bluuebunny/crossref_metadata_2025 huggingface dataset:
Die „Handballer-Schulter“ im Fokus von Diagnostik und Therapie
Authors: Hepp Pierre , Henkelmann Ralf
Published: August 2020

Handball zählt zu den beliebtesten Mannschaftssportarten in Deutschland. Bei Diagnostik und Therapie von Schulterverletzungen und Schulterbeschwerden muss zwischen der sportartspezifischen jahrelangen Adaptation und einer vermeintlichen Dekompensation zwingend unterschieden werden. Im Gegensatz zu reinen Wurfsportarten, wie z. B. Baseball oder Speerwerfen, werden im Handball wegen des gleichzeitigen Gegnerkontaktes die beabsichtigten Bewegungsabläufe durch erlaubte und unerlaubte Behinderungen oft plötzlich und ruckartig beeinflusst. Hierdurch können zusätzliche Verletzungen entstehen. Der Übergang einer physiologisch adaptierten Handballer-Schulter zu einer therapiebedürftigen pathologischen Werfer-Schulter ist meist fließend. Die Werfer-Schulter ist durch eine Leistungseinschränkung charakterisiert, die durch Schmerzen in der Schulter bei wiederholter sportartspezifischer Belastung hervorgerufen wird. Neben einer gründlichen klinischen Untersuchung ist, aufgrund der Tatsache, dass Veränderungen der Handballer-Schulter sich in der Muskultur, den Sehnen und im Knochen im Sinne von Überlastungsreaktionen (bone bruise) darstellen, das MRT die bevorzugte Untersuchungsmethode. Neben einer Sportkarenz und einer suffizienten Schmerztherapie sollte eine gezielte Physiotherapie erfolgen. Die Interpretation der MRT-Ergebnisse sollte immer mit den Symptomen und den klinischen Untersuchungsergebnissen abgeglichen werden. Indikationen zur Operation sind eine ausbleibende Besserung nach gezielter Schmerz- und Physiotherapie, strukturelle Schäden entsprechend der Symptome ohne Heilungschance bzw. mit höherer Gewissheit der Verbesserung der Beschwerden und Funktion durch eine Operation. Nach einer operativen Therapie spielt die anschließende Rehabilitation eine große Rolle. Eine Sportfähigkeit ist je nach Verletzung in bis zu 90 % wieder möglich.
Comparing major joint injuries, interventions and late sequelae in elite male handball players with an age-matched control group
Authors: Vogel Raphael , Zdravkovic Vilijam , Badulescu Michael , Puskás Gábor J. , Jost Bernhard
Published: August 2020

Introduction Handball is a contact sport which involves throwing and jumping, exposing players to serious physical stress. There is a high risk of injuries leading to possible long-term sequelae. The aim of this study was to assess the incidence of musculoskeletal injuries in elite male handball players compared with an age-matched control group.

Patients and methods Former elite handball players, who had played on the Swiss national team between 1980 and 1985, answered a questionnaire about injuries, surgical interventions and their current health status. A total of 34 athletes were compared with 58 age-matched volunteers, who only engaged in recreational sports or no sports at all.

Results The mean age of the athletes was 58.4 years (range 52–68 years) and did not differ significantly from the mean age of the control group of 58.7 years (range 53–69 years). In the control group, 70 % engaged in recreational sports. There was no statistical difference regarding the life-long incidence of shoulder injuries and surgical interventions, sequelae or persistent shoulder pain. Athletes had more interventions after elbow injuries (0.09 vs. 0, p = 0.047), but the difference with respect to chronic pain or late sequelae was not statistically significant. For knee injuries, there were no significant differences regarding the incidence of injuries or interventions, the prevalence of secondary consequences or persistent pain. Concerning the foot and ankle, there was a significantly higher incidence of injuries (0.5 vs. 0.03, p < 0.001) and interventions (0.5 vs. 0.09, p < 0.001) in athletes, but no statistical difference regarding sequelae or persistent pain. Overall quality of life had identical ratings in both groups (athletes mean 85.9 %, controls mean 85.8 %).

Discussion Top handball players did not sustain more shoulder or knee injuries than the age-matched control group. The elbow was more at risk in these top athletes, but long-term consequences appeared to be less severe. The most distinctive difference was seen in foot and ankle injuries.

Conclusions A career as an elite handball player had no adverse effect on the overall quality of life of elite handball players 25 to 30 years after retiring from professional sports.
Meningoenzephalitis und Meningitis beim Hund: retrospektive Analyse einer Klinikpopulation
Authors: Buhmann Gesine , Wielaender Franziska , Rosati Marco , Matiasek Kaspar , Hartmann Katrin , Fischer Andrea
Published: August 2020

Gegenstand und Ziel Charakterisierung der Ätiologie von Meningoenzephalitis und Meningitis beim Hund in einer Klinikpopulation.

Material und Methoden Retrospektive Studie (2011–2016) mit Auswertung der klinischen und diagnostischen Daten von Hunden mit einer Liquorpleozytose (> 15/3 µl). Einschlusskriterien waren vorliegende Befunde einer zytologischen Liquoruntersuchung oder einer histopathologischen Untersuchung des ZNS. Beurteilt wurde, ob im Liquorzellbild oder bei den routinemäßig durchgeführten Untersuchungen auf Infektionskrankheiten Hinweise auf eine infektiöse Ätiologie vorlagen.

Ergebnisse Insgesamt 62 Hunde erfüllten die Einschlusskriterien. Bei 14,5 % (n = 9) der Hunde lag eine reaktive Liquorpleozytose aufgrund einer anderen strukturellen Erkrankung des Gehirns wie ein Tumor oder Infarkt vor. Bei 56,5 % (n = 35) wurde eine Meningoenzephalitis oder Meningitis unbekannter Ursache diagnostiziert. Bei 29,0 % (n = 18) der Hunde bestand aufgrund der Diagnostik bezüglich Infektionskrankheiten oder durch Nachweis von Bakterien im Liquorzellbild (n = 5) der Verdacht auf eine infektiöse Meningoenzephalitis oder Meningitis. Bei 6 (9,7 %) diese Hunden war die Diagnose eindeutig, bei 9 (14,5 %) Hunden konnte nur ein Verdacht auf eine infektiöse Meningoenzephalitis oder Meningitis erhoben werden und bei 3 (4,8 %) Hunden lagen Befunde unklarer Bedeutung vor.

