bluuebunny/crossref_metadata_2025 huggingface dataset:
Organocatalytic enantioselective synthesis of 2,5,5-trisubstituted piperidines bearing a quaternary stereocenter. Vinyl sulfonamide as a new amine protecting group
Authors: Escolano Marcos , Guerola Marta , Torres Javier , Gaviña Daniel , Alzuet-Piña Gloria , Sánchez-Rosello María , del Pozo Carlos
Published: December 2019

An organocatalytic desymmetrizing IMAMR with vinyl sulfonamides as nitrogen nucleophiles has been devised with good levels of diastereo- and enantioselectivity.
Theoretical understanding of the thermodynamics and interactions in transcriptional regulator TtgR–ligand binding
Authors: Sun Zhaoxi , Wang Xiaohui , Zhang John Z. H.
Published: December 2019

The transcriptional regulator TtgR belongs to the TetR family of transcriptional repressors.
Interleaflet coupling of n-alkane incorporated bilayers
Authors: Usuda Hatsuho , Hishida Mafumi , Kelley Elizabeth G. , Yamamura Yasuhisa , Nagao Michihiro , Saito Kazuya
Published: December 2019

The relationship between the membrane bending modulus (κ) and compressibility modulus (KA) depends on the extent of coupling between the two monolayers (leaflets).
Isolation of the novel example of a monomeric organotellurinic acid
Authors: Deka Rajesh , Sarkar Arup , Butcher Ray J. , Junk Peter C. , Turner David R. , Deacon Glen B. , Singh Harkesh B.
Published: December 2019

The synthesis of the first example of a monomeric, stable organotellurinic acid is reported by utilizing the σ-hole participation of the Te atom with the N atom of the 2-(2′-pyridyl)phenyl moiety.
Manipulating the ion-transfer kinetics and interface stability for high-performance zinc metal anodes
Authors: Xie Xuesong , Liang Shuquan , Gao Jiawei , Guo Shan , Guo Jiabao , Wang Chao , Xu Guiyin , Wu Xianwen , Chen Gen , Zhou Jiang
Published: December 2019

We report a new class of Zn anodes modified by a three-dimensional nanoporous ZnO architecture (Zn@ZnO-3D), which can accelerate the kinetics of Zn2+ transfer and deposition, inhibit dendrite growth, and reduce the side-reactions.
A global atmospheric chemistry model for the fate and transport of PFCAs and their precursors
Authors: Thackray Colin P. , Selin Noelle E. , Young Cora J.
Published: December 2019

Global model for the atmospheric chemistry of PFCA precursors.
Correction: Sulfonated graphitic carbon nitride as a highly selective and efficient heterogeneous catalyst for the conversion of biomass-derived saccharides to 5-hydroxymethylfurfural in green solvents
Authors: Chhabra Tripti , Bahuguna Ashish , Dhankhar Sandeep Singh , Nagaraja C. M. , Krishnan Venkata
Published: December 2019

Correction for ‘Sulfonated graphitic carbon nitride as a highly selective and efficient heterogeneous catalyst for the conversion of biomass-derived saccharides to 5-hydroxymethylfurfural in green solvents’ by Tripti Chhabra, et al., Green Chem., 2019, 21, 6012–6026.
Exploiting the mechanical bond for molecular recognition and sensing of charged species
Authors: Bąk Krzysztof M. , Porfyrakis Kyriakos , Davis Jason J. , Beer Paul D.
Published: December 2019

This review presents progress in the field of MIM hosts for ion recognition and sensing since 2014, focusing on the synthetic approaches employed and mechanisms of host–guest binding and detection.
Ab initio-enabled phase transition prediction of solid carbon dioxide at ultra-high temperatures
Authors: Huang Lei , Han Yanqiang , He Xiao , Li Jinjin
Published: December 2019

Carbon dioxide is one of the fundamental chemical species on Earth, but its solid-phase behavior at high pressures is still far from well understood and some phases remain uncertain or unknown, which increases the challenge to predict its structures.
Engineering phytosterol-based oleogels for potential application as sustainable petrolatum replacement
Authors: Chen Xiao-Wei , Sun Shang-De , Yang Guo-Long , Ma Chuan-Guo
Published: December 2019

Phytosterols, as a family of plant-produced molecules, are recognized for their natural health benefits. Phytosterol-based oleogels have been engineered in edible oils to be potential applicable as sustainable petrolatum replacements.
Synthesis, structural characterization and Cu(ii) adsorption behavior of manganite (γ-MnOOH) nanorods
Authors: Cano-Salazar L. F. , Martínez-Luévanos A. , Claudio-Rizo J. A. , Carrillo-Pedroza F. R. , Montemayor S. M. , Rangel-Mendez J. R.
Published: December 2019

Manganite (γ-MnOOH) nanorods were synthesized and Cu(ii) adsorption on their hydroxylated surface was a spontaneous process (ΔG° < 0).
Development and assessment of speed-up algorithms for the reactive CFD–DEM simulation of fluidized bed reactors
Authors: Uglietti Riccardo , Bracconi Mauro , Maestri Matteo
Published: December 2019

PA and ISAT algorithms are developed to speed-up the CFD–DEM simulations of fluidized reactors. Also, a selection procedure of the most effective algorithm according to the operating conditions is developed, enabling the simulation of lab reactors.
Pyroelectric power generation from the waste heat of automotive exhaust gas
Authors: Kim Juyoung , Yamanaka Satoru , Murayama Ichiro , Katou Takanori , Sakamoto Tomokazu , Kawasaki Takuro , Fukuda Tatsuo , Sekino Tohru , Nakayama Tadachika , Takeda Masatoshi , Baba Masaaki , Tanaka Hirohisa , Aizawa Kazuya , Hashimoto Hideki , Kim Yoonho
Published: December 2019

