bluuebunny/crossref_metadata_2025 huggingface dataset:
Jurassic-Lower Cretaceous petroleum system of Faghur Basin, North Western Desert, Egypt
Authors: El Sherief Mai A. , Elbastawesy Mohamed A. , Abdeldayem Abdelaziz L. , Mohamed Shadia A.
Published: August 2022

Different parts of the Lower Cretaceous Alam El Bueib (AEB) and the Jurassic Khatatba source and reservoir rock units in the Faghur basin, like in other basins in the north Western Desert, act as hydrocarbon sources and reservoirs. In the present study, well-log data from five wells in Phiops field and geochemical data from the Neith S-2X well from the neighbor Neith field together with reflection 2D seismic data of thirty (30) lines have been utilized to evaluate the Jurassic-Lower Cretaceous petroleum system in the Faghur basin and to give evidence for future hydrocarbon exploration and development in the study area. Source rock evaluation shows that several units from both Alam El Bueib and the Jurassic Khatatba shale source rocks represent good source rocks. Total organic carbon (TOC) values of the studied units of Alam El Bueib shale source rocks range from 0.27 to 6.39 wt.% that reflect fair to very good source rock, while Toc value for the Alam El Bueib-6 shale source rock is 2.52 wt.% that indicates a very good source rock. These units are characterized by type (III) kerogen, reflecting their ability to produce gas with minor oil. On the other hand, the characterization of the Khatatba shale source rocks indicates a very good to fair organic richness and a type (III) kerogen with an input of type (II) as well, which appears their ability to generate gas with minor oil. Most of Alam El Bueib and Khatatba shale source rocks are found to be in the mature stage. Petrophysical evaluation indicates four definite reservoir units from the Alam El Bueib reservoirs (Alam El Bueib-3D, Alam El Bueib-3E, Alam El Bueib-3G, Alam El Bueib-6) and the Khatatba reservoir. Values for the net reservoir, hydrocarbon saturation, and water saturation indicate that these units represent very promising reservoirs in the studied Phiops field in Faghur basin. Local intra-formational shale intervals most probably seal these reservoirs in the AEB and carbonate interval of the Masajid Formation in the Khatatba Formation. Moreover, analysis and interpretation of the 2D seismic lines showed that both structural and stratigraphic traps dominate. Integration of geochemical, petrophysical, and seismic results, in light of available geological information, indicates a complete Mesozoic petroleum system in the Faghur basin.
Prodigiosin-Functionalized Probiotic Ghosts as a Bioinspired Combination Against Colorectal Cancer Cells
Authors: Saleh Nessrin , Mahmoud Hoda E. , Eltaher Hoda , Helmy Maged , El-Khordagui Labiba , Hussein Ahmed A.
Published: August 2022

Lactobacillus acidophilus ghosts (LAGs) with the unique safety of a probiotic, inherent tropism for colon cells, and multiple bioactivities offer promise as drug carriers for colon targeting. Our objective was to evaluate LAGs functionalized with prodigiosin (PG), apoptotic secondary bacterial metabolite, as a bioinspired formulation against colorectal cancer (CRC). LAGs were prepared by a chemical method and highly purified by density gradient centrifugation. LAGs were characterized by microscopic and staining techniques as relatively small-sized uniform vesicles (≈1.6 µm), nearly devoid of cytoplasmic and genetic materials and having a negatively charged intact envelope. PG was highly bound to LAGs envelope, generating a physiologically stable bioactive entity (PG-LAGs), as verified by multiple microscopic techniques and lack of PG release under physiological conditions. PG-LAGs were active against HCT116 CRC cells at both the cellular and molecular levels. Cell viability data highlighted the cytotoxicity of PG and LAGs and LAGs-induced enhancement of PG selectivity for HCT116 cells, anticipating dose reduction for PG and LAGs. Molecularly, expression of the apoptotic caspase 3 and P53 biomarkers in HCT116 intracellular proteins was significantly upregulated while that of the anti-apoptotic Bcl-2 (B-cell lymphoma 2) was downregulated by PG-LAGs relative to PG and 5-fluorouracil. PG-LAGs provide a novel bacteria-based combination for anticancer biomedicine.

Graphical abstract
Comparative effect of the three talc deposits in detoxification of Cr(VI) from wastewater
Authors: Elnazer A. A. , Azer M. K. , Mohamed Y. M. A. , El Nazer H. A.
Published: August 2022

Environmental application of three different talc deposits toward the removal of hexavalent chromium ions Cr(VI) from aqueous solution as simulated polluted water was investigated. Three talc samples (T1, T2 and T3) were used from Wadi Atshan area, Eastern desert, Egypt. The affecting parameters, such as pH, contact time, solution pH and the dosage, were studied during the progress of the adsorption process of chromium (IV). The results showed that a contact time of 65 min for T3, 80 min for T2, 85 min for T1 under optimum condition at pH 7 at 25 °C. The adsorption capacity for the removal of Cr(VI) using the three samples T1, T2 and T3 was evaluated to be 78%, 86% and 97%, respectively, under optimized conditions utilizing 1.0 g/L of the adsorbent. Characterization of the three talc samples was performed using XRF, XRD and FTIR analyses in order to assess the physicochemical properties of the adsorbents. This approach provided new class of adsorbent as highly efficient materials for Cr(VI) removal based on talc deposits which possess some privileges such as availability of the natural resources that makes the process to be low cost and simple.
An eigenfunction expansion formula for one-dimensional two-state quantum walks
Authors: Tate Tatsuya
Published: August 2022

The purpose of this paper is to give a direct proof of an eigenfunction expansion formula for one-dimensional two-state quantum walks, which is an analog of that for Sturm–Liouville operators due to Weyl, Stone, Titchmarsh, and Kodaira. In the context of the theory of CMV matrices, it had been already established by Gesztesy–Zinchenko. Our approach is restricted to the class of quantum walks mentioned above, whereas it is direct and it gives some important properties of Green functions. The properties given here enable us to give a concrete formula for a positive-matrix-valued measure, which gives directly the spectral measure, in a simplest case of the so-called two-phase model.
Construction of Fuzzy Linguistic Approximate Concept Lattice in an Incomplete Fuzzy Linguistic Formal Context
Authors: Yang Dongqiang , Yang Xinran , Jia Hui , Xu Lixian , Guo Jin
Published: August 2022

