Klinik Bad Bergzabern

BackgroundStroke is the leading cause of disability worldwide. Upper extremity paresis is the most common functional consequence, affecting more than half of all stroke survivors. Research has shown that an adequate therapy should begin in the sub-acute stage, but also that an enhanced intensity and frequency of therapy can positively affect patients’ recovery curve. Therefore, here we assessed whether an additional VR-based training can be beneficial for recovery of stroke patients, with particular emphasis on upper extremity functions.MethodsThe study was organized as prospective and single-blinded (analysis). Two groups of pairwise-matched subacute stroke patients with arm paresis were recruited at our rehabilitation clinic while controlling for gender, age, sidedness and modified Rankin scale (mRS). Both groups – conventional therapy (CT) and conventional therapy plus virtual reality (CT + VR) – received 30–45 min of conventional therapy on 3 to 4 days/week over 4 weeks; in addition to that, the CT + VR group received 3 times per week a specially designed VR-based training for upper extremity. Data acquisition was performed within 24 h before the baseline and after the training has ended. Main outcomes were patients’ performance on Fugl-Meyer test for upper extremity (FME), Box-and-Block test, hand dynamometry and Functional independence test (FIM).ResultsTwenty-two subjects aged 57–85 were pairwise-matched and assigned to the conventional therapy (CT) group (n = 11, 67.82 ± 8.69 years; three females) and the conventional therapy plus virtual reality (CT + VR) group (n = 11, 70.45 ± 6.79 years; three females). No difference in gender, age, sidedness, mRS and mini-mental status examination (MMSE) existed between the two groups. The CT + VR group showed significantly better improvements over time on FME (44.3 ± 7.8 to 58.7 ± 11.2 vs. 42.1 ± 6.2 to 49.5 ± 10.9; p = 0.009) and FIM (90.1 ± 18.0 to 118.1 ± 6.9 vs. 105.0 ± 12.4 to 110.6 ± 12.6; p < 0.001), compared to the CT group. Other tests revealed no significant differences.DiscussionAs hypothesized, an additional immersive VR-based training can be beneficial for stroke patients suffering from upper extremity deficiency. Nevertheless, the principle of specificity could be observed, with only trained functions being associated with improvements on FME and FIM. Future studies with larger sample of participants are required to confirm these findings.

Acute strokes can affect heart rate variability (HRV), the mechanisms how are not well understood. We included 42 acute stroke patients (2–7 days after ischemic stroke, mean age 66 years, 16 women). For analysis of HRV, 20 matched controls (mean age 60.7, 10 women) were recruited. HRV was assessed at rest, in a supine position and individual breathing rhythmus for 5 min. The coefficient of variation (VC), the root mean square of successive differences (RMSSD), the powers of low (LF, 0.04–0.14 Hz) and high (HF, 0.15–0.50 Hz) frequency bands were extracted. HRV parameters were z-transformed related to age- and sex-matched normal subjects. Z-values < -1 indicate reduced HRV. Acute stroke lesions were marked on diffusion-weighted images employing MRIcroN and co-registered to a T1-weighted structural volume-dataset. Using independent component analysis (ICA), stroke lesions were related to HRV. Subsequently, we used the ICA-derived lesion pattern as a seed and estimated the connectivity between these brain regions and seven common functional networks, which were obtained from 50 age-matched healthy subjects (mean age 68.9, 27 women). Especially, LF and VC were frequently reduced in patients. ICA revealed one covarying lesion pattern for LF and one similar for VC, predominantly affecting the right hemisphere. Activity in brain areas corresponding to these lesions mainly impact on limbic (r = 0.55 ± 0.08) and salience ventral attention networks (0.61 ± 0.10) in the group with reduced LF power (z-score < -1), but on control and default mode networks in the group with physiological LF power (z-score > -1). No different connectivity could be found for the respective VC groups. Our results suggest that HRV alteration after acute stroke might be due to affecting resting-state brain networks.

