Miracle-dz/UniFAR-FTUs huggingface dataset:
Die Bedeutung der Proteinkinase C in der Pathophysiologie der diabetischen Retinopathie

Hyperglycemic control in diabetes mellitus is a major key to prevent the development and progression of diabetic retinopathy. One important pathomechanism in the development of diabetic complications is the activation of protein kinase C (PKC) induced by high glucose due to an increased diacylglycerol (DAG) level. Resulting vascular dysfunctions are increased vascular permeability and contractility, increased production of extracellular matrix and cell proliferation. The PKC isoenzyme family plays a fundamental role in the cellular signal transduction via phosphorylation and modification of enzymes, receptors, transcription factors and kinases. The PKC activation influences the gene transcription and ion transport. Different PKC isoenzymes function as mediators but also as inhibitors of the insulin effects. The hyperglycemia induced DAG production seems to predominantly activate PKC-beta in retinal vascular endothelial cells. The development of selective PKC-beta inhibitors enables new pharmacological therapeutical approaches for treatment of diabetic retinopathy. Ongoing clinical studies investigate if the treatment with specific PKC-beta inhibitors can prevent the progression of diabetic retinopathy and diabetic macular edema.
Randomized clinical trial on epidural versus patient-controlled analgesia for laparoscopic colorectal surgery within an enhanced recovery pathway.

OBJECTIVE To compare epidural analgesia (EDA) to patient-controlled opioid-based analgesia (PCA) in patients undergoing laparoscopic colorectal surgery. BACKGROUND EDA is mainstay of multimodal pain management within enhanced recovery pathways [enhanced recovery after surgery (ERAS)]. For laparoscopic colorectal resections, the benefit of epidurals remains debated. Some consider EDA as useful, whereas others perceive epidurals as unnecessary or even deleterious. METHODS A total of 128 patients undergoing elective laparoscopic colorectal resections were enrolled in a randomized clinical trial comparing EDA versus PCA. Primary end point was medical recovery. Overall complications, hospital stay, perioperative vasopressor requirements, and postoperative pain scores were secondary outcome measures. Analysis was performed according to the intention-to-treat principle. RESULTS Final analysis included 65 EDA patients and 57 PCA patients. Both groups were similar regarding baseline characteristics. Medical recovery required a median of 5 days (interquartile range [IQR], 3-7.5 days) in EDA patients and 4 days (IQR, 3-6 days) in the PCA group (P = 0.082). PCA patients had significantly less overall complications [19 (33%) vs 35 (54%); P = 0.029] but a similar hospital stay [5 days (IQR, 4-8 days) vs 7 days (IQR, 4.5-12 days); P = 0.434]. Significantly more EDA patients needed vasopressor treatment perioperatively (90% vs 74%, P = 0.018), the day of surgery (27% vs 4%, P < 0.001), and on postoperative day 1 (29% vs 4%, P < 0.001), whereas no difference in postoperative pain scores was noted. CONCLUSIONS Epidurals seem to slow down recovery after laparoscopic colorectal resections without adding obvious benefits. EDA can therefore not be recommended as part of ERAS pathways in laparoscopic colorectal surgery.
High aspect ratio SiNW arrays with Ag nanoparticles decoration for strong SERS detection

Well-ordered silicon nanowires (SiNWs) are applied as surface-enhanced Raman scattering (SERS) substrates. Laser interference lithography is used to fabricate large-area periodic nanostructures. By controlling the reaction time of metal assisted chemical etching, various aspect ratios of SiNWs are generated. Ag nanoparticles are decorated on the substrates via redox reaction to allow a good coverage of Ag over the SiNWs. As the height of the SiNWs increases, the light scattering inside the structures is enhanced. The number of the probing molecules within the detection volume is increased as well. These factors contribute to stronger light–matter interaction and thus lead to higher SERS signal intensity. However, the light trapping effect is more significant for higher SiNWs, which prevents the detection of the SERS signals. An optimized aspect ratio ∼5:1 (1 μm height and 200 nm width) for the SiNW array is found. The well-ordered SiNWs demonstrate better SERS signal intensity and uniformity than the randomly arranged SiNWs.
Validation of Complications Selected by Consensus to Evaluate the Acute Phase of Adult Trauma Care: A Multicenter Cohort Study

