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"Unsere Väter hatten vielleicht noch die Zeit, sich zu beschäftigen mit den Idealen einer objektiven Wissenschaft und einer Kunst, die um ihrer selbst willen besteht. Wir dagegen befinden uns ganz eindeutig in einer Lage, in der nicht dieses oder jenes, sondern in der die Totalität unseres Lebens in Frage steht." - Diese Zeilen, die eine tiefe historische Kluft behaupten, welche die gefährliche Gegenwart der Moderne von der sekurierten Welt der Väter trennt, stammen aus dem 1932 veröffentlichten Buch 'Der Arbeiter. Gestalt und Herrschaft". Ihr Verfasser, der ehemalige Frontkämpfer und Autor Ernst Jünger, zieht in dieser in Kreisen der sogenannten "Konservativen Revolution" - diskursiv einflußreichen Schrift eine vorläufige Bilanz seiner nunmehr über zehn Jahre währenden Auseinandersetzung mit der Frage nach den Lebensbedingungen in der von ihm mit einer "mit Blut gespeisten Turbine" gleichgesetzten Moderne. Ihren Ausgangspunkt bei der Beschreibung und Analyse moderner Lebensverhältnisse nehmen Jüngers Überlegungen in dem mehr als dreihundert Seiten umfassenden Essay im Ersten Weltkrieg, jener epochalen "Urkatastrophe des 20. Jahrhunderts" mit ihrem für das deutsche Selbstverständnis so verheerenden Ausgang. Dieser Krieg wurde in Jüngers wie auch in vielen anderen deutschsprachigen Texten der nachwilhelminischen Ära - zu denken ist hier zum Beispiel an Thomas Manns 'Der Zauberberg', an Robert Musils 'Der Mann ohne Eigenschaften' oder auch an Oswald Spenglers 'Der Untergang des Abendlandes' - als eine tiefgreifende Schwellenerfahrung gedeutet, die das lange 19. Jahrhundert vom nun angebrochenen 20. Jahrhundert trenne und die gezeigt habe, daß das in den letzten beiden Jahrzehnten von soziokulturellen und politischen Umwälzungen schwer gezeichnete Europa in ein neues, postliberales Zeitalter eingetreten sei. "Dem Zustand, den der Krieg hinterlassen hat," so Jüngers Resümee in der Endphase der Weimarer Republik, "ist ein seltsamer Gegensatz eigentümlich zwischen der Lage des Menschen und den Mitteln, über die er verfügt. Man hat sich daran gewöhnt, in Erscheinungen wie der Arbeitslosigkeit, der Wohnungsnot, dem Versagen der Industrie und Wirtschaft eine Art von Naturereignis zu sehen. Diese Erscheinungen sind jedoch nichts anderes als Symptome für den Verfall der liberalen Ordnung."
Background: Mild therapeutic hypothermia following cardiac arrest is neuroprotective, but its effect on myocardial dysfunction that is a critical issue following resuscitation is not clear. This study sought to examine whether hypothermia and the combination of hypothermia and pharmacological postconditioning are cardioprotective in a model of cardiopulmonary resuscitation following acute myocardial ischemia. Methodology/Principal Findings: Thirty pigs (28–34 kg) were subjected to cardiac arrest following left anterior descending coronary artery ischemia. After 7 minutes of ventricular fibrillation and 2 minutes of basic life support, advanced cardiac life support was started according to the current AHA guidelines. After successful return of spontaneous circulation (n = 21), coronary perfusion was reestablished after 60 minutes of occlusion, and animals were randomized to either normothermia at 38°C, hypothermia at 33°C or hypothermia at 33°C combined with sevoflurane (each group n = 7) for 24 hours. The effects on cardiac damage especially on inflammation, apoptosis, and remodeling were studied using cellular and molecular approaches. Five animals were sham operated. Animals treated with hypothermia had lower troponin T levels (p<0.01), reduced infarct size (34±7 versus 57±12%; p<0.05) and improved left ventricular function compared to normothermia (p<0.05). Hypothermia was associated with a reduction in: (i) immune cell infiltration, (ii) apoptosis, (iii) IL-1beta and IL-6 mRNA up-regulation, and (iv) IL-1beta protein expression (p<0.05). Moreover, decreased matrix metalloproteinase-9 activity was detected in the ischemic myocardium after treatment with mild hypothermia. Sevoflurane conferred additional protective effects although statistic significance was not reached. Conclusions/Significance: Hypothermia reduced myocardial damage and dysfunction after cardiopulmonary resuscitation possible via a reduced rate of apoptosis and pro-inflammatory cytokine expression.
