bluuebunny/crossref_metadata_2025 huggingface dataset:
Donor polymer fluorination doubles the efficiency in non-fullerene organic photovoltaics
Authors: Bauer Nicole , Zhang Qianqian , Zhu Jingshuai , Peng Zhengxing , Yan Liang , Zhu Chenhui , Ade Harald , Zhan Xiaowei , You Wei
Published: October 2017

Donor polymer fluorination in ITIC-based device led to a large increase in the current and an efficiency twice that of the non-fluorinated polymer based device.
Bubble-supported engineering of hierarchical CuCo2S4 hollow spheres for enhanced electrochemical performance
Authors: You Huihui , Zhang Lei , Jiang Yinzhu , Shao Tianyan , Li Ming , Gong Jinlong
Published: October 2017

Hierarchical CuCo2S4 hollow spheres are constructed by continual aggregation and growth of CuCo2S4 nanocrystals on the surface of gas bubbles.
Cost-effective hole transporting material for stable and efficient perovskite solar cells with fill factors up to 82%
Authors: Guan Lei , Yin Xinxing , Zhao Dewei , Wang Changlei , An Qiaoshi , Yu Jiangsheng , Shrestha Niraj , Grice Corey R. , Awni Rasha A. , Yu Yue , Song Zhaoning , Zhou Jie , Meng Weiwei , Zhang Fujun , Ellingson Randy J. , Wang Jianbo , Tang Weihua , Yan Yanfa
Published: October 2017

A cost-effective truxene-based hole selective material has been facilely synthesized for efficient perovskite solar cells with 82% FFs.
Litchi-like Fe3O4@Fe-MOF capped with HAp gatekeepers for pH-triggered drug release and anticancer effect
Authors: Yang Yongmei , Xia Feng , Yang Ying , Gong Baoyou , Xie Anjian , Shen Yuhua , Zhu Manzhou
Published: October 2017

A novel litchi-like porous composite composed of a magnetic core, a tunable metal–organic framework (MOF) shell and a pH-sensitive hydroxyapatite (HAp) gatekeeper was successfully fabricated in this work.
Silver-doped keratin nanofibers preserve a titanium surface from biofilm contamination and favor soft-tissue healing
Authors: Cochis Andrea , Ferraris Sara , Sorrentino Rita , Azzimonti Barbara , Novara Chiara , Geobaldo Francesco , Truffa Giachet Francesca , Vineis Claudia , Varesano Alessio , Sayed Abdelgeliel Asmaa , Spriano Silvia , Rimondini Lia
Published: October 2017

Silver-doped keratin nanofibers coating prevents biofilm formation and improve fibroblasts repopulation on Ti surfaces.
Rapid synthesis of nitrogen doped carbon dots and their application as a label free sensor array for simultaneous discrimination of multiple proteins
Authors: Xu Shenghao , Su Zhengzhong , Zhang Zhuo , Nie Yongyin , Wang Jun , Ge Guanglu , Luo Xiliang
Published: October 2017

A label free sensor array for discriminating various proteins and distinguishing serums from rectal cancer patients, Alzheimer's disease patients and healthy people was developed by utilizing novel nitrogen doped carbon dots.
Robust and thermoplastic hydrogels with surface micro-patterns for highly oriented growth of osteoblasts
Authors: Guo Jinhua , Duan Jiangjiang , Wu Shuangquan , Guo Jingmei , Huang Cui , Zhang Lina
Published: October 2017

Robust and thermoplastic hydrogels combining the sol–gel transition behaviours of agarose and the double networks were constructed.
Platinum(ii) acetylide complexes with star- and V-shaped configurations possessing good trade-off between optical transparency and optical power limiting performance
Authors: Yao C. , Tian Z. , Jin D. , Zhao F. , Sun Y. , Yang X. , Zhou G. , Wong W.-Y.
Published: October 2017

Two series of Pt(ii) acetylide complexes containing dimesitylborane and phenyl terminal groups with star- and V-shaped configurations were synthesized.
Flexible, transparent and high dielectric-constant fluoropolymer-based nanocomposites with a fluoride-constructed interfacial structure
Authors: Li Li , Feng Rui , Zhang Yang , Dong Lijie
Published: October 2017

A fluoride-constructed interfacial structure is formed for manipulating crystallization of the semicrystalline fluoropolymer comprising ultra-small SiO2 nanoparticles, contributing to high dielectric constant dielectrics with excellent flexibility and transparency.
High-efficiency dispersion and sorting of single-walled carbon nanotubes via non-covalent interactions
Authors: Liang Liyuan , Xie Wanyi , Fang Shaoxi , He Feng , Yin Bohua , Tlili Chaker , Wang Deqiang , Qiu Song , Li Qingwen
Published: October 2017

Single-walled carbon nanotubes (SWCNTs) have attracted great attention on account of their superior and tunable electrical properties for promising applications in low-cost and high-performance nano-electronics and thin-film devices.
2 × 3.2 Gb/s single‐ended IO transmitter with low‐power dynamic FIR driver for the LPDDR4 standard
Authors: Kim S. , Oh T.
Published: October 2017

A novel FIR driver that can be applied to a low power mode in the (Low Power Double Data Rate 4) LPDDR4 standard has been developed. The proto‐type transmitter architecture is implemented in 45 nm CMOS process and occupies 0.009 mm2 area. The pre‐emphasis tap weighting improves the eye opening by 27.9% vertically and 27% horizontally, respectively, and the transmitter consumes only 2.25 mW at 3.2 Gb/s.
Uncertainty propagation in PMU‐based transmission line monitoring
Authors: Tuttelberg Kaur , Kilter Jako
Published: October 2017

