bluuebunny/crossref_metadata_2025 huggingface dataset:
Entscheidungshilfen
Authors: Kucera Martin
Published: July 2017

In Zeiten des zunehmenden Kliniksterbens und knapper Kassen bereiten die Themen Bauen und Planen vielen Klinikbetreibern Bauchschmerzen. Dennoch müssen Gebäude und Inneneinrichtungen den aktuellen und zukünftigen Ansprüchen von Patienten und Personal Rechnung tragen, wenn Krankenhäuser dem Konkurrenzdruck standhalten wollen. Im aktuellen kma report bauen & planen, den Sie in Händen halten, zeigen wir, wie sich diese Mammutaufgaben stemmen lassen. So veranschaulicht der Expertenbeitrag zum Neubau des Berliner Klinikums im Friedrichshain, wie sich durch das Zusammenspiel aller Beteiligten das Bauen bei laufendem Betrieb meistern lässt. Außerdem gehen wir der Frage nach, wie im Zuge von OP-Neubaumaßnahmen durch eine detaillierte Analyse der Ausgangssituation und dem Ausarbeiten eines mit allen Prozessbeteiligten abgestimmten Betriebskonzeptes effiziente und wirtschaftliche Prozessabläufe entstehen. Nicht zuletzt zeigen wir, dass Modulbauten mittlerweile ein interessante Alternative zur herkömmlichen Bauweise sind, wie sich Inneneinrichtungen durch ausgeklügelte Lichtkonzepte auch ohne aufwändige Umbauten verschönern lassen und welche Finanzierungsmöglichkeiten die Finanzinstitute für dringend notwendige Investitionen bieten.
Subacute Granulation Tissue of the Fornix after Resorbable Orbital Implant: An Unusual Case and Review of the Literature
Authors: Castro-Núñez Jaime , Clifton Trent , Van Sickels Joseph
Published: July 2017

Orbital blow-out fractures are very common. Goals of surgical treatment are to reestablish form and function with excellent cosmetic results. Materials used for orbital floor repair include autologous grafts and a variety of alloplastic materials. In this article, we present a case of subacute granulation tissue of the fornix that developed as a foreign body reaction 4 months after placing a resorbable implant to repair an orbital floor fracture. The implant was removed and the patient continued to heal uneventfully. Management of the case and biomaterials employed are discussed in light of current research.
Pediatric Short Bowel Syndrome: Predicting Four-Year Outcome after Massive Neonatal Resection
Authors: Capriati Teresa , Giorgio Daniela , Fusaro Fabio , Candusso Manila , Schingo Paolo , Caldaro Tamara , Laureti Francesca , Elia Domenica , Diamanti Antonella
Published: July 2017

Objectives The aim of this study was to ascertain predictors of survival, liver disease (LD), and enteral autonomy 48 months after resection in neonatal short bowel syndrome (SBS) patients with residual small bowel length (SBL) ≤40 cm.

Patients and Methods Medical records of all SBS patients followed up between 1996 and 2016 were retrospectively reviewed. Survival rate, prevalence of LD, and of enteral autonomy were evaluated.

Results Forty-seven patients were included, and 43 were still alive at the end of the study period, with cumulative 48-month survival of 91.5%. Twenty-one (45%) patients developed LD, all within the first 6 months. On the final follow-up visit, three (6%) patients were still jaundiced and progressed toward end-stage LD. LD prevalence was higher in patients with recurrent bloodstream infections (odds ratio [OR] 5.4, 95% confidence interval [CI] 1.5–19.3). Of the 43 surviving patients, 22 (51%) had enteral autonomy 48 months after resection. The probability of weaning off parenteral nutrition (PN) was strongly correlated with the remaining SBL.

Conclusion Survival of patients who have undergone neonatal massive small bowel resection has improved in recent years. Multidisciplinary strategies can improve the course of LD, but not the probability of weaning off PN, which seems to be strongly dependent on the anatomical profile of residual bowel. Therefore, the primary surgical approach should be as conservative as possible to gain even small amounts of intestinal length, which may be crucial in promoting intestinal adaptation.
Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results
Authors: Vulcano Ettore , Bettella Lorenzo , Tasarib Rohoman , Tondolo Tania , Sala Francesco , Lovisetti Giovanni
Published: July 2017

Surgical reconstruction of bicondylar tibial fractures with external fixation relies on indirect fracture reduction that could affect anatomical restoration. The aim of the present study is to evaluate the radiographic and clinical outcomes of tibial bicondylar fractures treated with circular external fixation. A total of 20 bicondylar fractures of the proximal tibia in 20 patients treated with circular external fixation were included in the study. Two fractures were open. Mean clinical and radiographic follow-up was 37.3 months after frame removal. Angular, translation, and length deformities were assessed on nonweight-bearing anteroposterior, lateral, and two 45 degrees oblique views. The medial proximal tibia (MPTA) and posterior proximal tibia angles (PPTA) were calculated in all cases. The condylar widening was calculated in relation to the width of the femoral condyles. Joint depressions or gaps of the articular surface were identified on the four views of the knee. The modified Hospital for Special Surgery (HSS) knee scoring system was used for clinical evaluation. The MPTA was good in 18 (90%) and fair in 2 patients (10%). The PPTA was good in 13 (65%), fair in 6 (30%), and poor in 1 patient (5%). The articular reduction was good in 12 (60%) and fair in 8 patients (40%). The condylar widening was good in 15 (75%) and fair in 5 patients (25%). Mechanical axis deviation was within the normal range in 11/12 patients (91.7%). All fractures consolidated. One deep infection was successfully treated with local debridement, the mean modified HSS knee score at the latest follow-up was 90.5 (range: 67–100). Articular reconstruction and tibia alignment based on radiographic evaluation in the present study, along with functional results compare favorably with those of external and internal fixation presented in the literature.
Biomechanics and Microstructural Analysis of the Mouse Knee and Ligaments
Authors: Carballo Camila , Hutchinson Ian , Album Zoe , Mosca Michael , Hall Arielle , Rodeo Scott , Ying Liang , Deng Xiang-Hua , Rodeo Scott
Published: July 2017

