bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative volumetrische Analyse der unteren Extremität:
Validierung gegenüber etablierter Maßbandmessung und
Wasserverdrängung
Authors: Koban Konstantin Christoph , Titze Virginia , Etzel Lucas , Frank Konstantin , Schenck Thilo , Giunta Riccardo
Published: January 2019

Hintergrund Zur Diagnostik und Therapieevaluation des Lip- und Lymphödems
werden im klinischen Alltag weiterhin Maßbandmessungen eingesetzt. Hierbei
werden ausgehend von standardisierten Umfangsmessungen im Bereich der
betroffenen Extremitäten deren Volumina errechnet. Andere Verfahren wie
Wasserverdrängung werden nicht regelhaft eingesetzt.

Ziel dieser Studie war die Erprobung eines 3D Scanners als alternatives und
reproduzierbares Tool zur objektiven Erfassung der Volumina der unteren
Extremität.

Patienten, Material und Methoden Wir führten an 20 Probanden 3D Scans der
unteren Extremitäten mit einem handelsüblichen 3D Scanner, dem Artec
Eva® durch, und errechneten das Volumen mit der dazugehörigen
Software. Das Volumen der Extremitäten wurde zudem gemäß standardisierter
Verfahren durch die Umfangsmethode (Konusmethode und Scheibenmethode) sowie per
Wasserverdrängungstechnik bestimmt. Die Ergebnisse sowie Durchführungsdauer der
drei Messmethoden wurde dokumentiert und statistisch ausgewertet.

Ergebnisse Mittels 3D Volumetrie zeigten sich keine signifikanten
Abweichungen zur Wasserverdrängung (p > 0,05). Die Konusmethode überschätzte
signifikant das in der Wasserverdrängung und 3D Volumetrie gemessene Volumen
deutlich. Die Scheibenmethode zeigte keine statistisch signifikanten
Abweichungen, jedoch klinisch relevant hohe Abweichungen mit einer ausgeprägten
Varianz im 95 % Konfidenzintervall. Alle Verfahren zeigten hohe positive
Korrelationen zueinander. Die Wasserverdrängung zeigte sich mit dem größten
zeitlichen Aufwand verbunden.

Schlussfolgerung Unserer Ergebnisse nach Untersuchung von 40 unteren
Extremitäten zeigen, dass durch 3D Scans und Software-basierte volumetrische
Berechnung in kurzer Zeit objektive und reproduzierbare Ergebnisse erzielt
werden können. Die Abweichung gegenüber dem Goldstandard
Recht(lich) bewegte Zeiten
Authors: Kämper Siegfried
Published: January 2019

Ärzte können gemäß einer Ausnahmeregelung in der DSGVO ohne ausdrückliche Einwilligung des Patienten Gesundheitsdaten verarbeiten. Heilpraktiker bisher noch nicht. Bis Ende 2020 können Heilpraktiker noch kosmetische Laserbehandlungen und Tattooentfernungen durchführen, ab 2021 nur noch medizinisch notwendige Laserbehandlungen. Laut eines kürzlich ergangenen Gerichtsurteils sollen bestimmte Eigenbluttherapievarianten unter das Transfusionsgesetz fallen und sind somit Heilpraktikern vorerst untersagt. Nicht so die homöopathische Eigenblutbehandlung.
Vermittlung von Patienten in eine Postakutbehandlung nach dem stationären qualifizierten Alkoholentzug
Authors: Buchholz Angela , Rosahl Anke , Spies Maren , Silkens Anna , Scherbaum Norbert , Reimer Jens , Hempleman Jochen , Röhrig Jeanette
Published: January 2019

Ziel der Studie Ziel dieser Studie war es, einen Eindruck über die klinische Praxis der Indikationsstellung und Empfehlung für eine Postakutbehandlung aus dem qualifizierten Alkoholentzug zu gewinnen. Im Einzelnen wurde untersucht, welche möglichen Barrieren für die Empfehlung und Planung einer geeigneten Postakutbehandlung aus Sicht der verantwortlichen Mitarbeiterinnen und Mitarbeiter im qualifizierten Alkoholentzug bestehen. Weiterhin wurde erfasst, welche Kriterien für die Indikationsstellung für Postakutbehandlungen in der klinischen Praxis als relevant erachtet werden.

Methodik Mit insgesamt 3 Erinnerungsrunden wurden 418 Kliniken mit dem Angebot einer stationären qualifizierten Alkoholentzugsbehandlung zu einer schriftlichen Befragung eingeladen. Die Teilnahme war sowohl online als auch schriftlich möglich und sollte von jeweils einem Mitarbeiter stellvertretend für die gesamte Station beantwortet werden. Die Befragung enthielt Fragen zu Barrieren für eine Weiterverweisung, der Bedeutung verschiedener Indikationskriterien sowie Fragen zur Einrichtungsstruktur.

Ergebnisse Von 88 antwortenden Einrichtungen (21% Rücklauf), gaben 81 Behandlungsplätze für den qualifizierten Alkoholentzug an und wurden in die deskriptive Auswertung einbezogen. Die meisten Teilnehmer sahen lange Wartezeiten auf eine psychotherapeutische Weiterbehandlung (65,4%), Rehabilitation (48,1%), fehlende Behandlungsangebote für schwer beeinträchtigte Patienten (61,7%) sowie die Klärung der Kostenübernahme (45,7%) als starke Barriere für die Vermittlung in eine Postakutbehandlung. Für eine differentielle Indikationsstellung wurden symptombezogene Kriterien wie die Schwere der Abhängigkeit und das Rückfallrisiko mit einem Mittelwert über 5 auf einer 6stufigen Skala als besonders relevant erachtet.