A waste heat recovery system is investigated basically. Original electro-thermodynamic cycle and novel system are expected to be viable in any heat sources with time dependent temperature changes instead of the spatial temperature gradient.
Inverse μ-photonic crystals enhanced the features of mini-sized quantum dot LEDs
Authors: Ho Shih-Jung , Chen Hsueh-Shih
Published: December 2019

Quantum dot-converted white RGB LEDs enhanced by micron-sized inverse photonic crystals.
A fiber-shaped light-emitting pressure sensor for visualized dynamic monitoring
Authors: Zhou Xufeng , Xu Xiaojie , Zuo Yong , Liao Meng , Shi Xiang , Chen Chuanrui , Xie Songlin , Zhou Peng , Sun Xuemei , Peng Huisheng
Published: December 2019

A fiber-shaped light-emitting pressure sensor is achieved to simultaneously detect and visualize force stimuli in one single device.
Pioglitazone protects blood vessels through inhibition of the apelin signaling pathway by promoting KLF4 expression in rat models of T2DM
Authors: Wang Ying , Zhang Ruonan , Shen Hailin , Kong Jing , Lv Xinrui
Published: December 2019

Apelin, identified as the endogenous ligand of APJ, exerts various cardiovascular effects. However, the molecular mechanism underlying the regulation of apelin expression in vascular cells is poorly described. Pioglitazone (PIO) and Krüppel-like factor 4 (KLF4) exhibit specific biological functions on vascular physiology and pathophysiology by regulating differentiation- and proliferation-related genes. The present study aimed to investigate the roles of PIO and KLF4 in the transcriptional regulation of apelin in a high-fat diet/streptozotocin rat model of diabetes and in PIO-stimulated vascular smooth muscle cells (VSMCs). Immunohistochemistry, qRT-PCR, and Western blotting assays revealed that the aorta of the Type 2 diabetes mellitus (T2DM) rat models had a high expression of apelin, PIO could decrease the expression of apelin in the PIO-treated rats. In vitro, Western blotting assays and immunofluorescent staining results showed that the basal expression of apelin was decreased but that of KLF4 was increased when VSMCs were stimulated by PIO treatment. Luciferase and chromatin immunoprecipitation assay results suggested that KLF4 bound to the GKLF-binding site of the apelin promoter and negatively regulated the transcription activity of apelin in VSMCs under PIO stimulation. Furthermore, qRT-PCR and Western blotting assay results showed that the overexpression of KLF4 markedly decreased the basal expression of apelin, but the knockdown of KLF4 restored the PIO-induced expression of apelin. In conclusion, PIO inhibited the expression of apelin in T2DM rat models to prevent diabetic macroangiopathy, and negatively regulated the gene transcription of apelin by promoting transcription of KLF4 in the apelin promoter.
Field enhancement of optical bowtie nano‐antenna using exponential tapered profile
Authors: El‐sherbiny Shamia , Wageh Swelm
Published: December 2019

In this work, both the near‐field and far‐field optical properties of curved sides bowtie nano‐antenna are investigated in the near‐infrared range. The curvature of the proposed structure is based on the Vivaldi antenna tapering shape. The effect of tapering rate on the near‐field enhancement is studied, and the results show that the proposed antenna structure produces better field enhancement compared with conventional bowtie antenna with linear sides and hence it is promising for energy harvesting and microscopy applications. Also, the far‐field properties are studied to decide the validity of the structure in optical communication applications.
Hybrid model for estimating the shielding effectiveness of metallic enclosures with arbitrary apertures
Authors: Hu Pu‐Yu , Sun Xiao‐Ying , Chen Jian
Published: December 2019

Electronic enclosures often require ventilation and electromagnetic shielding, which have conflicting design requirements. This study proposes a hybrid model, based on circuit model and full‐wave method, for estimating the shielding effectiveness of empty metallic enclosures with ventilation apertures of arbitrary shape or aperture arrays of arbitrary distribution on one side of the enclosures. Such perforated enclosures are split into a perforated plate and semi‐enclosed waveguide that is shorted at the end. The S parameters of the perforated plate are calculated by a full‐wave method and used to estimate the aperture impedance. An equivalent circuit model of a perforated enclosure is established, considering arbitrarily‐positioned apertures, arbitrarily‐chosen observation points, and higher‐order modes. A modified plane wave decomposition technique is adopted to solve the problem of plane waves with arbitrary incident and polarisation directions. In particular, the effects of the electric field components perpendicular to the perforated plate are considered. The efficiency and accuracy of the hybrid model are evaluated by the transmission line matrix method, finite integration technique, experimental observations and existing circuit models. The hybrid model requires much less simulation time than pure full‐wave methods such as the transmission line matrix method.
Sparse and hybrid modelling of relative humidity: the Krško basin case study
Authors: Kocijan Juš , Perne Matija , Grašic Boštjan , Božnar Marija Zlata , Mlakar Primož
Published: December 2019

This study describes an application of hybrid modelling for an atmospheric variable in the Krško basin. The hybrid model is a combination of a physics‐based and data‐driven model and has some properties of both modelling approaches. In the authors’ case, it is used for the modelling of an atmospheric variable, namely relative humidity in a particular location for the purpose of using the predictions of the model as an input to the air‐pollution‐dispersion model for radiation exposure. The presented hybrid model is a combination of a physics‐based atmospherical model and a Gaussian‐process (GP) regression model. The GP model is a probabilistic kernel method that also enables evaluation of prediction confidence. The problem of poor scalability of GP modelling was solved using sparse GP modelling; in particular, the fully independent training conditional method was used. Two different approaches to dataset selection for empirical model training were used and multiple‐step‐ahead predictions for different horizons were assessed. It is shown in this study that the accuracy of the predicted relative humidity in the Krško basin improved when using hybrid models over using the physics‐based model alone and that predictions for a considerable length of horizon can be used.
Nonlinear iteration acceleration solution for equilibrium radiation diffusion equation
Authors: Zhang Yanmei , Cui Xia , Yuan Guangwei
Published: December 2019