Uncertainty research is one of the critical problems in artificial intelligence. In an uncertain environment, a large quantity of information is expressed in linguistic values. Aiming at the missing linguistic-valued information, we first propose incomplete fuzzy linguistic formal context and then discuss the fuzzy linguistic approximate concept. Our proposal can describe the attributes of objects from two aspects simultaneously. One is an object's essential attributes, and another includes the essential and possible attributes. As a result, more object-related information can be obtained to reduce information loss effectively. We design a similarity metric for correcting the errors caused by the initial complement operation. We then construct a corresponding fuzzy linguistic approximate concept lattice for the task of approximate information retrieval. Finally, we illustrate the applicability and feasibility of the proposed approach with concrete examples, which clearly show that our approach can better deal with the linguistic-valued information in an uncertain environment.
Genomic Variations in the Tea Leafhopper Reveal the Basis of Its Adaptive Evolution
Authors: Zhao Qian , Shi Longqing , He Weiyi , Li Jinyu , You Shijun , Chen Shuai , Lin Jing , Wang Yibin , Zhang Liwen , Yang Guang , Vasseur Liette , You Minsheng
Published: August 2022

Tea green leafhopper (TGL), Empoasca onukii, is of biological and economic interest. Despite numerous studies, the mechanisms underlying its adaptation and evolution remain enigmatic. Here, we use previously untapped genome and population genetics approaches to examine how the pest adapted to different environmental variables and thus has expanded geographically. We complete a chromosome-level assembly and annotation of the E. onukii genome, showing notable expansions of gene families associated with adaptation to chemoreception and detoxification. Genomic signals indicating balancing selection highlight metabolic pathways involved in adaptation to a wide range of tea varieties grown across ecologically diverse regions. Patterns of genetic variations among 54 E. onukii samples unveil the population structure and evolutionary history across different tea-growing regions in China. Our results demonstrate that the genomic changes in key pathways, including those linked to metabolism, circadian rhythms, and immune system functions, may underlie the successful spread and adaptation of E. onukii. This work highlights the genetic and molecular basis underlying the evolutionary success of a species with broad economic impacts, and provides insights into insect adaptation to host plants, which will ultimately facilitate more sustainable pest management.
Late margin recurrence after curative resection for hepatocellular carcinoma – Case report of two cases and review of this enigmatic entity
Authors: Desai Gunjan , Wagle Prasad K.
Published: August 2022

ABSTRACT

Introduction:

The 5 year recurrence rate after curative treatment of hepatocellular carcinoma (HCC) is nearly 70%. However, there is limited data on recurrence patterns and its management. We present two cases of a very rare late recurrence pattern of HCC known as margin/scar recurrence.

Case reports:

Case 1: A 56 year old gentleman with hepatitis C infection, underwent angioembolization for ruptured HCC followed by future liver remnant augmentation and right trisectionectomy. After 20 months, he developed 4 subcentimetric pulmonary metastasis with a 11 × 10 cm margin recurrence. Resection with mesh reconstruction of diaphragm was performed. At 4.5 years follow up; he is on Sorafenib. Case 2: A 61 yr old gentleman with hepatitis B infection, underwent right lower transverse hepatectomy for a 16 × 15 cm HCC. On 5 years follow up, he had a margin recurrence of 16 × 12 cm. Excision with en-bloc omentectomy and colonic resection was performed. He is on sorafenib 400 mg per day at 4 months follow up.

Discussion:

Peritoneal recurrence is rare (2–16%). Scar/margin recurrence can be managed with complete surgical resection alone as the pathophysiological basis is localized expansive growth whereas, disseminated recurrences may be considered for cytoreductive surgery with/out hyperthermic intra-peritoneal chemotherapy as per the published case series or medically as per the current guidelines.

Conclusion:

Late margin recurrence after curative resection of HCC is a very rare entity. It can be managed surgically in a fit patient with preserved liver function so as to improve survival.

Highlights
A single-blind randomised controlled trial comparing clinical equivalence of Trulon® and Ethilon® polyamide sutures for the skin closure following laparotomy incisions
Authors: Subha Shree Rao Aruna Y. , Padmasri R. , Divya T. K. , Moharana Ashok Kumar , Deepak T. S.
Published: August 2022

ABSTRACT

Background:

Laparotomy is a common procedure to gain access to the peritoneal cavity, for obstetrics, gynecological, and digestive system-related surgeries. Wound infection is among other complications of laparotomy. This study compared the rate of wound infection post-laparotomy skin closure using Trulon® and Ethilon® polyamide sutures.

Methods:

This multicentric, prospective, two-arm, parallel-group, randomized (1:1), single-blind study (CTRI/2020/09/027978) was conducted between January and July 2021, and included 102 women undergoing laparotomy-based obstetric/gynecological procedures. The primary endpoint, incidence of wound infection [superficial and deep surgical site infection(SSI)] occurring within 12 weeks of the surgery was compared between two treatment groups, Trulon® (n = 50) and Ethilon® (n = 52). The secondary endpoints, incidence of wound dehiscence, suture sinus, seroma, hematoma, skin disruption, suture loosening, re-suturing, duration of surgery, suture removal, hospital stay, intraoperative suture handling parameters, pain score, return to normal day-to-day activities, modified Hollander cosmesis score, subject satisfaction score, and adverse events were also evaluated.

Results:

Non-significant differences were observed in the incidence of SSI, wound dehiscence, suture sinus, seroma, hematoma, skin disruption, suture loosening, re-suturing, intraoperative handling parameter (except ease of passage), operative time, hospital stay, suture removal duration, pain score, time to return to day-to-day activities, modified Hollander cosmesis score, and subject satisfaction score between the two groups.