Schlussfolgerungen Die benannten Barrieren beziehen sich v. a. auf die Versorgungsorganisation und sollten vor dem Hintergrund aktueller struktureller Änderungen repliziert werden, um einen Vergleich zu ermöglichen. Eine stärkere Betonung auch teilhabeorientierter Kriterien für die Wahl einer Postakutbehandlung sollte angestrebt werden, um die Wiederherstellung der Teilhabe als langfristigem Behandlungsziel stärker zu betonen.
Yogatherapie in der Schwangerschaft
Authors: Gupta Hedwig H.
Published: January 2019

Studien belegen, dass Yoga Frauen während der Schwangerschaft physisch und
psychisch unterstützt. Es kann zur Prophylaxe eingesetzt werden, z. B. von
Rückenschmerzen. Als Therapie bietet Yoga eine sichere und effiziente Option in
allen Phasen der Schwangerschaft, beispielsweise bei Adaptationsstörungen,
Gestosen, drohendem Abort, pränataler Depression bis hin zum Gestationsdiabetes.
Wichtig ist die Auswahl und Anpassung der yogischen Techniken an die
individuelle Situation der schwangeren Frau.

Gemäß dem Konzept der ayurvedischen Medizin wird die Yogatherapie von
Empfehlungen zu Ernährung und Lebensstil begleitet.
Strategiewechsel durch Therapiestratifizierung – Downsizing von primär inoperablen Lebermetastasen bei 3 Patienten mit metastasierendem kolorektalen Karzinom
Authors: Holzhauer Peter , Grosse Christina
Published: January 2019

Durch Fortschritte und Weiterentwicklungen bei diagnostischen Verfahren, Operationstechniken und lokal ablativen sowie strahlentherapeutischen Maßnahmen haben sich die Behandlungsmöglichkeiten für Patienten mit primär nicht resektablen Metastasen von kolorektalen Karzinomen deutlich verbessert. Das gilt besonders für eine begrenzte Metastasierung, die nur ein Organ betrifft. Drei Falldarstellungen.
Chronischer Husten – Neue diagnostische
Perspektiven?
Authors: Koehler Ulrich , Hildebrandt Olaf , Walliczek-Dworschak Ute , Nikolaizik Wilfried , Weissflog Andreas , Urban Christof , Kerzel Sebastian , Sohrabi Keywan , Groß Volker
Published: January 2019

Chronischer Husten wird bisher größtenteils über rein subjektive Mittel erfasst
und beurteilt – zum Beispiel mithilfe von Fragebögen und/oder Tagebüchern. Die
subjektive Beurteilung stimmt jedoch oft nicht mit den objektiven Messdaten
überein. Bei Patienten mit chronischem Husten sollte daher die Basisdiagnostik
und Verlaufskontrolle jedweder medikamentösen Therapie einer Kombination aus
objektiven und subjektiven Kriterien unterzogen werden.
Einnahme der Plazenta – Nutzen und Risiken
Authors: Johnson Sophia K. , Pastuschek Jana , Rödel Jürgen , Markert Udo R. , Heimann Yvonne , Groten Tanja
Published: January 2019

Die Einnahme der eigenen Plazenta durch die Mutter im Wochenbett geht auf traditionelle Anwendungen in der abendländischen und asiatischen Komplementärmedizin zurück. Hebammen in der Wochenbettbetreuung sehen sich einer gestiegenen Nachfrage gegenüber, jedoch mangelt es an evidenzbasierten Empfehlungen zur sogenannten Plazentophagie. Die Autoren der vorliegenden Übersichtsarbeit recherchierten Risiken und potenziellen Nutzen, um die Einnahme der verarbeiteten Plazenta als Heilmittel im Wochenbett zu bewerten.
Ernährung von Frühgeborenen mit gespendeter Muttermilch
Authors: Klotz Daniel
Published: January 2019

Experten-Interview | Sehr unreife Frühgeborene und kranke Neugeborene profitieren besonders von der Ernährung mit Muttermilch. Doch gerade bei Müttern nach Frühgeburt ist die Laktation oft nicht ausreichend, um das eigene Kind mit Muttermilch zu versorgen. Die Frauenmilchbank des Universitätsklinikums Freiburg bietet diesen Müttern eine Ernährung ihres Babys mit gespendeter, kontrollierter, pasteurisierter und angereicherter Muttermilch an. Dr. med. Daniel Klotz über Herausforderungen der Gründung einer Frauenmilchbank, Vorteile für die versorgten Säuglinge und den tatsächlichen Bedarf in Deutschland.
Traditionelle Afrikanische Medizin bei Hypertonie – Eine klinische Validierung
Authors: Assane Diop ElHadji
Published: January 2019

Ein großer Teil der Bevölkerung der westafrikanischen Länder verwendet Pflanzen zur gezielten Behandlung von Krankheiten. Im Senegal trinken die Menschen seit über 100 Jahren regelmäßig Tee aus den Blütenkelchen von Hibiscus sabdariffa L. („Bissap“) und aus den Blättern von Combretum micranthum G. Don („Kinkeliba“). Bissap hat in der senegalesischen Küche und allgemein in westafrikanischen Ländern eine herausragende Bedeutung. Kinkeliba ist in vielen afrikanischen Sprachen als „Medizin“ beschrieben, sie gehört zu den wichtigsten Arzneipflanzen der lokalen Flora. Für beide Pflanzen ist eine diuretische Wirkung beschrieben, sie werden für entsprechende Arzneitees verwendet. Die antihypertensive Wirkung von Bissap ist bereits seit den 1990er-Jahren bekannt, vor 4 Jahren wurde sie auch für Kinkeliba beschrieben.