This paper discusses accelerating iterative methods for solving the fully implicit (FI) scheme of equilibrium radiation diffusion problem. Together with the FI Picard factorization (PF) iteration method, three new nonlinear iterative methods, namely, the FI Picard-Newton factorization (PNF), FI Picard-Newton (PN) and derivative free Picard-Newton factorization (DFPNF) iteration methods are studied, in which the resulting linear equations can preserve the parabolic feature of the original PDE. By using the induction reasoning technique to deal with the strong nonlinearity of the problem, rigorous theoretical analysis is performed on the fundamental properties of the four iteration methods. It shows that they all have first-order time and second-order space convergence, and moreover, can preserve the positivity of solutions. It is also proved that the iterative sequences of the PF iteration method and the three Newton-type iteration methods converge to the solution of the FI scheme with a linear and a quadratic speed respectively. Numerical tests are presented to confirm the theoretical results and highlight the high performance of these Newton acceleration methods.
Schwachstelle praktische Ausbildung – Praxisanleiter in Zeiten der Akademisierung
Authors: Riese Marion
Published: December 2019

Seit es in der Physiotherapie primärqualifizierende Studiengänge gibt, sind nicht mehr die Ausbildungsstätten, sondern die Therapeuten in Kliniken und Praxen für die praktische Ausbildung zuständig. Dafür fehlen jedoch häufig pädagogische Qualifikationen und evidenzbasiertes Wissen, findet Prof. Dr. Marion Riese.
Zwischen zwei Polen – Evidence-based Practice versus erfahrungsbasierte Therapie
Authors: Tiebel Jakob , Huber Martin
Published: December 2019

Therapeuten sollen heute nicht mehr nach Intuition und Gefühl behandeln. Vielmehr sollen sie sich an klinischen Leitlinien orientieren. Wird klinische Entscheidungsfindung damit zu einem rationalen Denkprozess stilisiert? Schließen Vernunft und Gefühle einander aus? Für vernünftige Entscheidungen, so heißt es, braucht es einen kühlen Kopf. Doch stimmt das wirklich?
Jede Generation hat eigene Werte – Generation Z
Authors: Klein Claudia
Published: December 2019

Veränderungen finden ständig statt – egal, ob in der Politik, Mode oder Technik. Seit ein bis zwei Jahren macht besonders eine Entwicklung Schlagzeilen: die viel diskutierte, manchmal belächelte und oft kritisierte Generation Z. Mit ihren Werten und Einstellungen stellt sie Arbeitgeber, Kollegen und Lehrende vor neue Herausforderungen.
Anderthalb Dekaden Disease-Management-Programme – Eine Bilanz zum Status quo aus hausärztlicher Sicht
Authors: Wangler Julian , Jansky Michael
Published: December 2019

Hintergrund Im Jahr 2003 wurden die Disease-Management-Programme (DMP) zur Verbesserung der Versorgung chronisch kranker Patienten im ambulanten Bereich eingerichtet. Seitdem wurde insbesondere unter Hausärzten immer wieder kontrovers über Sinn und Nutzen der strukturierten Behandlungsprogramme diskutiert. Die vorliegende Studie geht der Frage nach, welche Einstellungs- und Erfahrungswerte Hausärzte in Bezug auf DMP vertreten, wie sie diese anderthalb Dekaden nach ihrer Einführung bilanzieren und wo sie Verbesserungsbedarfe ausmachen.

Methoden Mittels schriftlicher Befragung wurden zwischen April und Juni 2019 insgesamt 752 Hausärzte in Hessen befragt. Neben der deskriptiven Analyse kam eine Faktorenanalyse zum Einsatz.

Ergebnisse 59 % der Befragten beurteilen die DMP positiv und erachten sie als nützlichen Beitrag zur hausärztlichen Versorgung. 89 % nehmen zurzeit an einem oder mehreren DMP teil, wobei 52 % angeben, dass die Therapie der in DMP einbezogenen Patienten stark profitiert hat. Besonders positiv wird die Sicherstellung einer regelmäßigen, strukturierten Patientenbetreuung und die Verbesserung der Compliance gesehen. Ebenfalls wird konstatiert, dass die diagnostischen und therapeutischen Kenntnisse durch die DMP-Teilnahme erweitert werden konnten. 58 % richten sich prinzipiell nach den DMP-Empfehlungen zur (medikamentösen) Therapie. Kritisiert werden Dokumentationspflichten und häufige organisatorische Veränderungen an den Programmen. Eine weitgehende Starrheit des DMP-Konzepts führt aus Sicht der Befragten zu einer übertriebenen Einengung von Handlungsspielräumen und gelegentlich zu Komplikationen im Praxisablauf. Die Kooperation mit fachärztlichen Kollegen wird innerhalb von DMP häufig als unbefriedigend erlebt.