Conclusion:

Trulon® and Ethilon® polyamide sutures are clinically equivalent. For abdominal skin closure following laparotomy both the sutures deliver a lower chance of infection, minimal pain, higher satisfaction, and cosmesis score.

Registration of research:

This trial is registered prospectively at Clinical Trial Registry of India (CTRI Reg. No: CTRI/2020/09/027978; Registered on: 23/09/2020).

Highlights
River Floods Can Trigger Powerful Underwater Landslides
Authors: Wilke Carolyn
Published: August 2022

A record-length turbidity current triggered by river flooding has revealed a new link between the surface and the deep sea.
New USGS Director: Partnerships Are Our Superpower
Authors: Cartier Kimberly
Published: August 2022

The new director hopes to strengthen existing partnerships, build and retain a more diverse and inclusive workforce, and deliver the agency’s science to those who need it most.
Penetrating Electric Field Simulated by the MAGE and Comparison With ICON Observation
Authors: Wu Qian , Wang Wenbin , Lin Dong , Huang Chaosong , Zhang Yongliang
Published: August 2022

Using the newly developed, Multiscale Atmosphere‐Geospace Environment (MAGE) model, we simulated the penetrating electric field in the equatorial region under different interplanetary magnetic field (IMF) BZ conditions during September 2020. Two intervals were selected for detailed analysis and the latter one was compared with the vertical ion drift data from the NASA Ionospheric Connection Explorer (ICON) satellite. The MAGE simulations show that in southward IMF (S‐IMF) cases, the dawn‐dusk electric potential drop at the equator is about 12% of the cross polar cap potential difference. Based on the MAGE simulation, the dawn‐dusk potential drop at the equator varies nearly instantaneously on the order of a few minutes with the changes in the IMF BZ or interplanetary electric field, which in turn alters the vertical ion drift. The daytime changes of the equatorial vertical ion drift in response to the penetrating electric field related to the IMF BZ are only half of that during the nighttime. ICON data, though not inconsistent with the simulation, were not able to verify the occurrence of penetrating electric field because of its unfavorable location at the time. The MAGE simulation shows a pre‐reversal enhancement (PRE) during southward IMF cases, but the PRE was absent in the ICON IVM observations. Further observations and modeling are needed to resolve this discrepancy.
Signaling pathways in obesity: mechanisms and therapeutic interventions
Authors: Wen Xue , Zhang Bohan , Wu Beiyi , Xiao Haitao , Li Zehua , Li Ruoyu , Xu Xuewen , Li Tao
Published: August 2022

Obesity is a complex, chronic disease and global public health challenge. Characterized by excessive fat accumulation in the body, obesity sharply increases the risk of several diseases, such as type 2 diabetes, cardiovascular disease, and nonalcoholic fatty liver disease, and is linked to lower life expectancy. Although lifestyle intervention (diet and exercise) has remarkable effects on weight management, achieving long-term success at weight loss is extremely challenging, and the prevalence of obesity continues to rise worldwide. Over the past decades, the pathophysiology of obesity has been extensively investigated, and an increasing number of signal transduction pathways have been implicated in obesity, making it possible to fight obesity in a more effective and precise way. In this review, we summarize recent advances in the pathogenesis of obesity from both experimental and clinical studies, focusing on signaling pathways and their roles in the regulation of food intake, glucose homeostasis, adipogenesis, thermogenesis, and chronic inflammation. We also discuss the current anti-obesity drugs, as well as weight loss compounds in clinical trials, that target these signals. The evolving knowledge of signaling transduction may shed light on the future direction of obesity research, as we move into a new era of precision medicine.
Age as a primary driver of the gut microbial composition and function in wild harbor seals
Authors: Pacheco-Sandoval A. , Lago-Lestón A. , Abadía-Cardoso A. , Solana-Arellano E. , Schramm Y.
Published: August 2022

Dietary changes are the major variation cause in the composition of the gut microbiota. The short lactation phase in phocids provides an exceptional opportunity to explore the microbiota's response to a quick transition from a milk-based to a solid diet. We investigated the effects of age and sex on the gut microbiota of harbor seals in Mexico using rectal and fecal samples from pups and adults. 16S gene sequencing revealed age explains most of the observed variations in microbial composition. Individuals with frequent contact (pups—female adults) have major microbial similarities than those with little or no contact (pups—male adults). Overall, adults and females (regardless of sex and age, respectively) have a greater microbial richness; as seals grow, the core microbiome shrinks, and microbial diversity increases. We found pathways related to milk and chitin digestion in pups' microbiomes, indicating pups were transitioning to a solid diet. An enrichment of routes related to dramatic weight loss and body mass indicated higher metabolic stress in pups in late breeding season, when they are weaned and start intermittent fasting. Our findings highlight the host-microbiome interaction in harbor seals during late breeding season in response to food shifts and metabolic stress.
Unravelling the polyethylenimine mediated non-monotonic stability behaviour of silica colloids: the role of competing electrostatic and entropic interactions
Authors: Mehta Swati , Bahadur Jitendra , Sen Debasis , Aswal Vinod K. , Kohlbrecher Joachim
Published: August 2022

The reversible aggregation behavior of PEI–silica dispersion with varying concentrations of PEI is governed by electrosorption and free polymer induced depletion stabilization.
Design principles of nitrogen-doped graphene nanoribbons as highly effective bifunctional catalysts for Li–O2 batteries
Authors: Zheng Tao , Ren Yingru , Han Xiao , Zhang Jing
Published: August 2022

The possible doping sites and reaction sites in nitrogen-doped graphene nanoribbons (N-GNRs) are explored by means of DFT calculations to discuss the role of doping and edge effects in the ORR/OER activity in Li–O2 batteries.
Blockchain for applications of clinical trials: Taxonomy, challenges, and future directions
Authors: Hang Lei , Chen Chun , Zhang Linchao , Yang Jun
Published: August 2022

