bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural and spectroscopy characterization of coaxial GaAs/GaAsSb/GaAs single quantum well nanowires fabricated by molecular beam epitaxy
Authors: Zhang Jian , Tang Jilong , Kang Yubin , Lin Fengyuan , Fang Dan , Wang Dengkui , Fang Xuan , Wang Xiaohua , Wei Zhipeng
Published: June 2019

Through the growth and characterization of GaAs/GaAs0.75Sb0.25/GaAs SQW nanowires, an emission wavelength of about 1.2 μm is achieved.
Impact of ZnO nanoparticles on the antibiotic resistance genes (ARGs) in estuarine water: ARG variations and their association with the microbial community
Authors: Chen Yu-ru , Guo Xing-pan , Feng Jing-nan , Lu Da-pei , Niu Zuo-shun , Tou Fei-yun , Hou Li-jun , Liu Min , Yang Yi
Published: June 2019

The abundances of ARGs increased after exposure to ZnO NPs, especially at low doses (0.2 and 1 mg L−1). Compared to MGEs and dissolved Zn, the microbial community contributed more to the variations in ARGs in estuarine waters when exposed to ZnO NPs.
Synthesis and antitumor activity of fluorouracil – oleanolic acid/ursolic acid/glycyrrhetinic acid conjugates
Authors: Liu Chun-Mei , Huang Jia-Yan , Sheng Li-Xin , Wen Xiao-An , Cheng Ke-Guang
Published: June 2019

Due to the obvious adverse effects of 5-fluorouracil and considering the diverse biological activities of pentacyclic triterpenes, twelve pentacyclic triterpene-5-fluorouracil conjugates were synthesized and their antitumor activities were evaluated.
Quantum-confined stark effect in the ensemble of phase-pure CdSe/CdS quantum dots
Authors: Zhang Lei , Lv Bihu , Yang Hongyu , Xu Ruilin , Wang Xiaoyong , Xiao Min , Cui Yiping , Zhang Jiayu
Published: June 2019

The ensemble Stark effect (PL, absorption, and ASE) of phase-pure thick-shell CdSe/CdS QDs was systematically investigated under an electric field.
Size-dependent exciton substructure in CdSe nanoplatelets and its relation to photoluminescence dynamics
Authors: Specht Judith F. , Scott Riccardo , Corona Castro Marta , Christodoulou Sotirios , Bertrand Guillaume H. V. , Prudnikau Anatol V. , Antanovich Artsiom , Siebbeles Laurens D. A. , Owschimikow Nina , Moreels Iwan , Artemyev Mikhail , Woggon Ulrike , Achtstein Alexander W. , Richter Marten
Published: June 2019

Rich exciton fine structure in CdSe nanoplatelets.
Correction: Hierarchically structured iron-doped silver (Ag–Fe) lotus flowers for an efficient oxygen reduction reaction
Authors: El-Nagar Gumaa A. , Lauermann Iver , Sarhan Radwan M. , Roth Christina
Published: June 2019

Correction for ‘Hierarchically structured iron-doped silver (Ag–Fe) lotus flowers for an efficient oxygen reduction reaction’ by Gumaa A. El-Nagar et al., Nanoscale, 2018, 10, 7304–7310.
Transition-metal free oxidative C–H etherification of acylanilines with alcohols through a radical pathway
Authors: Xu Xiaobo , Chu Zhengzhou , Xia Chengcai
Published: June 2019

Synthesis of methyl/ethyl aryl ether via oxidative C–H etherification of acylanilines with alcohols under transition-metal-free conditions.
Fluorophore core-engineered supramolecular discotic columnar liquid crystals with tunable fluorescent behavior
Authors: Mu Bin , Quan Xuhong , Zhao Yu , Li Xun , Tian Wei
Published: June 2019

Tunable fluorescent behaviour was achieved for hydrogen-bonded supramolecular discotic columnar liquid crystals via a fluorophore core engineered approach.
Polyurethane ionomers based on amino ethers of ortho-phosphoric acid
Authors: Davletbaeva I. M. , Sazonov O. O. , Fazlyev A. R. , Davletbaev R. S. , Efimov S. V. , Klochkov V. V.
Published: June 2019

The etherification of ortho-phosphoric acid with triethanolamine and polyoxypropylene glycol is studied.
Enabling separation intensification of a lanthanide pair with closely similar kinetics based on droplet microfluidics: hydrodynamic and kinetic approaches
Authors: Zhang Hao , Wang Huizhi , Xu Hong , Zhang Li , Xuan Jin
Published: June 2019

Separation intensification of a lanthanide pair obtained through hydrodynamic and kinetic approaches in microfluidics.
Condensed ferric dimers for green photocatalytic synthesis of nylon precursors
Authors: Ide Yusuke , Tominaka Satoshi , Yoneno Yumi , Komaguchi Kenji , Takei Toshiaki , Nishida Hidechika , Tsunoji Nao , Machida Akihiko , Sano Tsuneji
Published: June 2019