Schlussfolgerung Die häufigste Ursache für eine Liquorpleozytose war eine Meningoenzephalitis oder Meningitis unbekannter Ursache. Dennoch gab es bei 29 % der Hunde Hinweise auf eine mögliche infektiöse Ätiologie. Daher ist es für eine sichere Diagnose wichtig, den Liquor zytologisch zu beurteilen und Untersuchungen auf Infektionskrankheiten durchzuführen.

Klinische Relevanz Die Meningoenzephalitis/Meningitis unbekannter Ursache erfordert eine immunsuppressive Therapie. Für den Ausschluss einer infektiösen Meningoenzephalitis oder Meningitis haben Liquorzytologie und Untersuchungen auf Infektionskrankheiten eine besondere Bedeutung.
Operabilität und pathologisches Ansprechen des Lungenkarzinoms nach neoadjuvanter Therapie mit Immun-Checkpoint-Inhibitoren
Authors: Lücke E. , Ganzert C. , Föllner S. , Wäsche A. , Jechorek D. , Schoeder V. , Walles T. , Genseke P. , Schreiber J.
Published: August 2020

Hintergrund Eine Blockade von Immun-Escape-Mechanismen (z. B. PD1 /PD-L1) mit Immun-Checkpoint-Inhibition (ICI) kann das Überleben von Patienten mit fortgeschrittenem NSCLC wesentlich verlängern und ausgeprägte Remissionen induzieren. Eine neoadjuvante ICI bei Patienten mit resektablem (UICC-Stadium III) oder oligometastasiertem (UICC-Stadium IVA) NSCLC wurde bisher kaum untersucht.

Patienten/Methoden Es wurden Biopsien von Patienten mit lokal fortgeschrittenem oder oligometastasiertem NSCLC untersucht. Es erfolgte bei einer PD-L1-Expression > 50 %, gutem ECOG-Status und zu erwartender Operabilität die ICI-Applikation und nach ca. 4 Wochen die thoraxchirurgische OP. Alle Patienten erhielten ein komplettes Staging einschließlich PET-CT, cMRT und endobronchialem Ultraschall. Es wurden die Verträglichkeit, das radiologische und histologische Tumoransprechen und das chirurgische Outcome analysiert.

Ergebnisse 4 Patienten (2 männlich, 2 weiblich, Alter 56 – 78 Jahre, n = 3 Adenokarzinom, n = 1 Plattenepithelkarzinom) erhielten präoperativ einen ICI. Alle Patienten hatten lokal fortgeschrittene Tumore, und die mediastinalen Lymphknoten waren in 3 Fällen positiv. Bei einem Patienten lag eine isolierte Hirnmetastase vor, welche stereotaktisch radiotherapiert wurde. Alle Patienten erhielten präoperativ komplikationslos 2 – 6 Zyklen eines ICI (3 × Pembrolizumab; 1 × Atezolizumab). Dies führte nicht zu einer Verzögerung der OP. Nach iRECIST zeigten 3 Tumore eine partielle response (PR), und ein Patient wies ein stable disease (SD) auf. Alle Tumore wurden komplett reseziert, und die OP erwies sich trotz inflammatorischer Veränderungen als technisch unproblematisch. Es gab keine behandlungsbezogene Morbidität oder Mortalität und keine perioperativen Komplikationen. In den Resektaten waren jeweils 2-mal ein komplettes pathologisches Ansprechen (CPR), Regressionsgrad III nach Junker, und 2-mal ein Regressionsgrad IIa nach Junker nachweisbar. Das mittlere Follow-up betrug 12 (1 – 24) Monate. Die PPR-Patienten entwickelten entweder Fernmetastasen nach 6 Monaten oder ein Lokalrezidiv nach 4 Monaten. Die CPR-Patienten sind bisher rezidivfrei.

Schlussfolgerungen Eine neoadjuvante Therapie mit ICI ist gut verträglich und kann bei ausgewählten Patienten eine komplette Tumorremission induzieren. Die Behandlung hat keinen negativen Einfluss auf den chirurgischen Eingriff. Die Prognose ist vielversprechend bei CPR und eingeschränkt bei PPR.
Die Verwendung lokaler Perforatorlappenplastiken der Arteria thoracica lateralis (LTAP) und Arteria thoracodorsalis (TDAP) zur axillären Rekonstruktion bei Hidradenitis suppurativa
Authors: Dietrich Sebastian , Reumuth Georg , Kuentscher Markus , Panchulidze Irakli
Published: August 2020

