Zusammenfassung
Die manuelle Medizin ist ein spezialisierter Zweig der Medizin und beschreibt die Therapie von gezielt gerichteten Krafteinwirkungen auf den menschlichen Körper, um die Beweglichkeit ...von Gelenken und Geweben zu verbessern, indem u. a. reversible segmentale Dysfunktionen (Blockierungen) behoben werden. Die Ausbildung in der manuellen Medizin setzt detaillierte Kenntnisse über die Anatomie, Neurophysiologie und Biomechanik des menschlichen Körpers voraus und beinhaltet zur Vermittlung von diagnostischen und therapeutischen Methoden neben theoretischen Grundlagen auch praktisches Training an erwachsenen Kursteilnehmern. Eine zu übende Technik, die sich gerade in der manuellen Medizin bei Kindern bewährt hat, ist die Atlastherapie nach Arlen. Das praktische Training dieser Technik ist jedoch bei Kindern nicht vollumfänglich möglich. Speziell bei der Behandlung von Säuglingen, Kleinkindern und Kindern mit Behinderungen wird eine präzise Technik vorausgesetzt, die ohne supervidiertes Training am Simulator nicht erlernt werden kann. Obwohl realistische Simulationen mit Echtzeit-Feedback als entscheidende Teile des supervidierten Trainings angesehen werden können, bilden die hohen Kosten von derzeit auf dem Markt erhältlichen Simulatoren sowie fehlende Messungen zur Richtung der Krafteinwirkung Hürden in der Ausbildung. Somit werden Simulatoren in der Ausbildung für manuelle Medizin bisher sehr selten eingesetzt.
Objective
HIV‐positive men who have sex with men (MSM) are a vulnerable group for anal cancer (AC), a cancer with a well‐described precursor lesion, which can be detected early in screening programs ...using anal liquid‐based cytology (aLBC). We aim to compare two aLBC sample collection devices: cytology brush (CB) and Dacron swab (DS).
Methods
Retrospective analysis of two consecutive study periods, the first using CB and the second DS. Participants underwent an aLBC, a human papillomavirus (HPV) DNA test and a high‐resolution anoscopy (HRA), and a biopsy was performed for suspicious lesions. The sensitivity and specificity of aLBC, area under the receiver operating characteristic (ROC) curve (AUC), and concordance between cytology and HRA were assessed using Cohen’s kappa coefficient.
Results
A total of 239 participants were enrolled (CB group, 120; DS group, 119). aLBC was benign in 46% of samples, and high‐grade squamous intraepithelial lesion (HSIL) was detected in 11.7%. Prevalence of biopsy‐proven HSIL was 15.3%. No differences in cytological and histological results were observed between the groups. aLBC‐HRA concordance was weak for benign results (CB group, k = 0.309; DS group, k = 0.350) as well as for HSIL (k = 0.321 and 0.387, respectively). Sensitivity and specificity were 100% and 51.4%, respectively, in the CB group and 88% and 54.3% in the DS group (AUC = 0.711 and 0.759, respectively, P‐value = .514). Representation of the transformation zone (TZ) was adequate in 83.3% of samples in the CB group and 50.4% in the DS group (P‐value <.001).
Conclusion
Our data suggest that both devices had similar accuracy to detect anal HSIL, although samples collected with CB are more likely to have an adequate TZ representation, the presence of which could be an indicator of sample quality.
This article aims to compare two anal cytology sample collection devices for anal cancer screening in HIV‐positive men who have sex with men: cytology brush and Dacron swab. The results suggest that both devices have similar accuracy to detect anal HSIL, although samples collected with CB are more likely to have an adequate TZ representation.
In this study we compared the aesthetic outcome of (1) Le Fort I (LFI) osteotomy and (2) intraoral quadrangular Le Fort II (IQLFII) osteotomy for surgical correction of skeletal class III dysgnathia ...involving midfacial deficiency. The aim was to investigate whether laypersons see differences in facial changes that occur due to variations of the osteotomy cuts. The patient collectives consisted of 23 patients in each group. Pre- and postoperative photographs were presented in a random sequence to 40 layperson raters. The rating procedure was conducted with a four-point Likert scale. Assessed characteristics were ‘attractiveness’ (‘Attraktivität’), ‘likeability’ (‘Sympathie’), ‘intelligence’ (‘Intelligenz’), ‘aggressiveness’ (‘Aggressivität’) and ‘dominance’ (‘Dominanz’). For preoperative photographs we found a significant difference for ‘likeability’ with lower ratings for the IQLFII group; all other criteria were rated similarly. For the IQLFII group we found a significantly larger shift from lower to higher ratings for ‘attractiveness’ and ‘likeability’ and a significantly larger shift from higher to lower ratings for ‘aggressiveness’ and ‘dominance’ than for the LF I group. Our study shows that lay raters detect significant differences between the two surgical groups. Thus, IQLFII osteotomy, when indicated, represents a favourable alternative to conventional LFI osteotomy, if patients desire the expectable change in recognition by their social circle.
Direct evidence of successful or failed predation is rare in the fossil record but essential for reconstructing extinct food webs. Here, we report the first evidence of a failed predation attempt by ...a pterosaur on a soft-bodied coleoid cephalopod. A perfectly preserved, fully grown soft-tissue specimen of the octobrachian coleoid Plesioteuthis subovata is associated with a tooth of the pterosaur Rhamphorhynchus muensteri from the Late Jurassic Solnhofen Archipelago. Examination under ultraviolet light reveals the pterosaur tooth is embedded in the now phosphatised cephalopod soft tissue, which makes a chance association highly improbable. According to its morphology, the tooth likely originates from the anterior to middle region of the upper or lower jaw of a large, osteologically mature individual. We propose the tooth became associated with the coleoid when the pterosaur attacked Plesioteuthis at or near the water surface. Thus, Rhamphorhynchus apparently fed on aquatic animals by grabbing prey whilst flying directly above, or floating upon (less likely), the water surface. It remains unclear whether the Plesioteuthis died from the pterosaur attack or survived for some time with the broken tooth lodged in its mantle. Sinking into oxygen depleted waters explains the exceptional soft tissue preservation.