In contrast to usual iron oxides, molecularly small iron oxides synthesized and stabilized on a porous silica scaffold exhibited an unprecedentedly high photocatalytic performance unrealized by previous photocatalysts like TiO2.
A Co(OH)x nanolayer integrated planar WO3/Fe2O3 photoanode for efficient photoelectrochemical water splitting
Authors: Ma Wei , Wu Xiaofeng , Huang Keke , Wang Meng , Fu Rong , Chen Huanwen , Feng Shouhua
Published: June 2019

A controllable planar Fe2O3/WO3 photoanode with an integrated Co(OH)x layer was prepared via an electrospray technique for enhanced PEC performance.
The glutathione degrading enzyme, Chac1, is required for calcium signaling in developing zebrafish: redox as an upstream activator of calcium
Authors: Yadav Shambhu , Chawla Bindia , Khursheed Mohammad Anwar , Ramachandran Rajesh , Bachhawat Anand Kumar
Published: June 2019

Calcium signaling is essential for embryonic development but the signals upstream of calcium are only partially understood. Here, we investigate the role of the intracellular glutathione redox potential in calcium signaling using the Chac1 protein of zebrafish. A member of the γ-glutamylcyclotransferase family of enzymes, the zebrafish Chac1 is a glutathione-degrading enzyme that acts only on reduced glutathione. The zebrafish chac1 expression was seen early in development, and in the latter stages, in the developing muscles, brain and heart. The chac1 knockdown was embryonic lethal, and the developmental defects were seen primarily in the myotome, brain and heart where chac1 was maximally expressed. The phenotypes could be rescued by the WT Chac1 but not by the catalytically inactive Chac1 that was incapable of degrading glutathione. The ability of chac1 to alter the intracellular glutathione redox potential in the live animals was examined using Grx1-roGFP2. The chac1 morphants lacked the increased degree of cellular oxidation seen in the WT zebrafish. As calcium is also known to be critical for the developing myotomes, brain and heart, we further investigated if the chac1 knockdown phenotypes were a consequence of the lack of calcium signals. We observed using GCaMP6s, that calcium transients normally seen in the developing embryos were strongly attenuated in these knockdowns. The study thus identifies Chac1 and the consequent change in intracellular glutathione redox potential as important upstream activators of calcium signaling during development.
Polyploidy in halophilic archaea: regulation, evolutionary advantages, and gene conversion
Authors: Ludt Katharina , Soppa Jörg
Published: June 2019

All analyzed haloarachea are polyploid. In addition, haloarchaea contain more than one type of chromosome, and thus the gene dosage can be regulated independently on different replicons. Haloarchaea and several additional archaea have more than one replication origin on their major chromosome, in stark contrast with bacteria, which have a single replication origin. Two of these replication origins of Haloferax volcanii have been studied in detail and turned out to have very different properties. The chromosome copy number appears to be regulated in response to growth phases and environmental factors. Archaea typically contain about two Origin Recognition Complex (ORC) proteins, which are homologous to eukaryotic ORC proteins. However, haloarchaea are the only archaeal group that contains a multitude of ORC proteins. All 16 ORC protein paralogs from H. volcanii are involved in chromosome copy number regulation. Polyploidy has many evolutionary advantages for haloarchaea, e.g. a high resistance to desiccation, survival over geological times, and the relaxation of cell cycle-specific replication control. A further advantage is the ability to grow in the absence of external phosphate while using the many genome copies as internal phosphate storage polymers. Very efficient gene conversion operates in haloarchaea and results in the unification of genome copies. Taken together, haloarchaea are excellent models to study many aspects of genome biology in prokaryotes, exhibiting properties that have not been found in bacteria.
A copula-based consistency analysis of education indicators
Authors: Cunha César , Fernández Mariela , García Jesús E. , González-López Verónica Andrea , Romano Nícolas
Published: June 2019

In this paper we investigate the consistency of quality indicators of the Brazilian public educational system. According to the newspaper Estado de São Paulo – Brazil, of January 18, 2017, only 7.3% of students in the third year of high school have an adequate level of mathematics, this shows the relevance of the evaluation and assessment of the Brazilian educational system. In this paper we explore the dependence between two indicators: (i) mean value between the proportions (in two subjects: Portuguese and Mathematics) of students under the basic level (SARESP classification) and (ii) rate of fails, during the years 2013, 2014 and 2015. (i) and (ii) are bases to define the educational quality of public schools for the population of young people, between 14 and 17 years old. This inspection is carried out through the Bayesian estimation of the parameters of the Asymmetric Cubic Sections (ACS) copula. We show that the dependence profile, year after year, behaves in a very unstable way, although during those years there were no substantial changes which justify such instability. Through the copula we compute conditional probabilities of tail events. We verify that an inversion occurred in the concordance/discordance between (i) and (ii). We compute the probability of (i) assuming high values, conditioned to a threshold in (ii). In 2013, as the threshold in (ii) increases the probability increases (concordance), in 2014 the threshold in (ii) is almost irrelevant to the probability and in 2015, as the threshold in (ii) increases the probability decreases (discordance). The inspection of the tail dependence allows to expose some kind of manipulation, in view of for instance, the maintenance of a global index índice de desenvolvimento da educação de São Paulo (IDESP) used to classify the educational institutions.
Age-related performance at the Ultra-Trail du Mont-Blanc®
Authors: Varesco Giorgio , Sabater-Pastor Frederic , Millet Guillaume Y , Rozand Vianney
Published: June 2019