Patient enrollment, data sharing, and data privacy are enormous medical challenges for clinical trial studies. In recent years, blockchain technology has drawn the attention of various researchers and institutes. As a new and innovative distributed ledger technology, blockchain can be critical to addressing these challenges, thus making clinical research transparent and building public trust fairly and openly. However, the existing literature lacks a comprehensive survey on the adoption of blockchain in clinical trials. To fill the research void, this paper presents a punctilious taxonomy of blockchain technology in clinical trials according to the literature. This taxonomy comprises decentralized scenarios, decentralized practices, blockchain types, deployment methods, and consensus algorithms. The results show that blockchain technology can cover all aspects of the clinical trial study in a decentralized, secure, transparent manner. Besides, some open research challenges of blockchain are categorized into three groups: technical challenges, security challenges, and organizational challenges. Moreover, some recent blockchain projects, micro applications in clinical trials, and several research areas or technologies for future research and development are discussed.
Performance analysis of communications systems with radar interference and hardware impairment
Authors: Wang Junqiu , Chen Yunfei
Published: August 2022

The development of future wireless communications systems faces a big challenge of spectrum scarcity. Co‐existence of radar and communications systems is thus of great interest. In this work, the performance of a communications system with hardware impairment (HWI) as well as interference from radar systems will be studied. The impact of radar interference, I/Q imbalance coefficients as well as channel state information (CSI) will be evaluated in terms of outage probability and symbol error rate. Simulation results prove that the proposed detectors provide explicit and conducive insights for further exploration of joint radar‐communications designs.
Flexible loop closing control method for an active distribution network based on dual rotary phase shifting transformers
Authors: Yan Xiangwu , Peng Weifeng , Wang Yang , Aslam Waseem , Shao Chen , Li Tiecheng
Published: August 2022

Load transfer without power interruption in the loop closing of an active distribution network is the core technology for improving the reliability of power supply. A single rotary phase shifting transformer (RPST) is used in the loop closing scenario with a 30° phase angle difference. However, its regulation mode is single and cannot realize flexible loop closing under any voltage deviation. In this study, a dual rotary phase shifting transformer (DRPST) is proposed to achieve the function of continuously regulating voltage amplitude and phase angle at the loop closing point through the cooperation of dual rotor angles. This DRPST exhibits the advantages of a flexible control mode, high control precision, and high reliability. First, the working principle and mathematical model of the proposed DRPST are analyzed in accordance with its topology. Second, the voltage phase difference feedback method at both sides of the loop closing point based on virtual power is adopted, and the reference value of the DRPST synthesis vector of voltage is obtained by combining with voltage phase and amplitude deviations. Then, the reference value is converted and decomposed into the reference values for dual rotary phase shifting angles, realizing the non‐differential regulation of voltage at both sides of the loop closing point through the closed loop control of double rotor angles and the coordinated control of the servo motors’ speed. Finally, a DRPST device with a capacity of 40 kVA is developed and a loop closing experiment is performed, verifying the feasibility and effectiveness of the proposed DRPST in realizing the loop closing of an active distribution network.
Investigation on the blurred image restoration based on brain‐inspired model
Authors: Xiangyan Meng , Chen Zhao , Li Zhao , Keding Yan , Yumiao Ren , Haixian Pan
Published: August 2022

Though relatively good effect has been achieved by the image de‐blurring method based on deep learning, the existing methods still suffer from the problem of unclear restoration of the edges. Therefore, brain‐inspired image restoration model based on human attention and “fine vision” is proposed to improve the blind restoration quality of the image in this paper according to the response mechanism of the different cerebral cortices for high and low spatial resolutions. The designed brain‐inspired model consists of dual‐channel network available to realize the function of feature merger for low and high resolutions, which is used to extract the image edges with detailed information filtered out. Confirmatory experiment is implemented based on the blurred image in the data set of GOPRO, LIVE and set14. As per the result, the model proposed is available for relatively good restoration of blurred image and super‐resolution, as well as looking results by visual inspection.
Deep learning serves traffic safety analysis: A forward‐looking review
Authors: Razi Abolfazl , Chen Xiwen , Li Huayu , Wang Hao , Russo Brendan , Chen Yan , Yu Hongbin
Published: August 2022

This paper explores deep learning (DL) methods that are used or have the potential to be used for traffic video analysis, emphasising driving safety for both autonomous vehicles and human‐operated vehicles. A typical processing pipeline is presented, which can be used to understand and interpret traffic videos by extracting operational safety metrics and providing general hints and guidelines to improve traffic safety. This processing framework includes several steps, including video enhancement, video stabilisation, semantic and incident segmentation, object detection and classification, trajectory extraction, speed estimation, event analysis, modelling, and anomaly detection. The main goal is to guide traffic analysts to develop their own custom‐built processing frameworks by selecting the best choices for each step and offering new designs for the lacking modules by providing a comparative analysis of the most successful conventional and DL‐based algorithms proposed for each step. Existing open‐source tools and public datasets that can help train DL models are also reviewed. To be more specific, exemplary traffic problems are reviewed and required steps are mentioned for each problem. Besides, connections to the closely related research areas of drivers' cognition evaluation, crowd‐sourcing‐based monitoring systems, edge computing in roadside infrastructures, automated driving systems‐equipped vehicles are investigated, and the missing gaps are highlighted. Finally, commercial implementations of traffic monitoring systems, their future outlook, and open problems and remaining challenges for widespread use of such systems are reviewed.
Optimal Planning and Bidding Strategy for Wind Farms in Joint Balancing and Day‐Ahead Energy Markets
Authors: Toolabi Moghadam Ali , Sarani Esmaeil , Rezaie Mehrdad , Sheykhi Ebrahim , Azimian Mahdi , Mohammed Adil Hussein
Published: August 2022