Die Hidradenitis suppurativa ist eine chronisch entzündliche Erkrankung von Terminalfollikeln und apokrinen Drüsen der Axilla. Die sichere und kosmetisch ansprechende Rekonstruktion großer Defekte nach radikaler Exzision erkrankter Areale in der Axilla stellt eine operative Herausforderung an den Chirurgen dar. Die laterale Thoraxregion bietet – neben weiteren – die Möglichkeit zur lokalen Perforatorlappenplastik, basierend auf der Arteria thoracodorsalis und der Arteria thoracica lateralis. Diese Arbeit zeigt erstmals in großer Fallzahl die Rekonstruktion axillärer Defekte durch den lateral thoracic artery perforator-Lappen. Insgesamt 13 Lappenplastiken (10 lateral thoracic artery perforator-Lappen und 3 thoracodorsal artery perforator-Lappen) wurden eingeschlossen. Die Patienten wurden im Rahmen der Nachuntersuchung auf postoperative Komplikationen nach Clavien-Dindo, das subjektive kosmetische Ergebnis, die Abduktionsfähigkeit des Arms in Form der range of motion und auf die Rezidivrate hin untersucht. Hierbei kam es weder zu einem Lappenuntergang noch zu einer Lappenteilnekrose. Bis auf einen Fall bewerteten alle Patienten das kosmetische Ergebnis als sehr gut oder gut. Die postoperative Schulterbeweglichkeit war stets uneingeschränkt mit einer maximalen Abduktionsfähigkeit von 178,8 ± 4,2° und in der postoperativen Nachuntersuchung von durchschnittlich 27,2 ± 14,4 Monaten kam es in keinem Fall zu einem Rezidiv. Die Verwendung der lokalen fasziokutanen Perforatorlappen der Arteria thoracica lateralis und Arteria thoracodorsalis zur plastisch-chirurgischen Behandlung der axillären HS im Stadium II und III führt zu guten ästhetischen und funktionellen Ergebnissen.
Blitzschlag auf der Pferdeweide – eine diagnostische Herausforderung?!
Authors: Stoff Melanie , Baumgärtner Wolfgang , Wohlsein Peter
Published: August 2020

Die permanente oder temporäre Weidehaltung in den Sommermonaten stellt ein erhöhtes Risiko für das Auftreten von Todesfällen durch Blitzeinschläge dar. Obwohl Großtiere durch Körperbau und Weidehaltungsform besonders empfänglich für Schrittspannungseffekte infolge eines Blitzeinschlags in den Boden sind, gibt es in der veterinärmedizinischen Fachliteratur nur wenige publizierte Fälle. Oftmals erfolgt bei Blitzunfällen eine Durchströmung des Herzens, die in einem akuten Herz-/Kreislaufversagen resultiert. Dies geht in der überwiegenden Anzahl der Fälle entweder ohne morphologische Veränderungen oder mit sehr unspezifischen Läsionen einher. Bei Fehlen eindeutiger blitzbedingter Schädigungen des Tierkörpers stellt die ätiologische Diagnosestellung daher eine besondere diagnostische Herausforderung dar. Die Auswertung meteorologischer Daten, die Betrachtung des Weidestandorts und die Position des Tierkörpers beim Auffinden können hier Schlüsselinformationen zur Aufklärung eines durch Blitzschlag bedingten Todesfalls darstellen.

Dieser Fallbericht dokumentiert die Befunde bei einem 7-jährigen Vollblut-Wallach, der mit 3 weiteren Pferden als Gruppe beieinanderliegend tot auf der Weide aufgefunden wurde. Bei der pathologischen Untersuchung zeigte sich an der rechten Vorder- und Hintergliedmaße eine jeweils 2–3 mm breite Linie von versengten, aufgekräuselten Haaren. Histopathologisch wiesen diese Hautareale in der Epidermis sowie in den Haarfollikeln in Gruppen angeordnete elongierte Epithelzellen mit fischgrätenartiger Verlängerung der Zellkerne auf und in der Dermis lagen multifokal Koagulationen dermaler Proteine vor.
GC-MS Analysis, Bioactivity-based Molecular Networking and
Antiparasitic Potential of the Antarctic Alga Desmarestia antarctica
Authors: Colepicolo-Neto Pio , Debonsi Hosana Maria , dos Santos Gustavo Souza , Rangel Karen Cristina , Teixeira Thaiz Rodrigues , Gaspar Lorena Rigo , Abreu-Filho Péricles Gama , Pereira Luíz Miguel , Yatsuda Ana Patrícia , Gallon Marília Elias , Gobbo-Neto Leonardo , da Costa Clementino Leandro , Graminha Márcia Aparecida Silva , Jordão Laís Garcia , Pohlit Adrian Martin
Published: August 2020

Leishmaniasis, malaria, and neosporosis are parasitic diseases that affect humans
and animals, causing public health problems and billions in economic losses.
Despite the advances in the development of new drugs, the severe side effects of
available leishmaniasis treatments, the Plasmodium spp. resistance to
antimalarial drugs, and the lack of a specific treatment against neosporosis
lead us to the search for new anti-protozoan molecules from underexplored
sources such as the Antarctic marine environment. Herein, we describe for the
first time the chemical profile of Desmarestia antarctica crude extract
and fractions using GC-MS and LC-MS/MS (molecular networking)
approaches, and evaluate their antiparasitic activity against Leishmania
amazonensis, Neospora caninum, and multi-drug-resistant
Plasmodium falciparum. Furthermore, the cytotoxicity in 3T3
BALB/c fibroblasts and Vero cells was evaluated. D. antarctica
fraction E ( IC50 of 53.8±4.4 μg
mL− 1 and selectivity index of 3.3) exhibited
anti-promastigote activity and was fourfold more selective to L.
amazonensis rather than to the host cells. D. antarctica fraction
D (IC50 of 1.6±1.3 μg
mL− 1 and selectivity index of 27.8), D.
antarctica fraction F (IC50 of
3.1±2.1 μg mL− 1 and
selectivity index of 23.1), and D. antarctica fraction H (IC50
of 3.1±2.0 μg mL− 1 and
selectivity index of 12.9) presented the highest antiparasitic effects against
N. caninum with no cytotoxic effects. Also, D. antarctica
fraction D presented a significant antiplasmodial inhibitory effect
(IC50 of 19.1±3.9 μg
mL− 1 and selectivity index of 6.0). GC-MS
analysis indicated palmitic acid, myristic acid, fucosterol, phthalic acid,
di(2-methylbutyl) ester, loliolide, and neophytadiene as the main components in
the active fractions. In addition, this is the first report of a biological
screening of macroalgae secondary metabolites against N. caninum
parasites.
Bakterielle Harnwegsinfektion und subklinische Bakteriurie des Hundes: eine aktuelle Übersicht
Authors: Harrer Julia , Dorsch Roswitha
Published: August 2020

