bluuebunny/crossref_metadata_2025 huggingface dataset:
Time-domain photoacoustic waveform analysis for glucose measurement
Authors: Zhang Ruochong , Luo Yunqi , Jin Haoran , Gao Fei , Zheng Yuanjin
Published: September 2020

A novel sensing method based on time-domain photoacoustic waveform analysis was proposed and demonstrated with glucose concentration measurement.
A multi-photon fluorescent probe based on quinoline groups for the highly selective and sensitive detection of lipid droplets
Authors: Zhang Sijing , Yang Zhenghui , Li Minghao , zhang Qiong , Tian Xiaohe , Li Dandan , Li Shengli , Wu Jieying , Tian Yupeng
Published: September 2020

Compound L3 possesses excellent two/three photon absorption properties, and has been successfully applied in the bioimaging of LDs.
A novel colorimetric probe with positive correlation between toxicity and the reaction for the assessment of chromium ions
Authors: Hou Jingzhou , Shui Zhengfan , Li Jiawei , Huo Danqun , Tang Xiaohui , Yu Chenhui , He Qiang , Qiao Cailin
Published: September 2020

We report a novel, rapid, simple and accurate probe for the detection of Cr3+ and Cr6+.
A spot test for determination of residual TBA levels in18F-radiotracers for human use using Dragendorff reagent
Authors: Tanzey Sean S. , Mossine Andrew V. , Sowa Alexandra R. , Torres Jovany , Brooks Allen F. , Sanford Melanie S. , Scott Peter J. H.
Published: September 2020

A TLC spot test for determining residual TBA levels in positron emission tomography (PET) radiotracer formulations has been developed using Dragendorff reagent. Proof-of-concept is demonstrated by quantification of residual TBA in 6-[18F]fluoro-DOPA.
Canola oil extraction in conjunction with a plastic free separation unit optimises microplastics monitoring in water and sediment
Authors: Lechthaler Simone , Hildebrandt Lars , Stauch Georg , Schüttrumpf Holger
Published: September 2020

Microplastics are widely distributed in the environment and to define contamination hot spots, environmental samples have to be analysed by means of cost-as well as time-efficient and reliable standardised protocols.
Regioselective benzannulation of allylic sulfur ylides with ynones: a rapid access to substituted thioanisoles
Authors: Parameshwar Matam , Singam Maneesh Kumar Reddy , Nagireddy Attunuri , Nanubolu Jagadeesh Babu , Reddy Maddi Sridhar
Published: September 2020

A novel benzannulation of allyl sulfer ylide (ASY) with alkynones is accomplished for highly regioselective formation of multi substituted thioanisoles where ASY was rarely found to be a 3C component as well as a sulphur source.
On generalized partition methods for interaction energies
Authors: Racioppi Stefano , Sironi Angelo , Macchi Piero
Published: September 2020

The breakdown of interaction energy has always been a very important means to understand chemical bonding and it has become a seamlessly useful tool for modern supramolecular chemistry.
Comparative analysis of ethanol dynamics in aqueous and non-aqueous solutions
Authors: Jukić Ivo , Požar Martina , Lovrinčević Bernarda
Published: September 2020

Dynamics of ethanol in water and in hexane across the whole concentration range is analyzed by molecular dynamics simulations.
Synthesis of the Se-HPCF composite via a liquid-solution route and its stable cycling performance in Li–Se batteries
Authors: Chen Xi , Xu Lihong , Zeng Lingxing , Wang Yiyi , Zeng Shihan , Li Hongzhou , Li Xinye , Qian Qingrong , Wei Mingdeng , Chen Qinghua
Published: September 2020

The Se-HPCF composite was fabricated via a liquid-solution route followed by calcination treatment, and was used as a high-rate anode material for Li–Se batteries.
Mangiferin protects against alcoholic liver injuryviasuppression of inflammation-induced adipose hyperlipolysis
Authors: Dong Meijun , Li Lisi , Li Guowei , Song Junna , Liu Baolin , Liu Xifu , Wang Meng
Published: September 2020

Mangiferin activates AMPK/TBK1 signalling to suppress inflammatory-associated hyperlipolysis, which ameliorates ethanol-induced liver injury.
Ultra-repeatability measurement of the coal calorific value by XRF assisted LIBS
Authors: Li Xiaolin , Zhang Lei , Tian Zhihui , Bai Yu , Wang Shuqing , Han Jianghua , Xia Guofu , Ma Weiguang , Dong Lei , Yin Wangbao , Xiao Liantuan , Jia Suotang
Published: September 2020

The calorific value of coal mainly depends on the content of combustible organic elements and ash, and is a comprehensive indicator of coal quality.
Unusual electrical conductivity driven by localized stoichiometry modification at vertical epitaxial interfaces
Authors: Zhang Wenrui , Cheng Shaobo , Rouleau Christopher M. , Kelley Kyle P. , Keum Jong , Stavitski Eli , Zhu Yimei , Chisholm Matthew F. , Gai Zheng , Eres Gyula
Published: September 2020

Directional cation segregation at the local interface enables unusual electrical conductivity at a macro scale.
A green ligand-based copper–organic framework: a high-capacity lithium storage material and insight into its abnormal capacity-increase behavior
Authors: Lou Xiaobing , Hu Xiaoshi , Xiang Shuyan , Li Chao , Yang Qi , Hu Bingwen
Published: September 2020

