bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Phenobarbital and Glutethimide on Biological Half-Life of Warfarin
Authors: Corn M
Published: June 2018

The administration of phenobarbital or glutethimide significantly decreased the half-life of warfarin in 21 of 34 hospitalized patients. Patients who demonstrated a decrease could not be distinguished from apparent non-responders by age, weight, sex, or race. These sedatives did not detectably affect gastrointestinal absorption of warfarin. The observed decrease in warfarin half-life supports the concept that barbiturates and other drugs can increase the concentration of some drug-metabolizing enzymes. Since anticoagulating activity of coumarins is related to drug half-life, it is suggested that barbiturates or glutethimide therapy be discontinued in patients who appear refractory to anticoagulation with coumarins.
Einfluß des Alkohols auf die Antikoagulantientherapie
Authors: Riedler G
Published: June 2018

Es wird ein möglicher Einfluß des Alkohols auf die Blutgerinnung untersucht. Die Resultate einer Serie von 10 Pat. nach Wein- und 2 Pat. nach Whiskygenuß werden beschrieben, wobei sich 1 Pat. für Untersuchungen sowohl nach Wein- wie auch nach Whiskygenuß zur Verfügung stellte. In der beschriebenen Versuchsanordnung war bei allen Pat. nach teilweisem Anstieg ein deutliches, z.T. massives Absinken der Faktoren VII und X, weniger ausgeprägt des Faktors II und des Quickwertes zu beobachten. Eine mögliche Erklärung dieser Resultate wird diskutiert. Der Alkoholgenuß während einer Antikoagulantientherapie, insbesondere beim älteren Pat. mit möglicher Leberschädigung und leicht insuffizientem Herzen, sollte auf Grund der Resultate vermieden werden, da besonders die Faktoren VII und X empfindlich reagieren und mehrmals unter die kritischen Werte abfielen.
A Comparison of Platelet Stickiness Tests during an Atromid-S Trial
Authors: O’Brien J. R , Path F. C , Heywood Joan B.
Published: June 2018

Seven patients were studied before and throughout 16 weeks’ treatment with Atromid-S. The typical cholesterol-lowering effect of this drug was found. The bleeding time increased considerably in 6 out of 7 patients, but platelet adhesiveness tested in a glass filter and in the Wright Rotator was not decreased.

New methods recently devised for the quantitation of the platelet response to adenosine diphosphate, adrenaline, 5-hydroxytryptamine and “collagen” were used. The average response to collagen decreased slightly and that to adrenaline increased slightly during the treatment period. The response to 5-hydroxytryptamine, the collagen and the Wright tests were significantly interrelated but no other associations were found between any “stickiness” tests or between these tests and the serum cholesterol or uric acid levels. Accordingly, most test seem to measure different and in independent parameters of platelet behaviour.
Heparinoide als eine Alternative für die parenterale Antikoagulation bei Patienten mit Heparin-induzierter Thrombozytopenie
Authors: Alban S. , Greinacher A.
Published: June 2018

Die Heparin-induzierte Thrombozytopenie (HIT Typ II) ist eine lebensbedrohliche Komplikation der Heparintherapie. Da betroffene Patienten durch diese immunologische, unerwünschte Wirkung der Heparingabe gefährdet sind, neue throm-boembolische Gefäßverschlüsse zu entwickeln, ist bei hinreichendem klinischen Verdacht die sofortige Umstellung auf ein kompatibles Antikoagulans notwendig. Hierfür kommen, neben rekombinantem Hirudin, verschiedene Heparinoide in Betracht. Die Pathophysiologie der HIT Typ II sowie die Struktur und die anti-koagulatorischen Eigenschaften verschiedener Heparinoide werden dargestellt. Der letzte Teil des Artikels faßt den gegenwärtigen Stand der Dosierungsempfehlungen für das Heparinoid Danaparoid (Orgaran®, NV Organon, Niederlande) bei HIT-Typ-Il-Patienten zusammen.
Gerinnungsbestimmungen am Zentrifugalanalysator - Messungen mit chromogenen Substraten und mit der Fibringerinnung
Authors: Farag A. M. , Ozawa T. , Mammen E. F.
Published: June 2018

Ziel aller traditionellen Gerinnungstests ist die Fibrinogenumwandlung in Fibrin durch Thrombin. Die Gerinnselbildung wird entweder mechanisch oder photooptisch gemessen. Die Entwicklung chromogener Substrate zur Bestimmung von Gerinnungsenzymen hat eine spektrophotometrische Erfassung der Enzymreaktionen ermöglicht, die zur Automatisierung der Analysen mittels Zentrifugalanalysatoren im klinisch chemischen Laboratorium geführt hat.

Das von Instrumentation Laboratory (IL) entwickelte Automated Coagulation Laboratory (ACL)-System bietet Zentrifugalanalysatoren, die nicht nur Fibringerinnungstests, sondern auch chromogene Substrattests weitgehend automatisch durchführen (ACL 200, und 300 und 300 Research). Die Tests sind bei den 200und 300-Geräten vorprogrammiert, mit dem 300-Research-Gerät ist dagegen diese Vorprogrammierung zu umgehen. Somit können mit dem Gerät fast unbegrenzt neue Einphasenoder Zweiphasentests unter Verwendung von Gerinnungsverfahren oder chromogenen Substraten entwickelt werden. Das ACL-System ist einfach zu bedienen, hat eine ausgezeichnete Präzision und Reproduzierbarkeit und wirkt durch Automatisierung und niedrige Testvolumina kostendämpfend.
Anwendung und Bedeutung von enzymimmunologischen Methoden in der Gerinnungsdiagnostik
Authors: Stötzer K.-E. , Spanuth E.
Published: June 2018

Das hämostaseologische Laboratorium hat sich schon seit langem immunologischer Analysentechniken bedient. Die am meisten eingesetzen Methoden sind die Immunelektrophorese nach Laurell und immunologische Latex-Agglutinationstests. Als beispielhaft ist in diesem Zusammenhang die Bestimmung des von-Willebrand-Faktors und der Fibrin(ogen)-Spaltprodukte zu erwähnen.