Bakterielle Harnwegsinfektionen (HWI) treten bei Hunden häufig auf und stellen eine häufige Indikation für den Einsatz von Antibiotika in der tierärztlichen Praxis dar. Bei HWI kommt es zum Anhaften, zur Vermehrung und Persistenz von Infektionserregern im Harntrakt. Durch die Gewebsinvasion wird eine Entzündungsreaktion ausgelöst, die mit klinischen Symptomen einhergeht. Je nach Lokalisation der Infektion erfolgt eine Einteilung in bakterielle Zystitis, Prostatitis oder Pyelonephritis. Davon abzugrenzen ist die subklinische Bakteriurie (SB). Diese liegt vor, wenn aus einer adäquat gewonnenen Urinprobe eine signifikante Anzahl an Bakterien isoliert werden kann, das Tier jedoch keine klinischen Symptome einer Harnwegserkrankung zeigt. HWI entstehen in aller Regel durch aufsteigende Infektion mit Bakterien aus der wirtseigenen fäkalen oder distalen urogenitalen Flora. Escherichia coli ist dabei sowohl bei Hunden mit HWI als auch bei Hunden mit SB das häufigste Isolat. Die Diagnose basiert auf den klinischen Symptomen und den Befunden der Urinuntersuchung und -kultur. Ausführliche Therapieempfehlungen finden sich in den kürzlich überarbeiteten Richtlinien der International Society for Companion Animal Infectious Diseases, die im Folgenden zusammengefasst werden. Das Befolgen solcher Richtlinien steigert nicht nur den Therapieerfolg, sondern leistet auch einen Beitrag zur Eindämmung der Antibiotikaresistenzen.
Protective Effect of Grape and Apple Juices against Cadmium Intoxication in the Kidney of Rats
Authors: Handan Bianca Andrade , De Moura Carolina Foot Gomes , Cardoso Caroline Margonato , Santamarina Aline Boveto , Pisani Luciana Pellegrini , Ribeiro Daniel Araki
Published: August 2020

Background The objective of this study was to evaluate protective effect of grape and apple juices against toxicity induced by cadmium in the kidney of rats.

Methods A total of 20 male-Wistar rats were distributed into four groups (n=5): Control group: animals received an intraperitoneal (i.p.) injection of 0.9% saline solution and after 15 days, 1 mL of water was administered for 15 days, via gavage; Cadmium group: animals received an intraperitoneal injection of cadmium chloride (1.2 mg/kg) and after 15 days, 1 mL of water was administered for 15 days via gavage; Cadmium+Grape Juice: animals received an i.p. injection of cadmium chloride (1.2 mg/kg), and after 15 days, 0.8 mL of grape juice was administered for 15 days, via gavage; Cadmium+Apple Juice: animals received i.p. injection of cadmium chloride (1.2 mg/kg) and after 15 days, 1.0 mL of apple juice was administered for 15 days, via gavage.

Results Histopathological analysis revealed severe tubular lesion and necrosis in the group exposed to cadmium, while animals exposed to grape or apple juices showed a significant reduction of tissue injury. 8-OHdG immunoexpression, DNA damage, cytochrome C and catalase gene expressions and Toll like signaling pathway (TLR2, and pIKKα/β) decreased in animals treated with grape juice when compared to cadmium group.

Conclusion Taken together, we conclude that grape and apple juices had a protective effect by means of antioxidant, antigenotoxic actions and for promoting tissue regeneration in the kidney of rats following cadmium intoxication.
Psychisches Befinden in der Bevölkerung während der COVID-19-Pandemie
Authors: Kuehner Christine , Schultz Katharina , Gass Peter , Meyer-Lindenberg Andreas , Dreßing Harald
Published: August 2020

Ziel der Studie Zusammenhangsanalyse von wahrgenommenen Alltagsbelastungen während der COVID-19-Krise und Persönlichkeitsaspekten mit dem aktuellen psychischen Befinden in der Bevölkerung sowie Vergleich der psychischen Symptomatik mit einem Survey von 2018.

Methodik Zufallsstichprobe aus der Bevölkerung (n = 721), die zu coronabezogenen Einschätzungen, Persönlichkeitsaspekten und aktuellem psychischen Befinden (WHO-5, PHQ-D) schriftlich befragt wurde.

Ergebnisse Angst um die Gesundheit Nahestehender, Belastungen durch Ausgangsbeschränkungen und vermehrter Substanzkonsum sowie psychische Risiko- und Resilienzfaktoren trugen im statistischen Modell unabhängig zur Vorhersage des psychischen Befindens bei. Ausprägungen und Häufigkeiten psychischer Symptomatik unterschieden sich nicht zwischen 2018 und 2020.

Schlussfolgerung Dies ist eine erste Studie in Deutschland, die Ergebnisse aus einer bevölkerungsbezogenen Zufallsstichprobe zu Determinanten psychischen Befindens während der COVID-19-Krise und einen Vergleich der psychischen Symptomatik mit einer präpandemischen Referenzstichprobe vorlegt.
Auswirkungen der COVID-19-Pandemie auf die klinische Versorgung,
Arbeitsprozesse und Mitarbeitenden in der Universitätsmedizin:
Ergebnisse einer Interviewstudie am UKE
Authors: Härter Martin , Bremer Daniel , Scherer Martin , von dem Knesebeck Olaf , Koch-Gromus Uwe
Published: August 2020

Ziel der Studie Die Studie beschreibt die Auswirkungen der
COVID-19-Pandemie mit Blick auf Bereiche mit und ohne spezifische Versorgung von
COVID-19-Patientinnen und -Patienten aus Sicht der Klinikdirektorinnen und
-direktoren am Universitätsklinikum Hamburg-Eppendorf (UKE).

Methodik Im Zeitraum vom 30. April bis 12. Mai 2020 wurden mit den im UKE
verantwortlichen Klinikdirektorinnen und -direktoren Interviews per Telefon,
Video bzw. face-to-face mithilfe eines teilstandardisierten Fragebogens
durchgeführt. Die standardisierten Antworten wurden deskriptiv
analysiert. Freitextantworten wurden einer qualitativen Inhaltsanalyse
unterzogen. Die entwickelten Kategorien wurden quantitativ nach
Häufigkeiten analysiert.