This study analyses the uncertainties of synchronised phasor measurement‐based transmission line monitoring applications. Uncertainty propagation is analysed in order to assess confidence in the accuracy of such monitoring applications and explain how systematic measurement errors affect the monitored quantities. Estimation of transmission losses and transmission line parameters is analysed as examples. The uncertainty analysis considers the entire measurement chain, i.e. it includes the measurement errors of instrument transformers and phasor measurement units (PMUs) and the propagation of resulting uncertainties into quantities of interest. The study adopts the principles of evaluating the uncertainties and their propagation in complex (i.e. two‐dimensional) quantities, as this would be the most appropriate approach for phasors that can have different uncertainties in magnitude and angle. The study demonstrates how uncertainties of measured voltages and currents are propagated into the estimated quantities and what accuracy can be expected from such monitoring applications in a common transmission system setting. The study also helps to understand better what causes most of the uncertainty (and inaccuracy) in particular quantities of interest. The analysis is carried out on real PMU measurements of an operating transmission line.
Creeping discharges features propagating in air at atmospheric pressure on various materials under positive lightning impulse voltage – part 1: noise suppression using the discrete wavelet transform approach
Authors: Douar Mohammed Adnane , Beroual Abderrahmane , Souche Xavier
Published: October 2017

The acquisition of discharges data is usually affected by external interference leading to erroneous interpretations. In the viewpoint of improving computation accuracy, the discrete wavelet transform (DWT) has been used as an effective tool for de‐noising purposes. In this study, creeping discharges waveforms have been investigated under the positive lightning impulse voltage over various materials. The used polymers belong to three distinct families (i) thermoplastics (namely polyamide 6 and polyamide 66), (ii) one filled cycloaliphatic epoxy resin and (iii) one unfilled ethylene propylene diene monomer(EPDM). Two approaches namely one‐dimensional (1D) and 2D DWT algorithms have been adopted for de‐noising signals and images, respectively. Both techniques were applied for simulated and laboratory data using various wavelet families (Daubechies, Symlet and Coiflet). The comparison of de‐noising performance for signals has been achieved through the calculation of signal‐to‐noise ratio, normalised correlation coefficient (Norm_corr) and root mean squared errors. Moreover, the computation of power spectral density of lightning current transients using a periodogram estimator is also analysed. For images, mean square error and peak‐signal‐to‐noise ratio assess the quality of filtering regarding the visualisation of discharges patterns. Results show that Coiflet wavelets demonstrate their effectiveness to reduce background noise and preserve the signals shape and images edges.
Optimal sizing of a wind/solar/battery hybrid grid‐connected microgrid system
Authors: Akram Umer , Khalid Muhammad , Shafiq Saifullah
Published: October 2017

Higher cost and stochastic nature of intermittent renewable energy (RE) resources complicate their planning, integration and operation of electric power system. Therefore, it is critical to determine the appropriate sizes of RE sources and associated energy storage for efficient, economic and reliable operation of electric power system. In this study, two constraint‐based iterative search algorithms are proposed for optimal sizing of the wind turbine (WT), solar photovoltaic (PV) and the battery energy storage system (BESS) in the grid‐connected configuration of a microgrid. The first algorithm, named as sources sizing algorithm, determines the optimal sizes of RE sources while the second algorithm, called as battery sizing algorithm, determines the optimal capacity of BESS. These algorithms are mainly based upon two key essentials, i.e. maximum reliability and minimum cost. The proposed methodology aims to avoid over‐ and under‐sizing by searching every possible solution in the given search space. Moreover, it considers the forced outage rates of PV, WT and utilisation factor of BESS which makes it more realistic. Simulation results depict the effectiveness of the proposed approach.
Efficient implementation of the ML estimator for high‐resolution angle estimation in an unmanned ground vehicle
Authors: Kim Eun Hee , Kim Ki Hyun
Published: October 2017

Using a maximum‐likelihood (ML) estimator for high‐resolution angle estimation is well‐suited for automotive radars. It is superior to other estimators in cases of small antenna aperture, small samples, and correlated signals. However, the computing power it requires prevents its widespread implementation. In this study, the authors propose a novel implementation method of the ML estimator that achieves appropriate memory requirements and computational costs by defining new variables. The proposed method is appropriate for practical implementation because calculation of the objective function is based only on independent multiply–add operations and can be easily parallelised. Real measured data from their radar of an unmanned ground vehicle system demonstrates the performance of the proposed method. Experimental results show that the proposed ML estimator is more robust than the conventional MUltiple SIgnal Classification method under conditions of low signal‐to‐noise ratio and a small number of snapshots.
Structure of sunspot light bridges in the chromosphere and transition region
Authors: Rezaei R.
Published: October 2017

Context. Light bridges (LBs) are elongated structures with enhanced intensity embedded in sunspot umbra and pores.

Aims. We studied the properties of a sample of 60 LBs observed with the Interface Region Imaging Spectrograph (IRIS).

Methods. Using IRIS near- and far-ultraviolet spectra, we measured the line intensity, width, and Doppler shift; followed traces of LBs in the chromosphere and transition region (TR); and compared LB parameters with umbra and quiet Sun.

Results. There is a systematic emission enhancement in LBs compared to nearby umbra from the photosphere up to the TR. Light bridges are systematically displaced toward the solar limb at higher layers: the amount of the displacement at one solar radius compares well with the typical height of the chromosphere and TR. The intensity of the LB sample compared to the umbra sample peaks at the middle/upper chromosphere where they are almost permanently bright. Spectral lines emerging from the LBs are broader than the nearby umbra. The systematic redshift of the Si iv line in the LB sample is reduced compared to the quiet Sun sample. We found a significant correlation between the line width of ions arising at temperatures from 3 × 104 to 1.5 × 105 K as there is also a strong spatial correlation among the line and continuum intensities. In addition, the intensity−line width relation holds for all spectral lines in this study. The correlations indicate that the cool and hot plasma in LBs are coupled.