The purpose of this study is to determine the feasibility of using murine models for translational study of knee ligament injury, repair, and reconstruction. To achieve this aim, we provide objective, quantitative data detailing the gross anatomy, biomechanical characteristics, and microscopic structure of knee ligaments of 44 male mice (C57BL6, 12 weeks of age). Biomechanical testing determined the load-to-failure force, stiffness, and the site of ligament failure for the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and the medial and lateral collateral ligaments (MCL and LCL). These data are complemented by histological characterization of each of the knee ligaments. In addition, the osseous morphology of the mouse knee was examined using high-resolution nanofocus computed tomography (CT), while standard micro-CT was employed to measure bone morphometrics of the distal femur and proximal tibia. Collectively, our findings suggest that the gross anatomy of the mouse knee is similar to the human knee despite some minor differences and features unique to the murine knee. The ACL had the highest load to failure (5.60 ± 0.75 N), the MCL (3.33 ± 1.45 N), and the PCL (3.45 ± 0.84 N) were similar, and the LCL (1.44 ± 0.37 N) had the lowest load to failure and stiffness. Murine models provide a unique opportunity to focus on biological processes that impact ligament pathology and healing due to the availability of transgenic strains. Our data support their use as a translational platform for the in vivo study of ligament injury, repair, and reconstruction.
A Pediatric Review of Facioscapulohumeral Muscular Dystrophy
Authors: Chen Yi-Wen , Mah Jean
Published: July 2017

Facioscapulohumeral dystrophy is one of the most common forms of muscular dystrophies worldwide. It is a complex and heterogeneous disease secondary to insufficient epigenetic repression of D4Z4 repeats and aberrant expression of DUX4 in skeletal muscles. Type 1 facioscapulohumeral muscular dystrophy (FSHD) is caused by contraction of D4Z4 repeats on 4q35, whereas type 2 FSHD is associated with mutations of the SMCHD1 or DNMT3B gene in the presence of a disease-permissive 4qA haplotype. Classical FSHD is a slowly progressive disorder with gradual-onset of muscle atrophy and a descending pattern of muscle weakness. In contrast, early-onset FSHD is associated with a large deletion of D4Z4 repeats and a more severe disease phenotype, including early loss of independent ambulation as well as extramuscular manifestations, such as retinal vasculopathy, hearing loss, and central nervous system (CNS) involvement. However, the correlation between D4Z4 repeats and disease severity remains imprecise. The current standard of care guidelines offers comprehensive assessment and symptomatic management of secondary complications. Several clinical trials are currently underway for FSHD. New and emerging treatments focus on correcting the transcriptional misregulation of D4Z4 and reversing the cytotoxic effects of DUX4. Other potential therapeutic targets include reduction of inflammation, improving muscle mass, and activating compensatory molecular pathways. The utility of disease-modifying treatments will depend on selection of sensitive clinical endpoints as well as validation of muscle magnetic resonance imaging (MRI) and other biomarkers to detect meaningful changes in disease progression. Correction of the epigenetic defects using new gene editing as well as other DUX4 silencing technologies offers potential treatment options for many individuals with FSHD.
Surgical Health Needs of Minor Refugees in Germany: A Cross-Sectional Study
Authors: Loucas Marios , Loucas Rafael , Muensterer Oliver
Published: July 2017

Introduction There has been a substantial rise in refugees entering Germany over the past years, of which approximately one-third are underaged. Many end up in pediatric surgical care, and little is known about the health of these individuals. Our study was designed to assess the surgical-related health status of underage refugees based on a large sample cohort.

Materials and Methods After ethics board approval, we used a structured questionnaire to collect demographic information and surgical health-related elements in three large refugee accommodation centers.

Results A total of 461 minor refugees were included. The majority were boys (54.5%) with an average age of 8 years. Out of the eight recorded countries of origin, most children came from Syria (33.6%) followed by Afghanistan (23.2%). Previous operative interventions were recorded in 42.2% of participants. Among girls, 11% suffered genital mutilation. Trauma was common and the most common mechanism was a fall from bicycle (38%) followed by burn injuries (7.4%). Up to 20% of them experienced physical violence during the flight or in the accommodation facility. Vaccination rates varied widely according to origin. Of the participants, only 63% were vaccinated according to schedule. Chronic diseases were found in only 13% of the study cohort, anemia being most prevalent at 4%.

Conclusion Minor refugees have specific health-related problems that must be considered to ensure appropriate medical care. Many refugee children were victims of physical violence and many girls suffered genital mutilation. Vaccination status is unreliable; therefore, tetanus vaccination should always be considered when these patients seek pediatric surgical care. Tailored anticipatory guidance should be provided to this patient population.
Kinderwunsch bei (permanenter) Infertiliät: Entwicklung und Ergebnisse des „Fragebogens Einstellungen zur Mutterschaft (FEMu)“
Authors: Fliegner Maike , Richter-Appelt Hertha , Krupp Kerstin , Brunner Franziska
Published: July 2017

Studie 1 Fragebogenentwicklung Die meisten Fragebögen zu Einstellungen zur Mutterschaft setzen Fertilität voraus und bilden positive und negative Einstellungen zur Mutterschaft auf einer Dimension ab. Häufig liegen zudem keine deutschsprachigen Versionen und Normwerte vor. Ziel dieser Studie ist es zu überprüfen, ob mit der Entwicklung des „FEMu“ ein Instrument zur Verfügung steht, mit dem Einstellungen mehrdimensional erfasst werden und welches unabhängig vom Fertilitätsstatus zu beantworten ist. Der FEMu wurde an einer weiblichen Stichprobe (n=932) mittels Hauptachsenanalyse (oblique Rotation) entwickelt, welche 2 unabhängige Hauptskalen („pro Kind“, „contra Kind“) mit 5 Unterskalen (Entbehrung/Fremdbestimmtheit, Attraktivität/Ausgeglichenheit, Unvollständigkeit, Verbundheit, Akzeptanz) und 4 Prototypen (Idealisierung, Ablehnung, Ambivalenz, Indifferenz) ergab.