Some of the effects of aging and inactivity can be confounded. Master athletes are an interesting model to investigate human aging as they are free from the deleterious effects of inactivity. The aim of the present study was to analyze the number of male finishers and their performance across age at the Ultra-Trail du Mont-Blanc® (UTMB®, 170 km, 10 000 m of elevation gain) and two shorter races organized during the same event, Courmayeur-Champex-Chamonix (CCC®, 101 km, 6100 m) and Orsières-Champex-Chamonix (OCC, 55 km, 3500 m). Eighty percent of the finishers were aged between 23 and 49 years when considering the three races together. Top 10 average speed progressively decreased with age independently of the distance of the race. For every competition, average speed for the Top 10 decreased by 10% between 23–39 yr and 40–49 yr, then by 20% per decade. Future interventional studies should investigate the physiological factors (e.g. neuromuscular fatigue) associated with the age-related decline in ultra-trail running performance.
Psychobiologische Aspekte der
Traumafolgestörungen
Authors: Ehrenthal Johannes C. , Stoffel Martin , Ditzen Beate
Published: June 2019

Traumafolgestörungen werden oftmals als stressassoziierte seelische
Erkrankungen verstanden. Neben den psychischen Symptomen bietet die
Stressforschung wichtige Einblicke in biopsychologische Veränderungen der
Traumafolgestörungen, die über das hinausgehen, was von Patientinnen und
Patienten berichtet werden kann. Der Beitrag stellt Stressmodelle und
zentrale Forschungsbefunde vor und diskutiert Fragen der Reversibilität
veränderter Stressachsenregulation.
Die Inflation des Traumabegriffs
Authors: Quindeau Ilka
Published: June 2019

Angesichts der zunehmend inflationären Verwendung des Traumabegriffs wird eine
psychodynamische Sichtweise vorgeschlagen, die Trauma und Konflikt (wieder)
in Zusammenhang bringt. Traumatisierungen sind nicht in erster Linie äußeren
Ereignissen geschuldet, sondern entstehen im Modus der Nachträglichkeit als
Verarbeitung von Gewalterfahrungen. Die Psychotherapie zielt darauf, diese
Sinnkonstruktionen aufzulösen, damit ein neues Realitätsgefühl entstehen
kann.
Somatische Folgen von Traumatisierungen aus Sicht der
Kardiologie
Authors: Langheim Eike
Published: June 2019

Das rein somatische und akutmedizinische Krankheitsverständnis definiert bei
vielen Erkrankungen klare Risikofaktoren. Für eine koronare Herzerkrankung
mit der möglichen Folge eines Herzinfarkts werden immer „die klassischen
Vier“ angegeben: Rauchen, Hypercholesterinämie, Bluthochdruck und Diabetes
mellitus. Nur beiläufig erwähnt werden auch Übergewicht und Stress. Aber –
wenn das traumatisch Vergangene nicht vergeht, dann leidet auch der
Körper.
Intergenerationale Weitergabe von Traumata
Authors: Bachem Rahel
Published: June 2019

Wenn ein nahestehender Mensch ein Trauma erlebt, ist dies auch für Angehörige oft
schwer zu ertragen. Durch den ständigen Kontakt mit der posttraumatischen
Symptomatik können sich psychische Symptome entwickeln, die jenen der
Betroffenen selbst sehr ähnlich sind: Alpträume, erhöhte Wachsamkeit, sowie
Vermeidung von Trigger, die Erinnerungen an das Trauma wachrufen. Ein Überblick
anhand einer Studie zu den Langzeitfolgen von Kriegsgefangenschaft.
Erste Hilfe bei Traumafolgestörungen – Angebote aus dem
Internet
Authors: Kupferschmitt Alexa
Published: June 2019

Traumatisierende Erfahrungen erschüttern das Selbst- und das Weltverständnis der
Betroffenen. Dies hat Auswirkungen auf das Sicherheitsgefühl, die Orientierung
und den Halt in der Welt sowie die Fähigkeit, Vertrauen zu fassen, und sich so
mit Hilfegesuchen an andere Menschen zu wenden. Hier ist das Internet eine
niedrigschwellige Möglichkeit, erste Informationen und Hilfsangebote zu finden.
Der Überblick zeigt Quellen und qualifizierte Angebote zu Traumafolgestörungen
für Betroffene und Experten.
Fallbericht PTBS – „Das Schlimmste ist das Gefühl der Hilflosigkeit“
Authors: Langner Peter , Dahm-Mory Claudia , Wiegand-Grefe Silke
Published: June 2019

Ein 55-jähriger, in den letzten 17 Jahren als Einkaufsleiter tätiger Koch kommt arbeitsfähig nach adäquater Auslösung seines implantierten kardialen Defibrillators (ICD) bei Kammerflimmern 2015 mit einem ausgeprägten Gefühl der Hilflosigkeit zur psychokardiologischen Rehabilitation.
Endoscopy-related musculoskeletal injuries in gastroenterology fellows
Authors: Villa Edward , Attar Bashar , Trick William , Kotwal Vikram
Published: June 2019

Background and study aims Gastroenterologists are at high risk for work-related musculoskeletal injuries. Studies have shown that 37 % to 89 % of endoscopists have work-related musculoskeletal injuries. While all surveys until now have focused on practicing endoscopists, there have been no publications assessing the prevalence of musculoskeletal injuries among gastrointerology fellows, which we sought to investigate.