The stability of the permanently installed terrestrial laser scanner (TLS) in a high mountain environment at Hintereisferner glacier, Ötztal Alps, Austria, is tested. From previous studies it is ...already known that the uncertainty of the permanent setup results from scanning geometry, atmospheric conditions and instrumental limitations. This study focuses on the instrumental limitations related to the lack of perfect stability of the TLS. A case study is performed with hourly scans over the glacier and the data of the internal inclination sensors are read. A comparison of the scanning data with the inclination data shows that the TLS at Hintereisferner is affected by both high-frequency vibrations and coarser movements. The high-frequency vibrations cause radial stripes in the data, and cannot be corrected, as the internal inclinations sensors of the TLS measure at a frequency of 1 Hz, whereas pulses are emitted at effectively 23 kHz. The coarser movements are indicated by the measurement of roll and pitch with the internal inclination sensors and can be corrected by manually georeferencing the data.In order to complete the uncertainty assessment of a permanent long-range TLS system in a high mountain environment, future work will concentrate on the impact from the scanning geometry and from the atmospheric variables. The finalised uncertainty assessment is crucial to derive the smallest magnitude at which snow (re)distribution can be detected and, thus, significantly will improve the treatment of snow cover dynamics in future glacier mass balance research.
Cleft Lip and Palate (CLP) - a common facial malformation in newborns - is typically corrected by surgical intervention to allow for normal speech development, psychosocial adjustment, and facial ...attractiveness. The long term treatment outcome can be evaluated after a number of years, possibly in adulthood. We investigated the aesthetics of the nasolabial region by subjective ratings. To compare various surgical approaches we recruited 12 raters to evaluate 429 patients. Expert and lay raters judged photographs from patients, who have completed treatment with one of three different surgical strategies performed in our institution over 50 years. Facial photographs were cropped, presented to the raters in a randomized sequence, and judged by the raters on a 5 point Likert scale. The subjective ratings between the raters revealed a fair to substantial inter-rater reliability. The average ratings of the surgical outcome improved continuously over the investigated 5 decades. Despite possible differences between raters and rater groups this overall result was consistently seen in the gender groups (male/female), or expertise related groups (expert/lay). Our analysis revealed that patients with bilateral CLP scored worse than patients with unilateral CLP when treated in the fifties; more recently treated patients of both groups scored similarly.
A terrestrial laser scanner (TLS) of the type RIEGL VZ-6000 has been permanently installed and automated at Hintereisferner glacier located in the Ötztal Alps, Austria, to identify snow ...(re)distribution from surface height changes. A first case study is presented that shows and discusses detected snow distribution at the glacier after a snowfall event, together with concurrent snow erosion and deposition caused by avalanches. The paper shows the potential of a TLS system in a high mountain environment, which is also applicable to other environmental mapping applications. It introduces the setup of the TLS system, its automation procedure, and a first and preliminary uncertainty analysis. TLS data are generally influenced by four uncertainty sources: atmospheric conditions, scanning geometry, mechanical properties, and surface reflectance properties. The first three sources have significant influence on the TLS data at Hintereisferner, whereby the total accuracy of the TLS system is estimated to be in a range of a few decimetres, subject to ongoing more detailed data analysis.
The assessment of muscular interactions between biceps, triceps, and brachioradialis can be used as an approach for the detection of spasticity in the upper limbs. A crucial prerequisite for the ...aforementioned validation of muscular interactions is the calculation of time frequencies due to the non-stationary characteristics of electromyographic (EMG) signals and thus the estimation of coherences. Adding biomechanical parameters increases the validity of the assessment process and simplifies the comparison of EMG data as a result of categorization. In this numerical-experimental study, a method will be introduced by using the smoothed pseudo Wigner-Ville distribution and a categorization algorithm to estimate and categorize coherences between biceps, triceps, and brachioradialis during dynamic contractions. The categorization will be performed according to the type of contraction, external load, joint angle, and angular velocity and will be used to assess 10 healthy subjects and 6 patients with spasticity. Generally, the introduced method shows the velocity dependence of coherence during spasticity in extension movements as well as much stronger muscular co-activation between triceps, biceps, and brachioradialis in spastic patients in comparison to healthy subjects. Furthermore, the influence of variables e.g. as joint angle, angular velocities, and type of contraction on the coherence is quantified.
Abstract Findings of ammonoid soft tissues are extremely rare compared to the rich fossil record of ammonoid conchs ranging from the Late Devonian to the Cretaceous/Paleogene boundary. Here, we apply ...the computed-tomography approach to detect ammonoid soft tissue remains in well-preserved fossils from the Early Cretaceous (early Albian) of NE-Germany of Proleymeriella. The ammonites were found in glauconitic–phosphatic sandstone boulders. Analyses of the high-resolution Ct-data revealed the presence of cameral sheets, the siphuncular tube wall, and the siphuncle itself. The siphuncle is a long, segmented soft tissue that begins at the rear end of the body chamber and comprises blood vessels. Chemical analyses using energy-dispersive spectroscopy (EDS) showed that all preserved soft tissues were phosphatized and are now composed of fluorapatite. The same holds true for preserved shell remains that locally show the nacreous microstructure. We provide a short description of these soft tissue remains and briefly discuss the taphonomic pathway.
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