Durch die Entwicklung hochsensitiver Meßmethoden, zunächst auf radioimmunologischer, inzwischen jedoch enzymimmunologischer Basis, hat sich das Spektrum der Parameter erweitert. Insbesondere die Vorgänge der intravaskulären Aktivierung der Hämostase sowie die thrombophile Diathese und damit die Thromboseprophylaxe sind durch die neuen immunologischen Analysetechniken besser beherrschbar geworden.

Nach ausführlicher Darstellung der Grundlagen der enzymimmunologischen Meßverfahren werden die wichtigsten Anwendungsbereiche aufgezeigt und ein Überblick zu den bisher vorliegenden klinischen Erfahrungen gegeben. Im einzelnen wird auf die Thrombophiliediagnostik mit der Bestimmung von Protein C, Protein S und Antiphospholipid-Antikörpern sowie der Abklärung der Fibrinolysekapazität durch Bestimmung des t-PA und PAI eingegangen. Darüber hinaus werden die neuen diagnostischen Möglichkeiten umrissen, die sich durch die Bestimmung der »Thrombosemarker« Antithrombin-Ill-Neoantigene, Antithrombin-Ill-Thrombinkomplexe und der spezifischen Fibrinspaltprodukte D-Dimere ergeben.
Hirudin als Antikoagulans zur Untersuchung der Thrombozytenfunktion
Authors: Rauschenbach C. , Demgen G. , Krupinski K. , Dechent C. , Roman C. , Breddin H. K. , Basic-Micic Mirjana
Published: June 2018

Hirudin ist ein spezifischer Thrombinhemmer, der jetzt auch in rekombinanter Form verfügbar ist. Hirudin wird zur Zeit als Antithrombotikum entwickelt; es hat aber auch einige Vorteile als Reagens und Antikoagulans im Vergleich zu Zitrat oder Heparin. Die Thrombozytenaktivierung in vitro und die Wechselwirkungen zwischen Thrombozyten und plasmatischer Gerinnung bei Verminderung von Ca++ unterscheiden sich deutlich von den Reaktionen in Gegenwart eines physiologischen Gehalts an Ca++.

In hirudinisierten Blutproben war die Thrombinund die Adrenalin-induzierte Aggregation im Vergleich zu Zitratblut deutlich gehemmt. Außerdem waren in Hirudin-PRP die Thrombozytenhaftneigung und die Thrombozytenausbreitung im Vergleich zu Zitrat-PRP deutlich vermindert. Die Thrombozytenzahl in Hirudin-PRP lag stets etwas höher als im parallel gewonnenen Zitrat-PRP. Wahrscheinlich hemmt Natriumzitrat die teilweise Thrombin-abhängige Plättchenvoraktivierung an den Wänden der Entnahmegefäße weniger stark als Hirudin.

Die Wirkung von Antithrombotika auf die Thrombozytenfunktion kann in vitro und wahrscheinlich auch ex vitro mit großer Sensitivität erfaßt werden, wenn für derartige Untersuchungen Hirudin als Antikoagulans verwendet wird.
Neutralisation von rekombinantem Hirudin
Authors: Walenga Jeanine , Hoppensteadt Debra , Pifarre Lalitha lyer , Fareed J.
Published: June 2018

Um die Beziehung zwischen dem Blutspiegel von Hirudin und dem Auftreten von Blutungen zu erfassen, benützten wir das Modell des Blutverlustes aus einem Kaninchenohr. Hirudin bewirkte keinen Blutverlust bei i. v. Dosierungen bis 1,0 mg/kg (20 µg/ml). Bei 2,5 bis 5,0 mg/kg (50 und 100 µg/ml, initialer Blutspiegel) wurde ein dosisabhängiger Anstieg des Blutverlustes wie nach 1,25 und 2,5 mg/kg Heparin i.v. beobachtet. Im Gegensatz zu Heparin werden die gerinnungshemmenden Wirkungen von Hirudin durch Protaminsulfat, Plättchenfaktor 4, andere polykationische Substanzen und Heparinase nicht neutralisiert, jedoch teilweise durch Faktor-Vl11- Konzentrate, Kryopräzipitate, aktivierte Prothrombinkomplexe, rekombinanten Faktor Vila und DDAVP.

Nach kardiovaskulären Bypassoperationen bei Hunden hören die gerinnungshemmenden und blutungserzeugenden Wirkungen von Hirudin innerhalb von 30 bis 45 Minuten nach dem chirurgischen Eingriff auf, und die Hämostase kann mit nichtantikoaguliertem autologen Blut oder nativem plättchenreichen Plasma wiederhergestellt werden. Bei Patienten mit Gerinnungsstörungen könnten spezifische therapeutische Methoden notwendig sein.
Ist die intrakoronare Thrombolyse heute noch aktuell?
Authors: Vogt A. , Neuhaus K.-L.
Published: June 2018

Die intrakoronare Thrombolyse kann thrombotisch verschlossene Infarktgefäße zu einem hohen Prozentsatz rekanalisieren. Dies gelingt mit einer relativ geringen Gesamtdosis von Thrombolytika im Vergleich zur i.v. Gabe. Sie ist aber logistisch sehr aufwendig und kann nur einem Teil der Infarktpatienten zukommen. Zudem entsteht ein Zeitverlust von 40-60 Minuten gegenüber der i. v. Lyse, der durch die intrakoronar raschere Reperfusion nicht wettgemacht wird. Auch nach i. c. Lyse tritt ein globaler Gerinnungsdefekt ein, Blutungskomplikationen sind nicht nachweislich seltener als nach i. v. Kurzlyse. Beim akuten Herzinfarkt ist deshalb heute die i.v. Thrombolyse vorzuziehen.
Wahl des Thrombolytikums und Erfolg der Thrombolyse bei Myokardinfarkt
Authors: Meyer J. , Görge G.
Published: June 2018