Die bisherigen Untersuchungen, insbesondere eine aktuelle randomisierte vergleichende Studie mit Ramipril, ergaben, dass sowohl Bissap als auch Kinkeliba bei leichter arterieller Hypertonie antihypertensiv wirksam und gut verträglich sind. Größere klinische Studien werden derzeit durchgeführt.
A Repeated-measures Case Series of Physiological Responses to a Transoceanic Rowing Race
Authors: Keohane David , Woods Trevor , McCarthy Yvonne , O'Connor Patrick , Underwood Sean , Molloy Michael
Published: January 2019

This repeated-measures case series describes the changes in cardiorespiratory fitness, body composition and systemic inflammation in 4 well-trained athletes pre- and post-completion of an unsupported transatlantic rowing race. The acute effects of endurance exercise have been well described previously, but the enduring consequences of ultra-endurance on the cardiorespiratory, metabolic and immune systems are largely unknown. This study explores these physiological adaptations following 2 weeks of recovery. Cardiorespiratory fitness testing, body composition analysis, and blood sampling for inflammatory cytokines were recorded immediately before race departure and repeated 14 days following race completion. Mean VO2max (ml/kg/min) was similar pre- (48.2±2.8) and post-race (46.7±1.5). Heart rate responses were equivalent at incremental workloads. Mean blood lactate (mmol/L) was higher at low to moderate power outputs and lower at maximal effort (14.6±1.85 vs. 13.1±2.5). Percentage body fat (17.7 ± 7.9 vs. 16.2±7.4) was analogous to pre-race analysis. Low-grade inflammation persisted, indicated by an increase in IL-1β (69%), IL-8 (10%), TNF-α (8%), IL-6 (5.4%), and C-reactive protein (22.4%). VO2max and heart rate responses were similar pre- and post-race, but sub-maximal efficiency measures of cardiorespiratory fitness were consistent with persistent fatigue. Body composition had returned to baseline but low-grade systemic inflammation persisted. Persistent pro-inflammatory cytokinaemia is known to exert deleterious consequences on immune, metabolic, and psychological function. Adequate recovery is necessary to re-establish inflammatory homeostasis, and the results of this study may inform these decisions.
Interdisziplinäre Versorgung reanimierter Patienten im
Kassel Center for Cardiac Arrest (KCCA)
Authors: Weber Klaus , Godau Jana , Reyher Christian , Beltschikow Wadim , Möller Michael , Gradaus Rainer , Bösel Julian , Peivandi Ali Asghar , Muellenbach Ralf Michael
Published: January 2019

Nach erfolgreicher prähospitaler Reanimation ist die Prognose quo ad restitutio
sehr ernst und bei Einlieferung unter laufender Reanimation gilt dies in
verschärfter Form. Die Kompetenz und fallzahlabhängige Erfahrung, sowie die
strukturellen und personellen Anforderungen sind essenziell für den
Therapieerfolg. Konsequente Interdisziplinarität und breit konsentierte
Behandlungspfade sind dabei entscheidende Faktoren. Das Klinikum Kassel hat die
Cardiac-Arrest-Center-Initiative des German Resuscitation Council aufgegriffen
und Ende 2017 für diese Ziele das Kassel Center for Cardiac Arrest (KCCA)
gegründet.
Der alte Mensch im Notfallzentrum
Authors: Groening Michael
Published: January 2019

Für die große Mehrheit alter Patienten ist die Zentrale Notaufnahme (ZNA) die
Eintrittspforte in die Klinik. Vorrangig gekennzeichnet ist der geriatrische
Patient durch meist mehrere chronische Erkrankungen. Die Mehrzahl der
geriatrischen Patienten nimmt eine Vielzahl von Medikamenten ein, was zu
zahlreichen Wechselwirkungen führt. Erschwerend kommt hinzu, dass der Organismus
eines hochbetagten Patienten anders funktioniert als bei einem jungen Menschen
und sich akute Erkrankungen im hohen Alter klinisch und laborchemisch anders
präsentieren. Am ehesten geeignet für geriatrische Patienten ist die Triage nach
dem Emergency Severity Index (ESI). Jedoch erfasst kein Triagesystem die
Besonderheiten des geriatrischen Notfallpatienten (Funktionalität, Risiken
etc.). Da die Zahl der älteren Menschen weiter steigen wird, müssen sich die
Notaufnahmen mit dem Thema beschäftigen. Durch ihre Notfallexpertise können sie
einen wertvollen Beitrag zur besseren Behandlung geriatrischer Patienten
leisten.
ASCO 2018: Neues in der pädiatrischen
Onkologie
Authors: Sparber-Sauer Monika , Bielack Stefan
Published: January 2019

Die Neuigkeiten beim ASCO 2018 im Bereich der pädiatrischen Onkologie sind
vielfältig. Die Therapien solider Tumoren und auch der Leukämien im Kindesalter
sind inzwischen sehr gut: bei akzeptabler akuter Toxizität ist ein 5-Jahres
ereignisfreies Überleben und Gesamtüberleben von inzwischen 80–90 % (je nach
onkologischer Erkrankung) erreichbar 1. Die
Herausforderungen dieser Zeit sind die Verhinderung von Rezidiven und die
Verminderung von Langzeitfolgen und auch Folgen für die Psyche. Mit
niedrigdosierten Erhaltungstherapien, mit neuen, möglichst spezifischen
ergänzenden Medikamenten wird versucht, bei gleichem Überleben diesen
Herausforderungen zu begegnen. So gibt es vielversprechende neue Therapieansätze
wie z. B. die Erhaltungstherapie bei den Rhabdomyosarkomen, dem der
Standardtherapie hinzugefügtem Nelarabine bei der T-Zell-Leukämie oder ein
alternatives Therapieregime bei dem Neuroblastom. Interessant sind Studien zur
Assoziation von sportlicher Betätigung und Spätmortalität sowie zur Verbesserung
psychosozialer Aspekte nach dem Überleben onkologischer Erkrankungen in der
Kindheit. Regelmäßige sportliche Betätigung verringert die Gesamtmortalität und
psychologische Interventionen können Denkmechanismen nach überlebter
onkologischer Erkrankung verbessern.
Intraluminal duodenal (“windsock”) diverticulum: a rare cause of biliary obstruction and acute pancreatitis in the adult
Authors: Karagyozov Petko , Tishkov Ivan , Georgieva Zhenya , Boeva Irina , Tzankov Dimitar
Published: January 2019