Objective: Evaluate the predictive validity of complications derived using expert consensus methodology to monitor the quality of trauma care. Secondary objectives were to assess the predictive validity of complications not selected by consensus and identify determinants of complications. Background: A list of complications to monitor the quality of trauma care has recently been derived using Delphi consensus methodology. However, the predictive validity of consensus complications has not yet been demonstrated. Methods: We conducted a multicenter cohort study of adults admitted to the 57 adult trauma centers of a Canadian integrated trauma system (2007–2012; n = 84,216). Multiple generalized linear models were used to assess the influence of complications on mortality and acute care length of stay (LOS) and to identify determinants of consensus complications. Results: The presence of at least 1 consensus complication was associated with a 2.7-fold [95% confidence interval (CI): 2.45–2.90] and 2.2-fold (95% CI: 2.11–2.19) increase in the odds of mortality and mean LOS, respectively. Nonselected complications were associated with no increase in mortality (odds ratio = 0.90, 95% CI: 0.80–1.01) and a 60% increase in LOS (geometric mean ratio = 1.60, 95% CI: 1.57–1.62). Patient-related factors and factors related to treatment explained 66% and 34% of the variation in complication rates, respectively. Conclusions: In addition to the face and content validity ensured by consensus methodology, this study suggests that consensus complications have good predictive validity. Monitoring these complications as part of quality improvement activities would provide an opportunity to improve outcome and resource use for injury admissions.
Assessing the multiscale architecture of muscular tissue with Q‐space magnetic resonance imaging: Review

Contraction of muscular tissue requires the synchronized shortening of myofibers arrayed in complex geometrical patterns. Imaging such myofiber patterns with diffusion‐weighted MRI reveals architectural ensembles that underlie force generation at the organ scale. Restricted proton diffusion is a stochastic process resulting from random translational motion that may be used to probe the directionality of myofibers in whole tissue. During diffusion‐weighted MRI, magnetic field gradients are applied to determine the directional dependence of proton diffusion through the analysis of a diffusional probability distribution function (PDF). The directions of principal (maximal) diffusion within the PDF are associated with similarly aligned diffusion maxima in adjacent voxels to derive multivoxel tracts. Diffusion‐weighted MRI with tractography thus constitutes a multiscale method for depicting patterns of cellular organization within biological tissues. We provide in this review, details of the method by which generalized Q‐space imaging is used to interrogate multidimensional diffusion space, and thereby to infer the organization of muscular tissue. Q‐space imaging derives the lowest possible angular separation of diffusion maxima by optimizing the conditions by which magnetic field gradients are applied to a given tissue. To illustrate, we present the methods and applications associated with Q‐space imaging of the multiscale myoarchitecture associated with the human and rodent tongues. These representations emphasize the intricate and continuous nature of muscle fiber organization and suggest a method to depict structural “blueprints” for skeletal and cardiac muscle tissue.
Pediatric Emergency Appendectomy and 30-Day Postoperative Outcomes in District General Hospitals and Specialist Pediatric Surgical Centers in England, April 2001 to March 2012: Retrospective Cohort Study.