Due to the fact that wind farms have a meagre operating cost, it is expected that their optimum utilization in the transmission network would improve the economic and technical condition of the network. Henceforth, this work aims to allocate wind farms' locations in the transmission network while persuading the farm owners to participate in the balancing and day‐ahead energy markets. The proposed scheme is formulated in the form of a bi‐level optimization model. The upper‐level problem aims to maximize wind farms' profit in joint day‐ahead and balancing markets bounded by the location and operational constraints. On the other hand, the lower‐level problem provides the operating model of the transmission network. Herein, the network operator is in authority to minimize the operational cost of non‐renewable resources, considering the linearized AC power flow and technical constraints of resources. Then, the Karush—Kuhn–Tucker is adopted to extract the proposed scheme single‐level model. One of the eminent novelties of this work is to propose a linear model for wind farms and to introduce an incentive plan for farm owners in the energy market by considering bidding errors. In the end, by implementing this scheme on IEEE 6‐bus and 24‐bus transmission networks, the numerical outcomes indicate the proposed scheme's potential to improve the economic and operational status of wind farms and the transmission network. With linear programming based on optimum utilization of wind farms, the utilization of traditional units, energy prices, energy plans, and the maximum voltage drop are reduced by 35%, 15%, 20%, and 21%, respectively, compared to the cases without wind farms penetrations.
Gastroduodenale Ulkuskrankheit und Helicobacter pylori
Authors: Schneider Cornelia , Venerito Marino
Published: August 2022

Was ist neu?

Risikofaktoren für eine gastrointestinale Ulkusblutung Die Helicobacter-pylori-Gastritis (H. pylori-Gastritis) und die Therapie mit nicht steroidalen Antirheumatika (NSAR) sind die wichtigsten Risikofaktoren für die Entstehung eines peptischen Ulkus (PUD) und einer Ulkusblutung. Eine Infektion mit H. pylori erhöht das Risiko einer Ulkusblutung bei Patienten mit PUD, die NSAR, Aspirin oder einen anderen Plättchen-Aggregationshemmer einnehmen. H. pylori-positive Patienten unter kombinierter Plättchen-Aggregationshemmung tragen das höchste Blutungsrisiko. Evidenzbasierte interdisziplinäre Behandlungsempfehlungen zur sicheren NSAR-Anwendung aus dem Jahr 2020 berücksichtigen sowohl das kardiovaskuläre als auch das gastrointestinale Risikoprofil der einzelnen Patienten. Für Patienten mit einem moderaten Risiko für die Entstehung eines PUD wird die Therapiekombination aus NSAR und Protonen-Pumpen-Inhibitoren (PPI) oder eine Monotherapie mit selektiven COX-2-Inhibitoren (COX-2: Cyclooxygenase-2) empfohlen. Patienten mit einem hohen Blutungsrisiko dagegen sollten eine Kombinationstherapie aus selektivem COX-2-Inhibitor und PPI erhalten. Bei Patienten mit einem hohen kardiovaskulären Risiko, bei denen auf eine NSAR-Therapie nicht verzichtet werden kann, werden Naproxen oder Celecoxib empfohlen.

Die Behandlung der gastrointestinalen Ulkusblutung Die Ulkusblutung geht mit einer erhöhten Letalität einher. Bei hämodynamisch stabilen Patienten mit Zeichen einer oberen gastrointestinalen Blutung und erhöhtem Sterberisiko (Glasgow-Blatchford Score ≥ 12) ist die Durchführung einer Ösophago-Gastro-Duodenoskopie (ÖGD) nach 6–24 Stunden ausreichend, eine Notfall-ÖGD (innerhalb der ersten 6 Stunden) verbessert vergleichsweise die 30-Tage-Letalität nicht. Nach erfolgreicher endoskopischer Hämostase reduziert eine zusätzliche prophylaktische angiografische Embolisation das Risiko einer erneuten Blutung nicht.

Die Helicobacter-pylori-Eradikation Eine erfolgreiche H. pylori-Eradikation reduziert das Risiko für die Entwicklung eines Magenkarzinoms bei Verwandten ersten Grades von Patienten mit Magenkarzinom um 73 %. Bei Patienten mit erfolgreicher endoskopischer Behandlung eines Magenfrühkarzinoms ist eine H. pylori-Testung mit anschließender Eradikation ebenfalls sinnvoll, da hierdurch die Rate an metachronen Magenkarzinomen halbiert werden konnte. Die Standard-Triple-Therapie zu der H. pylori-Eradikation zeigt aufgrund zunehmender Antibiotikaresistenzen, insbesondere gegen Makrolide, eine nachlassende Wirksamkeit. Dementsprechend wird die Bismut-haltige Quadrupel-Therapie als empirische Standard-Erstlinientherapie empfohlen.
Zwang in der Intensivmedizin: unzulässig, aber wir tun es
Authors: Jöbges Susanne
Published: August 2022

Was ist neu?

In welchen Formen wird Zwang auf Intensivstationen wahrgenommen? Formeller und informeller Zwang sowie Zwangsbehandlung existieren auf Intensivstationen und werden sowohl von den Patienten als auch von dem Team wahrgenommen. Formeller Zwang umfasst Maßnahmen wie Fixierungen, Sedierung und Umgebung. Informeller Zwang entsteht durch Beeinflussung, wie z. B. Manipulationen, unzureichende oder falsche Information, mangelnde Kommunikation und Drohung. Längerfristige, d. h. > 30 Minuten, freiheitsbeschränkende, -entziehende Maßnahmen sowie Zwangsbehandlung sind genehmigungspflichtig.

Begründung für die Anwendung von Zwang Die Anwendung von Zwang auf der Intensivstation bedeutet einen Spagat zwischen Patientenautonomie und dem Schutz des Patienten (Fürsorge).

Situation mit Risiko für Zwang erkennen Auf Intensivstationen sind Phasen mit Agitation, Delir, aber auch Demenz oder depressive Phasen, Hypoaktivität bei Patienten, alltäglich. Zwangsmaßnahmen in Notsituationen dürfen nur nach entsprechender Prüfung der juristischen und medizinethischen Kriterien eingesetzt werden und nur, wenn es keine Alternativen (Ultima Ratio) für deren Einsatz gibt. Die Anwendung von Zwang als Ultima Ratio umfasst die Überprüfung der Entscheidungsfähigkeit und die Einschätzung/Prüfung der kritischen Situation.