An intraluminal duodenal diverticulum (IDD) is a rare congenital anomaly, which is a result of incomplete recanalization of the foregut lumen during embryonic development. Most patients are asymptomatic. Symptoms usually occur after the third decade of life and mainly include epigastric pain, nausea, vomiting, or bloating. Less commonly, IDD may complicate with bleeding, duodenal obstruction, or acute pancreatitis. We present a case of IDD, manifested for a first time in adult with acute biliary obstruction and mild pancreatitis after laparoscopic cholecystectomy for acute calculous cholecystitis, successfully managed with endoscopic retrograde cholangiopancreatography (ERCP).
Novel PDE6B Mutation Presenting with Retinitis Pigmentosa – A Case Series of Three Patients
Authors: Palmowski-Wolfe Anja , Stingl Katarina , Habibi Imen , Schorderet Daniel , Tran Hoai
Published: January 2019

Background Retinitis pigmentosa (RP) affects 2.5 million people worldwide. Increased identification of causative gene defects and the increasing possibility of treatment necessitates better knowledge of phenotype-genotype correlations to help identify patients who would benefit from targeted gene therapy and improve patientsʼ care. Here, we report on three RP patients with mutations in the PDE6Β Gene that have not been described previously.

History and Signs Three patients with a PDE6Β mutation were identified: 1. A 30-year-old male with a homozygotous mutation (c.[2351dupA],[2351dupA], p.[Q785Gfs*20],[Q785Gfs*20]) who was followed for 8 years. 2. A 54-year-old Caucasian woman with a heterozygous mutation [p.(K611Nfs*6), p.(Q567*)] who was followed for 40 years. 3. A 46-year-old Caucasian male [p.(E271K), p.(R627_E631del)]. All had noted an onset in childhood and complained of night blindness and photophobia. Typical bone spiculae were seen, and peripheral visual fields were progressively affected in all patients. Ganzfeld-ERG showed typical signs of rod-cone dystrophy. Patients 1 and 2 underwent cataract surgery at ages 27 and 36 years with an improvement in vision, while patient 3 had not developed a cataract at age 54.

Conclusions In children complaining of night blindness, a PDE6Β-associated RP needs to be taken into consideration. Apart from helping patients with optical aids, such as polarizing filters or magnification, a specific diagnosis is especially important in view of emerging genetic treatment options. In particular, in RP patients with a PDE6Β mutation, a phase I/II study is currently ongoing (https://clinicaltrials.gov/ct2/show/NCT03328130).
Spinal Serotonin and 5HT6 Receptor Levels During Development of Neuropathy and Influence of Blockade of these Receptors on Thermal Hyperalgesia in Diabetic Mice
Authors: Sari Cagda Celik , Gunduz Ozgur , Ulugol Ahmet
Published: January 2019

Little is known about the role of 5-HT6 receptors in the pathophysiology of neuropathic pain. The aim of this study is firstly, to investigate the influence of spinal and systemic 5-HT6 receptors on thermal hyperalgesia, one of the most significant symptoms of neuropathy occurring in diabetes; and secondly to determine spinal lumbar serotonin and 5-HT6 receptor levels during development of diabetic neuropathy in mice. Diabetes was produced in Balb/c mice with a single injection of streptozocin (150 mg/kg, i.p.). Using the hot plate test, the 5-HT6 antagonist SB-258585 was given systemically (3, 10, 30 mg/kg) and intrathecally (0.01, 0.1, 1 nmol/mouse) to determine its effect on thermal hyperalgesia. Furthermore, on days 7 and 15 of diabetes, development of thermal hyperalgesia was evaluated in relation to changes in spinal serotonin and 5-HT6 receptor levels by using LC/MS/MS and Western blot analyses, respectively. Two-way analysis of variance and unpaired t-tests were used to evaluate data from hot-plate tests and 5-HT levels/ 5-HT6 receptor expression, respectively. Thermal hyperalgesia was observed in neuropathic mice, starting from day 5 after streptozocin administration. On day 15, systemic, but not intrathecal, SB-258585 attenuated thermal hyperalgesia in neuropathic mice. Spinal serotonin levels did not change during development of hyperalgesia after induction of diabetes, whereas spinal 5-HT6 receptor levels were significantly reduced on days 7 and 15. Our findings show that systemic, but not spinal, blockade of 5-HT6 receptors may exert antihyperalgesic effects in neuropathic mice and suggest that systemic 5-HT6 receptors contribute to the pathophysiology of diabetic neuropathy.
Cochlear Implantation for Single-Sided Deafness: Observations in Poor Performers
Authors: Mittmann Philipp , Ernst A. , Scholz S. , Battmer R. , Todt I.
Published: January 2019

Objectives Patients with single-sided deafness can nowadays receive a cochlear implant. A majority of these patients are well adapted and benefit from the implant. The aim of this study was to evaluate the reasons for poor performance in a group of patients with single-sided deafness, who received a cochlear implant.

Design A total of 65 patients were enrolled into a retrospective case series. Seven poor performers were present in the group. Freiburger monosyllabics, localization testing, and radiologic images were evaluated.

Results Localization testing showed the absence of lateralization ability in three patients, whereas the Freiburger monosyllabic word scores improved in three patients. One patient had no speech perception after 1 year of rehabilitation. Findings of magnetic resonance imaging (MRI) revealed cerebral involvement in five patients.