Ergebnisse Alle leitenden Ärztinnen und Ärzte mit einer
Verantwortung für die stationäre und ambulante Versorgung am UKE
konnten für die Interviewstudie gewonnen werden (N=38). Diese
berichten von gravierenden Veränderungen in der medizinischen
Versorgung, v. a. im Bereich der Bettenbelegung, der
Patientenzusammensetzung, den klinischen und Arbeitsprozessen sowie den
diagnostischen und Behandlungsprozessen. Zusätzlich mussten viele neue
Regelungen getroffen werden, um den Präventions-, Behandlungs- und
Nachsorgebedarf von Patientinnen und Patienten sowie den Schutz der
Mitarbeitenden zu gewährleisten. In den meisten klinischen Bereichen
zeigte sich stationär wie ambulant phasenweise eine starke Reduktion in
den Belegungszahlen und der Arbeitsauslastung. Teilweise stiegen aber auch
Arbeitsaufwände, z. B. durch die Anpassung von
Arbeitsabläufen, veränderte Kommunikations- und
Personalstrukturen sowie zusätzliche Hygienemaßnahmen. Viele
Befragte äußerten sich positiv über den effizienten
Aufbau einer digitalen Kommunikationsstruktur. Das Personal war durch die
Pandemie an sich, aber auch durch die damit verbundenen Maßnahmen
vielseitig gefordert.

Schlussfolgerung Die Ergebnisse helfen, die Auswirkungen der aktuellen
COVID-19-Pandemie auf die Versorgung und Arbeitsprozesse besser zu verstehen.
Zudem können sie dabei unterstützen, zukünftig
Maßnahmen für pandemische Krisensituationen noch besser
anzupassen. Weitere Studien könnten untersuchen, wie die Mitarbeitenden
unterhalb der Leitungsebene diese Krise und ihre Auswirkungen erlebt haben.
Evaluation of Stable Doses of Warfarin in a Patient
Cohort
Authors: Sridharan Kannan , Banny Rashed Al , Husain Aysha
Published: August 2020

Background Definitions for stable dose of warfarin varies in the reported
studies. International warfarin pharmacogenetic consortium (IWPC) algorithm was
generated from the data based on these definitions.

Objective In the present study, we primarily evaluated whether any
significant differences exist between the definitions for stable warfarin
dose.

Methods A prospective cross-sectional study in adults receiving warfarin
for at least 3 months was carried out. Stable doses of warfarin as defined in
previous studies were compared with the standard definition. Bland-Altman plots,
Pearson’s correlation and intra-class coefficients (ICC) were used to
assess the correlation, reliability and agreements between the doses.

Results Sixty-four patients were recruited. Twenty definitions were
obtained from the previous studies. We observed that all but one showed very
high or high positive correlations; and either excellent or good ICC. No
significant differences between the doses initiated and predicted by IWPC
algorithm.

Conclusion We observed similar stable doses between the definitions
except for one. Hence, IWPC algorithm may not have any bias associated with
inclusion of any studies with variable definitions for stable warfarin dose.
Patient Identification Techniques – Approaches, Implications, and Findings
Authors: Riplinger Lauren , Piera-Jiménez Jordi , Dooling Julie Pursley
Published: August 2020

Objectives: To identify current patient identification techniques and approaches used worldwide in today’s healthcare environment. To identify challenges associated with improper patient identification.

Methods: A literature review of relevant peer-reviewed and grey literature published from January 2015 to October 2019 was conducted to inform the paper. The focus was on: 1) patient identification techniques and 2) unintended consequences and ramifications of unresolved patient identification issues.

Results: The literature review showed six common patient identification techniques implemented worldwide ranging from unique patient identifiers, algorithmic approaches, referential matching software, biometrics, radio frequency identification device (RFID) systems, and hybrid models. The review revealed three themes associated with unresolved patient identification: 1) treatment, care delivery, and patient safety errors, 2) cost and resource considerations, and 3) data sharing and interoperability challenges.

Conclusions: Errors in patient identification have implications for patient care and safety, payment, as well as data sharing and interoperability. Different patient identification techniques ranging from unique patient identifiers and algorithms to hybrid models have been implemented worldwide. However, no current patient identification techniques have resulted in a 100% match rate. Optimizing algorithmic matching through data standardization and referential matching software should be studied further to identify opportunities to enhance patient identification techniques and approaches. Further efforts to improve patient identity management include adoption of patients’ photos at registration, naming conventions, and standardized processes for recording patients’ demographic data attributes.
Human-Computer Interaction, Ethics, and Biomedical Informatics
Authors: Hochheiser Harry , Valdez Rupa S.
Published: August 2020

Objectives: To provide an overview of recent work at the intersection of Biomedical Informatics, Human-Computer Interaction, and Ethics.

Methods: Search terms for Human-Computer Interaction, Biomedical Informatics, and Ethics were used to identify relevant papers published between 2017 and 2019.Relevant papers were identified through multiple methods, including database searches, manual reviews of citations, recent publications, and special collections, as well as through peer recommendations. Identified articles were reviewed and organized into broad themes.

Results: We identified relevant papers at the intersection of Biomedical Informatics, Human-Computer Interactions, and Ethics in over a dozen journals. The content of these papers was organized into three broad themes: ethical issues associated with systems in use, systems design, and responsible conduct of research.

Conclusions: The results of this overview demonstrate an active interest in exploring the ethical implications of Human-Computer Interaction concerns in Biomedical Informatics. Papers emphasizing ethical concerns associated with patient-facing tools, mobile devices, social media, privacy, inclusivity, and e-consent reflect the growing prominence of these topics in biomedical informatics research. New questions in these areas will likely continue to arise with the growth of precision medicine and citizen science.
Cancer Informatics in 2019: Deep Learning Takes Center Stage
Authors: Warner Jeremy L. , Patt Debra ,   Section Editors for the IMIA Yearbook Section on Cancer Informatics
Published: August 2020

Objective: To summarize significant research contributions on cancer informatics published in 2019.