The abnormal capacity-increase behavior of high-Li-storage-performance Cu-CIT MOF is investigated by EPR and XAFS, which is found to be induced by gradual redox participation of metal centers during cycles.
Enhancing LiAlOX synaptic performance by reducing the Schottky barrier height for deep neural network applications
Authors: Fu Yaoyao , Dong Boyi , Su Wan-Ching , Lin Chih-Yang , Zhou Kuan-Ju , Chang Ting-Chang , Zhuge Fuwei , Li Yi , He Yuhui , Gao Bin , Miao Xiang-Shui
Published: September 2020

The synaptic behaviors of LiAlOX devices are optimized by lowering the Schottky barrier height.
Carbon supported noble metal nanoparticles as efficient catalysts for electrochemical water splitting
Authors: Liu Meng , Hof Ferdinand , Moro Miriam , Valenti Giovanni , Paolucci Francesco , Pénicaud Alain
Published: September 2020

Due to an increasing requirement of clean and sustainable hydrogen energy economy, it is significant to develop new highly effective catalysts for electrochemical water splitting.
Usage of P–V–L bond theory in studying the structural/property regulation of microwave dielectric ceramics: a review
Authors: Yang Hongyu , Zhang Shuren , Yang Hongcheng , Li Enzhu
Published: September 2020

Combined with bond traits, such as ionicity, susceptibility and lattice energy obtainedviaP–V–L bond theory, and far-infrared reflectance spectroscopy, intrinsic structural effects on microwave dielectric properties can be specifically evaluated.
Improvement in the stability of γ-CsPbI3 nanowires enabled by lattice immobilization through the Pb–O anchor in SBA-15
Authors: Jia Feng-Yan , Sun Ling-Dong , Dong Hao , Huang Ling , Wang Li-Gang , Li Lin-Dong , Jung Yuhyeon , Zhou Liang , Yan Chun-Hua
Published: September 2020

γ-CsPbI3 nanowires crystallized inside channels of mesoporous SBA-15 template, exhibit improved phase stability from the Pb and O anchoring.
Organocatalytic site- and stereoselective 1,6-additions of N-aryl-3-oxobutanamides to propargylic aza-p-quinone methides
Authors: Li Fushuai , Chen Xuling , Liang Shuai , Shi Zhenyan , Li Pengfei , Li Wenjun
Published: September 2020

A chiral phosphoric acid catalyzed site-selective 1,6-conjugate addition of N-aryl-3-oxobutanamides to in situ formed propargylic aza-p-quinone methides from propargylic alcohols has been established for the first time.
Effect of chromium on the corrosion behaviour of low Cr-bearing alloy steel under an extremely high flow rate
Authors: Wang Bei , Wang Yun , Li Qingping , Li Huixin , Zhang Lei , Lu Minxu
Published: September 2020

The effect of chromium on the corrosion behavior of low Cr-bearing alloy steel in a wet gas pipeline with a high flow rate was studied using a rotating cylinder electrode (RCE) and self-built wet gas flow loop device.
Influence of the rate of radiation energy on the charge-carrier kinetics application of all-inorganic CsPbBr3 perovskite nanocrystals
Authors: Kumar Virendra , Nagal Vandana , Kumar Rahul , Srivastava Shubhda , Gupta Bipin Kumar , Kumar Mahesh , Hafiz Aurangzeb Khurram , Singh Kedar
Published: September 2020

A mechanistic framework for hot carrier cooling process in CsPbBr3 PNC is depicted via transient absorption spectroscopy.
First-principles study of structural, elastic and electronic properties of naphyne and naphdiyne
Authors: Liu Chuan , Liu Zixiang , Ye Xiangju , Cheng Ping , Li Yingjie
Published: September 2020

Naphyne and naphdiyne exhibit comparable stability to synthesized graphdiyne and graphtetrayne, and they show potential applications on membrane separations and fabrication of strain-tunable nanoelectronic devices.
Freestanding interconnected nanocluster textiles for efficient oxygen evolution reaction
Authors: Higashi Shougo , Tachikawa Takashi , Oh-ishi Keiichiro , Shigetoh Keisuke , Takechi Kensuke , Beniya Atsushi
Published: September 2020

We report a method for fabricating a support-free catalytic textile consisting solely of nanoclusters. With IrO2 textile, among the highest OER activity for IrO2 was achieved, attributed to the presence of a large number of undercoordinated Ir atoms.
Effect of π-bridge groups based on indeno[1,2-b]thiophene D–A–π–A sensitizers on the performance of dye-sensitized solar cells and photocatalytic hydrogen evolution
Authors: Ding Haoran , Chu Yanmeng , Xu Mengyu , Zhang Shicong , Ye Haoran , Hu Yue , Hua Jianli
Published: September 2020

Three new sensitizers (SD1, SD2 and SD3) with different π-bridge moieties were designed and investigated. SD1-based DSCs achieved a better PCE of 8.96%, while the composite of SD2@Pt/TiO2 afforded the highest H2 evolution rate of 23.5 mmol g−1 h−1.
Tunable valley splitting and anomalous valley Hall effect in VTe2/Ga2S3 heterostructures
Authors: Ma Xikui , Shao Xiaofei , Fan Yingcai , Liu Jian , Feng Xukun , Sun Lei , Zhao Mingwen
Published: September 2020

The modulation of valley splitting is not only of fundamental interest but is also crucial to valleytronics.
Structural insight into HEMK2–TRMT112-mediated glutamine methylation
Authors: Gao Jie , Wang Bin , Yu Huijuan , Wu Gao , Wan Cuihong , Liu Wenting , Liao Shanhui , Cheng Liansheng , Zhu Zhongliang
Published: September 2020