Methods A 22-question survey about ergonomics and work-related musculoskeletal injuries was sent to 114 gastroenterology fellows in different programs across the United States in June 2016, and an additional 103 surveys were distributed at Digestive Disease Week in May 2017. Responses were collected, and data were analyzed.

Results A total of 156 surveys were collected. Of these, 74 fellows (47 %) reported a new musculoskeletal injury related to endoscopy. Injuries occurred mostly in the first year of fellowship (85 %, P < 0.001). The most common sites of injury were the right wrist (53 %), left thumb (42 %), back (27 %), and neck (22 %). Only 26 % those who had endoscopy-related musculoskeletal injuries had received training in ergonomics compared to 45 % of those who did not have injury (P = 0.012), and ergonomics training was highly desirable among respondents, particularly among those with previous injuries (P = 0.0030)

Conclusion Musculoskeletal injuries related to endoscopy are very common among gastroenterology fellows, particularly during the first year of fellowship. While the overall percentage of fellows who received training in ergonomics was low, those who did receive training were less like to report a musculoskeletal injury. There is an urgent need for ergonomics training among Gastroenterology fellows.
Inverted “upside-down” esophageal fully-covered self-expanding metal stent is effective for temporary treatment of colorectal strictures: a pilot case series
Authors: Testoni Pier Alberto , Fanti Lorella , Antonucci Enrico , Dabizzi Emanuele
Published: June 2019

Background and study aims Placement of a fully-covered self-expanding metal stent (FC-SEMS) is a valid alternative for benign and malignant colorectal strictures treatment. Despite the reportedly high technical success rate, stenting is still challenging, due to high rates of adverse events. Migration still represents the main issue, although several anti-migration systems have been proposed.

Patients and methods Before insertion, esophageal Beta Niti-S FC-SEMSs were inverted and reloaded on the deployment device to invert the proximal and distal parts of the stent, with the largest end placed above the stricture to contrast peristaltic activity. The inverted “upside-down” Beta Niti-S FC-SEMS was placed in five consecutive patients: four pts with benign anastomotic stricture unresponsive to repeated balloon dilation and persisting for at least 10 weeks, and one with malignant rectal neoplasia. In five patients, six inverted FC-SEMSs were placed.

Results The modified FC-SEMS did not migrate in 5/6 cases (83 %). Stent migration occurred in the neoplastic case, induced by neoadjuvant chemotherapy. The “upside-down” esophageal Beta Niti-S FC-SEMS stayed in place for an average of 6 weeks, achieving resolution of stricture in all patients but one, who required an additional stent placement, due to incomplete stricture resolution after 6 weeks.

Conclusion The inverted esophageal Beta Niti-S FC-SEMSs proved to be effective in treating colorectal stricture in all cases, with no spontaneous migration or significant side effects, and achieved resolution of strictures where a traditional approach, recommended by guidelines, failed.
Validation of a Photoplethysmographic Heart Rate Monitor: Polar OH1
Authors: Hermand Eric , Cassirame Johan , Ennequin Gaël , Hue Olivier
Published: June 2019

This study assessed the validity of a photoplethysmographic heart rate (HR) monitor, the Polar OH1 in various sports performed in ecological conditions: running, cycling, soccer, kayaking, walking, tennis and fitness. Seventy trained athletes (56 males, 14 females) wore the Polar OH1 armband and the H7 chest belt during training. A total of 390 h and 38 min of recording were compared using a 20-bpm window to assess data quality, and Bland-Altman agreements and ICC analyses were used to test accuracy. Linear regression analyses evaluated the HR accuracy and correlation with skin tone. Training loads (TRIMPs) were compared for each session. Reliability was high for endurance sports (>99%) and lower for sports involving arm movements (92~95%). Biases were slightly negative for all sports, whereas widths of limits of agreement varied from 7–20bpm. Bland-Altman agreements were all under 5% except tennis, kayak and fitness. HR accuracy was positively correlated to skin tone (p<0.05). Finally, TRIMPs from the OH1 device were inferior to criterion’s (except walking and soccer), within a 3% range from reference. Hence, OH1 represents a valid tool to monitor instantaneous HR and training load, especially for endurance sports.
Aktuelles zur Charcot-Marie-Tooth-Erkrankung
Authors: Stassart Ruth M. , Fledrich Robert , Sereda Michael W. , Bartl Michael
Published: June 2019