Methods: An extensive search using PubMed/Medline and manual review was conducted to identify the scientific contributions published in 2019 that address topics in cancer informatics. The selection process comprised three steps: (i) 15 candidate best papers were first selected by the two section editors, (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper, and (iii) the final selection of two best papers was conducted by the editorial committee of the Yearbook.

Results: The two selected best papers demonstrate the clinical utility of deep learning in two important cancer domains: radiology and pathology.

Conclusion: Cancer informatics is a broad and vigorous subfield of biomedical informatics. Applications of new and emerging computational technologies are especially notable in 2019.
Human Factors and Organizational Issues
Authors: Senathirajah Yalini , Pelayo Sylvia ,   Section Editors for the IMIA Yearbook Section on Human Factors and Organizational Issues
Published: August 2020

Objective: To select the best papers that made original and high impact contributions in the area of human factors and organizational issues in biomedical informatics in 2019.

Methods: A rigorous extraction process based on queries from Web of Science® and PubMed/Medline was conducted to identify the scientific contributions published in 2019 that address human factors and organizational issues in biomedical informatics. The screening of papers on titles and abstracts independently by the two editors led to a total of 30 papers. These papers were discussed for a selection of 15 finalist papers, which were then reviewed by the two editors and by three external reviewers from internationally renowned research teams.

Results: The query process resulted in 626 papers that reveal interesting and rigorous methods and important studies in human factors that move the field forward, particularly in clinical informatics and emerging technologies such as brain-computer interfaces. This year three papers were clearly outstanding and help advance the field. They provide examples of applying existing frameworks together in novel and highly illuminating ways, showing the value of theory development in human factors.

Conclusion: The selected papers make important contributions to human factors and organizational issues, expanding and deepening our knowledge of how to apply theory and applications of new technologies in health.
Trends in Clinical Information Systems Research in 2019
Authors: Hackl W. O. , Hoerbst A. ,   Section Editors for the IMIA Yearbook Section on Clinical Information Systems
Published: August 2020

Objective: To give an overview of recent research and to propose a selection of best papers published in 2019 in the field of Clinical Information Systems (CIS).

Method: Each year, we apply a systematic process to retrieve articles for the CIS section of the IMIA Yearbook of Medical Informatics. For six years now, we use the same query to find relevant publications in the CIS field. Each year we retrieve more than 2,000 papers. As CIS section editors, we categorize the retrieved articles in a multi-pass review to distill a pre-selection of 15 candidate best papers. Then, Yearbook editors and external reviewers assess the selected candidate best papers. Based on the review results, the IMIA Yearbook Editorial Committee chooses the best papers during the selection meeting. We used text mining, and term co-occurrence mapping techniques to get an overview of the content of the retrieved articles.

Results: We carried out the query in mid-January 2020 and retrieved a de-duplicated result set of 2,407 articles from 1,023 different journals. This year, we nominated 14 papers as candidate best papers, and three of them were finally selected as best papers in the CIS section. As in previous years, the content analysis of the articles revealed the broad spectrum of topics covered by CIS research.

Conclusions: We could observe ongoing trends, as seen in the last years. Patient benefit research is in the focus of many research activities, and trans-institutional aggregation of data remains a relevant field of work. Powerful machine-learning-based approaches, that use readily available data now often outperform human-based procedures. However, the ethical perspective of this development often comes too short in the considerations. We thus assume that ethical aspects will and should deliver much food for thought for future CIS research.
Flow Synthesis of Triptycene via Triple Cycloaddition of Ynolate to Benzyne
Authors: Shindo Mitsuru , Iwata Takayuki , Yoshinaga Tatsuro
Published: August 2020

Flow synthesis of triptycene was achieved using triple cycloaddition of ynolate to benzyne. Employing the borate-type benzyne precursor, side reactions triggered by the addition of alkyllithium to benzyne were efficiently suppressed under microflow conditions, thus producing triptycene with a higher yield than that obtained under the corresponding batch conditions. Furthermore, ynolate prepared from α,α-dibromoester under microflow conditions was continuously added to the flow reaction with benzyne, which successfully synthesized triptycene in only one minute.
Integrated Synthesis Using Isothiocyanate-Substituted Aryllithiums by Flow Chemistry
Authors: Yoshida Jun-ichi , Kim Heejin , Lee Hyune-Jea , Torii Daiki , Jeon Yongju
Published: August 2020

The isothiocyanate (NCS) group is an attractive functional group in the field of organic and pharmaceutical chemistry. It can be transformed into other heteroatomic functional groups. It usually acts as the inductive group of biological activity and has also been traditionally used as the fluorescent-labeling reagent. However, it is not compatible with strong bases. When the NCS group is at para position in halobenzenes, it generally undergoes nucleophilic additions upon reaction with strong bases. To the best of our knowledge, there is currently no general methodology for the formation and reactions of NCS-functionalized aryllithiums for meta and para substituents. Herein, we report the continuous-flow generation of NCS-substituted aryllithiums from the corresponding haloarenes via a selective halogen–lithium exchange reaction and its reaction with various electrophiles to yield NCS-containing products. We also achieved an integrated synthesis through sequential reactions of the NCS-containing compounds with additional nucleophiles using the continuous-flow reactors.
Dual Photoredox/Palladium-Catalyzed C–H Acylation of 2-Arylpyridines with Oxime Esters
Authors: Liu Xiao-Peng , Chen Jia-Rong , He Bin-Qing , Gao Yuan , Wang Peng-Zi , Wu Hong , Zhou Hong-Bin
Published: August 2020