Conclusion Various factors influence the outcome in unilateral cochlear implantation in patients with single-sided deafness. These reasons may be preoperative, operative, or postoperative. Nevertheless, the majority of patients benefit from these implants.
Practical Synthesis of Precursors of Cyclohexyne and 1,2-Cyclohexadiene
Authors: Okano Kentaro , Nakura Ryo , Inoue Kazuki , Mori Atsunori
Published: January 2019

This study investigated a practical method for regiocontrolled synthesis of precursors of strained cyclohexynes and 1,2-cyclohexadienes, which is a one-pot procedure consisting of a rearrangement of silyl enol ether and subsequent formation of the enol triflates. Triethylsilyl enol ether, derived from cyclohexanone, was treated with a combination of LDA and t-BuOK in n-hexane/THF to encourage the migration of the silyl group to generate an α-silyl enolate. Subsequently, the α-silyl enolate was reacted with Comins’ reagent to yield the corresponding enol triflate. Finally, the α-silylated trisubstituted lithium enolate for the synthesis of 1,2-cyclohexadiene precursor was isomerized in the presence of a stoichiometric amount of water for one hour at room temperature to exclusively provide tetrasubstituted lithium enolate for the synthesis of cyclohexyne precursor in one pot.
Conformational Dynamics in Asymmetric Catalysis: Is Catalyst Flexibility a Design Element?
Authors: Crawford Jennifer , Sigman Matthew
Published: January 2019

Traditionally, highly selective low molecular weight catalysts have been designed to contain rigidifying structural elements. As a result, many proposed stereochemical models rely on steric repulsion for explaining the observed selectivity. Recently, as is the case for enzymatic systems, it has become apparent that some flexibility can be beneficial for imparting selectivity. Dynamic catalysts can reorganize to maximize attractive non-covalent interactions that stabilize the favored diastereomeric transition state, while minimizing repulsive non-covalent interactions for enhanced selectivity. This short review discusses catalyst conformational dynamics and how these effects have proven beneficial for a variety of catalyst classes, including tropos ligands, cinchona alkaloids, hydrogen-bond donating catalysts, and peptides.

1 Introduction

2 Tropos Ligands

3 Cinchona Alkaloids

4 Hydrogen-Bond Donating Catalysts

5 Peptide Catalysts

6 Conclusion
Alkali Metal Effects in Trans-Metal-Trapping (TMT): Comparing LiTMP with NaTMP in Cooperative MTMP/Ga(CH2SiMe3)3 Meta­lation Reactions
Authors: McLellan Ross , Uzelac Marina , Bole Leonie , Gil-Negrete Jose , Armstrong David , Kennedy Alan , Mulvey Robert , Hevia Eva
Published: January 2019

Stepwise metalation and trapping, so called trans-metal-trapping (TMT), of anisole is studied using LiTMP as base and Ga(CH2SiMe3)3 as trap. The isolated ‘trapped’ intermediate is also assessed in C–C bond forming reactions, highlighting the inherent advantages and remaining challenges of this system. The same base trap mixture is found to metallate N–Me bonds of the diamines TMEDA and PMDETA. Comparative studies replacing LiTMP by NaTMP have found significant alkali metal effects on the extent of both base-trap cocomplexation and onward reactivities of TMT products.
Gold Vinylidenes as Useful Intermediates in Synthetic Organic Chemistry
Authors: Gagosz Fabien
Published: January 2019

Gold vinylidenes have recently emerged as useful intermediates in synthetic organic chemistry. These species, which can principally be accessed by a 1,2-migration process from a gold-activated alkyne or by dual gold catalysis on a diyne substrate, can react with nucleophilic partners or by C–H insertion to produce a variety of functionalized (poly)cyclic compounds. This short review covers the synthetic approaches developed so far to access gold vinylidenes and the different reactivities these species can exhibit.

1 Introduction

2 1,2-Migration Processes

3 Dual Gold Catalysis

4 Other Processes

5 Conclusion
Palladium-Catalyzed C–H Bond Monofluorination of
2-Arylbenzo[d]oxazinone Using Nitrate as Crucial Promoter
Authors: Li Xu-Qin , Vu Huu-Manh , Chen Fei-Wu
Published: January 2019

Monofluorination of 2-arylbenzo[d]oxazinones with N-fluorobenzenesulfonimide (NFSI) was achieved by palladium catalysis in moderate to good yields. Promoted by nitrate, the reaction provides an economic and environmentally friendly strategy. The synthesis of monofluorinated 2-arylbenzo[d]oxazinones has good compatibility with many common functional groups. The plausible mechanism of this monofluorination is discussed.
Predisposing Sinonasal Disease Foci: Do They Really Affect Mucosal Chronic Otitis Media?
Authors: Bhat Vikram Kemmannu , Paramu Aroosh Thevaruparambil , Nagachar Shwetha
Published: January 2019

Background This study aimed to find the relationship between sinonasal predisposing foci in chronic otitis media mucosal disease (COMMD) and risk from these predisposing disease foci, and to identify the correlation of bacterial flora of the ear and nose in chronic otitis media.

Materials and Methods This was a prospective case–control study with 100 cases and 100 controls. All patients underwent a detailed clinical ear-nose-throat (ENT) examination and diagnostic nasal endoscopy to look for sinonasal and pharyngeal pathology. In all patients, ear and nasal swabs were taken at the first visit. The relationship between these factors and COMMD was studied by appropriate statistical tests.

Observations and Results Extremely significant association between tubal tonsil hypertrophy and COMMD, very significant association between adenoid hypertrophy and COMMD, and just significant association between deviated nasal septum, inferior turbinate hypertrophy, concha bullosa, and COMMD were found. No significant association was found between sinusitis and COMMD. In this study Staphylococcus aureus (51%) was the predominant organism isolated from ear swab, followed by Pseudomonas (27%). The same organism in nasal and ear swabs was demonstrated only in eight (13%) cases.