Conclusions. Light bridges comprise multi-temperature and multi-disciplinary structures extending up to the TR. Diverse heating sources supply the energy and momentum to different layers, resulting in distinct dynamics in the photosphere, chromosphere, and TR.
Detailed chemical composition of classical Cepheids in the LMC cluster NGC 1866 and in the field of the SMC
Authors: Lemasle B. , Groenewegen M. A. T. , Grebel E. K. , Bono G. , Fiorentino G. , François P. , Inno L. , Kovtyukh V. V. , Matsunaga N. , Pedicelli S. , Primas F. , Pritchard J. , Romaniello M. , da Silva R.
Published: October 2017

Context. Cepheids are excellent tracers of young stellar populations. They play a crucial role in astrophysics as standard candles. The chemistry of classical Cepheids in the Milky Way is now quite well-known, however despite a much larger sample, the chemical composition of Magellanic Cepheids has been only scarcely investigated.

Aims. For the first time, we study the chemical composition of several Cepheids located in the same populous cluster: NGC 1866, in the Large Magellanic Cloud (LMC). To also investigate the chemical composition of Cepheids at lower metallicity, we look at four targets located in the Small Magellanic Cloud (SMC). Our sample allows us to increase the number of Cepheids with known metallicities in the LMC/SMC by 20%/25% and the number of Cepheids with detailed chemical composition in the LMC/SMC by 46%/50%.

Methods. We use canonical spectroscopic analysis to determine the chemical composition of Cepheids and provide abundances for a good number of α, iron-peak, and neutron-capture elements.

Results. We find that six Cepheids in the LMC cluster NGC 1866 have a very homogeneous chemical composition, also consistent with red giant branch (RGB) stars in the cluster. Period–age relations that include no or average rotation indicate that all the Cepheids in NGC 1866 have a similar age and therefore belong to the same stellar population. Our results are in good agreement with theoretical models accounting for luminosity and radial velocity variations. Using distances based on period-luminosity relations in the near- or mid-infrared, we investigate for the first time the metallicity distribution of the young population in the SMC in the depth direction. Preliminary results show no metallicity gradient along the SMC main body, but our sample is small and does not contain Cepheids in the inner few degrees of the SMC.
Revisiting nucleosynthesis in globular clusters
Authors: Prantzos N. , Charbonnel C. , Iliadis C.
Published: October 2017

Context. Motivated by recent reports concerning the observation of limited enrichment in He but excess K in stars of globular clusters, we revisit the H-burning conditions that lead to the chemical properties of multiple stellar populations in these systems.

Aims. In particular, we are interested in correlations of He and K with other elements, such as O, Na, Al, Mg and Si, reported in stars of NGC 2808.

Methods. We performed calculations of nucleosynthesis at constant temperature and density, exploring the temperature range of 25 to 200 × 106 K (25 to 200 MK), using a detailed nuclear reaction network and the most up-to-date nuclear reaction rates.

Results. We find that Mg is the most sensitive “thermometer” of hydrostatic H-burning conditions, pointing to a temperature range of 70–80 MK for NGC 2808, while He is a lesser – but not negligible – constraint. Potassium can be produced at the levels reported for NGC 2808 at temperatures >180 MK and Si at T > 80 MK. However, in the former temperature range Al and Na are totally destroyed and no correlation can be obtained, in contrast to the reported observations. None of the putative polluter sources proposed so far seem to satisfy the ensemble of nucleosynthesis constraints.
Suppliers selection problem with quantity discounts and price changes: A heuristic approach
Authors: Rodrigues Filipe , Requejo Cristina
Published: October 2017

This paper addresses a complex suppliers selection problem with multiple products, considering minimum package quantities, minimum order values related to delivery costs and discounted pricing schemes. Its main contribution is to present an integer linear programming (ILP) model for this suppliers selection problem as well as a model to analyse the impact of prices change. Furthermore, a hybrid heuristic and a genetic algorithm to obtain feasible solutions for this problem are presented. Several randomly generated examples are solved by using the above two models and the heuristic approaches. Experimental results demonstrate the robustness of the genetic algorithm and allow to realize which are the most important decisions in the suppliers selection problem.
Implementation of a parametric procedure allowing efficient positioning of heat sources: application to high-temperature composites thermoforming process
Authors: Jebara Moaine , Belhabib Sofiane , Boillereaux Lionel , Havet Michel , Sarda Alain , Mousseau Pierre , Deterre Rémi
Published: October 2017

This work describes the implementation of a simple procedure that helps to easily position the heating elements in press plates used in high-temperature composites thermoforming process. The developed method permits to obtain desired temperature profiles on the surface of the press plates through two main steps. The first step consists in finding out an appropriate parametric curve that defines the spatial location of the heating sources into the thickness of the press heating plates. The second step uses an inverse method that combines a stochastic optimization algorithm in conjunction with finite element simulations. This second step serves for the adjustment of the position curve parameters to obtain a simulated temperature profile as close as possible to the expected one at the press plates surface. This easy-to-implement approach is shown to be very effective to rapidly obtain a suitable location of the heat sources that minimizes energy consumption.
Copper-Catalyzed Simultaneous Activation of C–H and N–H Bonds: Three-Component One-Pot Cascade Synthesis of Multi­substituted Imidazoles
Authors: Melone Lucio , Chaskar Atul , Pardeshi Sachin , Sathe Pratima , Vadagaonkar Kamlesh
Published: October 2017

A copper-catalyzed expedient, practical, and straightforward approach for the one-pot three-component modular synthesis of multisubstituted imidazoles has been described by using arylacetic acids, N-arylbenzamidines, and nitroalkanes. The reaction involves simultaneous activation of C–H and N–H bonds of arylacetic acids and N-arylbenzamidines, respectively. The use of inexpensive copper sulfate as a catalyst, readily available starting materials, and Celite-free workup makes this protocol economically viable. Multisubstituted imidazoles were obtained in moderate to good yields with significant functional group tolerance and high regioselectivity.
Patient Factors Associated with Failure of Flap Coverage Used during Revision Total Knee Arthroplasty
Authors: Gad Bishoy , Styron Joseph , Goergy Mark , Klika Alison , Barsoum Wael , Higuera Carlos
Published: October 2017