Post-translational modifications play important roles in mediating protein functions in a wide variety of cellular events in vivo. HEMK2–TRMT112 heterodimer has been reported to be responsible for both histone lysine methylation and eukaryotic release factor 1 (eRF1) glutamine methylation. However, how HEMK2–TRMT112 complex recognizes and catalyzes eRF1 glutamine methylation is largely unknown. Here, we present two structures of HEMK2–TRMT112, with one bound to SAM and the other bound with SAH and methylglutamine (Qme). Structural analyses of the post-catalytic complex, complemented by mass spectrometry experiments, indicate that the HEMK2 utilizes a specific pocket to accommodate the substrate glutamine and catalyzes the subsequent methylation. Therefore, our work not only throws light on the protein glutamine methylation mechanism, but also reveals the dual activity of HEMK2 by catalyzing the methylation of both Lys and Gln residues.
Grid clustering and fuzzy reinforcement‐learning based energy‐efficient data aggregation scheme for distributed WSN
Authors: Sanjay Gandhi Gundabatini , Vikas K. , Ratnam Vijayananda , Suresh Babu Kolluru
Published: September 2020

The widely acceptable problem in wireless sensor networks (WSNs) is to develop a practical scheme for data aggregation in the massive range of sensor nodes that are randomly distributed over a network region. The essential operation of cluster heads (CHs) in such a network is to transmit the aggregated data to the sink node through multi‐hop communication, thus the energy to be used in a better way during the period of aggregation and transmission. Therefore, this study presents a scheme based on grid clustering and fuzzy reinforcement‐learning to maximise network lifetime as well as energy‐efficient data aggregation for distributed WSN. Initially, grid clustering is employed for cluster formation and CH selection. Further, a fuzzy rule system‐based reinforcement learning algorithm is used to select the data aggregator node based on the parameters, such as distance, neighbourhood overlap, and algebraic connectivity. Finally, the dynamic relocation of the mobile sink is performed within a grid‐based clustered network region using a fruit fly optimisation algorithm. The experimental outcomes revealed that the proposed data aggregation scheme provides superior performance in terms of energy consumption and network lifetime compared to earlier systems.
Fractional‐order adaptive non‐singular fast terminal sliding mode control with time delay estimation for robotic manipulators
Authors: Zhang Yangyang , Yang Xiaohui , Wei Peng , Liu Peter Xiaoping
Published: September 2020

In this study, an adaptive fractional‐order non‐singular fast terminal sliding mode (FO‐NFTSM) scheme based on time delay estimation (TDE) is proposed for the control of robotic manipulators. A new FO‐NFTSM surface with a continuous TSM‐type switch item is designed to ensure good performance, such as fast finite‐time convergence, high precision and being non‐singular. The chattering problem is solved by introducing a saturation function into the control signal. The TDE element is used to estimate the robot's unknown dynamic parameters and external disturbances. The Lyapunov stability theory is used to prove the finite‐time stability of the control system. The proposed control algorithm is applied to a two‐link robotic manipulator and the comparative results verify the effectiveness and superiority of the proposed control approach in comparison with existing control methods.
Photon leaking or very hard ionizing radiation? Unveiling the nature of He II-emitters using the softness diagram
Authors: Pérez-Montero E. , Kehrig C. , Vílchez J. M. , García-Benito R. , Duarte Puertas S. , Iglesias-Páramo J.
Published: September 2020

Aims. Star-forming galaxies with nebular He II emission contain very energetic ionizing sources of radiation, which can be considered as analogs to the major contributors of the reionization of the Universe in early epochs. It is therefore of great importance to provide a reliable absolute scale for the equivalent effective temperature (T*) for these sources.

Methods. We study a sample of local (z <  0.2) star-forming galaxies showing optical nebular He II emission using the so-called softness diagrams, involving emission lines of two elements in two consecutive stages of ionization (e.g., [S II]/[S III] vs. [O II]/[O III]). We use for the first time the He I/He II ratio in these diagrams in order to explore the higher range of T* expected in these objects, and to investigate the role of possible mechanisms driving the distribution of galaxy points in these diagrams. We build grids of photoionization models covering different black-body temperatures, model cluster atmospheres, and density-bounded geometries to explain the conditions observed in the sample.

Results. We verified that the use of the softness diagrams including the emission-line ratio He I/He II combined with black-body photoionization models can provide an absolute scale of T* for these objects. The application of a Bayesian-like code indicates T* in the range 50−80 kK for the sample of galaxies, with a mean value higher than 60 kK. The average of these high temperature values can only be reproduced using cluster model populations with nearly metal-free stars, although such ionizing sources cannot explain either the highest T* values, beyond 1σ, or the dispersion observed in the softness diagrams. According to our photoionization models, most sample galaxies could be affected to some extent by ionizing photon leaking, presenting a mean photon absorption fraction of 26% or higher depending on the metallicity assumed for the ionizing cluster. The entire range of He I/He II, [S II]/[S III], and [O II]/[O III] ratios for these HeII-emitting galaxies is reproduced with our models, combining nearly metal-free ionizing clusters and photon leaking under different density-bounded conditions.
Uniqueness of solution to systems of elliptic operators and application to asymptotic synchronization of linear dissipative systems
Authors: Li Tatsien , Rao Bopeng
Published: September 2020

We show that under Kalman’s rank condition on the coupling matrices, the uniqueness of solution to a complex system of elliptic operators can be reduced to the observability of a scalar problem. Based on this result, we establish the asymptotic stability and the asymptotic synchronization for a large class of linear dissipative systems.
Overview of water-saving irrigation methods in arid/ semi-arid areas
Authors: Hu Rui
Published: September 2020