Conclusion Sinonasal predisposing foci play a substantial role in the development of COMMD and observed in 97% of the cases with bilateral disease and 91% with unilateral disease in this study. Hence, every case of COMMD must undergo investigations such as diagnostic nasal endoscopy to discover these foci. Because sinonasal disease is one of the important factors contributing to otitis media, timely detection and management of symptomatic sinonasal disease must precede surgical management of COMMD.
Enhanced Recovery After Surgery Interactive Audit System: 10 Years' Experience with an International Web-Based Clinical and Research Perioperative Care Database
Authors: Currie Andrew , Demartines Nicolas , Fearon Kenneth , Kennedy Robin , Ljungqvist Olle , Soop Mattias
Published: January 2019

The Enhanced Recovery After Surgery (ERAS) is a managed care program that has shown the ability to reduce complications following elective colorectal surgery. In 2006, the ERAS® Society developed the ERAS® Interactive Audit System (EIAS), which has allowed centers in over 20 countries to enter perioperative patient data to benchmark against international practice within the audit system and act as a stimulus for quality improvement. The de-identified patient data are coded in SQL (a relational database), stored on secure servers, and data governance aspects have been secured in all involved countries. A collaborative approach is undertaken within involved units toward research questions with published cohort data from the audit system having demonstrated the importance of overall compliance on improving patient outcomes and less cost of care. The EIAS has shown that collaborative clinical effort can drive quality improvement in a short time frame in an international context.
Japanese Encephalitis Virus-Induced Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report and Review of Literature
Authors: Tian Maoqiang , Li Juan , Lei Wenting , Shu Xiaomei
Published: January 2019

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARe) was originally described as a paraneoplastic disease with more than 50% cases involving a tumor. However, tumor incidence in anti-NMDARe in children is much lower. Herpes simplex virus-induced anti-NMDARe has been well-described; however, findings on Japanese encephalitis virus (JEV)-induced anti-NMDARe are scarce. Here, we describe a 7-year-old boy who presented with fever and headache that progressed to seizures and disturbance of consciousness. Brain magnetic resonance imaging (MRI) revealed abnormalities in the bilateral globus pallidus. The diagnosis of JE was made based on a positive JE antibody test results in serum and cerebrospinal fluid. Antiviral and symptomatic therapies led to rapid recovery. Four weeks after the onset of JE, the patient presented with emotional and behavioral disturbances, sleep difficulty, and extrapyramidal symptoms. MRI showed symmetrical lesions in the bilateral thalami and basal ganglia which were expanded than those on the original scan. Antibodies against NMDAR were detected and immunotherapy led to significant recovery. This case and our literature review suggest that JEV may be a clinically important cause of anti-NMDARe in children. Patients with JE-induced anti-NMDARe present with symptoms similar to those of patients with primary anti-NMDARe. Most patients with JE-induced anti-NMDARe showed a good response to first-line immunotherapies.
Otolaryngologic Lesions among Human Immunodeficiency Virus-infected Children
Authors: Babatunde Oluwabusayo , Adeyemo Adebolajo , Oladokun Regina
Published: January 2019

Background Otolaryngologic (ORL) lesions are common in children. ORL lesions occur even more commonly and more severely in HIV-infected children. The few available literature has reported a high prevalence in human immunodeficiency virus (HIV)–infected children; however, there are inadequate data on the impact of HIV infection on hearing and the pattern of manifestations of ORL lesions among African children.

Objectives This study was conducted to describe the prevalence and manifestations of ORL lesions among HIV-infected children and controls in Nigeria.

Materials and Methods A prospective comparative cross-sectional study design was adopted. Clinical evaluation was done, and hearing assessment was done using otoacoustic emission for all participants and pure tone audiometry for participants aged ≥ 5 years. Hearing thresholds were defined according to the World Health Organization classification.

Results One hundred children were studied: 50 HIV-infected and 50 HIV-negative children. The prevalence of ORL lesions among HIV-infected children was 66%, whereas it was 46% (p = 0.044) among HIV-negative children. ORL lesions were more prevalent among children between the 18-month and 5-year age group (p = 0.003) irrespective of HIV status. The lesions that were associated with HIV infection were cervical adenopathy (44%, p = 0.010) and hearing loss (36%, p = 0.023).

Conclusion The frequency of ORL lesions is high in HIV-infected children, but improved outcomes following use of medications may be responsible for the slight disparity in prevalence when compared with HIV-negative children.
Problems Faced by Married Women with Epilepsy in Indian Scenario: A Hospital-Based Study
Authors: Sharma Sunil Kumar , Sardana Vijay , Maheshwari Dilip , Bhushan Bharat , Jain Nishtha , Shringi Prashant , Bhattiprolu Rahi Kiran
Published: January 2019

Background Epilepsy is still being considered as a social stigma especially in developing countries such as India. This study was conducted to analyze the problems faced by married women with epilepsy in various aspects of personal and social life.

Objectives The main purpose of this article is to study the psychosocial problems, drug compliance, clinical course, attitude of in-laws, and effect of epilepsy on pregnancy and its outcome in married women with epilepsy in Indian scenario.

Design, Materials, and Methods This is a prospective observational study including 100 patients. Questionnaire-based face-to-face interview of all the patients was conducted. Patients were divided into informed and concealed groups and various attributes and their significance were compared. Statistical analysis was performed using SPSS-20.0 and Microsoft Office Excel software.

Results Out of 100 patients, a total of 58 (58%) patients had informed prior to marriage, while 42 (42%) concealed it. Attitude of husband was negative in 33% (14 out of 42) of concealed group and was statistically significant (p = 0.03). Statistically significant adverse marital outcome was observed in concealed group and Muslim community (p = 0.0001). Majority of the patients in both groups (86%) opined that it should be disclosed prior to marriage.