Zwang als Ultima Ratio Freiheitseinschränkende und freiheitsentziehende Maßnahmen sowie Zwangsmaßnahmen dürfen nur in Ausnahmesituationen der Einwilligungsunfähigkeit und bei „drohendem erheblichen Gesundheitsschaden“ angewendet werden.

Prophylaxe und Konzepte zur Vermeidung von Zwang auf der Intensivstation Eine Behandlung auf der Intensivstation basiert auf einer aktuellen Indikation mit medizinischer Evidenz sowie den sich daraus ableitenden Standards und Prozess-Strukturen. Zur Vermeidung von formellem und informellem Zwang ist es entscheidend, ein Menschenbild im interprofessionellen Team zu etablieren, welches den Respekt vor dem Patienten und seiner Autonomie wahrt und dies in den Alltag und die Ausbildungskonzepte umsetzt. Konzepte, um die Anwendung von Zwang zu erkennen, zu benennen und um Zwang zu vermeiden, umfassen: Erkennen von Risikosituationen für Zwang, Standards zur Vermeidung von Zwang auf der Intensivstation, Aus- und Weiterbildung in Kommunikation.
Hypertrophe Kardiomyopathien und die kardiale ATTR-Amyloidose – eine aktuelle Übersicht für den klinischen Alltag
Authors: Tschöpe Carsten , Elsanhoury Ahmed , Diekmann Sonja , Kühl Uwe
Published: August 2022

Was ist neu?

Hypertrophe obstruktive Kardiomyopathie Mavacamten, der erste Myosin-Aktivator, konnte erfolgreich in dem EXPLORER-HCM-Studienprogramm getestet werden. Lebensqualität und linksventrikuläre Druckgradienten-Abnahme wurden optimiert. Ob damit jedoch auch die Überlebensrate und Prognose der betroffenen Patienten verbessert wird, kann bis heute noch nicht gesagt werden. Die europäischen Zulassungsbehörden sehen allerdings bisher die Ergebnisse als so bedeutsam an, dass mit einer Führung der Substanzklasse vielleicht schon in den nächsten 6–8 Monaten zu rechnen ist. In den USA ist die Substanz bereits seit April 2022 zugelassen. Der Einsatz der Substanz bei HCM-Patienten ohne Obstruktion wird ebenfalls zurzeit untersucht.

Kardiale Transthyretin-Amyloidosen Kardiale Amyloidosen haben meist eine gute Ejektionsfraktion, jedoch sind auch EF mit 40 oder < 30 % möglich. Das Auftreten einer kardialen Amyloidose bei Patienten mit der Symptomatik einer Herzinsuffizienz mit erhaltener Ejektionsfraktion (HFpEF) ist in bis zu 15 % der Fälle nachzuweisen. Tafamidis ist die einzige zurzeit zugelassene erfolgreiche Therapiemöglichkeit bei Patienten mit kardialer ATTR-Amyloidose. Dies wurde auch durch weitere Beobachtungsregister der ATTR-ACT-Studie gezeigt. Für die Klinik ist zusätzlich wichtig, dass die Amyloidose auch die Aortenklappe befällt. Zahlreiche Patienten entwickeln somit auch eine Aortenstenose, die erkannt und meist interventionell zu behandeln ist.
Akute Myeloische Leukämien – Update 2022
Authors: Rausch Christian , Hiddemann Wolfgang , von Bergwelt-Baildon Michael , Spiekermann Karsten , Herold Tobias
Published: August 2022

Was ist neu?

Diagnostik Für die Risikostratifizierung und Therapie der akuten myeloischen Leukämie (AML) ist eine Klassifikation nach zytogenetischen und molekulargenetischen Merkmalen erforderlich. Die Panel-Sequenzierung mittels Next-Generation-Sequencing ist inzwischen in der initialen Diagnostik der AML Routine. Durch die Bestimmung der sogenannten messbaren Resterkrankung steht ein Werkzeug zur Verfügung, das auch innerhalb der kompletten Remission noch Abstufungen hinsichtlich der Tiefe des Ansprechens zulässt.

Therapie Die Therapie der AML ist in den letzten Jahren durch zahlreiche Neuzulassungen deutlich komplexer geworden. Die etablierte intensive Induktionstherapie mit Cytarabin und Anthracyclin wird inzwischen für bestimmte Patient*innen um zielgerichtete Substanzen wie das Antikörperkonjugat Gemtuzumab-Ozogamicin (GO) oder den FLT3-Inhibitor Midostaurin ergänzt. Insbesondere Patient*innen mit einer sekundären AML profitieren von der liposomalen Chemotherapie-Fixkombination CPX-351. Die Therapie mit der hypomethylierenden Substanz Azacitidin und dem BCL2-Inhibitor Venetoclax (Aza/Ven) hat sich als Standard für Patient*innen etabliert, die nicht fit genug für eine intensive Induktionstherapie sind. Bei dieser Therapie ist die Beachtung von Interaktionen mit CYP3A4-wirksamen Medikamenten besonders wichtig. Ob ältere Patienten*innen eher von einer intensiven Chemotherapie oder Aza/Ven profitieren, ist derzeit unklar.

Postremissionstherapie Auch in der Postremissionstherapie hat sich mit der (erneuten) Etablierung von Erhaltungstherapien viel verändert. So wird Midostaurin bei Patient*innen mit FLT3-Mutation eingesetzt oder der Multikinase-Inhibitor Sorafenib nach allogener Stammzell-Transplantation. Zudem steht für nicht allogen transplantierbare Patient*innen orales Azacitidin zur Verfügung.

Akute Promyelozyten-Leukämie Für die Therapie der APL erfolgt in den meisten Fällen eine „Chemotherapie-freie“ Behandlung mit All-trans-Retinsäure (ATRA) und Arsentrioxid (ATO). Bei hohem Risiko ist weiterhin die Kombination aus Chemotherapie und ATRA Standard.
Lungenerkrankung durch seltenere nicht-tuberkulöse Mykobakterien – Neue internationale Empfehlungen
Authors: Lange Christoph , Wagner Dirk
Published: August 2022

Was ist neu?