Bei der Infarktletalität haben die GISSI-1- und ISIS-2-Studie die Überlegenheit von Streptokinase i. v. gegenüber Plazebo gezeigt. Bei dem Vergleich von rt-PA i.v. gegen Streptokinase i.v. in der GISSI-2-und der ISIS-3-Studie ergaben sich im Hinblick auf die Sterblichkeit allerdings keine signifikanten Unterschiede. Diese Ergebnisse sind so nicht erwartet worden, da rt-PA schneller mehr Gefäße wiedereröffnet als Streptokinase. Kritisiert wurde die Art der Heparinapplikation bei der GISSI-2-Studie mit Beginn einer subkutanen Gabe von 12 500 E erst 12 Stunden nach Lysebeginn, was für den rt-PA mit seiner kurzen Halbwertszeit nachteilig gewesen sein muß. Neue Dosierungsschemata für rt-PA (»front-loading«) und die Kombination von Thrombolytika (rt-PA + ProUrokinase) führten zu höheren Patency-Raten. Ob dies in Zukunft zu einer niedrigeren Infarktletalität führen wird, werden erst größere Studien zeigen können.
Lokale intraarterielle Fibrinolyse hirnversorgender Arterien
Authors: Freitag H.-J. , Zeumer H.
Published: June 2018

Die überwiegende Mehrzahl aller Schlaganfälle wird durch thrombembolische Verschlüsse der großen intrakraniellen hirnversorgenden Arterien verursacht.. Eine schnelle Rekanalisierung der ursprünglichen Strombahn scheint der plausibelste Ansatz zu sein, neurologische Defizite zu minimieren.

Unsere Ergebnisse zeigen, daß die lokale intraarterielle Fibrinolyse (LIF) bei vertebro-basilären Verschlüssen die schlechte Spontanprognose in diesem Stromgebiet deutlich verbessern konnte. Ein etwas komplexeres Problem ist die Bewertung der Resultate der LIF im Karotisstromgebiet. Es hat sich aber gezeigt, daß eine hohe Rekanalisationsrate ohne schwere Blutungskomplikationen erreicht werden kann. Erste Ergebnisse der LIF im Bereich der A. ophthalmica bei Zentralarterien- oder Zentralarterienastverschlüssen zeigen erfolgversprechende Ansätze.
Die sozioökonomische Evaluation
Authors: Schramm W. , Szucs T. D.
Published: June 2018

Bedingt durch den enormen Ausgabenanstieg im Gesundheitswesen, wurde vermehrt die Notwendigkeit erkannt, daß neue medizinische Technologien einer sozioökonomischen Evaluation zu unterziehen sind. Leistungsanbieter, Kostenträger sowie Behörden verlangen verstärkt einen Vergleich von Kosten und Leistungen als Grundlage für Entscheidungen. Die am häufigsten angewandten Methoden sind die Kosten-Nutzen-, Kosten-Effektivitäts-, Nutzwertsowie Kostenminimierungsanalysen.

Insbesondere das Gebiet der Hämostaseologie ist zunehmend von Fragen der Sozioökonomie betroffen, zumal entweder sehr wenige Patienten extrem kostspielige Therapien in Anspruch nehmen (z. B. Hämophilie) oder viele Patienten von relativ kostengünstigen Interventionen profitieren können (z.B. Thromboembolie-Prophylaxe). Die vorliegende Arbeit gibt einen Überblick über die Methoden der sozioökonomischen Evaluation anhand von Beispielen aus der Hämostaseologie.
Erfahrungen mit einem Thromboplastin auf der Basis von rekombinantem Gewebefaktor und synthetischen Phospholipiden
Authors: Ramirez I. , Kolde H.-J.
Published: June 2018

Rekombinanter Gewebefaktor wurde mit synthetischen Phospholipiden lipidiert und daraus ein Thromboplastinreagenz hergestellt (Innovin™, Baxter Diagnostics). Bisherige Erfahrungen zeigen folgendes: sehr niedrige VK-Werte auf verschiedenen Geräten; ISI-Werte sind wie bei konventionellen Reagenzien gerätespezifisch; hohe Faktorenempfindlichkeit, insbesondere bei mittelschweren und schweren Mängeln; gute Plausibilität im Vergleich von TPZ und Faktorenspiegeln, auch in Gegenwart von Heparin; sehr gute Vergleichbarkeit bei Patienten mit oraler Antikoagulation im Vergleich zu BCT/253, Thrombotest™, Hepatoquick® und anderen sensitiven Reagenzien; gelegentlich ein Trend zu höheren INR-Werten gegenüber einigen anderen Thromboplastinen bei Patienten mit INR-Werten >3 und relativ niedrigen Werten von insbesondere Faktor VII und Faktor X; Vorteile in der Bestimmung der Einzelfaktoren durch stark gespreizte Bezugskurven; Anwendung im Kapillarblut ist möglich; sehr gute Chargenkonstanz.
Molekulargenetische Methoden zur Diagnostik von hereditären Gerinnungsstörungen
Authors: Brackmann H.-H. , Oldenburg J. , Schwaab R.
Published: June 2018

Innerhalb dieser Übersicht sollen Direktsequenzierung, Voruntersuchungsmethoden und spezifische Mutationstests für die molekulargenetische Diagnostik von hereditären Gerinnungsstörungen vorgestellt und deren unterschiedliche Einsatzmöglichkeiten diskutiert werden. Wenn eine familienspezifische Mutation gefunden ist, kann allen Angehörigen eine direkte Überträgerdiagnostik angeboten werden. Da in vielen betroffenen Familien die für die Erkrankung ursächliche Mutation nicht bekannt ist, werden die Prinzipien der indirekten Überträgerdiagnostik ebenfalls vorgestellt.
Molekularbiologische Grundlagen des Faktor-XII-Mangels
Authors: Kempter B.
Published: June 2018