Conclusion In a developing country such as India, epilepsy is still considered a social stigma that can manifest as felt or enacted stigma. Previous studies clearly indicate increasing awareness. Social stigma associated with epilepsy can only be eliminated with collaborative efforts of healthcare professional, government, and general public.
Isthmocele: From Risk Factors to Management
Authors: Iannone Piergiorgio , Nencini Giulia , Bonaccorsi Gloria , Martinello Ruby , Pontrelli Giovanni , Scioscia Marco , Nappi Luigi , Greco Pantaleo , Scutiero Gennaro
Published: January 2019

Objective The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele—a hypoechoic area within the myometrium at the site of the uterine scar of a previous cesarean section—by exploring in depth every aspect of this condition.

Methods A comprehensive review of the literature was performed to identify the most relevant studies about this topic.

Results Every aspect of isthmocele has been studied and described: pathophysiology, clinical symptoms, classification, and diagnosis. Its treatment, both medical and surgical, has also been reported according to the actual literature data.

Conclusion Cesarean section is the most common surgical procedure performed worldwide, and one of the consequences of this technique is isthmocele. A single and systematic classification of isthmocele is needed to improve its diagnosis and management. Further studies should be performed to better understand its pathogenesis.
The Role of Speech-Language Pathology in an Interdisciplinary Care Model for Persistent Symptomatology of Mild Traumatic Brain Injury
Authors: Kelly James , Hardin Kathryn
Published: January 2019

The Marcus Institute for Brain Health (MIBH) provides interdisciplinary care for adults struggling with persistent effects of mild traumatic brain injury and accompanying changes in behavioral health, with specific emphases on Veterans and retired elite athletes. The cognitive, physical, and behavioral symptoms associated with mild traumatic brain injury are interrelated, with neurobiopsychosocial modeling encompassing the factors related to recovery from a traumatic brain injury. The diffuse impacts of chronic concussive injuries require multiple clinical providers to address the breadth of symptoms, facilitating both interdisciplinary and transdisciplinary care models. By implementing integrated practice units, patients receive advanced medical care, imaging, speech-language pathology, physical therapy, behavioral health, neuropsychology, and clinical pharmacy for a cohesive diagnostic and intervention plan. Nationally, speech-language pathologists report challenges with best-practice options for concussion, particularly in the domain of assessment practices. At the MIBH, speech-language pathologists begin their assessment with a structured clinical interview that focuses on patients' needs and concerns. Evaluation modalities focus on hearing, communication, and functional cognition to guide therapeutic treatment planning. The intensive outpatient care program at MIBH incorporates both individual sessions targeting patient-centered goals and group care, where speech-language pathologists work transdisciplinarily to generalize care from all disciplines out into the community. Care practices for concussive injuries continue to evolve rapidly; speech-language pathology at the MIBH offers one such vision for excellence in clinical care.
Benign Bone Tumors When They Coexist with Common Orthopaedic Conditions
Authors: Hasan Khalid , Nguyen Duc , Conway Sheila
Published: January 2019

Benign and malignant bone tumors around the knee can be encountered with concomitant orthopaedic disease. As such, it is important to recognize these oncologic processes that may impact or alter the routine treatment of more common orthopaedic processes. Frequently, these rare oncologic conditions are discovered only through the evaluation of acute injuries as in the setting of fractures or sports injuries. Other times, they are encountered when evaluating chronic entities, such as arthroplasty. This article aims to provide general guidelines and management strategies for benign bone tumors when they coincide with common orthopaedic conditions around the knee.
Percutaneous Tracheostomy
Authors: Al-Shathri Ziyad , Susanto Irawan
Published: January 2019

Tracheostomy is a commonly performed surgical procedure in intensive care units (ICUs). Over the past three decades, there has been a substantial body of evidence to suggest percutaneous tracheostomy (PT) is at least as safe as surgical tracheostomy (ST) in the hands of trained clinicians. In most institutions, PT is more readily performed at bedside than ST in the ICU; hence, PT is an attractive alternative to ST in the ICU. Bedside PT generates significant cost savings by eliminating operating room and anesthesia charges. Bronchoscopy is commonly used as a visual aid during PT. Ultrasound (US)-guided PT is gaining popularity. It can be used as an adjunct or alternative to bronchoscopic-guided PT, especially in hospitals where access to bronchoscopy remains fairly limited and US is more widely available. There are many benefits in converting translaryngeal intubation to tracheostomy. It is widely accepted that tracheostomy is preferred if there is an anticipation of prolonged need for an artificial airway. The timing of this conversion from translaryngeal intubation to tracheostomy remains a subject of controversy. Limited data are available regarding the safety of PT on patients who are on dual antiplatelet therapy or active anticoagulation. Given the heterogeneity of PT techniques, adequate training and experience with the technique, coupled with careful planning are essential in minimizing any potential complication.
CDS in a Learning Health Care System: Identifying Physicians' Reasons for Rejection of Best-Practice Recommendations in Pneumonia through Computerized Clinical Decision Support
Authors: Jones Barbara , Collingridge Dave , Vines Caroline , Post Herman , Holmen John , Allen Todd , Haug Peter , Weir Charlene , Dean Nathan
Published: January 2019

Background Local implementation of guidelines for pneumonia care is strongly recommended, but the context of care that affects implementation is poorly understood. In a learning health care system, computerized clinical decision support (CDS) provides an opportunity to both improve and track practice, providing insights into the implementation process.

Objectives This article examines physician interactions with a CDS to identify reasons for rejection of guideline recommendations.

Methods We implemented a multicenter bedside CDS for the emergency department management of pneumonia that integrated patient data with guideline-based recommendations. We examined the frequency of adoption versus rejection of recommendations for site-of-care and antibiotic selection. We analyzed free-text responses provided by physicians explaining their clinical reasoning for rejection, using concept mapping and thematic analysis.