Schlussfolgerung Vordringlich für eine substanzielle Verbesserung von DMP aus hausärztlicher Sicht erscheinen eine Vereinfachung des Dokumentations- und Verwaltungsaufwands, eine besser geregelte und reibungslosere Zusammenarbeit mit anderen Versorgungsebenen, eine Einräumung von mehr Entscheidungsflexibilität, ein größeres und differenzierteres Angebot an Pflichtschulungen, der verstärkte Einbezug von hausärztlichen Erfahrungen im Prozess der DMP-Weiterentwicklung sowie eine bessere Honorierung.
Endoskopische Diagnostik der unklaren Gallengangsstenose: Aktueller Stand und Ausblick
Authors: Walter Dirk , Albert Jörg , Jung Michael , Friedrich-Rust Mireen
Published: December 2019

Patienten mit unklarer Gallengangsstenose stellen regelhaft eine Herausforderung an den klinisch tätigen Gastroenterologen dar. So sollten Patienten mit malignen und potenziell resektablen Erkrankungen so bald wie möglich einer kurativen Operation zugeführt werden. Gleichzeitig sollte bei Patienten mit benignen und potenziell konservativ behandelbaren Erkrankungen eine umfangreiche Operation vermieden werden. Diese Arbeit soll eine Übersicht vermitteln über die Aussagekraft der zurzeit verfügbaren endoskopischen Diagnostik sowie einen Ausblick geben auf potenziell in der Zukunft relevante Verfahren.
Hausärztlicher Umgang mit Patientenverfügung und Vorsorgevollmacht bei Demenzpatienten – Eine Querschnittsstudie unter deutschen Hausärzten
Authors: Tillmann Judith , Schnakenberg Rieke , Weckbecker Klaus , Just Johannes , Weltermann Birgitta , Münster Eva
Published: December 2019

Ziel Aufgrund der abnehmenden Selbstständigkeit und Handlungsfähigkeit von Demenzpatienten ist es wichtig, rechtzeitig Zukunftsvorkehrungen in Form einer Patientenverfügung und Vorsorgevollmacht zu treffen. Diese Studie zeigt, ob Hausärzte ihre Patienten mit Demenz auf diese Dokumente ansprechen und ob es Zusammenhänge dieses Vorgehens mit dem weiteren Kommunikations- und Aufklärungsverhalten der Ärzte gibt.

Methodik Eine Querschnittsstudie unter einer Zufallsstichprobe von 982 Hausärzten in Nordrhein-Westfalen wurde von Oktober 2017 bis Januar 2018 durchgeführt. Ein selbstentwickelter, schriftlicher, standardisierter Fragebogen wurde eingesetzt. Deskriptive statistische Analysen und logistische Regressionsanalysen wurden mittels IBM SPSS Statistics, Version 24, durchgeführt.

Ergebnisse 339 Hausärzte nahmen an der Befragung teil (Rücklaufquote: 34,5%). 70,1% der Hausärzte stimmen eher bzw. völlig zu, ihre Patienten nach Diagnosestellung einer Demenz auf die Notwendigkeit einer Patientenverfügung und Vorsorgevollmacht anzusprechen. Ärzte, die sich sicher in der Mitteilung von Demenzdiagnosen fühlen, berichten auch häufiger, dass sie diese Vorsorgedokumente ansprechen (aOR: 1,97; 95%-KI: 1,17–3,33). Auch sprechen tendenziell Hausärzte mit höherem Alter und Kenntnissen von lokalen Hilfestellen eher diese Thematik an.

Schlussfolgerung Hausärzte leisten einen wesentlichen Beitrag, Demenzpatienten und ihre Angehörigen frühzeitig auf eine Patientenverfügung und Vorsorgevollmacht anzusprechen. Aus den dargelegten Zusammenhängen lässt sich schließen, dass sowohl die hausärztliche Aneignung von Wissen und Erfahrungen zu Demenz und dem lokalen Hilfesystem als auch der Umgang mit Betroffenen gestärkt werden sollte, um die Ansprache dieser Vorsorgedokumente zu optimieren.
Qualitätssicherung in der Brustrekonstruktion – Etablierung eines prospektiven nationalen Onlineregisters für mikrochirurgische Brustrekonstruktionen
Authors: Fritschen Uwe von , Grill Barbara , Wagner Juri , Schuster Horst , Sukhova Inesa , Giunta Riccardo E. , Heitmann Christoph , Andree Christoph , Horch Raymund E. , Kneser Ulrich , Germann Günter
Published: December 2019

Hintergrund Der Verlust der weiblichen Brust ist für betroffene Frauen extrem traumatisierend. Obwohl sich freie Lappenplastiken zum Goldstandard in der rekonstruktiven Brustchirurgie entwickelt haben, war es bisher nicht gelungen, ihre Überlegenheit im Hinblick auf die alternativen konventionellen Techniken zweifelsfrei zu belegen. Bis heute existieren keine Daten zur Versorgungssituation in Deutschland. Durch den Aufbau eines prospektiven Onlineregisters zur Brustrekonstruktion sollte die Versorgungsstruktur und -qualität systematisch erfasst und transparent dargestellt werden, um Defizite zu verbessern und mittelfristig eine flächendeckende Versorgung auf hohem Niveau zu ermöglichen.

Methoden Hierfür hat die Deutsche Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC) eine internetbasierte Datenbank zur anonymisierten Erfassung der Behandlungsdaten aufgebaut. Im Rahmen einer Zertifizierung wurde die Strukturqualität, Erfüllung der Vorgaben und die Stringenz der eingegebenen Daten im Abgleich mit der krankenhausinternen Dokumentation überprüft. Bei positiver Bewertung wird das Qualitätssiegel der DGPRÄC vergeben.

Ergebnisse Seit ihrer Einführung im Jahr 2012 liefert die Datenbank validierte Informationen. Waren zu Anfang nur wenige Abteilungen zur transparenten Darstellung ihrer Resultate bereit, wuchs deren Zahl in den vergangenen Jahren stetig an. Die Qualitätsdarstellung konnte bundesweit eine Vorreiterfunktion übernehmen und wird von Patienten und Kollegen als seriöse und verlässliche Informationsquelle genutzt. Die Internetseite der DGPRÄC weist die Zentren nach ihrer jeweiligen Qualifikation aus. Inzwischen ist es gelungen, in akzeptabler Nähe zu jedem onkologischen Brustzentrum einen qualifizierten plastisch-chirurgischen Ansprechpartner auszuweisen. Auch zeigen die Daten, dass in Deutschland auf einem international vergleichbaren Spitzenniveau gearbeitet wird.