Studie 2 Überprüfung an klinischen Stichproben Zur Überprüfung an klinischen Gruppen wurden Personen mit Kompletter Androgeninsensitivität (CAIS, n=12), Mayer-Rokitansky-Küster-Hauser-Syndrom (MRKHS, n=49) und Polyzystischem Ovarsyndrom (PCOS, n=55) befragt, wobei die ersteren unter permanenter Infertilität leiden und bei PCOS eine eingeschränkte Fruchtbarkeit vorliegt. Es wurden die Stärke des Kinderwunsches, die FEMu-Hauptfaktoren sowie die Prototypen ausgewertet. Die Unabhängigkeit der Pro- und Contra-Kind-Scores und die Prototypen ließen sich empirisch bestätigen. Bei CAIS wurde ein geringer Kinderwunsch und eine indifferente Haltung, bei MRKHS ein mittelgradiger Kinderwunsch und Ambivalenz, bei PCOS ein maximaler Kinderwunsch und eine Idealisierung von Mutterschaft festgestellt.

Fazit Mit dem FEMu wird ein Instrument vorgestellt, das Einstellungen zur Mutterschaft mehrdimensional erfasst. Er ist unabhängig vom Fertilitätsstatus beantwortbar und kann zu Forschungszwecken sowie in der Einzelfall-Diagnostik eingesetzt werden. Die FEMu-Ergebnisse können zur gezielten Beratung herangezogen werden – orientierend im Rahmen von Fertilitätsbehandlungen, in der gynäkologischen Praxis, der Schwangerschaftskonfliktberatung oder begleitend zu psychologischen Beratungen. Im psychotherapeutischen Kontext können sie bei der Entwicklung geeignter Interventionen hilfreich sein. Auch außerhalb des klinischen Kontexts ist der Einsatz des FEMu interessant, bspw. bei Themen der Familienplanung oder dem Konflikt von Frauen zwischen Karriere und Familie.
Intrauterine Growth Restriction (IUGR) Induces Signs of Subclinical Atherosclerosis in 6-Year-Old Infants Despite Absence Of Excessive Growth
Authors: Tzschoppe Anja , von Kries Rüdiger , Struwe Ellen , Rascher Wolfgang , Dörr Helmuth-Guenther , Jüngert Jörg , Rauh Manfred , Beckmann Matthias , Schild Ralf , Goecke Tamme , Dötsch Jörg
Published: July 2017

Background Postnatal catch-up growth and rapid weight gain after intrauterine growth restriction (IUGR) seem to increase the risk for later disease. This study aimed to compare features of the metabolic syndrome early in life between IUGR and appropriate for gestational age (AGA) infants.

Patients Data for 9 infants with IUGR defined by a birth weight<10th percentile and ultrasound-proven placental insufficiency and 11 AGA children were available.

Method Postnatal growth, auxological, cardiovascular, and metabolic parameters up to a chronological age of 6 years were assessed: Fasting serum concentrations of LDL-cholesterol, insulin, leptin, IGF-I, DHEAS, skinfold thicknesses, blood pressure, and mean carotid intima-media thickness (cIMT).

Results All IUGR infants showed catch-up growth, although mean BMI SDS and total subcutaneous fat mass at the age of 6 years were still slightly lower compared to the AGA cohort. Reduced serum leptin concentrations were observed in IUGR infants (p=0.02), whereas no significant difference was found for IGF-I, insulin, LDL-cholesterol and DHEAS concentrations. Mean cIMT was significantly higher in IUGR infants (p<0.05). Mean arterial pressure did no differ.

Discussion and Conclusion In 6-year-old IUGR infants with catch-up growth, who still had a slightly reduced BMI SDS compared to the AGA group, signs of subclinical atherosclerosis were detectable suggesting that cardiovascular risk in IUGR may be present even in the absence of excessive growth.
Qualitätssicherung
Authors: Meusel Timo
Published: July 2017

Der Begriff „Pflegestandard“ wird im Berufsalltag als Sammelbegriff für dokumentierte Arbeitsanweisungen, Verlaufs- oder Prozessbeschreibungen und Anleitungen genutzt. Dabei wird die Abgrenzung eines Pflegestandards zu konkreten Handlungsabläufen und/oder technischen sowie Hygieneanweisungen nicht vorgenommen.
New Structures in Neurology: Palliative Care for Neurological Patients
Authors: Golla Heidrun , Fink Gereon , Rolke Roman , Lorenzl Stefan , Ebke Markus , Montag Thomas , Gold Ralf , Nelles Gereon , Eggers Carsten , Voltz Raymond
Published: July 2017

Although patients with incurable neurological diseases suffer from a variety of distressing symptoms and may die from their neurological condition and associated complications, palliative and hospice care for these patients to date remains rare. Initial estimates indicate that on average 10% of all patients suffering from a neurological disease need palliative and hospice care. However, within German neurology departments, only few physicians (on average 1.3/department) and nurses (on average 2.2./department) are specialized in palliative and hospice care and only about 3% of patients cared for in palliative or hospice care structures suffer from neurological diseases (in contrast to the approximately 80% of patients suffering from oncological diseases). This rather low number is due to the gradual increase in the awareness of palliative and hospice care needs for neurological patients and a currently predominant supply of oncological patients in palliative and hospice care structures that are primarily aimed at these patients. Correspondingly, the special aspects of neurological patients are currently not adequately addressed in the palliative training curricula of healthcare professionals. Rather, patients with advanced neurological conditions are medically cared for by general practitioners and by the existing inpatient and outpatient neurology structures, which may also offer sub-specialty services. Consequently, adequate care for severely affected neurological patients becomes difficult as soon as these patients are hardly able to visit these structures because home-based specialist treatment is currently rendered and financed only to a limited degree. Novel yet to date rare approaches, mostly of international origin, suggest that these patients may benefit from specialized home-based services, combining neurological and palliative care expertise. At present, data that characterizes the situation of neuro-palliative care in Germany remains scarce. In addition to the already known supply gaps (e. g., low rate of neurologists trained in palliative medicine as well as of nurses working in neurology trained in palliative care, lack of consideration of the specific (care) needs of neurological patients in general and specialized palliative and hospice care structures, few available home-based outpatient specialists) research is a prerequisite to identify current gaps in palliative care of neurological patients in more detail and how these might be overcome in the future.
Kritisch hinterfragt
Authors: Schikora Stephanie
Published: July 2017