Water-saving strategies play an important role in improving the resilience of water scarcity in arid and semi-arid areas. This paper has compared the advantages and disadvantages of four kinds of water-saving irrigation methods commonly used in arid/semi-arid areas: rainwater harvesting irrigation, plastic film mulching technology, deficit irrigation, and alternate furrow irrigation. The finding of this study is that biological water-saving which can improve the biological drought tolerance is more cost-effective of further study than the technological water-saving. It can be seen that the latter two (biological water-saving irrigation measures) have lower cost, stronger operability and more promising development prospects. Im addition, future research is suggested to focus more on automatic intelligence to pursue accurate irrigation.
Integrating GIS technologies in hydro power plant cascade simulation model
Authors: Khalyasmaa Alexandra , Eroshenko Stanislav , Arestova Anna , Mitrofanov Sergey , Rusina Anastasiya , Kolesnikov Alexey
Published: September 2020

The paper presents the calculation algorithm for water-energy regime of a hydroelectric power plants cascade. The block diagram of the algorithm is given for implementing the simulation model and automating the process of calculating the regime. The proposed algorithm allows to evaluate the efficiency of the cascade, as well as to optimize the regime according to various criteria. Additionally, an option is proposed for integrating GIS monitoring data into the calculation algorithm.
A numerical study of harmful gas dispersion based on CALPUFF model
Authors: Lu Yanyan
Published: September 2020

Severe gas leakage accidents occasionally happened during the exploitation of high-sulfur gas, the consequent harmful gas dispersion could seriously impact the air quality, cause large-scale casualties and economic losses. Therefore, people’s comprehensive understanding of harmful gas dispersion in both spatial and temporal dimensions should be improved. This paper takes gas well blowout accident in Kai County, China, as the case study, simulates and analyzes the dispersion characteristics of the leaked gas, mainly focuses on H2S. The CALPUFF model is applied to execute the experiment, the detailed meteorological data, complex terrain data, wet deposition and chemical transformations are all under consideration. The result shows that due to different impact factors, such as complex terrain and gas density variations, H2S exposure risk was higher in the valley area than that on the mountain, which also explains why Xiaoyang and Gaowang villages have a great number of casualties. Besides, the analysis result is basically consistent with the historical local news and reported data, which demonstrated that our case study of H2S gas dispersion simulation is reasonable and reliable.
Optimization of the electrical connection topology of a tidal farm network
Authors: Fakhri Eyman , Bourguet Salvy , Thiébot Jérôme , Machmoum Mohamed , Gualous Hamid
Published: September 2020

This article presents an approach to optimize the electrical connection topology of tidal energy converters in a tidal farm. The methodology is based on a genetic algorithm (GA). The main purpose is to present a technique of coding to find the best electrical connection topology of the tidal farm network. The optimization model takes into account the energy loss in the submarine cables. The model gives as its output the optimal number of turbine clusters connected to each offshore substation, the number of turbines in each cluster, the cross-section of MV and HV cables, the connection design for each cluster of turbines as well as the number and the locations of the offshore substations. A particle swarm optimization algorithm (PSO) is used to confirm the results obtained with the GA. The optimization approach is applied to the Fromveur Strait (France).
Effect of machining polarity on single discharge characteristics in micro-EDM
Authors: Wang Kan , Liu Yong
Published: September 2020

In micro electrical discharge machining (micro-EDM), polarity effect is attributed to the difference in energy distribution into the anode and cathode. Understanding the effect of machining polarity on energy distribution bears significance in predicting and controlling machining performances. Single discharge experiments were conducted in this study, to explore single discharge characteristics. The plasma radius and energy distribution were calculated by combining the crater size and the electro-thermal model. The results show that the influence of discharge current on crater depth-to-diameter ratio (H/D) is not significant with positive polarity. The plasma radius, fraction of energy transferred to workpiece, and crater size are greater for micro-EDM with negative polarity than positive polarity.
Calculation of the required noise reduction of a engine exhaust system
Authors: Matasova Olga , Tupov Vladimir
Published: September 2020

The problem of reduction of internal combustion engine (ICE) noise is most urgent at present when the fleet of vehicles has significantly expanded and their power has increased. Reactive mufflers are often used to solve it. The initial stage in the design of mufflers is a theoretical assessment of the frequency spectrum of sound power level (SPL) of an unmuffled ICE noise source, comparing it with the calculated maximum permissible spectrum and determining the required amount of its reduction in standard frequency bands. The paper presents a method for calculating the required noise reduction of a transport engine exhaust using the example of a two-stroke ICE of the class of 125 cm3. Thus, the designer has the opportunity to develop mufflers, the acoustic efficiency of which meets the calculated required noise reduction values, already at an early stage of the vehicle design.
Study of the Position of Sound Sources in a Turbulent Jet Using Nozzles of Different Configurations
Authors: Ershov Victor , Khramtsov Igor
Published: September 2020