Der Faktor XII ist nicht nur ein Auslöser des Gerinnungssystems, sondern kann auch das Kontaktaktivierungssystem initiieren. Über letzteres kommt es zu einem Anstoßen der Fibrinolysekaskade, woraus man sich die thrombophile Dia-these bei Faktor-Xll-Mangel erklärt. Es mehren sich die Hinweise, daß es sich um einen Risikofaktor für die Entstehung von Gefäßverschlüssen handelt. Faktor-Xll-Mangel tritt in zwei Formen auf: mit (CRM+) und ohne (CRM-) immunologisch nachweisbarem Protein. Das Faktor-Xll-Gen wurde auf Chromosom 5q33 lokalisiert, es umfaßt ca. 12 kb und besteht aus 14 Exons. In einem (CRM+) Fall konnte eine Aminosäuresubstitution (Cys 517-*Ser) nachgewiesen werden. In einer (CRM”)Familie konnte eine Deletion einer Base im Exon 12 festgestellt werden, die zu einem Nonsense-Protein führt. Der Patient ist heterozygot für diesen Defekt, wie sich durch einen deletionsspezifischen Restriktionsfragment-Längen-polymorphismus zeigen ließ. Beim Defekt auf dem zweiten Allel dürfte es sich um einen Promotordefekt handeln. Ein genetisches Screening für diesen Mangel kann sinnvoll erst erfolgen, wenn mehr Mutationen bekannt sind.
Predictors of Clinical Outcome after Reconstruction of Complex Soft Tissue Defects Involving the Achilles Tendon with the Composite Anterolateral Thigh Flap with Vascularized Fascia Lata
Authors: Jandali Zaher , Lam Martin , Merwart Benedikt , Möhring Bernd , Geil Stephanie , Müller Klaus , Ionac Mihai , Jiga Lucian
Published: June 2018

Background The composite anterolateral thigh flap with vascularized fascia lata (ALT-FL flap) for covering complex soft tissue defects involving the Achilles tendon has shown promising results. The age and body mass index (BMI) are important predictors of clinical outcome after surgical treatment of Achilles tendon ruptures. In this study, we investigate whether these also influence the outcome of patients after Achilles tendon reconstruction using the ALT-FL flap.

Methods Twenty patients (mean age: 55.9 ± 8.7 years) with complex tissue defects involving the Achilles tendon underwent reconstruction with the ALT-FL flap. Both the Achilles tendon Total Rupture Score (ATRS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score were assessed preoperatively and 12 months postoperatively. In addition, postoperative magnetic resonance imaging (MRI) studies and measurements of the ankle range of motion were performed and results compared with existing literature.

Results All flaps survived and MRI studies confirmed complete anatomical integration of the fascia lata as “neotendon” at the recipient site. In our patient cohort, the age did not correlate with the outcome measurements, whereas the BMI showed significant negative correlation with the postoperative ATRS (p < 0.001) and AOFAS scores (p < 0.05). The ATRS and AOFAS scores of all patients improved significantly (p < 0.001). However, obese patients with a BMI of more than 30 kg/m2 achieved significant lower ATRS (p < 0.001) and AOFAS scores (p < 0.01), as well as patients with peripheral artery disease (PAD) (p < 0.05). The mean ankle range of motion after ALT-FL flap reconstruction remained statistical insignificant compared with previous avascular or vascularized tendon repairs of the Achilles tendon.

Conclusion The ALT-FL flap enables reconstruction of complex tissue defects involving the Achilles tendon with good functional results. However, the presence of an increased BMI or PAD, but not necessarily the age, proves to be a predictor of poor clinical outcome and therefore should be subject to scrutiny during patient selection.
Yoga-Induced Myositis Ossificans Traumatica of the Scapholunate Ligament
Authors: An Tonya , Garlich John , Kulber David
Published: June 2018

Background Myositis ossificans traumatica (MOT) involves the heterotopic development of lamellar bone after a traumatic injury. Despite being termed “myositis,” MOT is not limited to muscle but rather can involve tendons, fat, and fascia. “Traumatica” reflects that lesions are usually associated with a history of significant trauma, that is, fractures or surgery; however, many reports suggest they can also be linked to repetitive low-energy insults. In both cases, the inflammatory response secondary to tissue injury generates a proliferative osteoblastic cascade.

Case Description We present a case of persistent wrist pain in a 43-year-old woman associated with yoga activities. Her radiographic studies demonstrated partial scapholunate (SL) ligament tear and an associated mass lesion. Surgical pathology revealed MOT involving the SL ligament.

Literature Review MOT lesions in the upper extremity are usually localized around the elbow, and cases in the hand are relatively rare. There are no prior reports of occurrences within the wrist joint or in association with the SL ligament. However, biomechanical studies have quantified significant mechanical strains across the SL interval during various yoga poses. This pattern of microtrauma is capable of generating MOT.

Clinical Relevance Upper extremity weight-bearing positions are common in yoga and subject the wrist, especially the SL interval, to high mechanical strains. This pattern of microtrauma should lead the clinician to suspect MOT when encountering a mass in the wrist, but malignancy and infection must be ruled out.
Acetaminophen and Acetylsalicylic Acid Exposure in a Preterm Infant after Maternal Overdose
Authors: Pavlek Leeann , Kraft Monica , Simmons Caitlyn , Ryan Mary , Prusakov Pavel , Campbell Amanda , Brandehoff Nicklaus , Ng Patrick , Russell Jason , Ciciora Steven , Fathi Omid
Published: June 2018