Liest man die Ergebnisse einer aktuellen retrospektiven Auswertung von mehr als 1,6 Millionen Versichertendaten von US-Bürgern aus den Jahren 2006–2013 [1], könnte man meinen, die Diabetologie wäre in den letzten 10 Jahren in der täglichen Praxis nicht vorangekommen. Denn im überprüften Zeitraum hat sich weder die Blutzuckerkontrolle der Patienten verbessert, noch ist die Zahl an schweren Unterzuckerungen gesunken – und dies trotz des verstärkten Einsatzes der in diesem Zeitraum neu eingeführten Antidiabetika und der damit verursachten höheren Kosten. Doch ist dies der Weisheit letzter Schluss?
Hyponatriämie
Authors: Artunc Ferruh
Published: July 2017

Die Hyponatriämie ist eine komplexe Elektrolytentgleisung, die durch Störungen sowohl des Wasser- als auch des Natriumhaushalts entstehen und diagnostische Schwierigkeiten bereiten können. Bei hospitalisierten Patienten wie auch bei Patienten mit Niereninsuffizienz ist die Hyponatriämie häufig und Indikator einer erhöhten Sterblichkeit. Bei rascher Entstehung führt sie zu zentralnervösen Störungen mit Sturzneigung, Vigilanzminderung und generalisierten Anfällen bis hin zu einem Koma. Die Rolle der Niere bei der Hyponatriämie kann entweder ursächlich oder kompensatorisch sein. Die Beurteilung gelingt am besten durch die Bestimmung der elektrolytfreien Wasser-Clearance, die bei einem negativen Wert eine renale Wasserretention, bei positivem Wert eine kompensatorische Wasserausscheidung anzeigt. Bei fast allen Formen der Hyponatriämie findet sich eine zu hohe Trinkmenge, die die renale Wasser-Clearance überschreitet. Demnach ist die Trinkmengenrestriktion der Grundpfeiler der Therapie, v. a. bei Patienten mit eingeschränkter Nierenfunktion und bei Dialysepatienten. Bei schweren Formen ist die Gabe von hypertoner Natriumlösung indiziert. Sofern die Nierenfunktion noch erhalten ist, können neuerdings Aquaretika eingesetzt werden, die selektiv die renale Wasser-Clearance erhöhen.
Der fnb e. V. informiert
Authors: Eikelmann Matthias
Published: July 2017

Ich bin mir sicher, dass jeder von Ihnen schon vom Fachverband nephrologischer Berufsgruppen e. V., kurz fnb, gehört hat. Genauso sicher bin ich mir, dass es Pflegekräfte in der Nephrologie gibt, die sich bewusst gegen eine Mitgliedschaft beim fnb oder einem anderen Berufsverband entschieden haben. Natürlich gibt es jede Menge Argumente dafür, sich nicht berufspolitisch zu engagieren: keine Lust, keine Zeit, zu teuer, bringt doch eh nichts, was tun die für mich, bin schon in der Gewerkschaft, das ist doch so etwas wie eine Kammer etc., um nur die häufigsten Gründe einmal zu nennen. Vielleicht nehmen Sie sich trotzdem die Zeit, diesen Artikel zu Ende zu lesen.
Elterliche Sorgen und psychische Belastung bei krebskranken Eltern mit minderjährigen und jungerwachsenen Kindern
Authors: Inhestern Laura , Bultmann Johanna , Beierlein Volker , Möller Birgit , Romer Georg , Koch Uwe , Bergelt Corinna
Published: July 2017

Hintergrund Ziel der dargestellten Untersuchung ist es, elterliche Sorgen von Krebsüberlebenden zu untersuchen und Kovariaten dieser spezifischen Belastungen zu identifizieren.

Material & Methoden In einer epidemiologischen Stichprobe von n=1416 an Krebs erkrankten Eltern wurden soziodemografische und medizinische Merkmale sowie die psychische Belastung der Eltern (HADS) erhoben. Elterliche Sorgen wurden mit dem Parenting Concerns Questionnaire (PCQ) erhoben, der die Subskalen Sorgen um die ‚praktischen Auswirkungen‘ der Erkrankung auf die Kinder, ‚emotionale Auswirkungen‘ auf die Kinder und Sorgen in Bezug auf den ‚Co-Elternteil‘ umfasst.

Ergebnisse 73% der Krebsüberlebenden sind Frauen, das durchschnittliche Alter liegt bei 47,5 Jahren (SD 5,9). Zwischen 24% und 71% der Patienten mit elterlichen Sorgen zeigen in den Skalen der HADS unauffällige Werte. Alleinleben, jüngeres Alter des jüngsten Kindes, ein höheres Tumorstadium und das Vorhandensein einer weiteren körperlichen Erkrankung sind mit Sorgen in allen 3 Subskalen des PCQ positiv assoziiert. Ein niedriger Sozialstatus konnte als Kovariate für elterliche Sorgen auf emotionaler Ebene und auf praktischer Ebene identifiziert werden. Weibliches Geschlecht ist assoziiert mit Sorgen auf der Subskala Co-Elternteil.