Die Charcot-Marie-Tooth-Erkrankung (CMT) ist die häufigste hereditäre Neuropathie (Prävalenz 1:2500) mit über 90 assoziierten Genen. Der häufigste Subtyp (CMT1A), assoziiert mit einer Duplikation des peripheren Myelinprotein-22-Gens (PMP22) ist Ursache für 40–50 % aller Fälle. Klinische Zeichen sind distal symmetrische Paresen, Atrophien, Sensibilitätsstörungen, Fußdeformitäten und Areflexie. Validierte Skalen zur Evaluation der Beeinträchtigung (CMTNS2, ONLS, 9-hole-pegtest, Gehtestungen) sind verfügbar und molekulare Biomarker aus Blut und Hautbiopsien wurden validiert. Therapieoptionen im Entwicklungsstadium sind das Gen-Silencing (Minderung der Überexpression von PMP22), Sekretasen zur Regulierung der Neuregulinaktivität mit Einfluss auf Meylindicke und Funktion sowie Inhibitoren des Kalziuminfluxes in Schwannzellen. PXT3003 (Sorbitol, Naltrexon, Baclofen) wurde im Tiermodell erfolgreich getestet. Ein möglicher Therapieansatz mittels Substitution des Fettmoleküls Lecithin konnte in CMT1A-Ratten die Muskelkraft und die Anzahl myelinisierter Axone erhöhen.
Relationship of Activity Patterns to Acute Mountain Sickness in South Pole Workers
Authors: Pathangey Girish , Wheatley-Guy Courtney M. , Stewart Glenn , Anderson Paul J. , Richert Maile L. Ceridon , Miller Andrew D. , Johnson Jacob B. , Johnson Bruce
Published: June 2019

This study aimed to evaluate the influence of physical activity on incidence of acute mountain sickness (AMS) by continuous activity monitoring in a free-living sample of South Pole workers over the initial 72 h at altitude exposure of 2,840 m (9,318 ft). Body Media activity monitors were worn by 47 healthy participants. AMS was defined by the Lake Louise symptom questionnaire. Venous blood samples were taken at sea level and approximately 48 h after high altitude exposure. AMS incidence was 34% (n=16/47) over the first 48 h and 40% (n=19/47) over 72 h. On day 2 at high altitude, individuals with AMS demonstrated a significantly greater increase in the percent change in physical activity metrics from baseline: total energy expenditure 19±13 vs. 5±7%, total steps 65±51 vs. 10±18%, metabolic equivalent of tasks 21±13 vs. 7±13%, and time spent performing moderate to vigorous physical activity 114±79 vs. 26±27% for individuals with AMS vs. no AMS, respectively, p<0.05. In addition, erythropoietin and vascular endothelial growth factor were 1.69 and 1.75 times higher, respectively, in those with AMS. In conclusion, workers who engaged in increased physical activity and activity intensity during initial exposure to the South Pole were more susceptible to developing AMS.
Aktuelle Aspekte bei mitochondrialen Erkrankungen
Authors: Klopstock Thomas , Freisinger Peter
Published: June 2019

Die Fortschritte in der Molekularbiologie haben in den letzten Jahren zu großen Fortschritten im molekularen Verständnis, in der Diagnostik und in der Therapie mitochondrialer Erkrankungen geführt. Insbesondere durch die Methode des Next-Generation-Sequencing sind Defekte in mehr als 350 Genen identifiziert worden, die mitochondriale Erkrankungen verursachen können. Eine exakte molekulare Diagnostik ist dabei Voraussetzung für die individuelle genetische Beratung der betroffenen Familien, auch hinsichtlich neuer reproduktiver Optionen. Das verbesserte Verständnis der molekularen Pathogenese hat darüber hinaus zu pathophysiologisch begründeten Therapieansätzen geführt: Die therapeutische Ära der mitochondrialen Medizin hat begonnen.

In diesem Übersichtsartikel werden ausgewählte aktuelle Aspekte der mitochondrialen Medizin aus dem Bereich der Grundlagenforschung, der Prävention, der Diagnostik und der Therapie vorgestellt.
Nusinersen bei spinaler Muskelatrophie
Authors: Abu-Fares Omar , Götz Friederich , Petri Susanne , Schreiber-Katz Olivia , Osmanovic Alma
Published: June 2019

Für die 5q-assoziierte spinale Muskelatrophie (SMA) ist mit dem Antisense-Oligonukleotid Nusinersen seit Juni 2017 in Europa die erste kausale Therapie verfügbar. Die Zulassung beruht auf Phase-III-Studien bei Kindern und umfasst altersunabhängig alle genetisch gesicherten Subtypen der SMA. Erfahrungen in der Anwendung von Nusinersen bei Erwachsenen werden dringend benötigt. Erwachsene SMA-Typ-II-Patienten stellen durch die fortgeschrittene Erkrankung mit Kontrakturen, Skoliosen und Metallimplantaten eine besondere Herausforderung für die regelmäßigen intrathekalen Gaben dar. Ein Drittel der in unserem Zentrum mit Nusinersen behandelten erwachsenen Patienten leiden an einer SMA Typ II. Die Behandlung erfolgt ausschließlich stationär in Begleitung einer pflegenden Person. Die CT-gestützte Lumbalpunktion hat sich als geeignete Methode zur sicheren Applikation erwiesen. Punktionsassoziierte Nebenwirkungen wurden berichtet, schwere Nebenwirkungen traten nicht auf. Mögliche Therapieeffekte bei diesen schwer betroffenen Patienten sind über motorische Funktionen hinaus durch geeignete Parameter wie patient-reported outcomes (PRO) langfristig zu bewerten. Unsere Erfahrung mit SMA-Typ II-Patienten zeigt die Machbarkeit und gute Verträglichkeit der Nusinersen-Anwendung, jedoch den Bedarf eines erfahrenen, interdisziplinären Behandlungssettings.
Hautveränderungen bei Störungen im Funktionskreis Leber
Authors: Huemer Gabriela
Published: June 2019

Auch wenn die Haut in der chinesischen Medizin dem Funktionskreis Lunge zugeordnet ist, entstehen weitaus mehr Hauterkrankungen aufgrund von Störungen anderer Funktionskreise. Eine individuelle Syndrom-Diagnostik ist erforderlich.