Revision total knee arthroplasty (rTKA) is a challenging problem in the setting of soft tissue defects. The purpose of this study was to evaluate patients who underwent rTKA requiring flap coverage and determine patient factors that predisposed them to failure. Forty-three consecutive patients (mean follow-up, 46.5 months) who underwent rTKA requiring flap coverage were retrospectively reviewed between January 1, 2000 and December 31, 2010. Sixteen of 43 patients experienced failure requiring either flap revision (n = 2) or above the knee amputation (n = 14). Patients with heart failure (p = 0.008), cancer (p = 0.049), or infection with Klebsiella pneumoniae (p = 0.002) had greater rates of failure. Smoking (p = 0.287), diabetes (p = 0.631), and flap type (p = 0.634, p = 0.801) were not associated with increased failure. Mean survival was 46.4 months. Survival of patients with a history of cancer (34.3 months) was less (p = 0.033) than those without (49.2 months). Flap coverage in rTKA is a viable limb salvage option for patients with soft tissue defects; however, failure rates are much higher than in patients not requiring flap coverage.
Factors and Outcomes of Persistent Pulmonary Hypertension of the Newborn Associated with Acute Kidney Injury in Thai Neonates
Authors: Kamolvisit Wuttichart , Jaroensri Sutthikiat , Ratchatapantanakorn Benthira , Nakwan Narongsak
Published: October 2017

Objective This study aims to determine the risk factors and outcome of persistent pulmonary hypertension of the newborn (PPHN)-associated acute kidney injury (AKI).

Study Design Infants diagnosed with PPHN at Hat Yai Hospital from January 2012 to December 2016 were retrospectively reviewed.

Results Of the 109 included PPHN infants, 28.4% (31/109) died, and AKI was found in 28.4% following neonatal KDIGO classification. Of the 31, 19 who died (61.3%) reached stage 1, 3 (9.7%) reached stage 2, and 9 (29.0%) reached stage 3. AKI (all stages combined) was significantly associated with increased mortality with an odds ratio (OR) of 8.71 (95% confidence interval [CI], 3.37–22.49). Multivariate logistic regression analysis indicated that male gender (adjusted OR = 8.56; 95% CI = 0.84–85.09) and urine output of < 1 mL/kg/h in 12 hours of admission (adjusted OR = 15.57; 95% CI = 2.58–93.98) were the main factors associated with an increased risk for AKI, while birth by cesarean delivery was associated with reduced risk of AKI (adjusted OR = 0.10; 95% CI = 0.16–0.68).

Conclusion The incidence of AKI in PPHN was high in this study, and this complication was also significantly associated with higher mortality. In PPHN neonates, AKI should be especially closely monitored in males and infants who have a urine output of < 1 mL/kg/h in the first 12 hours of admission.
Cataract Video Coaching: Surgical Curriculum Enhancement in a U.S. Residency Program
Authors: Tucker Steven , Jones Jeremy , Aaron Maria , Khalifa Yousuf
Published: October 2017

The aim of this study was to examine the perceived utility of a video-coaching curriculum in cataract surgery training. This study took place in a conference room at the Emory University School of Medicine. This is an evaluation study using questionnaires after each resident's presentation. A curriculum was developed with a resident presenting surgical cases to a group of students, residents, and faculty. All participants filled out a survey focused on video coaching, performance, and an Objective Structured Assessment of Technical Skill (OSATS) evaluation. Thirteen presenting residents, 99 observing residents, and 35 faculty provided responses for 12 video-coaching sessions. The average OSATS score was lower for presenting residents (3.32) compared with observing residents (4.14) and faculty (4.20) (p < 0.01). All 13 presenting and 99 observing residents as well as all 35 faculty found benefit in video coaching with the subcategories of avoiding errors and overall performance rated as the most beneficial. All 13 presenting and 99 observing residents felt comfortable presenting cases with zero preferring an alternative setting. A formal surgical video-coaching curriculum in ophthalmology is a useful adjunct to traditional surgical curricula. There was a consensus that the curriculum was beneficial for cataract surgery preparation. All participants were comfortable taking part in the curriculum and none preferred an alternative curriculum.
Myelodyplastische Syndrome – Standards und neue Entwicklungen in Diagnostik und Therapie
Authors: Nolte Florian , Hofmann Wolf-Karsten
Published: October 2017

Was ist neu?

Klassifikation Die aktuelle WHO-Klassifikation hat die Nomenklatur der „refraktären Anämien“ zugunsten des Begriffs „myelodysplastisches Syndrom“ (MDS) verlassen. Da die medulläre Blastenateil im Falle einer Expansion der erythroiden Vorläuferzellen nicht mehr auf die nicht erythropoetischen Zellen bezogen wird, wird statt einer akuten myeloischen Leukämie M6 zukünftig ein MDS mit Exzess von Blasten diagnostiziert.

Diagnostik Erstmals wird mit der Mutation im SF3B1-Gen eine Genmutation als Diagnosekriterium berücksichtigt. Nur mit dieser ist eine vollständige und präzise Diagnostik und Klassifikation gemäß WHO neben Durchführung zytomorphologischer, zytochemischer und zytogentischer Analysen möglich.

Risikostratifikation Der revidierte IPSS-Fragebogen erlaubt eine differenziertere Risikoabschätzung, da auch selteneren zytogenetischen Veränderungen eine prognostische Relevanz zugeordnet werden kann.

Therapie Ergebnisse einer Phase-III-Studie zum Einsatz von Darbepoetin als erythropoese-stimulierende Substanz wurde kürzlich publiziert. Ob diese zur Zulassung der Substanz führen, muss abgewartet werden. Die Rolle der Eisenchelation bleibt nach wie vor kontrovers.