Here, we review the case of a 26 1/7 weeks' gestation premature female infant born to a mother who intentionally ingested a large quantity of Tylenol, aspirin, quetiapine, and prenatal vitamins. The neonate subsequently had markedly elevated levels of both Tylenol and aspirin when checked on the first day of life. While overall clinically stable, the neonate did demonstrate coagulopathy as evidenced by abnormal coagulation studies. Both poison control and a pediatric gastroenterologist/hepatologist were consulted. She successfully tolerated a course of N-acetylcysteine; her subsequent Tylenol level was markedly decreased and the neonate exhibited no further effects of toxicity. The salicylate level decreased on its own accord. To our knowledge, this is the first report of a neonate at 26 weeks' gestation that has been successfully managed for supratherapeutic concentrations of acetaminophen and acetylsalicylic acid secondary to maternal ingestion. While rare, this case may serve as a reference for the effectiveness of N-acetylcysteine in premature infants in such instances.
Cardiac Arrest and Death in Neurosurgery: An Analysis of Perioperative Anesthetic Adverse Events in Thailand
Authors: Akavipat Phuping , Sookplung Pimwan , Boonsombat Thanatporn , Raksakietisak Manee , Tongrong Cataleya , Lerdsirisopon Surunchana , Lekprasert Varinee , Punjasawasdwong Yodying , Ittichaikulton Vichai
Published: June 2018

Background Complexities of pathological causes in cardiac arrest and death in neurosurgery require individualized management. To decrease the incidents, this study was performed to describe characteristics and factors reducing adverse outcomes together with potential corrective strategies of perioperative cardiac arrest and death in neurosurgical patients.

Methods An observational study was performed in 22 hospitals. Peer-reviewed consensus was formed using database from Perioperative Anesthetic Adverse Events in Thailand (PAAd Thai) study. The data contain demography, anesthetic, surgical details, opinions on contributing factors, and factors that minimized incident as well as suggested corrective strategies.

Results From 2,000 incidents, 64 (3%) cardiac arrest events were reported with a 50% chance of return of spontaneous circulation. The most common cardiac rhythm documented was asystole. Essentially, electrocardiography was the most frequent early detector. Surgical-related factors (81.3%), mostly intraoperative bleeding, played a major role in potential causes of arrest. In addition, anesthesia, patient conditions, and system-related factors were found in 65.6%, 57.8%, and 8.3% of the incidents, respectively. Moreover, the severity of the patients (73.3%) was considered to be the most common anesthesia-related risk factor. The prevention of an incident included rule enforcement for patient safety, mandatory knowledge, and also anesthesia personnel's skills development.

Conclusion The optimum fluid assessment and resuscitation, cerebral protection protocols, clinical awareness, and quality assurance together with human resource management are all essential to eliminate the catastrophic cardiac arrest and death in neurosurgery.
Der sichere Gefäßzugang – britisch-irische Leitlinie 2016
Authors: Bergmann Lars
Published: June 2018

Die Etablierung von Gefäßzugängen ist bei der Krankenversorgung die häufigste invasive Prozedur. Sie kann bei unsachgemäßer Durchführung äußerst traumatisierend für die Patientinnen und Patienten sein. Die neue Leitlinie der britisch-irischen Gesellschaft für Anästhesiologie wurde 2016 erstellt, da trotz existierender Handlungsempfehlungen immer noch schwere Komplikationen mit negativem Einfluss auf Morbidität und Mortalität auftreten.
Point-of-Care-Diagnostik in der Traumatologie – Methoden und Evidenz
Authors: Dirkmann Daniel , Britten Martin , Frey Ulrich
Published: June 2018

Jeder 4. Schwerverletzte weist bereits bei Krankenhausaufnahme eine traumainduzierte Koagulopathie (TIK) auf, die mit einer 4-fach erhöhten Mortalität einhergeht. Rasche und zielgenaue Behandlung kann die TIK-assoziierte Sterblichkeit senken. Point-of-Care-Tests ermöglichen im Vergleich mit herkömmlichen Labormethoden eine zeitnahe und umfassende Bestimmung des Gerinnungsstatus sowie eine zielgerichtete Therapie.
Point-of-Care-Gerinnungsdiagnostik in der Neurochirurgie
Authors: Adam Elisabeth , Füllenbach Christoph , Lindau Simone , Konczalla Jürgen
Published: June 2018

Gerinnungsstörungen können für neurochirurgische Patienten gravierende Auswirkungen auf den Krankheitsverlauf und das Outcome haben: Blutungskomplikationen können zu intrakraniellem Druckanstieg und Schädigung des Gehirns führen. Somit hat die Gerinnungsdiagnostik und ggf. -therapie hier einen hohen Stellenwert. Dieser Beitrag beleuchtet die Anwendung moderner Point-of-Care-Verfahren zur Gerinnungsdiagnostik bei neurochirurgischen Patienten.
Die Rolle der Ernährung beim herzchirurgischen Patienten – eine Übersicht
Authors: Hill Aileen , Goetzenich Andreas , Marx Gernot , Stoppe Christian
Published: June 2018

Der präoperative Ernährungsstatus und die perioperative Ernährungsstrategie spielen eine wichtige Rolle für das Outcome herzchirurgischer Patienten – dennoch gibt es nur wenige Studien zu Ernährungskonzepten für diese Patientengruppe. In diesem Beitrag werden die Ursachen der Mangelernährung, der Einfluss der Ernährungstherapie auf den herzchirurgischen Patienten und Strategien zur Verbesserung der Ernährung beschrieben.
Invertebrate disgust reduction in and out of school and its effects on state intrinsic motivation
Authors: Wüst-Ackermann Peter , Vollmer Christian , Itzek-Greulich Heike , Randler Christoph
Published: June 2018

Invertebrates are used in environmental, biology, and science education. However, they can elicit disgust, which can be detrimental for motivational and learning outcomes. In addition, practical work including hands-on interaction with living invertebrates could be a viable way to reduce invertebrate disgust and strengthen state intrinsic motivation. Moreover, Big-Five personality may explain the students’ reaction to the exposure with live invertebrates. Therefore, the present study tested the effects of an intervention with living invertebrates on disgust and state intrinsic motivation in a sample of 1861 students (age 10–12 years). Moreover, we tested whether an in-school or an out-of-school intervention was more successful in reducing disgust as compared to the control group. While disgust was measured at pre- and post-test, trait motivation was measured at pre-test and state intrinsic motivation was measured at post-test. Results show that while both treatment conditions reduced disgust more than the control condition, the out-of-school condition had a more pronounced disgust reduction than the school condition. Disgust was negatively related to state intrinsic motivation, but state intrinsic motivation was equally high in both treatment conditions (school and university). Extraversion was negatively and neuroticism was positively related to disgust. Big-Five personality was generally associated with state intrinsic motivation. In conclusion, invertebrate disgust can be successfully reduced by an intervention with live invertebrates. The workstation-based intervention with live invertebrates is useful in different settings, both in and out of school and effective with invertebrate species, especially with snails and mealworms, because children’s disgust for these species was significantly reduced and lower disgust was related to higher state intrinsic motivation.
Modeling of carbon credit prices using regime switching approach
Authors: Çanakoğlu Ethem , Adıyeke Esra , Ağralı Semra
Published: June 2018