An unprecedented dual photoredox/palladium-catalyzed iminyl-radical-mediated C–C bond cleavage and directed ortho C–H acylation of 2-arylpyridines by using oxime esters is described. Oxime esters can serve as efficient acyl sources through formation of the corresponding acyl radicals by photoredox-catalyzed iminyl-radical-mediated C–C bond cleavage. This redox-neutral protocol features excellent regioselectivity, a broad substrate scope, and good functional-group tolerance with respect to both components, giving a broad range of aryl ketones with generally good yields.
Two Novel Pathogenic FBN1 Variations and Their Phenotypic Relationship of Marfan Syndrome
Authors: Yalcintepe Sinem , Demir Selma , Atli Emine Ikbal , Deveci Murat , Atli Engin , Gurkan Hakan
Published: August 2020

Marfan syndrome is an autosomal dominant disease affecting connective tissue involving the ocular, skeletal systems with a prevalence of 1/5,000 to 1/10,000 cases. Especially cardiovascular system disorders (aortic root dilatation and enlargement of the pulmonary artery) may be life-threatening. We report here the genetic analysis results of three unrelated cases clinically diagnosed as Marfan syndrome. Deoxyribonucleic acid (DNA) was isolated from EDTA (ethylenediaminetetraacetic acid)-blood samples of the patients. A next-generation sequencing panel containing 15 genes including FBN1 was used to determine the underlying pathogenic variants of Marfan syndrome. Three different variations, NM_000138.4(FBN1):c.229G > A(p.Gly77Arg), NM_000138.4(FBN1):c.165–2A > G (novel), NM_000138.4(FBN1):c.399delC (p.Cys134ValfsTer8) (novel) were determined in our three cases referred with a prediagnosis of Marfan syndrome. Our study has confirmed the utility of molecular testing in Marfan syndrome to support clinical diagnosis. With an accurate diagnosis and genetic counseling for prognosis of patients and family testing, the prenatal diagnosis will be possible.
A Water-Dispersible Quinoid-Resonant Conducting Polymer for Organic Electronics
Authors: Yuan Dafei , Zhu Xiaozhang
Published: August 2020

Developing stable and solution-processable highly conductive polymers has been the research goal in organic electronics since the first demonstration of metallic conductive polyacetylene. Here, we used a unique quinoid-resonant building block thieno[3,4-b]thiophene (TbT) to develop a new water-dispersible conducting polymer, PTbT-Me:PSS. Linear polymerization and large surfactant counterion, poly(styrenesulfonate) (PSS−), were introduced, which enabled a high electrical conductivity of 68 S cm−1 and exhibited water-dispersible property. Interchain bipolaron was found in PTbT-Me:PSS when compared with polaron in PEDOT:PSS in their conducting mechanism. Moreover, we applied this highly conductive PTbT-Me:PSS as the solution-processed polymer thermoelectric material and a decent power factor of 3.1 μW m−1 K−2 was achieved.
Advances in Transcriptomics in the Response to Stress in Plants
Authors: Wang Xiaojuan , Li Na , Li Wei , Gao Xinlei , Cha Muha , Qin Lijin , Liu Lihong
Published: August 2020

Adverse stress influences the normal growth and development of plants. With the development of molecular biology technology, understanding the molecular mechanism of plants in response to adverse stress has gradually become an important topic for academic exploration. The expression of the transcriptome is dynamic, which reflects the level of expression of all genes in a particular cell, tissue, or organ of an individual organism at a particular stage of growth and development. Transcriptomics can disclose the expression at the whole genome level under stress from the whole transcriptional level, which can be useful in understanding the complex regulatory network associated with the adaptability and tolerance of plants to stress. In this article, we review the application of transcriptomics in understanding the response of plants to biotic stresses such as diseases and insect infestation and abiotic stresses such as water, temperature, salt, and heavy metals to provide a guideline for related research.
The Association between Glucose Levels and Adverse Pregnancy Outcomes in Nondiabetic Twin Pregnancies
Authors: Cheung Kevin , Fox Nathan S.
Published: August 2020

Objective The aim of this study is to determine if hyperglycemia in twin pregnancies without gestational diabetes mellitus (GDM) is associated with an increased risk of adverse pregnancy outcomes.

Study Design Retrospective cohort study of twin pregnancies in a single Maternal–Fetal Medicine practice between 2005 and 2019 who underwent two-step GDM screening at 24 to 28 weeks. We excluded women with pregestational or gestational diabetes. We examined the association between maternal glycemia and adverse pregnancy outcomes. Glycemia was defined as the 1-hour GCT in all women, and each of the four values of the 3-hour OGTT in women who failed the GCT (≥130 mg/dL). Primary outcomes were preeclampsia, cesarean delivery, and neonatal hypoglycemia in either twin. Statistical tests used included Pearson's correlation, Student's t-test, Mann–Whitney U test, Chi-square test for trend, and logistic regression.

Results A total of 847 women underwent a GCT and 246 women underwent an OGTT. Increasing maternal glucose levels had no positive association with adverse outcomes. Women with preeclampsia, cesarean delivery, and neonatal hypoglycemia did not have higher mean GCT or OGTT values than women without these outcomes. There was no increased risk of adverse outcomes with increasing quartiles of the GCT or OGTT values.

Conclusion In women with twin pregnancies without GDM, elevated maternal glucose levels are not associated with preeclampsia, cesarean delivery, or neonatal hypoglycemia. The altered physiology of twin gestations may modify the effect of maternal hyperglycemia on perinatal outcomes as compared with singleton pregnancies. Current approaches to screening for and treating GDM during pregnancy might not adequately account for these unique considerations among twins.
Influence of the Chelating Solutions in the Resistance of Glass Fiber Posts to the Root Dentin
Authors: Marques Eduardo Fernandes , Marceliano-Alves Marília Fagury  Videira , Pelegrine Rina Andrea , Pinheiro Sérgio Luiz , Bueno Carlos Eduardo Da Silveira
Published: August 2020

Objective This study aimed to evaluate the influence of chelating agents (EDTA, citric acid and Tetraclean) on glass fiber posts adhesion to root dentin.