Schlussfolgerung Die Datenbank liefert einen Überblick über die verschiedenen Operationstechniken und damit die Möglichkeit einer seriösen Selbstkontrolle und wissenschaftliche Analyse. Dies hat dazu geführt, dass die Akzeptanz mikrochirurgischer Eingriffe und die Stellung der Plastischen Chirurgie in der rekonstruktiven Brustchirurgie erheblich gestiegen ist. Die notwendige finanzielle und personelle Ausstattung zur Etablierung der Datenbank wurde jedoch deutlich zu gering eingeschätzt.
ERCP-related adverse events: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Authors: Dumonceau Jean-Marc , Kapral Christine , Aabakken Lars , Papanikolaou Ioannis S. , Tringali Andrea , Vanbiervliet Geoffroy , Beyna Torsten , Dinis-Ribeiro Mario , Hritz Istvan , Mariani Alberto , Paspatis Gregorios , Radaelli Franco , Lakhtakia Sundeep , Veitch Andrew M. , van Hooft Jeanin E.
Published: December 2019

Main Recommendations

Prophylaxis

1 ESGE recommends routine rectal administration of 100 mg of diclofenac or indomethacin immediately before endoscopic retrograde cholangiopancreatography (ERCP) in all patients without contraindications to nonsteroidal anti-inflammatory drug administration.

Strong recommendation, moderate quality evidence.

2 ESGE recommends prophylactic pancreatic stenting in selected patients at high risk for post-ERCP pancreatitis (inadvertent guidewire insertion/opacification of the pancreatic duct, double-guidewire cannulation).

Strong recommendation, moderate quality evidence.

3 ESGE suggests against routine endoscopic biliary sphincterotomy before the insertion of a single plastic stent or an uncovered/partially covered self-expandable metal stent for relief of biliary obstruction.

Weak recommendation, moderate quality evidence.

4 ESGE recommends against the routine use of antibiotic prophylaxis before ERCP.

Strong recommendation, moderate quality evidence.

5 ESGE suggests antibiotic prophylaxis before ERCP in the case of anticipated incomplete biliary drainage, for severely immunocompromised patients, and when performing cholangioscopy.

Weak recommendation, moderate quality evidence.

6 ESGE suggests tests of coagulation are not routinely required prior to ERCP for patients who are not on anticoagulants and not jaundiced.

Weak recommendation, low quality evidence.

Treatment

7 ESGE suggests against salvage pancreatic stenting in patients with post-ERCP pancreatitis.

Weak recommendation, low quality evidence.

8 ESGE suggests temporary placement of a biliary fully covered self-expandable metal stent for post-sphincterotomy bleeding refractory to standard hemostatic modalities.

Weak recommendation, low quality evidence.

9 ESGE suggests to evaluate patients with post-ERCP cholangitis by abdominal ultrasonography or computed tomography (CT) scan and, in the absence of improvement with conservative therapy, to consider repeat ERCP. A bile sample should be collected for microbiological examination during repeat ERCP.

Weak recommendation, low quality evidence.
Síndromes compresivos vasculares: un desafío diagnóstico
Authors: Sanabria Jesús , Zabala Andrea , DiCaro Vanesa , Pietrani Marcelo , Rabellino Martín
Published: December 2019

Los síndromes de compresión vascular constituyen un grupo de patologías poco frecuentes con prevalencia incierta, no solo por el desconocimiento que se tiene de estos, sino también por su presentación clínica inespecífica. Eso conlleva a que sean infradiagnosticados o detectados en etapas tardías, con secuelas a largo plazo.

Su fisiopatología y clínica dependen del tipo de vaso comprometido, el sitio anatómico afectado y la causa subyacente que lo esté produciendo.

La anamnesis, el examen físico dirigido y el uso de métodos complementarios como la ultrasonografía Doppler y la angiografía por tomografía computarizada (ATC) o angiografía por resonancia magnética (ARM), son herramientas vitales para su correcto diagnóstico, planificación terapéutica y seguimiento.
Colangiocarcinoma. Evaluación por Tomografía Computada y Resonancia Magnética
Authors: Sánchez Lucía , Labra Andrés , Schiappacasse Giancarlo
Published: December 2019

El colangiocarcinoma (CC) es el segundo tumor primario maligno más frecuente del hígado. La mayor incidencia se registra en Asia y su pronóstico es poco alentador. La resección quirúrgica del tumor es el único tratamiento potencialmente curativo. Sin embargo, la mayoría de los CC se diagnostican en estadios avanzados de la enfermedad y la recurrencia del tumor es común. Este trabajo pretende demostrar las características imagenológicas de los CC, su clasificación, así como también la evaluación preoperatoria por tomografía computada (TC) y resonancia magnética (RM) que el radiólogo debe realizar actualmente.
Scapholunate Ligament Injury and the Effect of Scaphoid Lengthening
Authors: Furey Matthew J. , White Neil J. , Dhaliwal Gurpreet S.
Published: December 2019

Objective We hypothesized that lengthening the scaphoid in a model of scapholunate ligament injury (SLI) will result in correction of radiographic markers of dorsal intercalated segment instability (DISI) deformity.