Background: Incisional heia is a frequent complication of midline laparotomy. The use of mesh in hernia repair has been reported to lead to fewer recurrences compared to primary repair. However, in Ventral Hernia Working Group (VHWG) Grade 3 hernia patients, whose hernia is potentially contaminated, synthetic mesh is prone to infection. There is a strong preference for resorbable biological mesh in contaminated fields, since it is more able to resist infection, and because it is fully resorbed, the chance of a foreign body reaction is reduced. However, when not crosslinked, biological resorbable mesh products tend to degrade too quickly to facilitate native cellular ingrowth. Phasix™ Mesh is a biosynthetic mesh with both the biocompatibility and resorbability of a biological mesh and the mechanical strength of a synthetic mesh. This multi-center single-arm study aims to collect data on safety and performance of Phasix™ Mesh in Grade 3 hernia patients.
Methods: A total of 85 VHWG Grade 3 hernia patients will be treated with Phasix™ Mesh in 15 sites across Europe. The primary outcome is Surgical Site Occurrence (SSO) including hematoma, seroma, infection, dehiscence and fistula formation (requiring intervention) through 3 months. Secondary outcomes include recurrence, infection and quality of life related outcomes after 24 months. Follow-up visits will be at drain removal (if drains were not placed, then on discharge or staple removal instead) and in the 1st, 3rd, 6th, 12th, 18th and 24th month after surgery.
Conclusion: Based on evidence from this clinical study Depending on the results this clinical study will yield, Phasix™ Mesh may become a preferred treatment option in VHWG Grade 3 patients.
Trial registration: The trial was registered on March 25, 2016 on clinicaltrials.gov: NCT02720042.
Introduction: Information on the long-term performance of biosynthetic meshes is scarce. This study analyses the performance of biosynthetic mesh (Phasix™) over 24 months.
Methods: A prospective, international European multi-center trial is described. Adult patients with a Ventral Hernia Working Group (VHWG) grade 3 incisional hernia larger than 10 cm2, scheduled for elective repair, were included. Biosynthetic mesh was placed in sublay position. Short-term outcomes included 3-month surgical site occurrences (SSO), and long-term outcomes comprised hernia recurrence, reoperation, and quality of life assessments until 24 months.
Results: Eighty-four patients were treated with biosynthetic mesh. Twenty-two patients (26.2%) developed 34 SSOs, of which 32 occurred within 3 months (primary endpoint). Eight patients (11.0%) developed a hernia recurrence. In 13 patients (15.5%), 14 reoperations took place, of which 6 were performed for hernia recurrence (42.9%), 3 for mesh infection (21.4%), and in 7 of which the mesh was explanted (50%). Compared to baseline, quality of life outcomes showed no significant difference after 24 months. Despite theoretical resorption, 10.7% of patients reported presence of mesh sensation in daily life 24 months after surgery.
Conclusion: After 2 years of follow-up, hernia repair with biosynthetic mesh shows manageable SSO rates and favorable recurrence rates in VHWG grade 3 patients. No statistically significant improvement in quality of life or reduction of pain was observed. Few patients report lasting presence of mesh sensation. Results of biosynthetic mesh after longer periods of follow-up on recurrences and remodeling will provide further valuable information to make clear recommendations.
Trial registration: Registered on clinicaltrials.gov (NCT02720042), March 25, 2016.
Background: Previous experimental research on testosterone (T) and psychological traits is inconclusive. Thus, we performed the first large-scale observational study of the association between T and dispositional optimism / pessimism.
Methods: We used prospective data from 6,493 primary-care patients (3,840 women) of the DETECT study (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment), including repeated immunoassay-based measurement of serum T and optimism / pessimism assessed by the revised Life-Orientation Test (LOT-R). Cross-sectional and longitudinal associations of baseline T and one-year change in T with optimism and pessimism were investigated using age- and multivariable-adjusted regression models.
Results: Cross-sectional analyses showed no association of T with optimism or pessimism in both sexes. Longitudinal analyses also showed no association of baseline T with optimism or pessimism at four-year follow-up. Multivariable analyses of total LOT-R score yielded similarly non-significant results (β-coefficient per unit change in T for men: -0.01 (95% CI: -0.24–0.22), women: 0.08 (-0.03–0.20)). Furthermore, change in T was not related to optimism or pessimism at four-year follow-up.
Conclusions: The present observational study of a large-scale prospective sample showed no association of T with optimism or pessimism. Integrating further experimental and interventional evidence from alternative methodological approaches would strengthen this conclusion and establish stronger evidence about the potential hormonal basis of psychological traits.