[Algorithms for early mobilization in intensive care units]. / Algorithmen zur Frühmobilisierung auf Intensivstationen.

Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.

[Early mobilization. Competencies, responsibilities, milestones]. / Frühmobilisierung. Zuständigkeiten, Verantwortungen, Meilensteine.

BACKGROUND: Early mobilization is an evident, interprofessional concept to improve the outcome of intensive care patients. It reduces psychocognitive deficits and delirium and attenuates a general deconditioning, including atrophy of the respiratory pump and skeletal muscles. In this regard the interdisciplinary approach of early mobilization, taking into account different levels of mobilization, appears to be beneficial. The purpose of this study was to explore opinions on collaboration and tasks between different professional groups. METHOD: During the 25th Bremen Conference on Intensive Medicine and Nursing on 20 February 2015, a questionnaire survey was carried out among the 120 participants of the German Early Mobilization Network meeting. RESULTS: In all, 102 questionnaires were analyzed. Most participants reported on the interdisciplinarity of the approach, but none of the tasks and responsibilities concerning early mobilization can be assigned to a single professional group. The practical implementation of mobilizing orally intubated patients may require two registered nurses as well as a physical therapist. Implementation in daily practice seems to be heterogeneous. CONCLUSIONS: There is no consensus regarding collaboration, competencies, and responsibilities with respect to early mobilization of intensive care patients. The approach to date has been characterized by a lack of interprofessional communication, which may lead to an inefficient use of the broad and varied base of knowledge and experienceof the different professions.

[Ornithine transcarbamylase deficiency in adolescence and adulthood: first manifestation with life-threatening decompensation]. / Ornithintranscarbamylasemangel im Jugend- und Erwachsenenalter: Erstmanifestation mit lebensbedrohlicher Dekompensation.

BACKGROUND: Ornithine transcarbamylase (OTC) deficiency is the most frequent innate disorder of the urea cycle and is X-chromosome linked. The disease normally manifests itself shortly after birth and is fatal when untreated. Due to the different expression and X-chromosomal inheritance the manifestation of symptoms can appear later particularly in girls and young women. The first symptoms are non-specific signs of elevated cerebral pressure as a result of a hyperammonemia, which range from nausea and headache up to cerebral herniation with fatal outcome. Measurement of plasma ammonia levels is a simple yet important screening test for patients with unexpected stupor or delirium. CASE REPORTS: The two case reports show the clinical range from acute decompensation with acute cerebral herniation followed by fatal outcome to recovery under emergency therapy without substantial neurological deficits. THERAPY: Emergency treatment consists of symptomatic securing of vital parameters and an immediate reduction in the ammonia level using high calorie, protein-free nutrition to avoid catabolism together with administration of arginine, benzoate or phenyl butyrate. In cases of coma with severe cerebral edema and the threat of a herniation reaction or excessive ammonia levels, emergency hemodialysis must be immediately carried out. CONCLUSIONS: In the clinical routine it is extremely important to consider a metabolic defect at an early phase and among others to determine the ammonia level so that the appropriate treatment can be instigated in time.

Optical selection, manipulation, trapping, and activation of a microgear structure for applications in micro-optical-electromechanical systems.

The optical processes involved in laser trapping and optical manipulation are explored theoretically and experimentally as a means of activating a micrometer-size gear structure. We modeled the structure by using an enhanced ray-optics technique, and results indicate that the torque present on the gear can induce the gear to rotate about the gear-arm plane center with light as the driving energy source. We confirmed these findings experimentally by using gears manufactured with conventional semiconductor techniques and from a layer of polyimide. It is expected that such a simple gear design activated by use of light could lead to an entire new class of micro-optical-electromechanical systems.

Oxidative stress in patients with Friedreich ataxia.

Increased generation of reactive oxygen species may underlie the pathophysiology of Friedreich ataxia (FRDA). The authors measured concentrations of 8-hydroxy-2'-deoxyguanosine (8OH2'dG), a marker of oxidative DNA damage, in urine and of dihydroxybenzoic acid (DHBA), a marker of hydroxyl radical attack, in plasma of 33 patients with FRDA. They found a 2.6-fold increase in normalized urinary 8OH2'dG but no change in plasma DHBA as compared with controls. Oral treatment with 5 mg/kg/day of the antioxidant idebenone for 8 weeks significantly decreased urinary 8OH2'dG concentrations, indicating that 8OH2'dG may be useful in monitoring therapeutic interventions in patients with FRDA.-1721

The Queensland fruit fly, Bactrocera tryoni, contains multiple members of the hAT family of transposable elements.