Der Beitrag gibt einen Überblick zu den wichtigsten Störungsmustern, die sich auch auf der Haut manifestieren. Herzstück der Behandlung sind Diätetik, Akupunktur und die chinesische Arzneipflanzentherapie. Ein Fall aus der Praxis zeigt das Vorgehen und die möglichen Erfolge.
Evidenz der Wirksamkeit von Methylsulfonylmethan
Authors: Vlachojannis Julia , Chrubasik-Hausmann Sigrun
Published: June 2019

Das in der Nahrung enthaltende Methylsulfonylmethan (MSM) ist ein Schwefelspender. In-vitro-Untersuchungen weisen auf eine antientzündliche, antioxidative, antikanzerogene sowie eine den Knochenstoffwechsel stimulierende Wirkung hin. Lokal aufgetragen, erhöhte MSM die Penetration von EDTA durch die Cornea.

Tierversuche zeigen Besserung bei altersbedingter Arthrose, experimentell erzeugter Arthrose/Arthritis und Ohrentzündungen. Auch auf eine krebsprogressions- und metastasenhemmende sowie auf eine blutzucker- und blutfettsenkende Wirkung von MSM weisen Tiermodelle hin. Nicht alle human-pharmakologischen Untersuchungen zeigen, dass MSM eine positive Wirkung bei hoher sportlicher Belastung besitzt. MSM wurde bei muskuloskelettalen Beschwerden als Monotherapie oder in Kombination mit anderen Antiarthrose-Präparaten eingesetzt. Die Kombinationstherapien waren der MSM-Monotherapie überlegen. Der Beweis für die Wirksamkeit, insbesondere auch für andere Indikationen, steht allerdings noch aus.
Colorectal endoscopic submucosal dissection can be efficiently performed by a trainee with use of a simple traction device and expert supervision
Authors: Ide Daisuke , Saito Shoichi , Ohya Tomohiko Richard , Nishikawa Yuske , Horie Yoshimasa , Yasue Chihiro , Chino Akiko , Igarashi Masahiro , Saruta Masayuki , Fujisaki Junko
Published: June 2019

Background and study aims Colorectal endoscopic submucosal dissection (ESD) is technically challenging owing to submucosal fibrosis and difficult endoscope manipulation. Therefore, various traction methods have been reported. We often use a simple looped nylon thread attached to a clip to assist with dissection. We assessed the feasibility of mentor-guided colorectal ESD using this traction device (TD).

Patients and methods From December 2017 to March 2018, we retrospectively reviewed outcomes of 101 colorectal ESDs performed by two groups of endoscopists (A, 5 endoscopists with colorectal ESD experience of < 50 cases; B, 5 endoscopists with experience of > 300 cases). Group A was further divided into two subgroups that performed ESD with or without TD.

Results No significant difference was observed in ESD completion rates (86.1 % [62/72] vs. 96.6 % [28/29]; odds ratio [OR], 0.22; 95 % conﬁdence interval [CI], 0.005 – 1.71; P = 0.17) or procedure times (52.0 min vs. 40.0 min; P = 0.27) and adverse event rates between groups A and B. The rate of TD use was significantly higher in group A than in group B (44.4 % [32/72] vs. 20.7 % [6/29]; OR, 3.03; CI, 1.04 – 10.23; P = 0.03). The completion rate was not different between the two subgroups of group A (with vs. without TD) (81.2 % [26/32] vs. 90.0 % [36/40]; OR, 0.49; CI, 0.09 – 2.29; P = 0.32); however, the proportion of fibrosis cases was significantly higher in the TD-use group (46.8 % [15/32] vs. 22.5 % [9/40]; OR, 2.99; CI, 0.98 – 9.59; P = 0.03).

Conclusion Mentor-guided colorectal ESD using TD was performed efficiently, safely, and in a manner comparable to that of experts.
Lower endoscopic ultrasound in preoperative evaluation of rectosigmoid endometriosis
Authors: James Theodore W. , Fan Y. Claire , Schiff Lauren D. , Gangarosa Lisa M.
Published: June 2019

Background and study aims Endometriosis affects a significant proportion of reproductive-aged women and involves the bowel in up to one-third of patients with the condition. Lower endoscopic ultrasound (LEUS) in assessment of endometriosis of the rectosigmoid colon was first described 20 years ago in European populations. The current study aimed to describe the diagnostic characteristics of this imaging modality at a tertiary US referral center in a large cohort and its impact on surgical planning.