Neue therapeutische Ansätze Luspatercept, welches über eine Differenzierung erythroider Vorläuferzellen zu einem erythroiden Ansprechen bei Patienten mit Niedrig-Risiko-MDS insbesondere jenen mit Nachweis von Ringsideroblasten führen kann, wird aktuell in einer Phase-III-Studie untersucht. Die Rationale für eine Prüfung des Fas-Ligand-Inhibitors Asunercept im Rahmen klinischer Studien ist das Vorliegen eines proapoptotischen Milieus bei einem Teil der Patienten mit Niedrig-Risiko-MDS. Im Gegensatz dazu zielt Venetoclax als BCL2-Inhibitor auf einen Apoptoseblock bei Patienten mit Hoch-Risiko-MDS.
Management Vorhofflimmern – die aktualisierte ESC-Leitlinie 2016
Authors: Eckardt Lars , Wasmer Kristina
Published: October 2017

Was ist neu?

EKG-Diagnostik/Screening/Klassifikation Der Begriff „valvuläres Vorhofflimmern“ wird in der Leitlinie nicht mehr verwendet. Die Klassifikation von paroxysmalem und persistierendem Vorhofflimmern hat sich geringfügig geändert. Ein regelmäßiges, zufälliges Screening auf Vorhofflimmern nach dem 65. Lebensjahr sowie die Suche nach asymptomatischen atrialen Hochfrequenzepisoden bei Herzschrittmacherpatienten wird empfohlen. Die Beeinflussung kardiovaskulärer Risikofaktoren (u. a. Blutdruckeinstellung, Gewichtsreduktion) wird besonders betont. Für die Einteilung der Symptomatik hat sich die EHRA-Klassifikation geringfügig geändert.

Schlaganfallprävention Eine orale Antikoagulation wird für alle Männer mit einem CHA2DS2-VASc-Score von > 2 sowie Frauen mit einem CHA2DS2-VASc-Score > 3 empfohlen. Nicht-Vitamin-K-basierte orale Antikoagulanzien (NOAK) werden bei Neueinstellungen als Antikoagulanzien der ersten Wahl empfohlen. Vitamin-K-abhängige Antikoagulanzien (VKA) sollen primär lediglich zur Schlaganfallprophylaxe bei mittel- bis hochgradiger Mitralklappenstenose oder mechanischen Herzklappen eingesetzt werden. Nach jeder medikamentösen und/oder elektrischen Kardioversion sollte unabhängig vom CHA2DS2-VASc-Score eine zumindest 4-wöchige orale Antikoagulation erfolgen. Die Verwendung von Blutungs-Scores tritt gegenüber dem CHA2DS2-VASc-Score in den Hintergrund. Das weibliche Geschlecht ist als unabhängiger Risikofaktor abgewertet worden. Bei postoperativem Vorhofflimmern sollte eine dauerhafte orale Antikoagulation erwogen werden.

Frequenzregulierende und antiarrhythmische Therapie Digoxin sowie Diltiazem/Verapamil werden zur Frequenzregulation gleichwertig empfohlen. Eine Kardioversion kann unter einem NOAK ebenso wie unter einer VKA-Therapie erfolgen. Nach jeder medikamentösen/elektrischen Kardioversion ist unabhängig vom CHA2DS2-VASc-Score eine zumindest 4-wöchige Antikoagulation erforderlich. Bei der medikamentösen antiarrhythmischen Therapie richtet sich die Auswahl des Antiarrhythmikums nach einer evtl. vorhandenen kardialen Grunderkrankung. Chirurgische Ablationsverfahren wurden aufgewertet und sollen insbesondere bei persistierendem oder langanhaltendem persistierendem Vorhofflimmern erwogen werden. Bei der interventionellen Ablation werden die Cryo- und Radiofrequenzstrom-Ablation als gleichwertig betrachtet.
Individualisierte Therapie des metastasierten Lungenkarzinoms
Authors: Evers Georg , Mohr Michael , Kerkhoff Andrea , Lenz Georg , Wiewrodt Rainer , Schmidt Lars
Published: October 2017

Was ist neu?

Molekulare Therapieoptionen in der Erstlinie Tyrosinkinaseinhibitoren (TKI) stellen bei bestimmten Mutationen neben der Chemotherapie heute die zweite Therapiesäule des metastasierten nicht kleinzelligen Lungenkarzinoms dar. Für EGFR-TKI der dritten Generation liegen gute Ergebnisse vor, sie sind aber derzeit in Deutschland nicht zugelassen. Zweitgenerations-TKI (z. B. Ceritinib oder Alectinib) zeigen günstige Effekte in der Erstlinientherapie fortgeschrittener ALK-positiver NSCLC Patienten.

Immunonkologische Therapieansätze Als dritte therapeutische Säule für fortgeschrittene und metastasierte Lungenkarzinompatienten sind die Checkpointinhibitoren hinzugekommen. Neu ist Zulassung von Pembrolizumab in der Erstlinienbehandlung metastasierter NSCLC bei einer PD-L1-Expression.

Angiogeneseinhibition Angiogeneseinhibitoren wie Bevacizumab können bei ausgewählten Patienten zur Therapieintensivierung herangezogen werden. Auch in der Erst- und Zweitlinientherapie konnten günstige Effekte mit dem Zusatz eines Angiogeneseinhibitors im Vergleich zur Monotherapie erreicht werden.

Ausblick Es wird eine Erweiterung der Indikation für molekulare und immunonkologische Systemtherapien erwartet.
Burnout-Prävention und mobile Achtsamkeit: Evaluation eines appbasierten Gesundheitstrainings bei Berufstätigen
Authors: Möltner Hannah , Leve Jonas , Esch Tobias
Published: October 2017

Ziel Das Konzept der Achtsamkeit findet aktuell eine große Beachtung und das nicht allein im therapeutischen Umfeld, sondern auch in präventiven beruflichen Kontexten. Die vorliegende Studie untersucht die Wirksamkeit eines appbasierten Achtsamkeitstrainings in Bezug auf arbeits- und gesundheitsrelevante Indikatoren bei Berufstätigen.