OBJECTIVE To compare trends in pediatric emergency appendectomy and adverse surgical outcomes between district general hospitals (DGHs) and specialist pediatric centers (SPCs). BACKGROUND In the past decades in England, a significant reduction in the number of children operated by adult general surgeons has raised concerns about their surgical outcomes compared with specialist pediatric surgeons. METHODS Using Hospital Episode Statistics, we analyzed patient-level data between April 2001 and March 2012. Main inclusion criteria were children younger than 16 years admitted to NHS-England hospitals for an emergency appendectomy. Main outcomes were annual age-sex adjusted appendectomy rates and postoperative risk of readmission, complication, and reintervention. RESULTS A total of 83,679 emergency pediatric appendectomies were performed in 21 SPCs and 183 DGHs in England. SPCs performed only 18% of these operations (15,002). Annual age-sex standardized appendectomy rates fell from 87 to 68 per 100,000 population at an estimated 2% (rate ratio, 0.98) fall per annum. This was accompanied by a national annual increased risk of negative appendectomy, complication, reintervention, and readmission (adjusted odds ratio: 1.02, 1.03, 1.04, and 1.06, respectively). Children who had appendectomies in DGHs had 28% more negative appendectomies, 11% more complications, and 11% more readmissions than those in SPCs. Postoperative length of stay was double in SPCs compared with DGHs (median, 4 vs 2 days). CONCLUSIONS Major reductions in the number of pediatric emergency appendectomies in England over the past decade were associated with an overall increase in adverse surgical outcomes. Children operated in DGHs have more reinterventions, complications, and negative appendectomy rates than those operated in SPCs.
Effects of Bolus and Continuous Nasogastric Feeding on Gastric Emptying, Small Bowel Water Content, Superior Mesenteric Artery Blood Flow, and Plasma Hormone Concentrations in Healthy Adults

Objective:We aimed to demonstrate the effect of continuous or bolus nasogastric feeding on gastric emptying, small bowel water content, and splanchnic blood flow measured by magnetic resonance imaging (MRI) in the context of changes in plasma gastrointestinal hormone secretion. Background:Nasogastric/nasoenteral tube feeding is often complicated by diarrhea but the contribution of feeding strategy to the etiology is unclear. Methods:Twelve healthy adult male participants who underwent nasogastric intubation before a baseline MRI scan, received 400 mL of Resource Energy (Nestle) as a bolus over 5 minutes or continuously over 4 hours via pump in this randomized crossover study. Changes in gastric volume, small bowel water content, and superior mesenteric artery blood flow and velocity were measured over 4 hours using MRI and blood glucose and plasma concentrations of insulin, peptide YY, and ghrelin were assayed every 30 minutes. Results:Bolus nasogastric feeding led to significant elevations in gastric volume (P < 0.0001), superior mesenteric artery blood flow (P < 0.0001), and velocity (P = 0.0011) compared with continuous feeding. Both types of feeding reduced small bowel water content, although there was an increase in small bowel water content with bolus feeding after 90 minutes (P < 0.0068). Similarly, both types of feeding led to a fall in plasma ghrelin concentration although this fall was greater with bolus feeding (P < 0.0001). Bolus feeding also led to an increase in concentrations of insulin (P = 0.0024) and peptide YY (P < 0.0001), not seen with continuous feeding. Conclusion:Continuous nasogastric feeding does not increase small bowel water content, thus fluid flux within the small bowel is not a major contributor to the etiology of tube feeding-related diarrhea.
A Measure of Malpractice: Medical Injury, Malpractice Litigation, and Patient Compensation

For many years, proponents of alternative medical malpractice liability systems would illustrate the shortcomings of the present system with anecdotal evidence. However compelling these individual examples were, they could not and do not form a basis for intelligent discourse on malpractice policy considerations. A Measure of Malpractice recounts the Harvard Medical Practice Study and meets the need for such a systematic, empirical investigation. In dispassionate, painstaking detail, the specifics of a large number of hospital admissions in New York are recounted, along with subsequent medical negligence allegations and the response of both the medical and legal systems. Inpatient medical records documenting the care afforded to 30 000 hospitalized individuals were examined. Criteria were developed to identify not only adverse events, but also the subset of injuries that were the result of substandard medical care. The varying severity of injury in these adverse incidents was described, and comparative data were collected
Oncologic Outcomes of Single-incision Laparoscopic Surgery Compared With Conventional Laparoscopy for Colon Cancer