Functional near-infrared spectroscopy (fNIRS) allows for a reliable assessment of oxygenated blood flow in relevant brain regions. Recent advancements in immersive virtual reality (VR)-based technology have generated many new possibilities for its application, such as in stroke rehabilitation. In this study, we asked whether there is a difference in oxygenated hemoglobin (HbO2) within brain motor areas during hand/arm movements between immersive and non-immersive VR settings. Ten healthy young participants (24.3 ± 3.7, three females) were tested using a specially developed VR paradigm, called "bus riding", whereby participants used their hand to steer a moving bus. Both immersive and non-immersive conditions stimulated brain regions controlling hand movements, namely motor cortex, but no significant differences in HbO2 could be found between the two conditions in any of the relevant brain regions. These results are to be interpreted with caution, as only ten participants were included in the study.

Abstract Aim Hernia meshes slip easily upon cyclic load (dynamic intermittend strain, DIS). Meshes were classified and those with the best adhesiveness were named DIS class A. How durable are reconstructions with these meshes after 3 years? Material and methods The adhesiveness of the meshes was analyzed with cyclic load on a bench test. The best-gripping meshes were clinically applied. All patients were followed in yearly intervals up to three years. Results A total of 166 patients (85 males, 85 ASA III/IV, 179 risk factors, 46 recurrent) were included. Progrip® was used in 60 cases (P), Dahlhausen® Cicat in 106 cases (C). Smaller hernias were augmented with P needing less overlap due to the higher tackiness (median minimal overlap P = 4.5, C = 6 cm). Hernia sizes treated with C were significantly larger (median P = 20, median C = 143 cm2; u-test: p &amp;lt; 0.001). The mesh-defect area ratio was higher with P compared with C (13.2 vs 6.3). Fixation requirements were lower with 8 points for P and 81 points for C. GRIP was twice that minimally required. Larger hernia took longer OR times (median P: 103 vs. median C: 203 min; p &amp;lt; 0.001). Larger hernias coincided more postoperative minor complications (5–14%, 1 re-operation for seroma). In-hospital stay was comparable with 5–6 days. Pain levels were low in both groups after 3 years (median NAS = 0). No recurrences were detected. Conclusion Incisional hernia can be repaired durably based on biomechanical principles.

Abstract Two closely spaced geothermal doublets were operated in the Californië geothermal field near Venlo, the Netherlands. The geothermal wells target the Dinantian Zeeland formation below 2 km depth. For several years, hot fluid was produced from the Tegelen fault, a regional fault in the Roer Valley rift system, until a felt M1.7 earthquake led to the suspension of geothermal activities. The Californië showcase provides a rare opportunity to retrospectively evaluate the assessment and the management of induced seismicity risks for a geothermal project. A seismic hazard assessment was conducted at several stages of the project, and seismicity was continuously monitored with a local station network. In this paper, we report on the characteristics of the induced seismicity and evaluate the findings of the seismic hazard assessments conducted prior to the earthquakes. Seismic hazard assessments were based on numerical simulations of subsurface stress changes associated with geothermal operations. A geomechanical analysis indicated that the mapped faults in the subsurface are likely to be critically stressed. The largest hazard was inferred to result from thermo-elastic stresses, originating from cold water injection close to the Tegelen fault. Subsequent earthquakes predominantly occurred near a production well after stopping or reducing production. We attributed this observation to a thermo-elastic stress load caused by cold water injection close to the Tegelen fault, combined with a counter-acting stabilisation of the fault due to pressure depletion during production. This mechanism was consistent with the dominating mechanism considered in the preceeding seismic hazard assessments. Although geothermal operations have not resumed yet, the geomechanical analysis indicates that re-locating one of the injection wells further away from the Tegelen fault could provide an efficient measure for mitigating induced seismicity risks at Californië.

Malignant tumours of the thyroid gland show a rising incidence. As in the ENT-department Bad Hersfeld the management of thyroid disorders has been in focus for a longer period, we want to share our experiences in this field. The investigation started in the year of 2014 till July 2020. All patients who underwent thyroid surgery were evaluated concerning important demographic and medical parameters such as age, sex, histology, calcium, recurrent nerve palsy etc. RESULTS: So far 63 patients with a malignant thyroid disease were enrolled in this study. The sex ratio showed a preponderance of the female patients with 42 and 21 males. Age had a wide range from 11 to 95 years. Patients with a differentiated cancer were in average younger than those with anaplastic disease. Histologically the papillary variant dominated with 65 % (n = 41) the other tumours as the follicular (n = 6), the medullary (n = 5) and the anaplastic carcinoma (n = 6). In two female patients with primary hyperparathyroidism a carcinoma of the parathyroid was found surprisingly. All patients underwent surgery; those with an advanced differentiated carcinoma were treated with radioiodine additionally. To our knowledge there was just one tumour related death in case of a differentiated carcinoma, whereas all patients with an anaplastic disease died of their malignancy. The otorhinolaryngologist is involved in the management of thyroid malignancies. As well as in the benign diseases of the endocrine neck organs the interdisciplinary collaboration is mandatory for a high medical standard.