Diskussion Betroffene Eltern sind neben der allgemeinen psychischen Belastung durch die Erkrankung auch durch Sorgen um ihre Kinder belastet. Psychologische Unterstützungsangebote für krebskranke Eltern sollten auch spezifische elterliche Sorgen thematisieren. Eltern mit Risikokonstellationen für eine erhöhte Belastung sollten besonders berücksichtigt werden, um bedarfsgerecht Unterstützung anbieten zu können.
D,L-Methadon erhöht den zytotoxischen Effekt konventioneller Krebstherapien
Authors: Friesen Claudia
Published: July 2017

Resistenzen gegenüber konventionellen Behandlungsmethoden limitieren den Erfolg in der Krebstherapie. Dies fordert, neue Therapiestrategien zu entwickeln, um den therapeutischen Erfolg zu verbessern. Krebszellen exprimieren auf ihrer Zelloberfläche sehr stark Opioidrezeptoren. Dies ermöglicht Opioiden, an die Krebszelle zu binden.

Methadon, das an Opioidrezeptoren bindet und in der Schmerztherapie bei Tumorpatienten eingesetzt wird, hat in vitro und im Mausmodell in vivo gezeigt, dass Chemotherapeutika in ihrer zytotoxischen Wirkung verstärkt werden können. Über die Aktivierung des Opioidrezeptors und die Herunterregulation von zyklischem Adenosinmonophosphat (cAMP) kann D,L-Methadon Apoptose-Signalwege aktivieren und antiapoptotische Moleküle, die zur Therapieresistenz führen können, blockieren. Des Weiteren kann D,L-Methadon zur einer stärkeren Aufnahme des Chemotherapeutikum in der Tumorzelle führen. Hierbei kommt es auf die Expression der Opioidrezeptoren auf der Oberfläche der Tumorzellen an. Bei einer starken Expression kann D,L-Methadon sogar allein den Zelltod in der Tumorzelle auslösen. Bei einer moderaten Expression verstärkt D,L-Methadon konventionelle Therapien in ihrer zytotoxischen Wirkung. Gesundes Gewebe, das wenig oder keine Opioidrezeptoren exprimiert, wird von der zytotoxischen Verstärkung von D,L-Methadon verschont. In einer retrospektiven klinischen Studie zur Behandlung von Gliomen wurde gezeigt, dass D,L-Methadon ohne erhebliche oder toxische Nebenwirkungen zusätzlich bei der Behandlung von Gliomen eingesetzt werden kann.
Versorgungsatlas
Authors: Stephanie Schikora
Published: July 2017

Immer mehr Patienten mit Diabetes stellen unser Gesundheitssystem vor große Herausforderungen: Hat die Prävalenz im Osten Deutschlands die 10-%-Marke bereits überschritten, in einigen Regionen liegen die Prävalenzraten dort schon über 15 %, steht der Westen kurz davor – vorausgesetzt, dieser Trend wird nicht beispielsweise durch eine verstärkte Präventionsarbeit umgekehrt. In welchen Regionen und in welchen Bevölkerungsgruppen der Handlungsbedarf am größten ist, das zeigt der Versorgungsatlas anhand einer Analyse ambulanter Versorgungsdaten.
Besser mit oder ohne Fleisch?
Authors: Leitzmann Claus , Uebel Ulf , Kämmerer Ulrike , Klement Rainer Johannes
Published: July 2017

Die Ernährung ist ein wichtiger Bestandteil der integrativen Krebstherapie. Doch welche ist die richtige? Sollten Krebspatienten lieber vegetarisch essen oder eher Fleisch? Oder ist viel Fett bei dieser zehrenden Erkrankung das Beste für den Körper? Unsere Ernährungsexperten erklären, welche Vorteile die vegetarische Kost, die Paläo-Diät und die ketogene Diät bei Krebs haben.
Rausch- oder Arzneipflanze?
Authors: Voigt Toni
Published: July 2017

Nach Jahren des Streits rehabilitiert sich Cannabis als Therapeutikum.
Die Kommunikation schlechter Nachrichten bei Krebspatienten: Inhalte, Kommunikationspräferenzen und psychische Belastungen
Authors: Gebhardt Claudia , Gorba Claudia , Oechsle Karin , Vehling Sigrun , Koch Uwe , Mehnert Anja
Published: July 2017

Hintergrund Die Übermittlung schlechter Nachrichten stellt sowohl für Ärzte als auch für Patienten eine sehr belastende Situation dar. Deshalb ist die Passung zwischen den patientenseitigen Kommunikationspräferenzen und dem ärztlichen Kommunikationsverhalten in dieser Gesprächssituation wichtig. In der vorliegenden Studie soll untersucht werden, welche Informationen im Behandlungsverlauf aus Sicht von Krebspatienten zu schlechten Nachrichten zählen und welche patientenseitigen Kommunikationspräferenzen bei der Mitteilung einer schlechten Nachricht vorliegen. Analysiert wird die Passung zwischen den Präferenzen und der ärztlichen Kommunikation aus Patientensicht und die psychische Belastung bei Nicht-Beachtung der Kommunikationspräferenzen.

Methodik Es wurden N=270 Krebspatienten (mittleres Alter 56,8 Jahre, 48% weiblich) verschiedener Tumorarten in einem frühen (n=115) und fortgeschrittenen Erkrankungsstadium (n=155) untersucht. Die Inhalte schlechter Nachrichten wurden durch einen eigens zusammengestellten Fragenkomplex erfasst. Kommunikationspräferenzen wurden mit dem Measure of Patients’ Preferences Fragebogen (MPP-D) erfragt. Die psychischen Belastungen umfassten krebsspezifische Belastung (NCCN-Distress-Thermometer), Depressivität und Ängstlichkeit (Hospital Anxiety and Depression Scale – HADS) sowie Demoralisierung (Demoralisierungs-Skala – DS).