Objective:The aim of this study is to document perioperative results and mid-term oncologic outcomes of single-incision laparoscopic (SIL) colectomy compared to conventional laparoscopic (CL) colectomy. Background:SIL surgery is an advance in minimally invasive operative techniques and is widely accepted for various types of surgery. Methods:We prospectively collected data from 767 patients who underwent radical colectomy (250 SIL colectomy and 517 CL colectomy) between 2010 and 2011 due to primary colon cancer and retrospectively analyzed these patients with propensity score matching. Results:Before matching, patients with CL surgery had a significantly higher percentage of comorbidities (49.2% vs 57.8%, P = 0.024). Tumor location significantly differed between 2 groups: SIL surgery was performed more frequently in patients with right colon cancer. After propensity score matching, each group included 239 patients, and there was no difference between the SIL and CL surgery groups. Estimated blood loss was more in the patients with SIL colectomy, but the rate itself of intraoperative complications was not statistically different (P = 0.662). The median follow-up period was 37 months. There were 20 recurrences in the SIL surgery group (8.4%), including 3 locoregional recurrences and 18 (7.5%) in the CL surgery group. Disease-free survival at 48 months did not differ significantly between the SIL and CL surgery groups (89.8% vs 89.9%, P = 0.548). Conclusions:SIL colectomy for colon cancer shows probably higher, but an acceptable complication rate and can provide resection and oncologic outcomes equal to those of CL colectomy.
Perceptions of Very Old Adults About Informed Care in Medical Encounters

To the Editor: Cognitive, physical, and sensory limitations in older adults often limit informed decision-making in medical encounters. [1]However,older adults remaininterested in making informed healthcare choices,and patient-centered care will require innovations that promote engagement of older adults in care decisions. [2-3] The aim of this study was to determine the proportion of very old adults who felt adequately informed about their care following their most recent clinical encounter and identify correlates of informed care.
Dermal Neurovascular Dysfunction in Type 2 Diabetes

OBJECTIVE —To review evidence for a relationship between dermal neurovascular dysfunction and other components of the metabolic syndrome of type 2 diabetes. RESEARCH DESIGN AND METHODS —We review and present data supporting concepts relating dermal neurovascular function to prediabetes and the metabolic syndrome. Skin blood flow can be easily measured by laser Doppler techniques. RESULTS —Heat and gravity have been shown to have specific neural, nitrergic, and independent mediators to regulate skin blood flow. We describe data showing that this new tool identifies dermal neurovascular dysfunction in the majority of type 2 diabetic patients. The defect in skin vasodilation is detectable before the development of diabetes and is partially correctable with insulin sensitizers. This defect is associated with C-fiber dysfunction (i.e., the dermal neurovascular unit) and coexists with variables of the insulin resistance syndrome. The defect most likely results from an imbalance among the endogenous vasodilator compound nitric oxide, the vasodilator neuropeptides substance P and calcitonin gene-related peptide, and the vasoconstrictors angiotensin II and endothelin. Hypertension per se increases skin vasodilation and does not impair the responses to gravity, which is opposite to that of diabetes, suggesting that the effects of diabetes override and counteract those of hypertension. CONCLUSIONS —These observations suggest that dermal neurovascular function is largely regulated by peripheral C-fiber neurons and that dysregulation may be a component of the metabolic syndrome associated with type 2 diabetes.
Samenspender in Deutschland – liberaler als die Vorgaben des Berufsrechts?

In Germany, the Federal Medical Chamber advises against using donor insemination for lesbian and single women. Irrespective of the question of legitimacy, donors providing semen to these groups are not completely protected from legal paternity responsibilities. This study explores donors’ attitudes with regard to their willingness to donate for various groups, their attitudes towards information sharing and their knowledge of the legal implications. Thirteen of 15 semen banks were prepared to participate in this study. They were sent 153 questionnaires with 22 mainly closed questions. 63 (41 %) of the questionnaires were returned. Over half of the respondents agreed to donate for lesbian and single women. One third recommended parental disclosure, agreed for the doctor to provide information to offspring and were willing to be contacted by adult offspring. 60 % of the respondents assumed that they had no legal responsibilities towards their offspring. In this study, a large proportion of respondents are willing to donate for lesbian and single women. Apparently, semen donors’ attitudes are more liberal than specified by professional guidelines. However, the majority of donors assumes that they have no any legal responsibility towards the offspring. It is unclear whether their liberal attitude is based on incorrect legal assumptions or whether they are willing to donate for these groups despite the legal risks. Results indicate that the legal information provided to donors should be improved. This study also suggests challenging current guidelines and legislation, especially as research shows that the development of children growing up with lesbian and single women does not give cause for concern.
Ultraclean and large-area monolayer hexagonal boron nitride on Cu foil using chemical vapor deposition