Results Among 1,722 patient episodes, physicians rejected recommendations to send a patient home in 24%, leaving text in 53%; reasons for rejection of the recommendations included additional or alternative diagnoses beyond pneumonia, and comorbidities or signs of physiologic derangement contributing to risk of outpatient failure that were not processed by the CDS. Physicians rejected broad-spectrum antibiotic recommendations in 10%, leaving text in 76%; differences in pathogen risk assessment, additional patient information, concern about antibiotic properties, and admitting physician preferences were given as reasons for rejection.

Conclusion While adoption of CDS recommendations for pneumonia was high, physicians rejecting recommendations frequently provided feedback, reporting alternative diagnoses, additional individual patient characteristics, and provider preferences as major reasons for rejection. CDS that collects user feedback is feasible and can contribute to a learning health system.
Qualitative and Quantitative Analysis of Patients' Perceptions of the Patient Portal Experience with OpenNotes
Authors: Mishra Vimal , Hoyt Robert , Wolver Susan , Yoshihashi Ann , Banas Colin
Published: January 2019

Background Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers.

Objectives This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity.

Materials and Methods Patients at an academic health care system who accessed the patient portal from February 2016 to May 2016 were provided a link to complete a 15-item online survey. Those who had viewed at least one note were asked about patient characteristics, frequency of note access, note usefulness, note understanding, and if any action was taken after accessing the note. Free-text comments were associated with nine questions which were analyzed using qualitative methods.

Results A total of 23% (1,487/6,439) of patients who viewed the survey in the portal, participated. Seventy-six percent (1,126/1,487) knew that the notes were available on the portal, and of those, 957 had viewed at least one note to continue the survey. Ninety percent of those were older than 30 years of age, and 90% had some college education. The majority (83%) thought OpenNotes helped them take better care of themselves, without increasing worry (94%) or contacting the physician after reading the note (91%). The qualitative analysis of free-text responses demonstrated multiple positive and negative themes, and they were analyzed for potential improvement opportunities.

Conclusion Our survey confirms that patients who choose to access their primary care and specialists' online medical records perceive benefits of OpenNotes. Additionally, the qualitative analysis of comments revealed positive benefits and several potential patient portal improvement opportunities which could inform implementation of OpenNotes at other health systems.
Distribution of the Force in the Knee Joint during Daily Activities after Open Wedge High Tibial Osteotomy: A Rationale for the Proper Postoperative Management
Authors: Seo Hansol , Lim Dohyung , Jang Young Woong , Kang Kwan-su , Lee Myung Chul , Lee O-Sung , Im Byeong-Eun , Lee Yong Seuk
Published: January 2019

The present study was conducted to evaluate the force distribution in knee joint during daily activities after open-wedge high tibial osteotomy (OWHTO). A three-dimensional proximal tibial finite element model (FEM) was created using Mimics software to evaluate computed tomography (CT) scans of the tibia after OWHTO. The anterior and posterior gaps were 7.0 and 12.1 mm, respectively, and the target opening angle was 12 degrees. The loading ratio of the medial and lateral tibial plateaus was 6:4. To evaluate force distribution in the knee joint during activities of daily living (ADLs) after OWHTO, peak von Mises stresses (PVMSs) were analyzed at the plate and posterolateral edge region of osteotomized tibia. ADLs associated with greater knee flexion (sitting 90 degrees, standing 90 degrees, bending 90 degrees, stepping up stairs 60 degrees, and stepping downstairs 30 and 60 degrees) yielded PVMSs ranging from 195.2 to 221.5 MPa at the posterolateral edge region. In particular, stepping downstairs with knee flexion to 60 degrees produced the highest PVMS (221.5 MPa), greater than the yield strength (100–200 MPa). The highest plate PVMS was greater than 300 MPa during ADLs associated with flexion angles of approximately 90 degrees. However, these values did not exceed the yield stress (760.0 MPa). Conclusively, higher force was generated during higher flexion associated with weight-bearing and stepping downstairs produced a high force (even at lower flexion) on the posterolateral area of the tibial plateau. Therefore, a caution should be exercised when engaging in knee flexion of approximately 90 degrees and stepping downstairs in the early postoperative period when patients follow a weight-bearing rehabilitation protocol. However, this study is based on modeling; further translational studies are needed prior to clinical application.
Macrophage Polarization is Deregulated in Haemophilia
Authors: Knowles Lynn , Kagiri Daniela , Bernard Martin , Schwarz Eva , Eichler Hermann , Pilch Jan
Published: January 2019

Macrophages make important contributions to inflammation and wound healing. We show here that macrophage polarization is deregulated in haemophilia in response to macrophage colony-stimulating factor (M-CSF) and partially in response to granulocyte-macrophage colony-stimulating factor (GM-CSF). As a result, haemophilia macrophages exhibit a specific impairment of M-CSF-mediated functions involved in wound healing such as clot invasion and phagocytosis. Haemophilia monocytes express reduced amounts of the receptors for M-CSF and GM-CSF, which correlates with a failure to express tumour necrosis factor α (TNFα) and CD163 in M-CSF-treated haemophilia macrophages and reduced expression of TNFα and CD206 after treatment with GM-CSF. Protein expression in response to M-CSF was regained with respect to CD163 and CD206 after embedding haemophilia monocytes in clotted plasma suggesting that a functioning coagulation system has positive effects on macrophage M2 polarization. Mimicking the functional deficits of haemophilia macrophages in normal macrophages was possible by adding leptin, which we found to be elevated in the blood of haemophilia patients, to a monocyte cell line. The increase of leptin occurred in conjunction with C-reactive protein in a body mass index-controlled cohort suggesting that haemophilia patients harbour chronic low-grade inflammation. Together, our data indicate that impaired clotting in haemophilia patients leads to increased inflammation and a deregulation in macrophage differentiation, which may explain the commonly observed deficits in wound healing and tissue regeneration.