Methodik An der Studie nahmen Berufstätige teil, die randomisiert einer Interventions- und einer Wartegruppe zugeteilt wurden. 146 Berufstätige der Interventionsgruppe nutzten die mobile Applikation ‚7mind‘ über einen Zeitraum von 14 Tagen. Verglichen wurden sie mit 160 Berufstätigen der Wartegruppe, die nach Abschluss der Studie ebenfalls Zugriff auf die App erhielten.

Ergebnisse Im Vergleich zur Wartegruppe zeigen sich bei der Interventionsgruppe nach dem 2-wöchigen Training in allen untersuchten Bereichen positive (signifikante) Effekte, z.T. mit großen Effektstärken: Die Nutzer und Nutzerinnen weisen höhere Werte in Bezug auf Achtsamkeit, Arbeitsengagement, Arbeitszufriedenheit, emotionale Intelligenz, Innovation und Kreativität sowie Selbstwirksamkeit und geringere Werte in der emotionalen Erschöpfung auf.

Schlussfolgerungen Klassische Achtsamkeitstrainings werden in Form von Gruppenkursen durchgeführt. Die vorliegende Studie zeigt, dass auch ein appbasiertes Training bei Berufstätigen positive Effekte mit arbeits- und gesundheitsbezogener Relevanz erzielt. Die mobile App bietet damit einen einfachen und flexiblen Einstieg zur Stärkung von Achtsamkeit, auch unter präventiv- und arbeitsmedizinischen Gesichtspunkten.
Pulmonalembolie trotz Rivaroxaban bei einer adipösen Patientin
Authors: Schuh Thomas , Stöllberger Claudia
Published: October 2017

Zusammenfassung Rivaroxaban, ein oraler Faktor Xa Inhibitor, ist zur Behandlung venöser Thromboembolien zugelassen. Es ist unklar, ob die Dosis bei einem Body-Mass-Index (BMI) > 40 kg/m2 ausreichend ist.

Anamnese Die 45-jährige Patientin wurde wegen zunehmender Atemnot stationär aufgenommen. In der Anamnese fand sich eine Pulmonalembolie vor 30 Monaten, eine Faktor V Leiden-Mutation und mehrere stationäre Aufenthalte wegen Dermatomykosen. Die Patientin stand unter einer oralen Antikoagulationsbehandlung mit Rivaroxaban 20 mg. Sechs Monate vor der Aufnahme hatte die Patientin wegen eines zahnärztlichen Eingriffs Rivaroxaban pausiert und eine Rezidiv-Pulmonalembolie erlitten.

Untersuchungen und Diagnose Im Status finden sich eine morbide Adipositas mit einem BMI von 59,3 kg/m2 und ein Intertrigo der unteren Extremitäten. Das EKG zeigte einen überdrehten Rechtstyp, ein P-Pulmonale und einen inkompletten Rechtsschenkelblock. Die Computertomografie der Lunge zeigte eine Thromboembolie im linken Unterlappen. Der Truncus pulmonalis war erweitert und der rechte Vorhof vergrößert. 16 Stunden nach Beginn der Symptomatik, 22 Stunden nach der letzten Einnahme, war die Plasmakonzentration von Rivaroxaban 137 ng/ml. Laut Hersteller soll die Plasmakonzentration nach 2 – 4 Stunden 22 – 535 ng/ml und nach 24 Stunden 6 – 239 ng/ml betragen.

Therapie und Verlauf Nach Einleitung einer Therapie mit niedermolekularem Heparin besserte sich die Atemnot. In den folgenden Tagen wurde eine Therapie mit Phenprocoumon begonnen und die Patientin nach 7 Tagen entlassen.

Folgerung Es lässt sich mit hoher Wahrscheinlichkeit vermuten, dass die Pulmonalembolie zu einem Zeitpunkt aufgetreten ist, in dem die Rivaroxaban-Plasmakonzentration in einem Bereich lag, der als therapeutisch angenommen wird. Da es nur wenige Daten über den Einsatz von Rivaroxaban und anderen nicht Vitamin-K-Antagonisten (NOAKs) bei Patienten mit morbider Adipositas gibt sollten die Empfehlungen der „International Society for Thrombosis and Haemostasis” befolgt werden: Rivaroxaban und andere NOAKs sollen bei Patienten mit einem BMI > 40 kg/m2 oder einem Gewicht > 120 kg nicht verwendet werden. Ist der Einsatz von NOAKs erforderlich, sollten Plasmakonzentrationen gemessen werden.
S2k-Leitlinie zur Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter
Authors: Feiterna-Sperling C. , Brinkmann F. , Adamczick C. , Ahrens F. , Barker M. , Berger C. , Berthold L. , Bogyi M. , von Both U. , Frischer T. , Haas W. , Hartmann P. , Hillemann D. , Hirsch F. , Kranzer K. , Kunitz F. , Maritz E. , Pizzulli A. , Ritz N. , Schlags R. , Spindler T. , Thee S. , Weizsäcker K.
Published: October 2017

Aktuelle epidemiologische Daten zeigen in den letzten Jahren einen Anstieg der Tuberkulose im Kindes- und Jugendalter. Es findet sich zudem auch in Deutschland ein Anstieg von Infektionen mit gegenüber Tuberkulosemedikamenten resistenten Erregern. In diesem Zusammenhang stellt die Diagnose, Prävention und Therapie der Tuberkulose vor allem im Kindesalter eine Herausforderung dar.

Leitlinien für die Diagnostik und Therapie der Tuberkulose im Erwachsenenalter können nicht generell auf das Kindesalter übertragen werden, da hier relevante altersabhängige Unterschiede bzgl. der Krankheitsprogression, Krankheitsmanifestation, Unterschiede in der Anwendung von diagnostischen Maßnahmen und der Therapie bestehen.