Einleitung Kopf-Hals-Malignome sind bei Risikogruppen geläufige Ursachen für Halsschmerzen bzw. Schluckbeschwerden. Allerdings gibt es auch seltenere, an sich jedoch typische Erkrankungen mit hoher Bedeutung, die in der Differenzialdiagnose nicht außer Acht gelassen werden sollten.

Department of Anesthesiology and Critical Care Medicine, Hospital Bergstrasse, Heppenheim, Germany [email protected] Department of Anesthesiology and Critical Care, Medicine Hospital Bergstrasse, Heppenheim, Germany

Research Article| March 27, 2019 Traffic Light Systems: To What Extent Can Induced Seismicity Be Controlled? Stefan Baisch; Stefan Baisch aQ‐con GmbH, Marktstrasse 39, 76887 Bad Bergzabern, Germany, baisch@q-con.de, koch@q-con.de Search for other works by this author on: GSW Google Scholar Christopher Koch; Christopher Koch aQ‐con GmbH, Marktstrasse 39, 76887 Bad Bergzabern, Germany, baisch@q-con.de, koch@q-con.de Search for other works by this author on: GSW Google Scholar Annemarie Muntendam‐Bos Annemarie Muntendam‐Bos bState Supervision of the Mines, Henri Faasdreef 312, 2492 JP The Hague, The Netherlands, A.G.Muntendam-Bos@minez.nl Search for other works by this author on: GSW Google Scholar Seismological Research Letters (2019) 90 (3): 1145–1154. https://doi.org/10.1785/0220180337 Article history first online: 27 Mar 2019 Cite View This Citation Add to Citation Manager Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Search Site Citation Stefan Baisch, Christopher Koch, Annemarie Muntendam‐Bos; Traffic Light Systems: To What Extent Can Induced Seismicity Be Controlled?. Seismological Research Letters 2019;; 90 (3): 1145–1154. doi: https://doi.org/10.1785/0220180337 Download citation file: Ris (Zotero) Refmanager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentBy SocietySeismological Research Letters Search Advanced Search ABSTRACT In different subsurface energy technologies, traffic light systems (TLSs) have been implemented for limiting the strength of induced seismicity. Despite their widespread application, fundamental assumptions regarding the controllability of induced seismicity were usually not reviewed. This is the focus of the current article, in which we discuss limitations of a TLS in the context of seismicity induced by fluid injection and gas production.Most existing TLSs are based on a critical earthquake magnitude or vibration level that should be prevented to occur. Operational measures are defined to be taken after an induced earthquake exceeds predefined threshold values. This concept rests on the tacit assumptions that induced earthquakes of a critical strength announce themselves by precursory events of smaller strength and that future earthquakes of a critical strength can be prevented by modifying or stopping subsurface operations. We investigate to what extent these assumptions can be justified by studying observation data from a dozen fluid‐injection operations in geothermal reservoirs as well as from gas production in 26 gas fields in The Netherlands.In our case studies, whereas fluid injection–induced seismicity generally starts at a low‐magnitude level and exhibits a gradual temporal increase of the maximum earthquake magnitude with the duration of the injection, the largest magnitude event frequently occurs postinjection. The temporal evolution of the seismicity induced by gas production in The Netherlands is less systematic. In some gas fields, seismicity started at a comparatively large‐magnitude level (⁠ML≥2.7⁠) without detectable precursors. A correlation between seismic activity and the gas production rate is only observed in the largest gas field.Our findings indicate that the precision to what an earthquake of a given strength can be prevented by a TLS has more limitations than typically assumed. You do not have access to this content, please speak to your institutional administrator if you feel you should have access.