Members of the hAT transposable element family are mobile in non-host insect species and have been used as transformation vectors in some of these species. We report that the Queensland fruit fly, Bactrocera tryoni, contains at least two types of insect hAT elements called Homer and a Homer-like element (HLE). The Homer element is 3789 bp in size and contains 12-bp imperfect inverted terminal repeats. The Homer element contains a long open reading frame (ORF) that encodes a putative transposase. Three different copies of this long ORF were recovered from the B. tryoni genome and, upon transcription and translation in an in vitro system, all produced transposase. The HLE is an incomplete element since no 3' inverted terminal repeat (ITR) was found. Homer and the HLE are as related to one another as either is to the other insect hAT elements such as Hermes, hobo, hermit and hopper. The structure and distribution of these two Homer elements is described.

Radiation-pressure-based cylindrically shaped microactuator capable of smooth, continuous, reversible, and stepped rotation.

Long cylindrical objects have been observed to align their central axis with the propagation axis of the illuminating laser beam through the action of radiation-pressure-generated force and torque. A cylindrically shaped microactuator based on this principle and suitable for micromachine applications is examined theoretically. When four in-plane laser beams converging at a common point centered on the cylinder are used, the cylinder can be made to rotate about a pivot point. In one mode, smooth, continuous, and reversible rotation is possible, whereas the other cylinder can be step rotated and locked, similar to the operation of conventional stepping motors. The properties of the device are analyzed based on obtaining either a constant rotation rate with variable beam power levels or a quasi-constant rotation rate with constant beam power levels or on using a fixed beam sequence rate that matches the system parameters and produces smooth or stepped operation.

[Sodium, potassium, magnesium and calcium in vaginal content]. / Natrium, Kalium, Magnesium und Calcium im Scheideninhalt.

Flame photometric determinations of sodium, potassium, and calcium, moreover magnesium concentrations according to a complexometric method in 197 healthy nonpregnant women aged 16-46 years were performed in serum and fluid of the vagina. The concentrations of K+, Ca++, and Mg++ in vaginal fluid showed marked increase of some 5, 6, respectively 4 times from those of serum. The sodium concentration of the vaginal fluid is half of serum. The concentration of magnesium in vaginal fluid showed a significant increase of a quarter in comparison with serum after application of hormonal contraceptiva. The origin of vaginal fluid is discussed.

[Amine colpitis]. / Ein Beitrag zur Aminkolpitis.

Significance of KOH test and isonitril (isocyanide) reaction tested in 104 patients was compared with our microbial culture results. In Gardnerella vaginalis as well as in no spores forming anaerobic germs the KOH test was not and the isonitril reaction was only insignificant reliable. Both tests are not able to substitute the procedures of culturing germs including those of Mycoplasma hominis and Ureaplasma urealyticum.

[Transudation and resorption--a physiologic process in the area of the vagina?]. / Die Transsudation und Rückresorption--ein physiologischer Prozess im Bereich der Vagina?

We report about the histo-microscopical and electro-microscopical examinations to clearing up the transudation and reresorption. It was made the trial about to explain, because we found appointed substances in high concentration in the fluid of the vagina.

[Experimental studies into effects of various antiseptics on vaginal flora]. / Experimentelle Untersuchungen über den Einfluss verschiedener Antiseptika auf die Scheidenflora.

Substances of antiseptic action were tested for their intravaginal applicability in gynaecology and obstetrics. Serial dilution and diffusion tests were conducted to that end. The results were limited by the properties of the substances tested. Only few of the antiseptics tested seemed to be suitable for intravaginal application.

[Possibilities for cultural diagnosis of vaginal flora (author's transl)]. / Möglichkeiten zur kulturellen Diagnostik der Scheidenflora.

Reported in this paper are some possible approaches to culturing of vaginal flora. Plastic slides and various selective culturing media are described. The results so far achieved are likely to suggest that the above approach is applicable in practice.

[Screening method for diagnosis of bacterial infections of the vagina (author's transl)]. / Ein Screening-Verfahren zur Diagnostik bakterieller Scheideninfektionen.

Reported is the use of TTC-containing culture media. They were used by the authors in screening tests to determine bacterial vaginal flora. The method seems to be promising in terms of better diagnostic and therapeutic results.