Therapie von NTM-Infektionen Für die Behandlung von NTM-Infektionen der Lungen stehen erstmals Evidenz-basierte internationale Leitlinien zur Verfügung. Nach der ersten Publikation der neuen ATS/ERS/ESCMID- und IDSA-Leitlinien zur Behandlung von Lungenerkrankungen durch M. avium complex, M. kansasii, M. xenopi und M. abscessus von 2020 liegen nun weitere Empfehlungen zur Behandlung von selteneren Lungenerkrankungen durch NTM vor.

Relevante NTM-Spezies Die neuen Empfehlungen umfassen Lungenerkrankungen durch die schnellwachsenden Mykobakterien M. chelonae und M. fortuitum sowie durch die langsam-wachsenden Mykobakterien M. genavense, M. gordonae, M. malmoense, M. simiae und M. szulgai.
SIADH & Diabetes insipidus: Neues zu Diagnosestellung und Therapie
Authors: Fenske Wiebke , Charlotte Fries
Published: August 2022

Was ist neu?

COVID-19 und Störungen der Wasser- und Natriumhomöostase Eine Dysnatriämie tritt bei hospitalisierten Patient*innen mit COVID-19 gehäuft auf und ist mit einer erhöhten Mortalität und vermehrt septischen Verläufen assoziiert. Insbesondere eine profunde Hyponatriämie kann auch Ausdruck für ein zugrunde liegendes Syndrom der inadäquaten AVP-Sekretion (SIADH) oder einen Cortisolmangel unter COVID-19-Infektion sein. Patient*innen mit bereits bekannten Störungen des AVP-Systems – wie dem SIADH oder Diabetes insipidus – sind einem erhöhten Risiko einer mitunter schwerwiegenden Elektrolyt-Entgleisung unter COVID-19-Infektion ausgesetzt und sollten engmaschig kontrolliert werden.

Hyponatriämie unter Immun-Checkpoint-Blockade – nicht immer SIADH Der wachsende Einsatz von Immun-Checkpoint-Inhibitoren (ICI) in der Tumortherapie hat auch zu einem Zuwachs von immunvermittelten endokrinen Nebenwirkungen geführt. Diese können zeitlich sehr variabel, auch noch nach Beendigung einer ICI-Therapie, auftreten und initial eine unspezifische Klinik aufweisen. Als ein einfacher, allgemein verfügbarer Biomarker und zugleich sensitives Warnsignal für mögliche endokrine Nebenwirkungen kann die Hyponatriämie dienen. Eine unklare und neu aufgetretene Hyponatriämie unter ICI-Therapie sollte vor Diagnose eines SIADH stets abgeklärt und endokrine Nebenwirkungen sollten ausgeschlossen werden.

Neue Evidenz in der Behandlung der akuten und chronischen Hyponatriämie In der Behandlung der akuten symptomatischen Hyponatriämie eignen sich sowohl die rasche intermittierende Bolusgabe als auch die langsam kontinuierliche Infusion von 3 % NaCl zur Akuttherapie. Die Bolusgabe bietet eine geringe Überlegenheit im Sicherheitsprofil und wird in den Empfehlungen der Europäischen Praxisleitlinie favorisiert. In der Behandlung der chronischen Hyponatriämie bei SIADH ist die Flüssigkeitsrestriktion als Erstlinientherapie ein probates Mittel zur Elektrolyt-Korrektur. Die additive Gabe von Furosemid und NaCl-Kapseln zeigt keine gesteigerte Wirkeffizienz, jedoch eine schlechtere Verträglichkeit.

Copeptin-basierte Diagnostik in der Abklärung des Polyurie-Polydipsie-Syndroms Bei der Abklärung des Polyurie-Polydipsie-Syndroms ist die Sicherung einer hypotonen Polyurie vor der erweiterten diagnostischen Differenzierung essenziell. Copeptin-basierte Testverfahren zeigen eine deutliche Überlegenheit gegenüber dem indirekten Durstversuch in der Differenzierung zwischen Patient*innen mit einem Diabetes insipidus und einer Primären Polydipsie. Das eskalierende Vorgehen der diagnostischen Verfahren ist ebenso zielführend wie ressourceneffizient.
Rezidivierende Harnwegsinfektionen – was tun?
Authors: Klußmann Daniel , Wagenlehner Florian
Published: August 2022

Was ist neu?

Nicht antibiotische Therapieregime Neben allgemeiner Aufklärung und Beratung über Risikofaktoren von Harnwegsinfektionen sind vor allem die nichtantibiotischen Therapie-Optionen zur Rezidivreduktion wichtig. Das Ziel hierbei ist es, Resistenzentwicklungen und den entsprechenden unerwünschten Nebenwirkungen von Antibiotika vorzubeugen. Zu den nicht antibiotischen Strategien zählen allen voran eine persönliche Beratung mit Vermittlung von Verhaltensempfehlungen, die Immunoprophylaxe, Phytotherapeutika, sowie eine lokale Östrogensubstitution

Antibiotische Prävention Bei hohem Leidensdruck der Patientinnen ist jedoch nach entsprechender Abwägung auch eine antibiotische Prophylaxe in Betracht zu ziehen. Zusammenfassend sollte eine individuelle Beratung erfolgen und es sollte mit einem multimodalen Therapieansatz behandelt werden.
Fehlendes Therapieansprechen: Ist es wirklich eine rheumatoide Arthritis?
Authors: Marinoska Tatjana , Lauf Carla , Schorn Corinna , Schwarting Andreas
Published: August 2022

Anamnese Eine 78-jährige Patientin wurde unserer Klinik mit einer therapieresistenten, seronegativen und ACPA-negativen rheumatoiden Arthritis zugewiesen. Der Verlauf war von hoher klinischer Krankheitsaktivität und rascher Progression der erosiven Veränderungen geprägt. Unter der erforderlichen hochdosierten Prednisolon-Therapie kam es zu einer Osteoporose sowie einer TVT mit Lungenembolie.