The aim of this work is to study the position of dominant sound sources in a small-scale turbulent jet using the beamforming method. Two nozzles of equivalent diameter and different geometric configurations (conical and chevron) were used to create different initial conditions for the outflow. Based on the analysis of the results obtained, it can be concluded that they are in good agreement with the well-known concepts of the physics of noise generation processes by turbulent jets: higher-frequency sources are generated by smaller-scale turbulent structures located closer to the nozzle edge, which is confirmed by the localization of high-frequency noise sources also closer to the nozzle edge. The chevron nozzles loosen the initial section of the jet, making it less short and thereby facilitating a faster displacement of noise sources to the nozzle edge, as seen when comparing localization maps for conical and chevron nozzles at the same frequencies. The results of localization were compared with the data obtained by other researchers. The results obtained were found to provide confidence in the use of acoustic beamforming to measure the location of the jet noise source with accuracy similar to other methods that have been used in the past.
Study of acoustic characteristics of noise barriers
Authors: Kulkina Valeriya , Komkin Alexandr
Published: September 2020

The acoustic efficiency of noise barriers has been studied using the developed two-dimensional finite element model in the COMSOL Multiphysics software package. Numerical calculations of the semi-infinite barrier efficiency have been compared with calculations conducted by the Maekawa formula. The main attention has been paid to the influence of the underlying surface on barrier acoustic characteristics. The barrier acoustic efficiency depends on its height, the position of the noise source and on the calculation point above the underlying surface. This dependence has been presented in this research.
The study of the effectiveness of sound insulation of gypsum wall boards with “Shimast” coating
Authors: Totunov Semen , Ivanov Michael , Ivanova Olga
Published: September 2020

The article presents the experimental studies of sound insulation of a single-layer barrier made of gypsum wall boards with a thin-layer coating. The coating consists of a viscous base and glass airless microgranules. The coating increases the efficiency of reducing air noise. The material is applied as a normal paint by spraying on the surface. The research results have been obtained in an acoustic reverberation chamber designed to study the partition walls effectiveness.
Zwischen Macht und Machtlosigkeit
Authors: Dumont Alicia , Desch Janine , Fischer Johannes , Schild Sarah , Waldschmidt Maximilian-Erik
Published: September 2020

Freiheitseinschränkende Maßnahmen sollen aggressive Patienten vor sich und anderen schützen und sind für Pflegende häufig eine Gratwanderung zwischen Macht und Machtlosigkeit. Seit einer Gesetzesänderung vor rund 2 Jahren dürfen Patienten ohne richterlichen Beschluss nicht länger als 30 Minuten am Bett fixiert werden. Unsere Autoren haben erforscht, ob seit der Gesetzesänderung weniger fixiert wird und Alternativen zu 5- oder 7-Punkt-Fixierungen attraktiver geworden sind.
Das verspätete Tako-Tsubo-Syndrom – Ein kritischer perioperativer Zwischenfall
Authors: Speer Tillmann , Fiege Marko , Fastner Christian
Published: September 2020

Einleitung Das Tako-Tsubo-Syndrom (TTS) beschreibt eine transiente ventrikuläre Dysfunktion. Symptome und Komplikationsrate ähneln denen eines Myokardinfarkts.

Anamnese Eine 81-jährige Patientin wurde zur Thrombendarteriektomie der linken Femoralarterie aufgenommen. Kurz zuvor war ein biologischer Aortenklappenersatz durchgeführt und eine koronare Herzkrankheit ausgeschlossen worden.

Narkoseeinleitung und klinischer Befund Nach Narkoseeinleitung kam es zu einer relevanten arteriellen Hypotonie und Sinusbradykardie. Nach Katecholamin-Gabe zeigten sich transient angehobene ST-Strecken, welche postoperativ eine Myokardinfarkt-ähnliche Dynamik entwickelten. Echokardiografisch und in den kardialen Enzymen waren initial keine Auﬀälligkeiten zu beobachten.

Therapie, Verlauf und Diagnose Nach einem symptomfreien Intervall entwickelte die Patienten am dritten postoperativen Tag unvermittelt eine schwere kardiale Dekompensation. Nun war das Vollbild eines TTS zu erkennen. Unter Therapie mit Levosimendan gelang eine Stabilisierung des klinischen Zustands.

Folgerung Dynamische EKG-Veränderungen in der perioperativen Situation erfordern stets eine diﬀerenzierte Diagnostik und ggf. eine längere Überwachung. Das TTS ist hierbei eine relevante und komplikationsbehaftete Diﬀerenzialdiagnose.
Twilight of Immunity
Authors: Holzhauer Peter
Published: September 2020

Vor dem Hintergrund der uns noch täglich konfrontierenden SARS-CoV-2-Pandemie
rücken auch für immer mehr medizinische Laien die komplexen Aspekte
des menschlichen Immunsystems in den Fokus des Interesses. Während es auf
der einen Seite leider nicht wenige, eher verworrene Gemüter, gibt,
die eine Relevanz oder sogar die Existenz des neuartigen Coronavirus leugnen, gibt
es auf der anderen Seite zahlreiche engagierte, verantwortungsbewusste und
vorsichtige Menschen, die neben den offiziell empfohlenen/verordneten
Präventivmaßnahmen nichts unversucht lassen, um ihr Immunsystem zu
stärken. Wie wir alle wissen, scheinen dabei eher ältere Menschen
ein höheres Risiko zu tragen, einen schweren oder auch tödlichen
Verlauf der COVID-Erkrankung zu erleiden. Was sind die Hintergründe? Bereits
2017 publizierte Prof. Nikolich-Žugich von der Universität in
Arizona in der Zeitschrift „Nature Immunology“ einen lesenswerten
Beitrag zur „Abenddämmerung der Abwehrkräfte“.
CARD-Studie – Bedeutung für die Therapie des fortgeschrittenen Prostatakarzinoms
Authors: Merseburger Axel S. , Bannowsky Andreas , Becker Klaus , Bokemeyer Carsten , Eichenauer Rolf , Lehmann Jan , Mickisch Gerald , Steuber Thomas , von Amsberg Gunhild , von Kügelgen Tobias , Wülfing Christian
Published: September 2020

Hintergrund Für die Behandlung des metastasierten kastrationsresistenten Prostatakarzinoms (mCRPC) stehen verschiedene lebensverlängernde Therapieoptionen zur Verfügung.