Materials and Methods Forty mandibular premolars single canals, with complete apical root, straight, circular cross sections were selected, accessed and had the cervical third prepared with Gates-Glidden drills, then included in resin, instrumented with ProTaper Universal and the root canal obturation was carried out. After, the samples were randomly divided into 4 groups (n = 10) to test the final irrigation solutions: G1:17% EDTA; G2:10% citric acid; G3: Tetraclean and G4: saline solution (control). After 30 days of storage (36.5° C and 100% humidity), the post preparation was performed leaving 4 mm of apical endodontic filling. Then, a fiber-glass post previously selected was coated with ED Primer adhesive system and resin sealer Panavia, installed and stored for 24 hours at 37°C. The samples were subjected to a tensile test with a constant speed of 1 mm/min with 2000 Kgf. The results were analyzed with the ANOVA test.

Results The statistical analyzes indicated no significant differences between the groups (p > 0.05).

Conclusion The type of chelating agent used in the final irrigation of the endodontic treatment did not influence the tensile strength of the fixation system used to sealer the glass fiber posts to the intracanal dentin.
Multidisciplinary Approach to the Management of Extensive Dermato-fibro-sarcomas Involving the Chest Wall
Authors: Nangole Wanjala F. , Muhinga M.
Published: August 2020

Dermato-fibro-sarcomas are known for high-recurrence rates. The gold standard of management is surgical excision with clear margins. Such margins on the chest results in large defects which require complex reconstructive procedures. We report a case series of patients managed by a multidisciplinary team with good outcomes. A total of 12 patients with extensive dermato-fibro-sarcoma of the anterior chest wall were treated over a period of 5 years in our setting. The age range was 25 to 54 years. Skeletal defects were reconstructed with Prolene mesh and methyl acrylate cement in 10 of the 12 patients. Pedicle flaps were used in nine patients. All margins were clear of tumors, with the nearest margin being 1.5 cm. One patient had a recurrence. No donor-site morbidity was recorded in any of the patients.

In conclusion, a multidisciplinary approach provides improved outcomes in the management of large dermato-fibro-sarcomas of the chest wall. With this approach, extensive dissection of the tumor is achieved, and reconstruction is performed with minimal complication.
Thrombin Generation and Cirrhosis: State of the Art and Perspectives
Authors: Lebreton Aurélien , Sinegre Thomas , Lecompte Thomas , Talon Laurie , Abergel Armand , Lisman Ton
Published: August 2020

Epidemiological and laboratory studies performed in the last decades have changed our understanding of coagulopathy in cirrhosis, from a condition at increased risk of hemorrhagic events to one at higher thrombotic risk. However, it is not clear whether the decrease in factors that promote (except factor [F] VIII) versus inhibit coagulation in patients with cirrhosis results in a rebalanced state or in a hypercoagulable phenotype. This issue can be partially addressed using thrombin generation assays (TGA), which unlike routine clotting tests (prothrombin time or activated partial thromboplastin time) are sensitive to both procoagulant factors and coagulation inhibitors. However, many preanalytical issues and variable analytical methodologies used in TGAs complicate data analysis and interlaboratory comparisons. The introduction of TGAs in which activators of the protein C pathway (particularly soluble forms of thrombomodulin [TM]) are added has allowed detection of a reduced anticoagulant effect of TM or even a hypercoagulable phenotype as judged by endogenous thrombin potential. However, inter- and intra-assay variability may be greater with this TGA variant compared with “standard” TGAs. TGAs also allowed identifying main determinants of the hypercoagulability phenotype in the presence of TM: acquired antithrombin and protein C deficiencies, and elevated FVIII levels. The aim of this narrative review is to summarize the preanalytical and methodological variables of TGAs and also the findings of the main studies that have evaluated TGAs in patients with cirrhosis. The review also provides some propositions for future studies and outlines some perspectives on the potential implementation of this promising tool in clinical practice for the study of coagulation in patients with cirrhosis.
Wolman's Disease: A Rare Cause of Infantile Cholestasis and Cirrhosis
Authors: Menon Jagadeesh , Shanmugam Naresh , Srinivas Sripriya , Vij Mukul , Jalan Anil , Srinivas Reddy Mettu , Rela Mohamed
Published: August 2020

Liver cirrhosis in infancy can be secondary to various etiologies such as biliary atresia, familial cholestatic and metabolic disorders. Wolman's disease (WD) is a lysosomal storage disorder caused by the absence of lysosomal acid lipase enzyme activity and a significant association with infantile cholestasis and cirrhosis. We encountered an infant presenting with advanced cirrhosis and decompensation having splenomegaly for which the underlying etiology was found to be WD and the diagnostic clue came from abdominal X-ray showing bilateral adrenal calcifications. The diagnosis was confirmed by genetic analysis. The outcome was poor and died before 6 months of age without enzyme replacement therapy or hematopoietic stem cell transplantation.
Chronic Traumatic Encephalopathy: A Comparison with Alzheimer's Disease and Frontotemporal Dementia
Authors: Lesman-Segev Orit H. , Edwards Lauren , Rabinovici Gil D.
Published: August 2020

The clinical diagnosis of chronic traumatic encephalopathy (CTE) is challenging due to heterogeneous clinical presentations and overlap with other neurodegenerative dementias. Depending on the clinical presentation, the differential diagnosis of CTE includes Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), Parkinson's disease, amyotrophic lateral sclerosis, primary mood disorders, posttraumatic stress disorder, and psychotic disorders. The aim of this article is to compare the clinical aspects, genetics, fluid biomarkers, imaging, treatment, and pathology of CTE to those of AD and bvFTD. A detailed clinical evaluation, neurocognitive assessment, and structural brain imaging can inform the differential diagnosis, while molecular biomarkers can help exclude underlying AD pathology. Prospective studies that include clinicopathological correlations are needed to establish tools that can more accurately determine the cause of neuropsychiatric decline in patients at risk for CTE.