Ergebnisse Patienten im frühen Krankheitsstadium erhielten M=1,6 (SD=1,1, range: 1–5) und Patienten im fortgeschrittenen Stadium M=2,1 schlechte Nachrichten (S=1,8, range: 1–12). Als subjektiv schlimmste Nachricht empfanden Patienten im frühen (77%) als auch im fortgeschrittenen Stadium (70%) die Übermittlung der Diagnose gefolgt von Informationen über die Behandlungsoptionen. Zu den wichtigsten Kommunikationspräferenzen zählen aus Patientensicht die Fachkompetenz und Patientenorientierung, die Eindeutigkeit und Direktheit im Gespräch sowie die Erfassung des subjektiven Informationsbedürfnisses. Patienten im fortgeschrittenen Stadium geben signifikant mehr (29%) unberücksichtigte Präferenzen an, als Patienten im frühen Erkrankungsstadium (20%) (p<0,01). Die Vermittlung schlechter Nachrichten ohne Berücksichtigung der patientenseitigen Kommunikationspräferenzen geht mit erhöhter psychischer Belastung der Patienten einher.

Schlussfolgerung Ärztliche Kommunikation sollte die patientenseitigen Kommunikationspräferenzen berücksichtigen, um psychische Belastungen auf Patientenseite zu reduzieren.
Electrically tunable liquid crystal lens with suppressed axial chromatic aberration
Authors: Chang Kai-Han , Varanytsia Andrii , Chien Liang-Chy
Published: July 2017

We demonstrate an electrically tunable dual-switching liquid crystal lens with suppressed axial chromatic aberration. A liquid crystal (LC) switch twisted vertical alignment (TVA) mode is utilized in the lens. By using a chiral nematic LC with a proper cell thickness-to-helical pitch ratio (d/p) and a thick cell gap, the lens provides a low director rotation rate, and the focal length dispersion at different wavelengths is reduced. The image quality of the LC lenses with different d/p ratios is investigated. The axial chromatic aberration can be reduced up to 30% when the d/p ratio is 0.5 ± 0.05. Comparing with a traditional liquid crystal lens without a twisted-nematic structure (i.e., d/p = 0), the contrast ratio of the image obtained from a lens with a twist structure (d/p = 0.5 ± 0.05) increases by 15%. The static voltage response from a LC cell shows that the suppressed chromatic aberration results from the suppressed wavelength dispersion of phase retardation-voltage relation of the TVA mode.
Velocity-space sensitivities of neutron emission spectrometers at the tokamaks JET and ASDEX Upgrade in deuterium plasmas
Authors: Jacobsen A. S. , Binda F. , Cazzaniga C. , Eriksson J. , Hjalmarsson A. , Nocente M. , Salewski M. , Tardini G. ,   JET Contributors,   ASDEX Upgrade Team
Published: July 2017

Future fusion reactors are foreseen to be heated by the energetic alpha particles produced in fusion reactions. For this to happen, it is important that the energetic ions are sufficiently confined. In present day fusion experiments, energetic ions are primarily produced using external heating systems such as neutral beam injection and ion cyclotron resonance heating. In order to diagnose these fast ions, several different fast-ion diagnostics have been developed and implemented in the various experiments around the world. The velocity-space sensitivities of fast-ion diagnostics are given by so-called weight functions. Here instrument-specific weight functions are derived for neutron emission spectrometry detectors at the tokamaks JET and ASDEX Upgrade for the 2.45 MeV neutrons produced in deuterium-deuterium reactions in deuterium plasmas. Using these, it is possible to directly determine which part of velocity space each detector observes.
Time-domain Brillouin scattering for the determination of laser-induced temperature gradients in liquids
Authors: Chaban Ievgeniia , Shin Hyun D. , Klieber Christoph , Busselez Rémi , Gusev Vitalyi E. , Nelson Keith A. , Pezeril Thomas
Published: July 2017

We present an optical technique based on ultrafast photoacoustics to determine the local temperature distribution profile in liquid samples in contact with a laser heated optical transducer. This ultrafast pump-probe experiment uses time-domain Brillouin scattering (TDBS) to locally determine the light scattering frequency shift. As the temperature influences the Brillouin scattering frequency, the TDBS signal probes the local laser-induced temperature distribution in the liquid. We demonstrate the relevance and the sensitivity of this technique for the measurement of the absolute laser-induced temperature gradient of a glass forming liquid prototype, glycerol, at different laser pump powers—i.e., different steady state background temperatures. Complementarily, our experiments illustrate how this TDBS technique can be applied to measure thermal diffusion in complex multilayer systems in contact with a surrounding liquid.
Topological bifurcations in the evolution of coherent structures in a convection model
Authors: Dam Magnus , Juul Rasmussen Jens , Naulin Volker , Brøns Morten
Published: July 2017

Blob filaments are coherent structures in a turbulent plasma flow. Understanding the evolution of these structures is important to improve magnetic plasma confinement. Three state variables describe blob filaments in a plasma convection model. A dynamical systems approach analyzes the evolution of these three variables. A critical point of a variable defines a feature point for a region where that variable is significant. For a range of Rayleigh and Prandtl numbers, the bifurcations of the critical points of the three variables are investigated with time as the primary bifurcation parameter. Bifurcation curves separate the parameter planes into regions with different critical point configurations for the state variables. For Prandtl number equal to 1, the number of critical points of each state variable increases with increasing Rayleigh number. For Rayleigh number equal to 104, the number of critical points is the greatest for Prandtl numbers of magnitude 100.
Note: Lossless laser beam combiner employing a high-speed rotating half-wave plate
Authors: Yatsuka E. , Yamamoto T. , Hatae T. , Torimoto K. , Itami K.
Published: July 2017