In this study, we analyze the price dynamics of carbon certificates that are traded under the European Union's Emissions Trading System (EU-ETS). With the aim of investigating the joint relations among carbon, electricity, and fuel prices, we model historical prices using several methods and incorporating structural changes, such as econometric time series, regime switching, and multivariate vector autoregression models. We compare the results of the structural model with the results of traditional Markov switching and autoregressive models with breaks and present performance analysis based on the mean average percentage error, root mean squared error, and coefficient of determination. According to these performance tests, models with regimes outperform the approaches where breaks are defined using ex ante dummy variables. Moreover, we conclude that among regime switching models, univariate models are better than multivariate counterparts for modeling carbon price series for the analysis of both in-sample and out-of-samples.
Discrete spectra for critical Dirac-Coulomb Hamiltonians
Authors: Gallone M. , Michelangeli A.
Published: June 2018

The one-particle Dirac Hamiltonian with Coulomb interaction is known to be realised, in a regime of large (critical) couplings, by an infinite multiplicity of distinct self-adjoint operators, including a distinguished physically most natural one. For the latter, Sommerfeld’s celebrated fine structure formula provides the well-known expression for the eigenvalues in the gap of the continuum spectrum. Exploiting our recent general classification of all other self-adjoint realisations, we generalise Sommerfeld’s formula so as to determine the discrete spectrum of all other self-adjoint versions of the Dirac-Coulomb Hamiltonian. Such discrete spectra display naturally a fibred structure, whose bundle covers the whole gap of the continuum spectrum.
Phase uniqueness for the Mallows measure on permutations
Authors: Starr Shannon , Walters Meg
Published: June 2018

For a positive number q, the Mallows measure on the symmetric group is the probability measure on Sn such that Pn,q(π) is proportional to q-to-the-power-inv(π) where inv(π) equals the number of inversions: inv(π) equals the number of pairs i < j such that πi > πj. One may consider this as a mean-field model from statistical mechanics. The weak large deviation principle may replace the Gibbs variational principle for characterizing equilibrium measures. In this sense, we prove the absence of phase transition, i.e., phase uniqueness.
Changes in political party systems arising from conflict and transfer among political parties
Authors: Park Junpyo
Published: June 2018

Conflict that arises between two groups of different paradigms is an inevitable phenomenon, and a representative example of the conflict among different groups is a conflict phenomenon caused by competition among political parties. In this paper, we study the dynamical behavior of a political party system. Considering three major political parties, we investigate how political party systems can be changed by employing a mathematical model. By considering the transfer mechanism of recruitment as well as conflict of competition between political parties, we found that all parties are likely to coexist when both the competition and transfer between the parties are weak, or if either mechanism can occur at a relatively low level. Otherwise, a political party system is changed to a single-party system. In addition, we found that when a party system was changed into a single-party system, it appeared to be either bistable or multistable, and has been elucidate by linear stability analysis. Our results may provide insights to understand mechanisms how political party systems can be changed by conflict and transfer.
Direct determination of the interlayer van der Waals bonding force in 2D indium selenide semiconductor crystal
Authors: Tanabe Tadao , Tang Chao , Sato Yohei , Oyama Yutaka
Published: June 2018

The interlayer van der Waals bonding force in crystalline InSe was directly measured using a mechanical test equipment. The bulk γ-InSe crystal was grown by the temperature difference method under controlled vapor pressure, a unique liquid phase solution crystal growth method with a low and fixed growth temperature. The measured bonding force in the crystal was 20.8 N/cm2, which is greater than that in 2D crystalline GaSe. We also made theoretical discussion of the van der Waals forces in InSe, based on the fluctuations in the electron cloud distributions around the atoms.
Band alignment of AlxGa1–xN/Cu2O heterojunctions in dependence on alloy composition x and its effect on the photovoltaic properties
Authors: Michel F. , Kramm B. , Becker M. , Hering K. P. , Hofmann D. M. , Klar P. J.
Published: June 2018

The band alignment of p-Cu2O/n-AlxGa1–xN heterojunction with x up to 0.15 was studied by X-ray photoelectron spectroscopy. The conduction band offset between binary Cu2O and ternary AlxGa1–xN is found to decrease with increasing x. The data suggest that a flatband situation in the conduction band of p-Cu2O/n-AlxGa1–xN heterojunctions can be achieved for x about 0.4, which is an Al-content where n-type doping is still feasible. Thus, n-AlxGa1–xN with x between 0.4 and 0.6 may be a suitable window material for heterojunction solar cells with a p-Cu2O absorber layer. The current-voltage characteristics of the p-Cu2O/n-AlxGa1–xN heterojunctions under illumination confirm the anticipated improvement of the photovoltaic properties with increasing x.
Correlation in brain networks at different time scale resolution
Authors: Perinelli A. , Chiari D. E. , Ricci L.
Published: June 2018