Fragestellung Die Therapiesequenz beim mCRPC wird seit Jahren diskutiert. Mit den finalen Ergebnissen der CARD-Studie stehen wichtige prospektive Daten zur Verfügung, um mehr Klarheit in die Diskussion um die Therapiesequenz zu bringen.

Material und Methode CARD ist eine randomisierte Phase IV-Studie bei Patienten mit mCRPC, die bereits mit Docetaxel und einer gegen den Androgenrezeptor gerichteten Substanz (ARTA) vorbehandelt waren. In der Studie zeigten sich signifikanten Wirksamkeitsvorteile zugunsten der Weiterbehandlung mit Cabazitaxel versus eine zweite ARTA-Therapie. Die Studienergebnisse werden dargelegt und im Kontext früherer Studiendaten hinsichtlich ihrer Bedeutung für den klinischen Alltag diskutiert.

Ergebnisse Die CARD-Studiendaten bestätigen Cabazitaxel als wirksame Therapieoption beim mCRPC für Patienten, die bereits mit Docetaxel und einer ARTA vorbehandelt sind. Eine Therapie mit Cabazitaxel war sicher durchführbar. Die Studienergebnisse bestätigen die Kreuzresistenz zwischen den beiden ARTAs Abiraterone und Enzalutamid.

Schlussfolgerungen Bei für eine Chemotherapie geeigneten Patienten mit mCRPC sollte die Therapiesequenz so gewählt werden, dass die Patienten auch Cabazitaxel erhalten. Eine direkte Therapiesequenz mit zwei ARTAs sollte vermieden werden, oder zumindest nur bei Kontraindikationen von anderen Subtanzen erwogen werden.
Patienten – Partner im medizinischen
Entscheidungsprozess
Authors: Häfner Steffen , Doering Thorsten , Gil Francisco Pedrosa
Published: September 2020

Das Problem Compliance kann von einem anderen Standpunkt aus und mit anderer
Gewichtung und Zielsetzung einen neuen Namen bekommen:
„Entscheidungspartizipation“ in der
Patienten-Arzt-Beziehung. In der angelsächsischen Literatur wird
neben anderen Empfehlungen dazu zunehmend der Begriff der
„Concordanz“ angeboten.

Compliance wurde lange kritisiert als Synonym für Gehorsam –
„die Befolgung der Anordnungen des Arztes”. Auch wenn viele
Forscher und Praktiker sorgsam versucht haben, diesen Ausdruck zu vermeiden,
implizieren die Alternativen – „Adherence“ oder
„Cooperation” – auch nicht sehr andere Bedeutungen
als „Compliance“. David Sackett hat 1976 in seiner damals
bahnbrechenden Publikation „Compliance with Therapeutic
Regimes“, den Weg beschrieben, neue Aspekte der
Patienten-Arzt-Beziehung zu eröffnen. In dieser Publikation klingen
einfühlsame Ideen an wie die „angepaßte
übereinstimmende Therapie” und die „Notwendigkeit
einer fehlerfreien Annäherung“ in der therapeutischen
Beziehung.

Die Auseinandersetzung mit Compliance führte zur Folgerung: Es sollte
mehr Zeit darauf verwendet werden, nicht nur festzustellen, welches das
beste Medikament für eine bestimmte Erkrankung ist, sondern auch
welches das beste Medikament für ein bestimmtes Individuum mit
seinem besonderen Lebensstil und Vorlieben ist. Das Konzept der Concordance
setzt einen offenen Austausch von Informationen, Ansichten, Vorerfahrungen
und den Willen zur Kooperation voraus.

Durch „Coaching“ und eine „nicht bewertende
Einstellung“ des Arztes ist es wahrscheinlicher, dass Patienten die
Einnahmegewohnheiten ihrer Medikamente oder Durchführung anderer
verordneter Maßnahmen ehrlich beschreiben. Den Patienten als
„Entscheidenden“ zu sehen, als denjenigen, der die
Entscheidung (mit) trifft, ist ein grundsätzlicher Schritt von der
Richtung des Compliancemodells weg.
Zum Balint-Journal Juni 2020
Authors: Baur Wolfgang
Published: September 2020

Das Balint-Journal Juni 2020 hat für mich eine besondere Bedeutung.

Einerseits ist der ausführliche Rückblick von Rita Kielhorn zu ihrer
Geschichte, aber auch zu der Geschichte der Balintbewegung, ein einfühlsamer
Rückblick auf ihre Balintsozialisation und erinnert dann auch an die eigenen
Erfahrungen, wie man zur Balintgruppenarbeit und schließlich auch zur
Gruppenleitung gekommen ist.
Hearing Loss in Mucopolysaccharidosis
Authors: Bicalho Cibele Gomes , de Araújo Leão Emília Katiane Embiruçu , de Andrade Álvaro Muiños , Acosta Angelina Xavier
Published: September 2020

Introduction Mucopolysaccharidosis (MPS) is a set of rare diseases caused by deficiency of lysosomal enzymes that lead to the accumulation of glycosaminoglycans (GAG) in tissues and organs, which, in turn, is responsible for the multisystemic clinical, chronic, and progressive symptoms.