We have developed a laser beam combiner employing a high-speed rotating half-wave plate based on the specific requirements of the Thomson scattering measurement systems in the ITER. The polarization extinction ratio of the output beam may exceed 1000 and was maintained for more than 1 h via feedback control of the half-wave plate rotation speed. The pointing fluctuations introduced by rotating the half-wave plate were in the order of microradians. The high-speed rotating half-wave plate provides a lossless means of combining laser beams together with stable beam pointing.
Evidence for Cu2–xSe platelets at grain boundaries and within grains in Cu(In,Ga)Se2 thin films
Authors: Simsek Sanli E. , Ramasse Q. M. , Mainz R. , Weber A. , Abou-Ras D. , Sigle W. , van Aken P. A.
Published: July 2017

Cu(In,Ga)Se2 (CIGS)-based solar cells reach high power-conversion efficiencies of above 22%. In this work, a three-stage co-evaporation method was used for their fabrication. During the growth stages, the stoichiometry of the absorbers changes from Cu-poor ([Cu]/([In] + [Ga]) < 1) to Cu-rich ([Cu]/([In] + [Ga]) > 1) and finally becomes Cu-poor again when the growth process is completed. It is known that, according to the Cu-In-Ga-Se phase diagram, a Cu-rich growth leads to the presence of Cu2–xSe (x = 0–0.25), which is assumed to assist in recrystallization, grain growth, and defect annihilation in the CIGS layer. So far, Cu2–xSe precipitates with spatial extensions on the order of 10–100 nm have been detected only in Cu-rich CIGS layers. In the present work, we report Cu2–xSe platelets with widths of only a few atomic planes at grain boundaries and as inclusions within grains in a polycrystalline, Cu-poor CIGS layer, as evidenced by high-resolution scanning transmission electron microscopy (STEM). The chemistry of the Cu–Se secondary phase was analyzed by electron energy-loss spectroscopy, and STEM image simulation confirmed the identification of the detected phase. These results represent additional experimental evidence for the proposed topotactical growth model for Cu–Se–assisted CIGS thin-film formation under Cu-rich conditions.
High power passively mode-locked fiber laser based on graphene nanocoated optical taper
Authors: Mouchel Paul , Semaan Georges , Niang Alioune , Salhi Mohamed , Le Flohic Marc , Sanchez François
Published: July 2017

We experimentally demonstrate a passively mode-locked Er:Yb doped double-clad fiber laser using a graphene nanocoated optical taper. Averaging 20 μm of clad diameter with a length of 6 mm, such a saturable absorber enables a strong light–graphene interaction owing to the evanescent field of the excited cladding mode. With the highest pump power of 5 W, the 326th harmonic mode locking of soliton bunches with an average output power of 520 mW was obtained in a fiber ring cavity that has a fundamental frequency of 1.67 MHz. This is the highest average output power yet reported in graphene-based passively mode-locked fiber lasers.
Simplified parameter extraction method for single and back-to-back Schottky diodes fabricated on silicon-on-insulator substrates
Authors: Mikhelashvili V. , Padmanabhan R. , Eisenstein G.
Published: July 2017

We describe a technique to extract room temperature parameters of Schottky diodes based on single or double-terminal configurations whose barrier height is bias dependent. This method allows us to extract the zero bias barrier height without specific knowledge of interface states or the existence of insulator layers at the metal-semiconductor boundaries. This technique enables us to establish the type of thermionic emission mechanism, limited by a bias dependent image force potential and/or diffusion, taking into account interfacial states or layers. This technique makes use of experimental current-voltage (I-V) characteristics measured at both bias polarities and different intensities of illumination and the corresponding voltage-dependent differential slope-voltage characteristics α=dln(I)/dln(V). This method is verified experimentally on a conventional p-Silicon based Schottky diode and on metal-semiconductor and metal-insulator-semiconductor diodes fabricated on n-silicon-on-insulator substrates. Pd/Au Schottky electrodes were used, while the insulator stack of the metal-insulator-semiconductor diodes comprises an HfO2 layer on top of an SiO2 layer.
Microwave chirality discrimination in enantiomeric liquids
Authors: Hollander E. , Kamenetskii E. O. , Shavit R.
Published: July 2017

Chirality discrimination is of fundamental interest in biology, chemistry, and metamaterial studies. In optics, near-field plasmon-resonance spectroscopy with superchiral probing fields is effectively applicable for analyses of large biomolecules with chiral properties. We show possibility for microwave near-field chirality discrimination analysis based on magnon-resonance spectroscopy. Newly developed capabilities in microwave sensing using magnetoelectric (ME) probing fields originated from multiresonance magnetic-dipolar-mode oscillations in quasi-2D yttrium-iron-garnet disks provide potential for unprecedented measurements of chemical and biological objects. We report on microwave near-field chirality discrimination for aqueous D- and L-glucose solutions. The shown ME-field sensing is addressed to deepen our understanding of microwave-biosystem interactions. It can also be important for an analysis and design of microwave chiral metamaterials.
Impact of the external resistance on the switching power consumption in VO2 nano gap junctions
Authors: Sánchez L. , Rosa A. , Griol A. , Gutierrez A. , Homm P. , Van Bilzen B. , Menghini M. , Locquet J. P. , Sanchis P.
Published: July 2017

The influence of an external resistance on the performance of VO2 nanogap junctions is analyzed and experimentally characterized. The current-voltage response shows the reversible metal-insulator transition typical of VO2 based devices. When reaching the metallic state, the current through the VO2 junction is abruptly increased, which may result in electrical contact damage. Therefore, an external resistance in series with the VO2 junction is usually employed to limit the maximum current through the device. Our results indicate that the external resistance plays a key role in the switching power consumption showing an optimum value, which depends on the dimensions of the VO2 junction. In such a way, power consumption reductions up to 90% have been demonstrated by selecting the optimum external resistance value.
Frequency reconfigurable phase modulated magnetoelectric sensors using ΔE effect
Authors: Staruch M. , Yang M.-T. , Li J. F. , Dolabdjian C. , Viehland D. , Finkel P.
Published: July 2017