Materials and Methods An SLI with DISI deformity was created by sectioning the SL ligament, the palmar radiocarpal ligaments, and scapho-trapezio-trapezoid ligaments of a cadaveric upper extremity (n = 5). The wrist was radiographed in both anteroposterior and lateral planes to confirm creation of SLI and DISI. The scaphoid was then osteotomized at its waist. A series of grafts (1–8 mm) were then placed at the osteotomy site. Radiographs were completed at each length. The main outcome measures were scapholunate interval (SL, mm), scapholunate angle (SLA, degrees), and radiolunate angle (RLA, degrees). These values, measured following the insertion of varying graft lengths, were compared with baseline measurements taken “post-injury” status.

Results The ability to create an SLI with DISI was confirmed in the postinjury group with a statistically significant change in RLA, SLA, and SL compared with preinjury. With osteotomy and progressive insertion of spacers, the values improved into the accepted normal ranges for RLA (6 mm) and SLA (4 mm) with scaphoid lengthening.

Conclusions In this cadaveric model of SL injury, radiographic markers of DISI were returned to within normal ranges with scaphoid osteotomy and lengthening.

Clinical Relevance The results of this study add insight into wrist kinematics in our injury model and may represent a potential future direction for surgical treatment of SLI.
Effect of percutaneous electrical nerve stimulation currents applied at different frequencies on post-needling soreness
Authors: J. Gascón Jaén , EJ Poveda Pagán , A. Martín-Pintado Zugasti
Published: December 2019

Background and Aims Percutaneous Electrical Nerve Stimulation (PENS) is a type of current which is frequently used for post-needling soreness. However, to date, no studies have compared the different frequencies available for reducing post-needling soreness. The aim of this study was to research the immediate and short-term effects of the PENS current at 2 Hz frequency compared to PENS at 1000 Hz frequency applied after dry needling on post-needling soreness, disability associated with post-needling soreness and the pain pressure threshold (PPT) in latent myofascial trigger points (MTrPs) of the upper trapezius.

Material and Methods An experimental double-blind non-controlled study. In total, 23 subjects without pain and with latent MTrPs in the upper trapezius participated in the study. Dry needling was performed, until the disappearance of local twitch responses. After randomization, 11 subjects received PENS at 100 Hz, whereas 12 received PENS at 2 Hz. The current was applied during 15 minutes, the duration of the current pulse was 100 microseconds. The main variable used was the Visual Analog Scale (VAS) to evaluate post-needling pain. The Neck Disability Index (NDI) and the PPT were secondary variables. The patient completed a diary on post-needling soreness in the hours following the intervention. A follow-up of the study variables was performed at 24 hours, 72 hours and one week after performing the intervention.

Results Statistically significant differences were obtained between both groups in post-needling soreness immediately after the intervention (P = 0.002) and at 5 minutes (P = 0.03) in favor of the high frequency group. No differences were found in any of the follow-up periods and the pain disappeared in all subjects before 72 hours. Regarding the PPT, no significant differences were found between both groups. However, the group who received high frequency returned to their baseline conditions at 24 hours, whereas those who received low frequency returned to baseline conditions at 72 hours. All the subjects increased their PPT one week after receiving the intervention (P < 0.05), nonetheless, they did not reach the minimum detectable change. No significant differences were found between groups according to the NDI.

Conclusion The application of high frequency PENS after dry needling is more effective than low frequency PENS to reduce post-needling soreness in the short term in patients with latent MTrPs in the sample under study. No differences were found between groups regarding disability or the PPT. Our results are limited, future studies are required to establish the optimal frequency for reducing post-needling soreness.
Effectiveness of joint mobilization and dry needling in myofascial pain syndrome with neck pain
Authors: S. Martín Pérez , J. Montaño Ocaña , C. Barragán Carballar , H. Arribas Pérez
Published: December 2019

Background and Aim Almost 70% of the population has suffered from cervical pain of a mechanical origin (CPM) at some point in their life. In myofascial pain syndrome (MPS), besides the zygapophyseal joint, the myofascial trigger point (MTrP) is involved as the main source of CPM. Manual therapy (MT) based on joint mobilization (JM) in combination with dry needling (DN), are the most used treatments in these patients.

Aims 1) To compare the pain and range of motion (ROM) between the MT interventions using JM and deep DN and MT using JM and sham DN in patients with CPM and activation of MTrP 2 of the upper trapezius (UT). 2) To assess the changes in the active cervical ROM, pain pressure threshold (PPT), intensity of pain at rest and with movement (measured using the Visual Analog Scale) and post-needling soreness in these patients.

Material and Methods An experimental, double blind randomized pilot study in which the effects produced by the interventions were compared among two groups: a first group (n = 5) received a treatment based on sham DN of the UT and MT using JM of C2 and a second group (n = 6) who received deep DN of the MTrP 2 of the UT and the same mobilization technique. Three prospective measurements were performed: pre-intervention, post-intervention and follow-up (1 month after the post-intervention measurement).

Results 11 subjects participated in this study (7 women and 4 men; mean age: 49.9 ±  10.8 years) who completed both the four interventions (1 session/week) as well as the follow-up. According to the PPT, measured on the MTrP 2 of the UT, none of the two groups presented clinically significant changes, and only 3 patients presented increases beyond the MDC (MDC) in the follow-up measurement (1.11 kg/cm2). Regarding the VAS measured at rest, only the first group (sham DN) obtained a clinically significant post intervention improvement (56%) and at follow-up (150%). The VAS in response to movement decreased significantly with treatment in both groups for all movement planes and axes; however, the active cervical ROM did not display significant changes in any of the two groups; lastly, the mean, maximum and minimum values of post-needling soreness in the group with placebo DN were lesser to those of the group who received the real deep DN technique, for the entire treatment.