Objective To describe the profile of the otorhinolaryngological clinical examination and audiology tests of patients with MPS disease.

Methods The present study is a case series. The evaluation was performed, initially, in 24 patients with MPS types I, II, IIIA, IV and VI.

Results The most common hearing complaint was hearing loss, which was confirmed by audiology tests in almost 100% of the patients, most of whom presented conductive hearing loss.

Conclusions It is important to evaluate the complaints, physical examination, and audiology tests in patients with MPS. The otorhinolaryngologistshould be part of the group of professionals that follows these patients to better monitor their hearing and provide early hearing rehabilitation.
Atlantoaxial Rotatory Dislocation: Delayed Diagnose Will Result in More Invasive Treatment Options
Authors: Pitzen Tobias , Ruf Michael , Meyer Carolin , Drumm Joerg
Published: September 2020

Purpose The atlantoaxial joint represents the most mobile joint complex within the spine, secured by ligaments and capsules. Integrity of the atlantoaxial joint is crucial with respect to the mobility of the head and the upper spine. Atlantoaxial rotatory dislocation is the most common type of injury within this joint in children and is characterized by a typical position of the head (cock robin position). Nevertheless, this type of injury is frequently overlooked. The purpose of the current study was threefold. First, the characteristics of the patients with atlantoaxial dislocation were identified. Next, we checked if the time to treatment did influence the type of treatment. Finally, we checked if the age of the child at the time of treatment influenced the type of treatment.

Methods Forty-four children, who were treated consecutively due to atlantoaxial dislocation at a single spine center between September 1993 and October 2018, are analyzed retrospectively regarding age, sex, symptoms, etiology, time to diagnosis, time to treatment, and outcome.

Results Forty-four children (30 girls, mean age 8.9 years) were included in the study. The cock robin head position was found in all of them, but neurological deficits were not found in any of them. In 21 patients, dislocation was caused by previous infection (Grisel's syndrome), whereas in 19 patients, dislocation was due to minor trauma. In 4 cases, etiology remained unknown. Mean time to sufficient treatment was 178 days. Eighteen patients received closed reduction and immobilization after 57 days at mean. Open reduction followed by temporary fixation was done in 12 patients after a mean time gap of 188 days. Bony atlantoaxial fusion was necessary in 14 children, who were diagnosed after 319 days on average. Invasiveness of treatment was dependent on the time delay between development of dislocation and treatment; a significant difference was found between invasiveness of treatment and time to treatment (Kruskal–Wallis test, p < 0,05). Moreover, older children were treated significantly more often with fusion than younger ones (χ
2, p = 0,002).

Conclusion Young girls are predisposed to incur an atlantoaxial rotatory dislocation, which usually occurs due to minor trauma or infection. The cock robin position is characteristic, but neurological deficits are not common. There is a need for early and sufficient treatment because delayed treatment necessitates more invasive treatment, thus leading to a complete loss of function of the most mobile joint within the spine. Finally, older children are predisposed to more invasive treatment strategies.
Bayes Theorem and Protopathic Bias: Methodological Concerns When Addressing the Impact of Fetal Heart Rate Patterns on the Cesarean Section Rate
Authors: Balayla Jacques , Lasry Ariane , Gil Yaron , Volodarsky-Perel Alexander
Published: September 2020

Over the last 30 years, the caesarean section rate has reached global epidemic proportions. This trend is driven by multiple factors, an important one of which is the use and inconsistent interpretation of the electronic fetal monitoring (EFM) system. Despite its introduction in the 1960s, the EFM has not definitively improved neonatal outcomes, yet it has since significantly contributed to a seven-fold increase in the caesarean section rate. As we attempt to reduce the caesarean rates in the developed world, we should consider focusing on areas that have garnered little attention in the literature, such as physician sensitization to the poor predictive power of the EFM and the research method biases that are involved in studying the abnormal heart rate patterns—umbilical cord pH relationship. Herein, we apply Bayes theorem to different clinical scenarios to illustrate the poor predictive power of the EFM, as well as shed light on the principle of protopathic bias, which affects the classification of research outcomes among studies addressing the effects of the EFM on caesarean rates. We propose and discuss potential solutions to the aforementioned considerations, which include the re-examination of guidelines with which we interpret fetal heart rate patterns and the development of noninvasive technologies that evaluate fetal pH in real time.
Ultrasound-Guided Insertion of the Ventricular Catheter in Ventriculoperitoneal Shunt Surgery: Evaluation of Accuracy and Feasibility in a Prospective Cohort
Authors: Leu Severina , Kamenova Maria , Mariani Luigi , Soleman Jehuda
Published: September 2020

Objective Ventriculoperitoneal shunt (VPS) placement is one of the most frequent neurosurgical procedures. The position of the proximal catheter is important for shunt survival. Shunt placement is done either without image guidance (“freehand”) according to anatomical landmarks or by use of various image-guided techniques. Studies evaluating ultrasound-guided (US-G) VPS placement are sparse. We evaluate the accuracy and feasibility of US-G VPS placement, and compare it to freehand VPS placement.

Methods We prospectively collected data of consecutive patients undergoing US-G VPS placement. Thereafter, the US cohort was compared with a cohort of patients in whom VPS was inserted using the freehand technique (freehand cohort). Primary outcome was accuracy of catheter positioning, and secondary outcomes were postoperative improvement in Evans' index (EI), rates of shunt dysfunction and revision surgery, perioperative complications, as well as operation, and anesthesia times.