Patients and methods This was a retrospective cohort study of adult women evaluated for rectosigmoid endometriosis by LEUS at an American tertiary referral center between January 2003 through June 2017. The reference standard for rectosigmoid endometriosis was surgical evaluation regardless of whether tissue was obtained for histologic evaluation. Two separate analyses were run; one comparing EUS to laparoscopic findings and another comparing EUS to histologic findings.

Results LEUS demonstrated a positive predictive value (PPV) of 93.8 % (CI:68.1,99.1) and negative predictive value (NPV) of 96.4 % (CI:87.8,99.0) in the diagnosis of rectosigmoid endometriosis. Test sensitivity was 88.2 % (CI:63.6,98.5) and specificity was 98.2 % (CI:90.1,99.9). Overall diagnostic accuracy of the test was 95.8 % (CI:88.1,99.1).

Conclusions In this large cohort of women at an American tertiary referral center undergoing evaluation for rectosigmoid endometriosis, LEUS demonstrated high PPV and NPV as well as excellent diagnostic accuracy. In addition, the LEUS findings provided important information to the referring gynecologic surgeon. This minimally-invasive imaging modality should be utilized in preoperative evaluation of women undergoing surgery for suspected or known endometriosis.
Eigenblutbehandlung bei Urtikaria
Authors: Maurer Marcus , Buttgereit Thomas , Stange Rainer
Published: June 2019

Die meisten Leitlinien zu chronischer Urtikaria empfehlen derzeit eine Prophylaxe bzw. Therapie mit nicht sedierenden Antihistaminika. Es spricht jedoch nur etwa die Hälfte der Patienten darauf an. Die Therapie der Urtikaria mit autologem Vollblut oder Serum wird in den Leitlinien als „alternative Behandlungsoption“ gelistet. Sie eignet sich in erster Linie zur Therapie der chronischen spontanen Urtikaria, Studien deuten darauf hin, dass Patienten mit autoimmuner Komponente am ehesten profitieren.

Die aktuelle Datenlage zeigt, dass die Eigenbluttherapie bei Urtikaria nach wie vor ihren Stellenwert hat. Unklar ist aktuell aber, wie sich die verschiedenen angewendeten Protokolle bezüglich Wirksamkeit und der Wirkmechanismen unterscheiden.
Total Syntheses of (–)-7-epi-Alexine and (+)-Alexine Using Stereoselective Allylation
Authors: Myeong In-Soo , Jung Changyoung , Ham Won-Hun
Published: June 2019

Total syntheses of (–)-7-epi-alexine and (+)-alexine were achieved by using stereoselective allylation via a functionalized pyrrolidine obtained from an extended chiral 1,3-oxazine. The synthetic strategies include pyrrolidine formation via oxazine cleavage and diastereoselective allylations of a pyrrolidine aldehyde. (–)-7-epi-Alexine and (+)-alexine were synthesized from anti,syn,anti-oxazine in 12 steps.
Hypervalent Iodine Mediated Efficient Solvent-Free Regioselective Halogenation and Thiocyanation of Fused N-Heterocycles
Authors: Indukuri Divakar Reddy , Potuganti Gal Reddy , Alla Manjula
Published: June 2019

A facile, rapid, metal-free regioselective halogenation and thiocyanation of imidazo[1,2-a]pyridine/pyrimidine heterocycles has been achieved under solvent-free reaction conditions. Halogenations and thiocyanation of the heterocycles could be accomplished by simple grinding of reactants and hypervalent iodine reagents with the corresponding alkali metal or ammonium salts. The method has been extrapolated to a cleaner synthesis of brominated imidazo[1,2-a]pyridine/pyrimidine derivatives, starting from the corresponding heterocyclic amines and substituted α-bromoketones, utilising HBr generated in situ as the source of bromine.
Are We Clinicians Away from Ethics?
Authors: Choudhury Minati , Kapoor Poonam Malhotra
Published: June 2019

Medicine has always stood at the intersection between science and society. From antiquity to the present, everyone has faced health challenges that prompted the formation of groups of healers and the development of codes of ethics to govern the treatments that they offered. Medical codes of ethics blend the moral precepts, normative behavior, and social duties of the population in which they are used, and they change as new medical therapies and social issues arise. The written codes of ethics are based on modern terms for many of the issues raised in Charak Samhita. They also represent an effort to codify the essence of “the clinical encounter between physician and patient” and the role of society while emphasizing the importance of compassion, beneficence, nonmaleficence, respect for persons, and accountability. Medical ethics have been an integral part of Charak Samhita and its complete incorporation in present-day medical teaching and clinical practice will yield great results to this noble profession. Is it true that we clinicians are away from practice of ethics in medicine? Are we not following a structural approach to identify, analyze, and resolve ethical issue in clinical practice? We as clinicians should have some working knowledge about informed consent, confidentiality, patient's rights, and end-of-life care. At times, clinicians and patients disagree about the choices that may challenge their lives. It is then that ethical problem rises. While dealing with a patient, ethical problem can be avoided when the case is analyzed in four important areas: medical/surgical indications, preference by patient, quality of life with or without treatment, and other circumstantial features, for example socioeconomic, legal, or administrative aspects of the case.
Fat Grafting for Facial Contouring
Authors: Lam Samuel M.
Published: June 2019