Conclusion Deep DN combined with MT improved the intensity of pain in response to cervical movement, whereas sham dry needling combined with MT caused a greater decrease of intensity at rest. Although both techniques are similar for improving active cervical ROM, sham DN combined with MT increased post-needling soreness both during treatment as well as at follow-up. Further research is necessary to deepen our information of the effects of the combination of these two techniques in the treatment of MPS.
Ultrasound-guided percutaneous neuromodulation in chronic lateral elbow pain
Authors: B. De la Cruz-Torres
Published: December 2019

Background Lateral epicondylalgia (LE), also known as tennis elbow, refers to a painful condition around the lateral epicondyle of the humerus and the common extensor tendon, which worsens with dorsiflexion and/or wrist supination against resistance. The aim of this study was to evaluate the effect of ultrasound-guided percutaneous neuromodulation (PNM) applied to the radial nerve in relation to pain, functionality, electrophysiological excitation and the morphology of the nerve in patients with chronic lateral epicondylalgia.

Material and Methods A randomized clinical trial was performed. In total, 28 patients (15 women, 13 men) with chronic unilateral LE were randomly divided into two groups: a control group (CG = 12) who did not receive any treatment and an experimental group (PNM = 16) who received a weekly session during three weeks of ultrasound-guided PNM on the affected radial nerve. Concretely, the therapy consisted of the application of an asymmetric biphasic current on the symptomatic side, with a frequency of 10 Hz, a phase duration of 250 microseconds, and sufficient current intensity to observe a contraction in the forearm during 1.5 minutes. The variables analyzed were: pain, measured via the visual analog scale (VAS); functionality, measured using the Patient-Rated Tennis Elbow Evaluation (PRTEE); the morphology of the nerve with the calculation of the cross-sectional area (CSA) and the electrophysiological excitability with the intensity-time curve (accommodation coefficient) of the radial nerve studied

Results There were no differences between the two groups in the initial assessment regarding pain, functionality and nerve morphology (all comparisons obtained a p > 0.05). However, at the end of the study, the groups were significantly different. After treatment, there were significant differences in all variables: for the VAS (p < 0.001) with a large effect size (d > 0.8); for all values of the PRTEE (p < 0.001) the effect size was median (d > 0.5) and for the CSA (p = 0.001) the effect size was large (d > 0.8). Only the PNM group displayed significant increases in their values compared to the initial assessment, with a large effect size for all variables (d > 0.8). Regarding the accommodation coefficient, 75% of patients (12/16) displayed hypoexcitability of the nerve in the PNM group and 64% of patients (8/12) in the CG at the beginning of the study. After treatment, only the PNM group showed significant improvements in the pattern of excitability of the radial nerve, reaching normal nerve function in all subjects (p < 0.001).

Conclusion Ultrasound-guided PNM leads to a decrease in pain and CSA of the radial nerve; furthermore, it produces an increased functionality of the elbow and normalization of the electrophysiological excitability of the affected radial nerve. Ultrasound-guided PNM appears to be an appropriate tool for the treatment of patients with chronic LE.
Effects of ultrasound-guided percutaneus neuromodulation in chronic shoulder pain in the hemiplegic patient. A case series
Authors: A. Ventero Gómez , M. Martín-Macho Martínez , M. Carrió Font , A. Martín Buigues
Published: December 2019

Background and Aims Hemiplegic shoulder pain (HSP) is a very common complaint among patients affected with cerebrovascular accident (CVA). This type of pathology is related with a neuropathic type of pain. Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is a physical therapy technique consisting of low-frequency electric stimulation of peripheral nerves via an acupuncture needle under ultrasound guidance. Because of the relationship between the suprascapular and axillary nerves with the shoulder joint, these represent the target structure for US-guided PNM. This study aimed to observe the effects of the application of US-guided PNM in HSP and to evaluate the possible changes in variables such as pain, functionality and quality of life of patients.

Material and Methods This study was a case series. Patients with HSP were selected between the months of April and June 2018 in the Hospital of Denia. Seven patients were interviewed, after which the experimental group was reduced to five participants. These patients received weekly PNM treatment during three weeks. The parameters used were: frequency (10Hz), pulse width (250 μs), intensity (pain threshold) and time (10 min). The main clinical variables examined were pain, measured using the VAS scale, functionality, via the SPADI scale and physical and mental components of quality of life using the SF12 scale.

Results The results of the VAS scale, expressed as the mean (SD) was 7.2 (1.3) pre-intervention; 3.6 (0.89) post-intervention week 3; and 4 (1.23) post intervention week 5. The results revealed significant changes in the VAS scale which continued until week 5 (p < 0.05). The mean obtained in the SPADI scale, expressed as the mean (SD) was 72.4 (1.3) pre-intervention, 55.7 (19.72) post-intervention in week 3 and 59.8 (20.66) post intervention week 5. The changes observed between the pre-intervention sample and the measurements obtained in week 3 and 5 were significant (p < 0.05).

Conclusions The US-guided PNM technique was effective in the sample under study for improvement of the patient's sensation of pain. The US-guided PNM technique improves functionality of HSP, as well as the emotional status of patients.
Liberation of the interleukin-1 beta in macrophages stimulated using galvanic current
Authors: F. Medina i Mirapeix , P. Pelegrin Vivancos , JA García Vidal , P. Escolar Reina
Published: December 2019

Introduction and Aims Percutaneous needle electrolysis (PNE) is a therapeutic tool which has demonstrated its effectiveness for the treatment of tendinopathies and muscle problems. However, there is a scarcity of basic and fundamental information directed at getting to know the effects of the same on the molecular level. The aim of the present study was to confirm whether, after the use of galvanic current on macrophages in culture, there is a liberation of pro-inflammatory cytokines.