Results We included 15 patients undergoing US-G VPS insertion. Rates of optimally placed shunts were higher in the US cohort (67 vs. 49%, p = 0.28), whereas there were no malpositioned VPS (0%) in the US cohort, compared with 10 (5.8%) in the freehand cohort (p = 0.422). None of the factors in the univariate analysis showed significant association with nonoptimal (NOC) VPS placement in the US cohort. The mean EI improvement was significantly better in the US cohort than in the freehand cohort (0.043 vs. 0.014, p = 0.035).

Conclusion Based on our preliminary results, US-G VPS placement seems to be feasible, safe, and increases the rate of optimally placed catheters.
Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes
Authors: Wach Johannes , Banat Mohammad , Borger Valeri , Vatter Hartmut , Haberl Hannes , Sarikaya-Seiwert Sevgi
Published: September 2020

Background The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery.

Methods MEDLINE/PubMed Service was searched for the terms “intraoperative MRI,” “pediatric,” “brain,” “tumor,” “glioma,” and “surgery.” The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included.

Results IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6–89.7, p < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1–85.5, p = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7–2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients.

Conclusion IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.
Duration of the Third Stage of Labor and Estimated Blood Loss in Twin Vaginal Deliveries
Authors: Whittington Julie R. , Pagan Megan , Daugherty Kristen , Cummings Kelly , Ounpraseuth Songthip T. , Eads Lauren , Magann Everett F.
Published: September 2020

Objective The main aim of this study was to characterize the duration of the third stage of labor and estimated blood loss in twin vaginal deliveries.

Study Design This was a retrospective case–control study. The data was collected from deliveries at the University of Arkansas for Medical Sciences in Little Rock, Arkansas, from January 2013 to June 2017. Women were identified who had twin gestation, were delivered vaginally, and whose maternal age was greater than 18 years old. Women were excluded if they had an intrauterine fetal demise, delivered either/both fetuses via cesarean, history of a previous cesarean or a fetus with a congenital anomaly. If a subject met criteria to be included in the study, the next normal singleton vaginal delivery was used as the control subject.

Results There were 132 singleton vaginal deliveries and 133 twin vaginal deliveries analyzed. There was no significant difference in the length of the third stage of labor between twin and singleton vaginal deliveries except in the 95th percentile of the distribution. Mothers delivering twins had an increase in third-stage duration by 7.618 minutes (95% confidence interval [CI]: 0.73, 14.50; p = 0.03) compared with those who delivered singletons. The twin group had a higher estimated blood loss than singleton deliveries. The increase in blood loss in the twin group was 149.02 mL (95% CI: 100.2, 197.8), 257.01 mL (95% CI: 117.9, 396.1), and 381.53 mL (95% CI: 201.1, 562.1) at the 50th, 90th, and 95th percentiles, respectively. When the third stage of labor was at the 90th percentile or less in twin pregnancy (14 minutes), estimated blood loss was less than 1000 mL.

Conclusion Twin pregnancy is a known risk factor for postpartum hemorrhage. As the duration of the third stage prolongs, the risk for hemorrhage also increases. We recommend delivery of the placenta in twin pregnancies by 15 minutes to reduce this risk.

Key Points
Interdisciplinary Approach for the Medical Management of Gestational Gigantomastia
Authors: Cabrera Camila , Radolec Mackenzy , Prescott Angela , De La Cruz Carolyn , Beck Stacy
Published: September 2020

Background Gestational gigantomastia is a rare and debilitating condition that is thought to result from hormone hypersensitivity. Several definitions have been proposed using breast weight and change in body mass index, but the breast growth is best summarized as rapid, diffuse, and excessive.

Case We report a case of a 31-year-old woman with a history of infertility and cystic fibrosis that developed pathologic breast growth during hormonal preparation for in vitro fertilization. Her serum laboratories were unremarkable, and she was medically managed until 31 weeks of gestation. After delivery, she experienced rapid decrease in breast size and was followed by plastic surgery with plan to allow spontaneous regression with interval breast reduction

Conclusion We highlight a successful interdisciplinary medical management approach, which helped to avoid a morbid, intrapartum breast reduction.
Late Presentation of Uterine Rupture Following Vaginal Birth After Cesarean Delivery: A Case Report
Authors: Choi Lindsey A. , Chung Ariel A. , Pierce Brian
Published: September 2020

Background A trial of labor after cesarean delivery is associated with uterine rupture rates of 0.5 to 0.9%, which can have devastating neonatal and maternal consequences. While uterine rupture typically occurs during labor, it can clinically manifest after delivery.

Case A 23-year-old multiparous female presented in labor at term. Her obstetrical history was significant for a prior low transverse cesarean delivery. She had an uncomplicated labor course and spontaneous vaginal delivery.

Immediately after delivery, she complained of severe right shoulder and left lower quadrant pain. Bedside ultrasound revealed a 10-cm, complex, adnexal mass adjacent to the uterus without free fluid. She was hemodynamically stable and appeared clinically well. On repeat ultrasound, the mass was unchanged; however, the patient now had free intraperitoneal fluid along the liver edge.

Emergent laparotomy revealed a uterine rupture along her prior hysterotomy with extension into the right uterine artery. A 10-cm broad ligament hematoma ruptured posteriorly resulting in a 1-L hemoperitoneum. She received multiple blood products intraoperatively and recovered well postpartum.

Conclusion Delivery after trial of labor after cesarean delivery usually decreases acuity; however, these patients remain at risk for significant complications. Clinicians should continue to assess patients in the immediate postpartum period and proceed with surgical intervention if necessary.