Assessing brain connectivity makes up a major issue in the field of network dynamics and neuroscience. Conventional experimental techniques are based on functional imaging and magnetoencephalography, allowing to reconstruct the activity of relatively small brain volume elements. A common approach to identify networks consists in singling out sets of elements that maintain a correlated activity over time. Despite the general consensus that these networks are detectable on a time window of 10 s, no study is presently available on the distribution and thus the reliability of this time scale. In this work, we describe a new method to assess time scales on which correlations between network elements occur and to consequently identify the underlying network structures. The analysis relies on the evaluation of quasi-zero-delay cross-correlation between power sequences associated with distinct volume elements. By changing the width of the running window used to analyze successive segments of time series, the behavior of cross-correlation at different time scales was investigated. The onset of connectivity was estimated to be observable at about 30 s. The method was applied to a set of volume elements that are supposed to belong to a known resting-state network, namely the Default Mode Network. Fully connected networks were identified, provided that a sufficiently long time scale is considered. Our method makes up a new tool for the investigation of the temporal dynamics of networks.
Impact of blade mounting structures on cross-flow turbine performance
Authors: Strom Benjamin , Johnson Noah , Polagye Brian
Published: June 2018

Cross-flow or vertical-axis turbines are flow energy conversion devices in which lift forces cause blades to rotate around an axis perpendicular to the flow. In marine currents, rivers, and some wind energy applications, cross-flow turbines are a promising alternative to more conventional axial-flow turbines. The performance implications of the choice of structure used to mount turbine blades to the central shaft are examined experimentally in a recirculating water flume. Turbine performance is found to be strongly dependent on the choice of the mounting structure. Power loss due to rotational drag on these structures is estimated experimentally by rotating the mounting structure without blades. Through a perturbation-theory approach, interactions between turbine blades and mounting structures are examined. Analytical models for the power loss due to mounting structure drag are introduced and shown to be consistent with experiments. To provide guidance for cross-flow turbine design, the models are re-formulated in terms of non-dimensional turbine geometric and operational parameters. Mounting blades solely at their mid-span is shown to decrease performance through multiple fluid effects. Using foil cross-section struts located at the turbine blade tips is found to result in the highest turbine performance.
Electronic structure, pore size distribution, and sorption characterization of an unusual MOF, {[Ni(dpbz)][Ni(CN)4]}n, dpbz = 1,4-bis(4-pyridyl)benzene
Authors: Wong-Ng Winnie , Williamson Izaak , Lawson Matthew , Siderus Daniel W. , Culp Jeffrey T. , Chen Yu-S. , Li Lan
Published: June 2018

The monoclinic (Ni(L)[Ni(CN)4] (L= 1,4-Bis(4-pyridyl) benzene) compound (defined as Ni-dpbz) is a flexible metal organic framework which assumes a pillared structure with layers defined by 2D Ni[Ni(CN)4]n nets and dpbz ligands as pillars. The structure features an entrapped dpbz ligand that links between the open ends of four-fold Ni sites from two neighboring chains. This arrangement results in an unusual 5-fold pseudo square-pyramid environment for Ni and a significantly long Ni-N distance of 2.369(4) Å. Using Density Functional Theory calculations, the different bonding characteristics between the 5-fold and 6-fold Ni's were determined. We found that there is weak covalent bonding between the 5-fold Ni and N in the entrapped ligand, and the 6-fold Ni-N bonds provide effective electronic conduction. The disordered dimethyl sulfoxide (DMSO) solvent molecules are not bonded to the framework. The material has a single pore with a diameter of 4.1 Å. This pore includes approximately 55% of the total free volume (based on a zero-diameter probe). The accessible pore surface area and pore volume were calculated to be 507 m2/g and 6.99 cm3/kg, respectively. The maximum amount of CO2 that can be accommodated in the pores after DMSO is removed was found to be 204 mg/g, agreeing with the results of adsorption/desorption experiments of about 220 mg/g.
Carrier dynamics and optical nonlinearities in a GaN epitaxial thin film under three-photon absorption
Authors: Martins R. J. , Siqueira J. P. , Manglano Clavero I. , Margenfeld C. , Fündling S. , Vogt A. , Waag A. , Voss T. , Mendonca C. R.
Published: June 2018

We studied the near-band-edge emission (NBE) and yellow defect luminescence (YL) of GaN under below bandgap excitation with 40-fs laser pulses at a wavelength of 775 nm. Even though in this case three-photon absorption processes are required for the excitation of band-to-band transitions, fourth-order (INBE ∝ Iexc4) and sub-linear (IYL ∝ Iexc0.5) dependencies were observed for the intensity of the NBE and YL as a function of the excitation intensity, respectively. Modelling the carrier dynamics with a few-level rate-equation model revealed that, for high excitation irradiances, the electron-hole population generated by three-photon absorption is such that the NBE recombination rate is intensified (exponent > 3) and, at the same time, the competition between the electron capturing and the defect-level emission rate suppresses the YL (exponent < 1).
Fluctuation-induced tunneling conduction in iodine-doped bilayer graphene
Authors: Wu Zefei , Chen Xiaolong , Zhang Mingwei , Wang Lin , Han Yu , Xu Shuigang , Han Tianyi , Lin Jiangxiazi , An Liheng , Wang Jingwei , Cai Xiangbin , Shi Run , Cheng Chun , Wang Ning
Published: June 2018

Intrinsic bilayer graphene is a semimetal. Upon applying an electric field, the potential difference between top and bottom layers can open an energy gap and tune bilayer graphene to an insulating state at the charge neutrality point. Here, we demonstrate that the properties of semimetallic bilayer graphene can be controllably tuned to either metallic or insulating by a simple way of iodine molecular doping. The transport properties of iodine-doped bilayer graphene have been systematically investigated. At high iodine doping concentrations, the Fermi level shifts by approximately 0.35 eV to the metallic region because of the symmetric doping on the top and bottom bilayer surfaces. At low iodine doping concentrations, small energy gaps open in local areas due to the asymmetric doping between the top and the bottom graphene layers. In this case, an insulating behavior at low temperatures is observed, which can be well explained by employing the fluctuation-induced tunneling (FIT) model. At medium iodine doping concentrations, both metallic and insulating behaviors can be observed at different temperatures, implying that both FIT and metallic mechanisms take effect. Our work may have potential applications in on/off controllable electronic devices, gas sensors, and transparent flexible electrode in optoelectronics.
Role of oxygen vacancies and interstitials on structural phase transition, grain growth, and optical properties of Ga doped TiO2
Authors: Khatun Nasima , Tiwari Saurabh , Vinod C. P. , Tseng Chuan-Ming , Wei Liu Shun , Biring Sajal , Sen Somaditya
Published: June 2018