Unter Federführung der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) e. V. wurde die S2k-Leitlinie für die Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter verfasst, um die adäquate Versorgung von Kindern und Jugendlichen mit Tuberkulose-Exposition, Infektion oder Erkrankung nach neuesten wissenschaftlichen Erkenntnissen zu sichern.

Aktualisierte Dosierungsempfehlungen berücksichtigen die altersabhängige Pharmakokinetik in der Therapie der medikamentensensiblen, aber auch resistenten Tuberkulose. Darüber hinaus werden die Themen perinatale Exposition und Erkrankung sowie die im Kindesalter häufigeren extrapulmonalen Manifestationsformen gesondert behandelt.
Aggressive treatment of cerebral venous sinus thrombosis (CVT) with stent retrievers and local thrombolysis: why we
need a registry
Authors: Kowoll Christina Maria , Lockau Hannah , Dorn Franziska , Dohmen Christian
Published: October 2017

Purpose Anticoagulation is the first-line therapy for cerebral venous sinus thrombosis (CVT). Endovascular treatment is increasingly
applied in patients deteriorating despite anticoagulation with extensive thrombosis or contraindications for anticoagulation. Experience
with stent retrievers in CVT is limited.

Results We present three cases of severe CVT treated with stent-retrievers, thrombus aspiration and local thrombolysis. In two
patients with extensive thrombosis, a partial recanalization was achieved, but only one of them showed significant improvement. Despite
failed recanalization, the third patient recovered completely.

Conclusions Limited experience with three cases indicates that recanalization may not necessarily result in favourable clinical
outcome even in severely affected patients. Therefore, invasive procedures such as local thrombolysis and thrombectomy remain individual
therapeutic options when anticoagulation fails and in patients with extensive thrombosis.
Die Rolle des Eye Movement Desensitization and Reprocessing (EMDR) bei Substanzgebrauchsstörungen: Ein systematischer
Überblick
Authors: Pilz René , Hartleb Riccarda , Konrad Gabriela , Reininghaus Eva , Unterrainer Human Friedrich
Published: October 2017

Das Eye Movement Desensitization and Reprocessing (EMDR) ist eine therapeutische Methode, deren Wirksamkeit in der Behandlung von
traumatischen Erkrankungen gezeigt werden konnte. Seit der Annahme eines spezifischen Suchtgedächtnisses bildet EMDR auch für
Substanzgebrauchsstörungen einen eigenen Anwendungsbereich. Die vorliegende Überblicksarbeit fasst den aktuellen Forschungsstand zu
EMDR-Behandlungseffekten bei stoffgebundenen Abhängigkeitserkrankungen zusammen. Mithilfe der Datenbanken PubMed und PsychInfo wurde eine
systematische Literaturrecherche durchgeführt, wobei vier relevante Studien identifiziert wurden. Bei der Behandlung mit EMDR zeigte sich
eine Reduktion des Cravings, der Angst und der Depressionswerte, sowie eine Verbesserung der Emotionsregulierung und des Selbstwertgefühls.
Erste Ergebnisse verweisen auf das hohe therapeutische Potential von EMDR für den Bereich der Substanzgebrauchsstörungen
Allokation von Nieren im Eurotransplant Kidney Allocation
System (ETKAS)
Authors: Aßfalg Volker , Hüser Norbert , Heemann Uwe
Published: October 2017

In Zeiten anhaltend niedriger Organspendezahlen müssen neue Wege in der
Allokation von Nierentransplantaten gegangen werden. Notwendig ist dies zum
einen, um aus dem dramatisch angespannten Spenderpool ein Maximum an
Transplantationen zu erzielen, die darüber hinaus auch langfristig ein gutes
Transplantat-Outcome aufweisen sollen. Zum anderen gilt es, eine frühzeitige
Wiederaufnahme des Empfängers auf die Warteliste wegen des Verlusts des
Transplantats zu vermeiden. Eurotransplant hat inzwischen vielfältigen
Allokationswege von Nierentransplantaten etabliert, unter anderem die sogenannte
„High-urgency“-Nierentransplantation, die es aufgrund aktueller
Studienergebnisse vor dem Hintergrund des Organspendermangels medizinisch,
ethisch und gesundheitspolitisch neu zu bewerten gilt
Immunsuppression: Warum Blutspiegel schwanken und was wir
dagegen unternehmen können
Authors: Huber Monika , Wen Ming , Moog Philipp , Küchle Claudius , Schmaderer Christoph , Renders Lutz
Published: October 2017

Calcineurininhibitoren (CNIs) wie Tacrolimus und Ciclosporin und die
mTOR-Inhibitoren Everolimus und Sirolimus (mTOR: „mammalian target of
rapamycin“) gehören zu den Medikamenten, die eine enge therapeutische Breite
aufweisen. Deshalb wird ein regelmäßiges Monitoring ihrer Bluttalspiegel
empfohlen. Denn eine hohe intraindividuelle Variabilität (IPV: "intra-patient
variability") als Maß schwankender Bluttalspiegel ist mit einem reduzierten
Transplantatüberleben assoziiert. Ursächlich findet sich an erster Stelle die
Nichtadhärenz, gefolgt vom Einfluss durch die Nahrungsaufnahme oder Diarrhö.
Interaktionen mit Medikamenten, die ähnlich metabolisiert werden, inklusive
mancher Immunsuppressiva, können ebenso wie die Änderung der Galenik eine
erhöhte intraindividuelle Variabilität bewirken. Deshalb muss eine hohe IPV
individuell evaluiert werden, und Risikosituationen erfordern ein engmaschiges
Monitoring.
Curcumin Affects Adipose Tissue-Derived Mesenchymal Stem Cell Aging Through TERT Gene Expression
Authors: Pirmoradi Samaneh , Fathi Ezzatollah , Farahzadi Raheleh , Pilehvar-Soltanahmadi Younes , Zarghami Nosratollah
Published: October 2017