Atomically thin hexagonal boron nitride (h-BN) has been demonstrated to be an excellent dielectric layer as well as an ideal van der Waals epitaxial substrate for fabrication of two-dimensional (2D) atomic layers and their vertical heterostructures. Although many groups have obtained large-scale monolayer h-BN through low pressure chemical vapor deposition (LPCVD), it is still a challenge to grow clean monolayers without the reduction of domain size. Here we report the synthesis of large-area (4 × 2 cm2) high quality monolayer h-BN with an ultraclean and unbroken surface on copper foil by using LPCVD. A detailed investigation of the key factors affecting growth and transfer of the monolayer was carried out in order to eliminate the adverse effects of impurity particles. Furthermore, an optimized transfer approach allowed the nondestructive and clean transfer of the monolayer from copper foil onto an arbitrary substrate, including a flexible substrate, under mild conditions. Atomic force microscopy indicated that the root-mean-square (RMS) roughness of the monolayer h-BN on SiO2 was less than 0.269 nm for areas with fewer wrinkles. Selective area electron diffraction analysis of the h-BN revealed a pattern of hexagonal diffraction spots, which unambiguously demonstrated its highly crystalline character. Our work paves the way toward the use of ultraclean and large-area monolayer h-BN as the dielectric layer in the fabrication of high performance electronic and optoelectronic devices for novel 2D atomic layer materials.
Ensemble effect of intrinsic defects and Mn ions on the enhancement of third order nonlinearity of ZnO nanoparticles

Mn doped ZnO nanoparticles were synthesized by the chemical co-precipitation method and XRD confirms the hexagonal structure of nanoparticles with good crystallinity. From TEM analysis, the average crystallite size of the nanoparticles is evaluated as 7–13 nm. All the prepared nanoparticles exhibit reverse saturable absorption in open aperture Z-scan measurements. The experimental data best fits for two-photon absorption along with saturable absorption and the obtained β values are found to be in the range of 0.3–0.5 × 10−10 m W−1. The enhancement of β upon increasing Mn concentration is attributed to the increase of absorption due to defect states created by Mn doping. EPR and PL measurements provide evidence of the presence of zinc vacancy defects. The self-defocusing nonlinearity exhibited in Mn doped ZnO nanoparticles at 532 nm indicates the reverse saturable absorption (RSA) based optical limiting behavior.
Levels of Acculturation of Chinese Older Adults in the Greater Chicago Area — The Population Study of Chinese Elderly in Chicago

Acculturation is a difficult process for minority older adults for a variety of reasons, including access and exposure to mainstream culture, competing ethnic identities, and linguistic ability and preference. There is a paucity of research regarding overall level of acculturation for Chinese older adults in the United States. This study aimed to provide an overall estimate of level of acculturation of Chinese older adults in the United States and to examine correlations between sociodemographic characteristics, self‐reported health measures, and level of acculturation. Data were collected through the Population Study of Chinese Elderly in Chicago (PINE) study. This community‐based participatory research study surveyed 3,159 Chinese older adults aged 60 and older. The PINE Study Acculturation Scale was used to assess level of acculturation in three dimensions: language preference, media use, and ethnic social relations. Mean acculturation level for all items was 15.3 ± 5.1, indicating low levels of acculturation. Older age, more offspring, lower income, fewer years living in the United States, lower overall health status, and lower quality of life were associated with lower levels of acculturation. Level of acculturation was low in Chinese older adults, and certain subsets of the population were more likely to have a lower level of acculturation. Future research should investigate causality and effects of level of acculturation.