Magnetoelectric composites have shown promise in low power magnetic field sensing with responsive detection of low frequency fields through the modulation of electromechanical resonance by exploiting a nonlinearity in magnetoelastic properties (ΔE effect). There is also the as-of-yet unrealized potential of tuning this effect to further enhance the shift in resonant frequency of these devices. In the present work, the magnetic field sensitivity was modulated in a bending mode stress reconfigurable sensor through the application of uniaxial tensile stress, reaching up to 8% f0/mT. The minimum magnetic noise floor was determined by detecting the frequency shift using a phase locked loop circuit and was found to directly correspond to the maximum in magnetic field sensitivity that resulted from the ΔE effect.
Visualization of trap dilution in polyfluorene based light-emitting diodes
Authors: Khodabakhshi Elham , Michels Jasper J. , Blom Paul W. M.
Published: July 2017

The effects of electron trapping and resulting trap-assisted recombination can be strongly suppressed by diluting a semiconducting polymer with a large band gap polymer such as polystyrene. Polyfluorene (PFO)-based light-emitting diodes (PLEDs) are an excellent model system to visualize this trap dilution effect. The blue emission from the pristine PFO backbone is accompanied by a broad, featureless green emission band originating from monomeric ketone defects that act as an electron trap. We demonstrate that the green emission from radiative trap-assisted recombination at these ketone defects is nearly eliminated upon dilution. The ratio between bimolecular blue emission and trap-assisted green emission as a function of dilution is shown to be in quantitative agreement with model predictions.
Internalized CD44s splice isoform attenuates EGFR degradation by targeting Rab7A
Authors: Wang Wei , Zhang Honghong , Liu Sali , Kim Chung Kwon , Xu Yilin , Hurley Lisa A. , Nishikawa Ryo , Nagane Motoo , Hu Bo , Stegh Alexander H. , Cheng Shi-Yuan , Cheng Chonghui
Published: July 2017

Significance

Abnormal EGFR signaling is frequently observed in glioblastoma multiforme (GBM). However, the clinical benefit of EGFR inhibitors has been limited. Here we show that the cell surface molecule CD44s splice isoform acts as a signaling modulator that attenuates EGFR degradation and sustains EGFR’s downstream AKT signaling. CD44s internalizes in cells and inhibits Rab7A-mediated EGFR trafficking for degradation, resulting in sustained EGFR protein levels. CD44 depletion combined with EGFR inhibitor results in a robust and synergistic GBM cancer cell killing. Because CD44s-mediated inhibition on Rab7A also affects other receptor tyrosine kinases (RTKs), inhibiting CD44s may be an exciting approach for perturbation of multiple RTKs in GBMs.
Altered metabotropic glutamate receptor 5 markers in PTSD: In vivo and postmortem evidence
Authors: Holmes Sophie E. , Girgenti Matthew J. , Davis Margaret T. , Pietrzak Robert H. , DellaGioia Nicole , Nabulsi Nabeel , Matuskey David , Southwick Steven , Duman Ronald S. , Carson Richard E. , Krystal John H. , Esterlis Irina ,   the Traumatic Stress Brain Study Group, Friedman Matthew , Kowall Neil , Brady Christopher , McKee Ann , Stein Thor , Huber Bertrand , Kaloupek Danny , Alvarez Victor , Benedek David , Ursano Robert , Williamson Douglas , Cruz Dianne , Young Keith , Duman Ronald , Krystal John , Mash Deborah , Hardegree Melanie , Serlin Gayle
Published: July 2017

Significance

Posttraumatic stress disorder (PTSD) is a highly prevalent and disabling disorder, but there are currently no targeted medications for its treatment. Glutamate dysfunction is thought to be involved in the pathophysiology of PTSD, and the metabotropic glutamate receptor 5 (mGluR5) may represent a treatment target. We show alterations in mGluR5 availability in vivo and mGluR5- and glucocorticoid-related gene expression in postmortem tissue in PTSD, providing insight into the molecular mechanisms underlying this disorder. Our findings could, therefore, help inform the development of critically needed targeted and effective treatments for those suffering from PTSD.
Conserved gene regulatory module specifies lateral neural borders across bilaterians
Authors: Li Yongbin , Zhao Di , Horie Takeo , Chen Geng , Bao Hongcun , Chen Siyu , Liu Weihong , Horie Ryoko , Liang Tao , Dong Biyu , Feng Qianqian , Tao Qinghua , Liu Xiao
Published: July 2017

Significance

The lateral neural plate border (NPB) gives rise to the neural crest, one of the precursors of the peripheral nervous system (PNS) and generally considered an evolutionary innovation of the vertebrate lineage. Recently, it has been reported that a rudimentary neural crest exists in protovertebrate
Ciona
, but whether this is true in other invertebrates and there is conserved molecular machinery specifying the NPB lineage are unknown. We present evidence that orthologs of the NPB specification module specify lateral neural progenitor cells in several invertebrates, including worm, fly, and tunicate. We propose that an ancient lateral neuroblast gene regulatory module was coopted by chordates during the evolution of PNS progenitors.
Combining experimental and simulation data of molecular processes via augmented Markov models
Authors: Olsson Simon , Wu Hao , Paul Fabian , Clementi Cecilia , Noé Frank
Published: July 2017

Significance

Structural biology is moving toward a paradigm characterized by data from a broad range of sources sensitive to multiple timescales and length scales. However, a major open problem remains: to devise an inference method that optimally combines all of this information into models amenable to human analysis. In this work, we make a significant step toward achieving this goal. We introduce a statistically rigorous method to merge information from molecular simulations and experimental data into augmented Markov models (AMMs). AMMs are easy-to-analyze atomistic descriptions of biomolecular structure and exchange kinetics. We show how AMMs may provide accurate descriptions of molecular dynamics probed by NMR spin relaxation and thereby provide a unique way to integrate analysis of experimental with simulation data.