Material and Methods Using a special device designed for cellular cultures (Physio Invasiva® device, PRIM), two impacts were applied with a current intensity of 3 mA during two seconds to differentiated cell macrophage cell cultures of C57/BL6 mice of the bone marrow and previously stimulated with bacterial lipopolysaccharides (1 μg/ml, 4h). Once the currents were applied, the macrophages were incubated 16h and subsequently, the amount of interleukin-1 beta (IL-1b) was determined in the supernatant of lactate dehydrogenase.

Results The application of the galvanic current resulted in the liberation of IL-1b, without an increase in cell death. The Western blot study demonstrated that the IL-1b that is liberated corresponds with the mature form of 17 kDa of this cytokine, therefore we speculate that the galvanic current may induce the activation of the inflammatory caspase, caspase-1, via the formation of inflammasomes.

Conclusions The data obtained suggest that the liberation of IL-1b may regulate the inflammatory and therapeutic effects of the galvanic current.
Nutritional Profile of Patients in Hemodialysis of the Hospital Universitário Ciências Médicas - Minas Gerais
Authors: Machado Renata Silva , Pessoa Bruno Porto , Lima Patricia Vasconcelos , Costa Glauber Adriano Rodrigues , Giancott Frenanda Amaral , Alves Thiago Abramo , Soares Renata Peluso , Nogueira Adalberto Fernades
Published: December 2019

Objetivos Avaliar o estado nutricional dos pacientes em hemodiálise (HD).

Métodos Estudo transversal realizado em todos os pacientes em HD de um único centro.

Resultados Foram estudados 72 pacientes, sexo masculino (57%) e 45,8% entre 45 e 64 anos. A etiologia mais frequente foi hipertensão arterial sistêmica (50,0%) e diabetes (20,8%). O teste de depuração fracional da ureia (KT/V) > 1,2 foi encontrado em 88,8% dos pacientes, e nível de fósforo > 5,5 mg/dL em 25%. Os desnutridos classificados pelo índice de massa corporal (IMC) < 25 Kg/m2 (66,67%), índice de circunferência muscular do braço (CMB) (84,72%) e albumina (≤ 4,0 g/dL) (28,8%), sendo que 22,22% utilizam suplemento nutricional oral específico para paciente dialítico hiperproteico hipercalórico, fornecido pelo serviço de hemodiálise. O ganho de peso interdialítico médio (GPIDm) foi < 2,5kg em 58,3%, e o ganho de peso interdialítico relativo (GPIDr) foi < 4,5% em 75,0% dos pacientes. Houve associação significativa entre o GPIDm e a CMB, pacientes com menor GPIDm (≤ 2,5 Kg) tendem a ter mais desnutrição leve ou moderada (p = 0,003). Não foram observadas diferenças por tempo em hemodiálise em relação à idade, ganho de peso interdialítico, medidas laboratoriais e antropométricas.

Conclusão A avaliação nutricional pelo IMC esteve de acordo com a literatura brasileira. Pela CMB, a maioria foi classificada como desnutridos, o que difere da albumina, pela qual apenas ∼ 30% eram desnutridos. Os resultados mostram a importância da suplementação para esse público. Vimos que > 75% dos pacientes estão dentro do GPIDr ideal (< 4,5% do peso seco). O tempo de diálise não afetou os parâmetros de avaliação nutricional.
Evaluation of the Scopinaro Modified Technique in the Surgical Treatment of Obesity Compared to the Classic Scopinaro Surgery – Results after an 18-Month Randomized Clinical Trial
Authors: de Melo Paulo Reis Esselin , Braga Thonya Cruz , de Moura Neusa Dias , Gonçalves Junior João Carlos , de Oliveira Marcos Vinicius Macedo , Gava-Brandolis Marcella Giovana , Homar Dimitri Gabriel
Published: December 2019

Objetivo Avaliar se a cirurgia de Scopinaro modificada é tão eficaz e segura quanto a cirurgia de Scopinaro clássica para reduzir o excesso de peso, controlar as comorbidades, e avaliar o surgimento de intercorrências clínicas e nutricionais, caso elas ocorram.

Métodos O estudo teve 28 participantes obesos, que foram randomizados para a realização de um dos procedimentos cirúrgicos, e acompanhados por uma equipe multiprofissional em saúde para avaliar o impacto das cirurgias no tratamento da obesidade. Foram observadas as seguintes variáveis: comorbidades, e intercorrências clínicas e nutricionais. O protocolo de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa das Faculdades Integradas Pitágoras de Montes Claros (CAAE 26919414.9.0000.5109). Todos os participantes da pesquisa assinaram o termo de consentimento livre e esclarecido.

Resultados A média do índice de massa corporal (IMC) pré-cirurgia do grupo Scopinaro clássica e do grupo Scopinaro modificada foi de, respectivamente, 46,89 kg/m2 e 43,22 kg/m2. Após 540 dias da realização das cirurgias, esses valores foram reduzidos para 32,16 kg/m2 e 28,79 kg/m2. A avaliação da porcentagem de IMC perdido (percentage of excess body mass index lost, %EBL, em inglês) no período comprovou o sucesso cirúrgico, com valores de 67,33% para a cirurgia de Scopinaro clássica, e de 80,37% para a cirurgia de Scopinaro modificada. Ocorreu controle das comorbidades, bem como melhora geral do quadro laboratorial para a maioria dos participantes submetidos a quaisquer das duas técnicas. Flatulência e diarreia constituíram as intercorrências clínicas predominantemente encontradas em ambos procedimentos.

Conclusão A cirurgia de Scopinaro modificada mostrou-se tão eficaz e segura quanto a cirurgia de Scopinaro clássica na redução de peso e controle das comorbidades, apresentando ainda a possibilidade de acesso endoscópio a todo o estômago e duodeno, reversibilidade cirúrgica, e conversão em outro procedimento cirúrgico.