consequences: dishonesty in dating and HIV/AIDS-related issues in a college-age population.

This article examines the issue of dishonesty in dating among college students as it relates to the HIV/AIDS epidemic in the United States. The authors surveyed 171 under-graduates at a large midwestern university in January 1991. They conducted an analysis by gender and found significant differences in responses of male and female students. Of those students involved in monogamous relationships, 36% of the men and 21% of the women reported being sexually unfaithful to their current partner or to any of their previous partners. A greater percentage of women than of men inquired about past sexual histories before engaging in sexual activity. In addition, men admitted they had lied to their sexual partner or partners more often than did women. Because a large portion of HIV/AIDS and STD education involves teaching students to inquire about previous sexual histories, the results of this study should influence the direction and content of behaviorally focused educational programs. The authors also address implications for health educators and clinicians.

Perceptions of sexual responsibility: do young men and women agree?

PIP: A nonprobability, convenience sample of 248 subjects of a large midwestern university agreed to participate in this study designed to investigate the perception of responsibility for contraception among late adolescents (over age 17), to determine whether age, gender, or sexual activity influences perceptions of responsibility, and to explore the relationship between perceived contraceptive responsibility and subsequent contraceptive choice among late adolescent males and females. The students were enrolled in an undergraduate public health class during the 1984 spring quarter. After initial data examination, 28 married subjects were eliminated from analysis. Of the final sample size of 220 students, 131 were female and 89 were male. The majority of the students, 57.5%, were between the ages of 20-22; 19% were between the ages of 17-19; and the remaining 23% were older than 22. The students completed a questionnaire anonymously as part of the development of a slide-tape program entitled "Young Men's Sexual Responsibility." Contraceptive responsibility was defined as perceived responsibility for pregnancy control, perceived responsibility to initiate conversation about contraception in a dating relationship, and perceived responsibility for who should pay for contraceptives. 63% of the students indicated that they had engaged in sexual intercourse at least once. Male students were significantly more likely to have had sexual intercourse than female students. Only 7% of the entire sample reported having had intercourse before the age of 15, but this sample consisted primarily of white, middle-class college students who may not represent students in inner-city school districts reported to have had 1st intercourse at earlier ages. 91% of the students perceived contraceptive responsibility as a shared responsibility. Of the small number of students who perceived 1 sex or the other responsible for pregnancy control, most (7%) perceived that it was the woman's responsibility. No relationship was found between age or intercourse experience and perceived contraceptive responsibility. 52.3% of the students reported using effective birth control methods at 1st intercourse, but 37.2% reported not using contraceptives. The remaining students used 2 of the least effective methods for adolescents (withdrawal, 7.2%; rhythm, 3.5%). No relationship was found between the students' perception of responsibility for pregnancy control or responsibility for initiating a conversation about contraception and the type of contraceptive used at most recent intercourse. If the concept of shared responsibility is in fact an emerging value, health professionals and educators must reconsider sex education curricula for adolescents.^ieng