Körperliche Untersuchung Bei Aufnahme bestanden symmetrische, schmerzhafte, synovialitische Schwellungen der MCPs, PIPs und DIPs, Fingergelenk-bezogene rötlich-livide Verfärbungen sowie Kontrakturen der Langfinger und fortgeschrittene Deformitäten. Eine ausgeprägte proximale Muskelschwäche führte zu Einschränkungen beim Treppensteigen sowie beim An- und Auskleiden.

Diagnostik Das Labor zeigte bei negativem RF und anti-CCP-Ak einen positiven ANA (1:5120) mit nukleärem Fluoreszenzmuster und einen positiven anti-Mi-2-Ak im Myositis-Blot. Nativradiologisch imponierten fortgeschrittene mutilierende Gelenkveränderungen im Bereich beider Hände, in der Magnet-Resonanz-Tomografie (MRT) der Oberarme zeigte sich eine ausgeprägte Atrophie der Oberarmmuskulatur ohne Hinweis auf eine aktive Myositis. Diese klinische Konstellation führte zu der Diagnosestellung einer amyositischen Dermatomyositis.

Therapie und Verlauf Unter einem initial erhaltenen Steroidstoß von 100 mg Prednisolon i. v./Tag über 4 Tage waren die klinischen Beschwerden rückläufig. Bei begleitenden Risikofaktoren (Osteoporosis, arterieller Hypertonie, verschwommenem Sehen) erfolgte ein schnelles Steroid-Tapering. Die Basistherapie wurde auf Rituximab umgestellt. Eine erweiterte Tumorsuche wurde ambulant empfohlen.

Diskussion Eine seronegative, ACPA-negative, therapieresistente RA mit schnell fortschreitendem erosivem Verlauf erfordert eine diagnostische Re-Evaluation. Eine erosive, rapid progressive Polyarthritis gehört zu dem Krankheitsbild der mit Anti-Jo-1-Antikörpern assoziierten idiopathischen Myopathien, dem Antisynthetase-Syndrom. Allerdings sind auch Assoziationen mit dem Vorhandensein anderer Myositis-spezifischer Antikörper (MSA) beschrieben. Die Anti-Mi-2-Ab sind hochspezifisch für Dermatomyositis (DM). Eine amyopathische DM ist selten und untypisch. Trotzdem, abgesehen von der muskulären Beteiligung, unterscheiden sich der Krankheitsverlauf und die Prognose nicht wesentlich von einer myopathischen DM.

Da eine plötzlich aufgetretene DM eine paraneoplastische Genese haben könnte, ist eine erweiterte Diagnostik zum Malignom-Ausschluss indiziert.
The Impact of “Fear of Falling” on Physical Performance, Balance, and Ambulation in Duchenne Muscular Dystrophy
Authors: Alemdaroğlu-Gürbüz İpek , İpek Canan , Bulut Numan , Karaduman Ayşe , Yılmaz Öznur
Published: August 2022

Objective The aim of this study was to investigate falls and the fear of falling (FOF) in children with Duchenne muscular dystrophy (DMD) and to determine the relationships between the FOF and physical performance, balance, and ambulation.

Methods Thirty-eight ambulatory children with DMD were included in the study. The functional level, falling history, FOF, physical performance, balance, and ambulation were assessed by using Brooke Lower Extremity Functional Classification, History of Falls Questionnaire, Pediatric Fear of Falling Questionnaire (Ped-FOF), timed performance tests, Timed “Up and Go” (TUG) test, and North Star Ambulatory Assessment (NSAA), respectively.

Results Of the 38 children (mean age: 9.00 ± 2.03 years) 97.4% had a history of serious fall last year and 62.2% were injured due to this fall. The Ped-FOF score was 13.79 ± 7.20. Weak to moderate relations were determined between Ped-FOF and functional level (r = 0.33), frequency of falls (r = 0.41), duration of climbing 4-steps (r = 0.38), TUG (r = 0.36), and NSAA (r = –0.32) (p < 0.05).

Conclusion Ambulatory children with better performance scores had lower levels of FOF despite their history of serious falls and injuries. FOF tends to increase as the symptoms of the disease progresses. Investigating the history of falls and FOF from the earliest period will guide to take precautions and make necessary interventions on time in treatment programs.
The black hole of traffic
Authors: Patrick Chris
Published: August 2022

Car pileups due to low visibility on the road offer an analog model for black holes that may help prevent accidents.
Mesoscopic modeling of vapor cavitation bubbles collapse and interaction in near-wall region with a pseudopotential lattice Boltzmann method
Authors: Peng Yiyun , He Xiaolong , Peng Haonan , Lin Yuqing , Zhang Jianmin
Published: August 2022

A multi-relaxation-time pseudopotential lattice Boltzmann (LB) model was developed to simulate multiphase flow with a large density ratio (1000) and wide viscosity ratio (15), which are highly close to the realistic cavitation phenomenon. The model is validated by Laplace law and is implemented to simulate the collapse process of single and multiple cavitation bubbles. The simulation results are in accordance with the experimental results. By comparing to other LB models and numerical methods, the stability and superiority of the present model are morphologically demonstrated. The collapse pressure and the impact jet velocity on the wall are investigated, and the jet velocity on the wall shows a typical bimodal distribution, while only one perk is observed on the pressure distribution for a single bubble collapse in near-wall region. Moreover, the results indicated that the wall–bubble distance has a greater influence on the wall pressure than the bubble–bubble distance for double bubble interactions. Finally, the simulation of the bubble cluster indicated that the inner bubble has stronger collapse intensity than the outer layer bubble, while the side bubble collapse intensity is stronger than the corner bubbles. The simulation of a series of cases proves that the proposed model is a reliable tool to investigate realistic cavitation bubble dynamics.