Aging and losing cell survival is one of the main problems in cell therapy. Aging of Mesenchymal Stem Cells (MSCs) is associated with a rise in intracellular reactive oxygen species, decrease in telomerase reverse transcriptase (TERT) expression and finally eroded telomere ends. Given that the production of free radicals in the aging process is effective, the use of antioxidants can help in scavenging free radicals and prevent the aging of cells. The aim of this study is to evaluate the effects of curcumin on proliferation, aging and TERT expression of rat adipose tissue-derived stem cells (rADSC). rADSCs were isolated from inguinal rat adipose tissue and their viabilities were assessed by MTT after exposure to different concentrations of curcumin. Flow-cytometry was performed for investigating the cell surface markers. Adipogenic and osteogenic differentiation were carried out to evaluate the pluripotency of rADSCs. Telomerase expression and percentage of senescent cells were evaluated using real-time PCR and senescence-associated β-galactosidase activity, respectively. The results demonstrated significant proliferation of rADSCs after 48 h treatment with 1 and 5 µM curcumin. Additionally, these concentrations could significantly reduce the population doubling time and aging of rADSCs at different passages. The findings of SA-ß-gal staining showed that curcumin significantly decreased the number of senescent cells in the 5 and 7 cell passages. Moreover, expression levels of TERT increased in the presence of 1 and 5 µM curcumin than control group (P<0.001). As a conclusion, curcumin may be a good candidate to improve lifespan of rADSCs through promoting TERT gene expression.
Erratum: Corrigendum: Advance directives and knowledge of future selves
Authors: Buford Christopher
Published: October 2017

Correction to: Palgrave Communications (2017) 3, Article number: 17077 doi: 10.1057/palcomms.2017.77; Published 22 Aug 2017; Updated 10 Oct 2017 The previous title was ‘Advanced directives and knowledge of future selves’. This has been updated to ‘Advance directives and knowledge of future selves’. Two instances on page 2 and one instance on page 3 of ‘advanced directive’ have been corrected to ‘advance directive’.
Rethinking higher education and its relationship with social inequalities: past knowledge, present state and future potential
Authors: Kromydas Theocharis
Published: October 2017

The purposes and impact of higher education on the economy and the broader society have been transformed through time in various ways. Higher education institutional and policy dynamics differ across time, but also between countries and political regimes and therefore context cannot be neglected. This article reviews the purpose of higher education and its institutional characteristics juxtaposing two, allegedly rival, conceptual frameworks; the instrumental and the intrinsic one. Various pedagogical traditions are critically reviewed and used as examples, which can potentially inform today’s policy making. Since, higher education cannot be seen as detached from all other lower levels of education appropriate conceptual links are offered throughout this article. Its significance lies on the organic synthesis of literature across social science, suggesting ways of going forward based on the traditions that already exist but seem underutilized so far because of overdependence in market-driven practices. This offers a new insight on how theories can inform policy making, through conceptual “bridging” and reconciliation. The debate on the purpose of higher education is placed under the context of the most recent developments of increasing social inequalities in the western world and its relation to the mass model of higher education and the relevant policy decisions for a continuous increase in participation. This article suggests that the current policy focus on labor market driven policies in higher education have led to an ever growing competition transforming this social institution to an ordinary market-place, where attainment and degrees are seen as a currency that can be converted to a labour market value. Education has become an instrument for economic progress moving away from its original role to provide context for human development. As a result, higher education becomes very expensive and even if policies are directed towards openness, in practice, just a few have the money to afford it. A shift toward a hybrid model, where the intrinsic purpose of higher education is equally acknowledged along with its instrumental purpose should be seen by policy makers as the way forward to create educational systems that are more inclusive and societies that are more knowledgeable and just.
Turbulent structures of non-Newtonian solutions containing rigid polymers
Authors: Mohammadtabar M. , Sanders R. S. , Ghaemi S.
Published: October 2017

The turbulent structure of a channel flow of Xanthan Gum (XG) polymer solution is experimentally investigated and compared with water flow at a Reynolds number of Re = 7200 (based on channel height and properties of water) and Reτ = 220 (based on channel height and friction velocity, uτ0). The polymer concentration is varied from 75, 100, and 125 ppm to reach the point of maximum drag reduction (MDR). Measurements are carried out using high-resolution, two-component Particle Image Velocimetry (PIV) to capture the inner and outer layer turbulence. The measurements showed that the logarithmic layer shifts away from the wall with increasing polymer concentration. The slopes of the mean velocity profile for flows containing 100 and 125 ppm XG are greater than that measured for XG at 75 ppm, which is parallel with the slope obtained for deionized water. The increase in slope results in thickening buffer layer. At MDR, the streamwise Reynolds stresses are as large as those of the Newtonian flow while the wall-normal Reynolds stresses and Reynolds shear stresses are significantly attenuated. The sweep-dominated region in the immediate vicinity of the wall extends further from the wall with increasing polymer concentration. The near-wall skewness intensifies towards positive streamwise fluctuations and covers a larger wall-normal length at larger drag reduction values. The quadrant analysis at y+  0 = 25 shows that the addition of polymers inclines the principal axis of v versus u plot to almost zero (horizontal) as the joint probability density function of fluctuations becomes symmetric with respect to the u axis at MDR. The reduction of turbulence production is mainly associated with the attenuation of the ejection motions. The spatial-correlation of the fluctuating velocity field shows that increasing the polymer concentration increases the spatial coherence of u fluctuations in the streamwise direction while they appear to have the opposite effect in the wall-normal direction. The proper orthogonal decomposition of velocity fluctuations shows that the inclined shear layer structure of Newtonian wall flows becomes horizontal at the MDR and does not contribute to turbulence production.