A systematic study on the effect of gallium (Ga) doping (0 ≤ x ≤ 0.10) on the structural phase transition and grain growth of TiO2 is reported here. X-ray diffraction spectroscopy and Raman spectroscopy confirm that Ga doping inhibits the phase transition. Activation energy increases from 125 kJ/mol (x = 0.00) to 300 kJ/mol (x = 0.10) upon Ga incorporation. X-ray photoelectron spectroscopy shows the presence of Ti3+/Ga3+ interstitials, substitution (Ti4+ by Ga3+), and oxygen vacancies in the samples. At lower doping (x ≤ 0.05), interstitials play a more significant role over substitution and oxygen vacancies, thereby resulting in a considerable lattice expansion. At higher doping (x ≥ 0.05), the effect of interstitials is compensated by both the effect of substitution and oxygen vacancies, thereby resulting in relatively lesser lattice expansion. Inhibition of the phase transition is the result of this lattice expansion. The crystallite size (anatase) and particle size (rutile) both are reduced due to Ga incorporation. It also modifies optical properties of pure TiO2 by increasing the bandgap (from 3.06 to 3.09 eV) and decreasing the Urbach energy (from 58.59 to 47.25 meV). This happens due to regularization of the lattice by the combined effect of substitution/interstitials and oxygen vacancies.
Velocity-space cascade in magnetized plasmas: Numerical simulations
Authors: Pezzi O. , Servidio S. , Perrone D. , Valentini F. , Sorriso-Valvo L. , Greco A. , Matthaeus W. H. , Veltri P.
Published: June 2018

Plasma turbulence is studied via direct numerical simulations in a two-dimensional spatial geometry. Using a hybrid Vlasov-Maxwell model, we investigate the possibility of a velocity-space cascade. A novel theory of space plasma turbulence has been recently proposed by Servidio et al. [Phys. Rev. Lett. 119, 205101 (2017)], supported by a three-dimensional Hermite decomposition applied to spacecraft measurements, showing that velocity space fluctuations of the ion velocity distribution follow a broad-band, power-law Hermite spectrum P(m), where m is the Hermite index. We numerically explore these mechanisms in a more magnetized regime. We find that (1) the plasma reveals spectral anisotropy in velocity space, due to the presence of an external magnetic field (analogous to spatial anisotropy of fluid and plasma turbulence); (2) the distribution of energy follows the prediction P(m)∼m−2, proposed in the above theoretical-observational work; and (3) the velocity-space activity is intermittent in space, being enhanced close to coherent structures such as the reconnecting current sheets produced by turbulence. These results may be relevant to the nonlinear dynamics weakly collisional plasma in a wide variety of circumstances.
Electric-field tuning of magnetism in spin gapless semiconductor (SGS)-like CoFeMnSi thin film
Authors: Fu H. R. , You C. Y. , Xin F. Q. , Ma L. , Tian N.
Published: June 2018

The experimental demonstration of the controllable or tunable magnetism of Heusler compounds, which theoretically exhibit the feature of spin gapless semiconductor, has drawn wide interest due to their promises for spintronic device concepts. Here, we realized the spin gapless semiconductor-like characteristic of Heusler alloy CoFeMnSi thin film deposited on [Pb(Mg1/3Nb2/3)O3]0.7[PbTiO3]0.3 ferroelectric single-crystal substrates, and demonstrated that its magnetism can be tuned through applying an electric-field or performing the electric pre-polarization. The transport properties reveal that the electric conductivity of CoFeMnSi is small and almost independent of temperature. The in-plane remanent magnetization Mr can be tuned up to 17% by applying a relatively small in situ electric-field of 4.2 kV/cm. The controlled coercivity of CoFeMnSi is observed with the electric pre-polarization, which might suggest a non-volatile magnetic switching for the controllable magnetic properties.
Anion photoelectron spectroscopy and chemical bonding of ThO2− and ThO3−
Authors: Li Yanli , Zou Jinghan , Xiong Xiao-Gen , Xie Hua , Tang Zichao , Ge Min , Zhao Yafan , Liu Hongtao
Published: June 2018

We conducted a study of electronic structures and chemical bonding of gaseous ThO2− and ThO3− using velocity-map imaging and ab initio calculations. The electron affinity of neutral ThO2 molecule is reported for the first time with the value of 1.21(5) eV. We obtained a vibrationally resolved photoelectron spectroscopy of ThO2− and observed the symmetric stretching frequency of 824(40) cm−1 for neutral molecules. One hot band transition is observed in the spectrum of ThO2−, which allows the measurement of symmetric stretching mode for ThO2−. The ground state of ThO2− is 2A1 with C2v symmetry: the detachment of an electron from the singly occupied molecular orbital (SOMO) results in the ground state of ThO2. Kohn-Sham molecular orbital analyses reveal an σ and two weak π bonds for Th–O multiple bonds in ThO2. Global minimum search methodology combined with quantum chemical calculations are used to find the minima of ThO3 and ThO3−, and the adiabatic detachment energy of ThO3− is calculated to be 3.26 eV at the coupled cluster with singles and doubles plus perturbative triples level. Our theoretical calculations suggest that the ground state of ThO3 is 1A′ with a symmetry of Cs, while the most stable ThO3− is 2A1 with C2v symmetry; thus, the transition from ThO3− to ThO3 undergoes a significant geometry reorganization. Molecular orbital analyses suggest that the SOMO of ThO3− is mainly participated by O 2p and O to Th back donation was found in HOMO-2 molecular orbital. This investigation will shed some light on the understanding of covalent bonding in Th-contained molecules.