[Role and results of placental scintigraphy in modern obstetrics (author's transl)]. / Bedeutung und Ergebnisse der Plazentaszintigraphie in der modernen Geburtshilfe.

Placental scintigraphy was performed on 367 pregnant women over seven years. Indications were prepartum bleeding in 200 patients, Rh incompatibility in 111, and other types of high-risk pregnancy in 56. Nuclide113m In Cl3 was primarily used, with a scintillation camera being used for scintigraph recording. The sensitivity accounted for 98 per cent. The placenta was found to stick to the fundus or other parts of the uterus in 280 cases or in deep positions in 37 cases. It was partially existent in 27 cases and totally existent in 16 instances. Placenta praevia had been the cause of prepartum bleeding in 17 per cent of the patients checked, in that context. Abnormal foetal presentations were recordable more often from those cases, but rates of malformation were not increased. Clinical retention time and mode of delivery were found to depend on both obstetric results and position of the placenta. - Dependable findings with regard to localisation prior to the 28th week of pregnancy were scintigraphically obtainable only from 82 per cent of all cases, which figure went up to the order of 91.2 per cent in response to scintigraphy as of the 35th week of pregnancy. - The scintigraphic findings recorded from 209 patients were rechecked and verified in 193 cases, bringing the accuracy to 92.4 per cent.

[Diagnosis of blastomyces infection in genital region (author's transl)]. / Zur Diagnostik von Sprosspilzinfektionen im Genitallbereich.

Bismuth-containing Sabouraud's glucose agar was used as an indicator medium. Preliminary experience is reported in this paper. Blastomyces infection was properly identified in some 82 per cent of all cases checked, and falsely negative results cropped up in 18 per cent. The causes are discussed. The medium is considered by the authors are being suitable for the diagnosis of blastomyces infection in the genital region of women.

[Magnesium level in the serum and erythrocytes during pregnancy, delivery and puerperium]. / Magnesiumspiegel des Serums und der Erythrozyten während Schwangerschaft, Geburt und Wochenbett

Complexometric determinations of serum magnesium levels, moreover partly of Mg concentrations in whole blood, and withal determinations of hematocrit in 489 healthy pregnancies, parturients, puerperants (1 to 10 days post partum), and nonpregnant women were performed. By aid of these values we were able to calculate Mg concentrations in 100 ml erythrocytes (Mg E 100). The apparent decrease of serum Mg during pregnancy may be founded according to the changes of the plasma volume. However, actually the total (absolute) ammount of serum Mg is increased in pregnancy. We suppose some influences on serum Mg due to stimulation of the thyroid gland in pregnancy and further those of Mg being released from the muscular cells of uterus those been destroyed after delivery. The increased erythrocyte Mg during pregnancy and post partum confirm the view that there are no corresponding relations between Mg concentrations of serum and those of erythrocytes. The possible causes of the increase of erythrocyte Mg in pregnancy are discussed in detail.

[Behavior of serum magnesium level during abortion]. / Uber das Verhalten des Magnesiumspiegels des Blutes bei Abortus

Double determinations of whole blood- and serum magnesium levels were according to a complexometric method as described by Schwarzenbach (Hôlasek and Flaschka's procedure) in 134 females (66 healthy pregnant women, 68 abortions). Further, hematocrit was determined in these women. By aid of these values we were able to calculate Mg-concentrations/100 ml erythrocytes in all cases. Serum magnesium levels were depressed in the same relation in abortions and normal gravidae. Therefore, we do not confirm the results of other authors (22) asserting a typical significant decrease of serum-Mg in abortions. We warn against excessive differential-diagnostic interpretation of depressed serum magnesium in abortions. Magnesium concentrations in 100 ml erythrocytes were found significant increased over in abortions against women going through a successfully pregnancy. The cause of this magnesium increase is believed in reactive increased pouring out young partly immature erythrocytes containing high magnesium concentrations caused by losses of blood.

PIP: Whole blood and serum magnesium levels were determined in 66 healthy pregnant women and in 68 women with imminent, incipient, or incomplete abortions. Serum magnesium levels were equally depressed in abortion and in normal pregnancy, but magnesium concentrations per 100 ml erythrocytes were significantly higher in abortion patients. This finding is probably due to the increased release of immature erythrocytes with high magnesium concentrations to compensate for blood losses.