Fat grafting is a safe, effective method for facial rejuvenation if used to restore lost facial volume, but it is not as a method to correct cutaneous deformities and rhytids, or to counteract gravitational effects. The most significant postoperative complication is weight gain that can make a face look overinflated. Accordingly, it is important to select a safe and appropriate candidate. This article outlines who is a suitable prospect for fat grafting and juxtaposes the two methods of facial volume restoration: fat grafting versus injectable fillers. Then a detailed exposition of the operative technique is outlined, including anesthesia, harvesting, processing, and injection. Finally, this article concludes with a description of the postoperative course and the management of potential complications.
Nonsurgical Treatment of Keloids and Hypertrophic Scars
Authors: Saddawi-Konefka Robert , Watson Deborah
Published: June 2019

Despite the ubiquitous nature of scar tissue, there is not a single, reliable strategy to prevent or treat excessive scarring. The difficulty in arriving at a universally accepted form of management is multifaceted: there is an incomplete understanding of the complex pathophysiology of scar formation; a lack of common metrics hampers the accurate description of scar quality and characteristics; model systems do not exist for proper investigation in the controlled environment of a laboratory; and there is only limited data from prospective, randomized controlled clinical trials. Accordingly, the management of cutaneous scars is typically based upon the experience from practitioners rather than from evidence-based data. This article will review the pathophysiology of excessive scar formation, define the most common scars—hypertrophic scars and keloids—and discuss the evidence to support the current nonsurgical therapies in use to both prevent and treat excessive scars.
An Improved Synthesis of Urea Derivatives from N-Acylbenzotriazole via Curtius Rearrangement
Authors: Singh Anoop S. , Agrahari Anand K. , Singh Sumit K. , Yadav Mangal S. , Tiwari Vinod K.
Published: June 2019

The good leaving tendency of the benzotriazole moiety has been exploited for the synthesis of symmetric, unsymmetric, N-acyl, and cyclic ureas in good yields from N-acylbenzotriazoles by treating the latter with various amines in the presence of TMSN3/Et3N in a sealed tube. The salient features of the devised protocol includes the high-yield, mild, metal-free, one-pot reaction conditions, and short reaction time. Furthermore, in many cases, no column chromatography is required for the purification.
Building Usability Knowledge for Health Information Technology: A Usability-Oriented Analysis of Incident Reports
Authors: Marcilly Romaric , Schiro Jessica , Beuscart-Zéphir Marie Catherine , Magrabi Farah
Published: June 2019

Background The contribution of usability flaws to patient safety issues is acknowledged but not well-investigated. Free-text descriptions of incident reports may provide useful data to identify the connection between health information technology (HIT) usability flaws and patient safety.

Objectives This article examines the feasibility of using incident reports about HIT to learn about the usability flaws that affect patient safety. We posed three questions: (1) To what extent can we gain knowledge about usability issues from incident reports? (2) What types of usability flaws, related usage problems, and negative outcomes are reported in incidents reports? (3) What are the reported usability issues that give rise to patient safety issues?

Methods A sample of 359 reports from the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience database was examined. Descriptions of usability flaws, usage problems, and negative outcomes were extracted and categorized. A supplementary analysis was performed on the incidents which contained the full chain going from a usability flaw up to a patient safety issue to identify the usability issues that gave rise to patient safety incidents.

Results A total of 249 reports were included. We found that incident reports can provide knowledge about usability flaws, usage problems, and negative outcomes. Thirty-six incidents report how usability flaws affected patient safety (ranging from incidents without consequence, to death) involving electronic patient scales, imaging systems, and HIT for medication management. The most significant class of involved usability flaws is related to the reliability, the understandability, and the availability of the clinical information.

Conclusion Incidents reports involving HIT are an exploitable source of information to learn about usability flaws and their effects on patient safety. Results can be used to convince all stakeholders involved in the HIT system lifecycle that usability should be considered seriously to prevent patient safety incidents.
A Newborn with Severe Ventriculomegaly: Expanding the PPP2R1A Gene Mutation Phenotype
Authors: Wallace Alexandra , Caruso Paul , Karaa Amel
Published: June 2019

Protein phosphatase 2A (PP2A) is a heterotrimeric protein serine/threonine phosphatase that regulates a diverse range of cellular activities. The PPP2R1A gene on chromosome 19 (19q13.41) encodes the α isoform of the scaffolding subunit of the PP2A holoenzyme, which functions to link the catalytic subunit to the regulatory subunit. Here we present a case of a newborn boy with a novel PPP2R1A gene mutation (c.548G>A; p.Arg183Gln) with severe lateral and third ventriculomegaly, hypoplastic corpus callosum, and pontocerebellar hypoplasia. To our knowledge, this is the sixth case reported in the literature, thus expanding the phenotype of this rare genetic condition.
Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery
Authors: Shen Sarek A. , Jafari Aria , Qualliotine Jesse R. , DeConde Adam S.
Published: June 2019

Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS.

Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery.

Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79–1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40–5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41–7,751.10, p = 0.034) were associated with additional prescriptions postoperatively.

Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.
Clinical Outcomes and Multidisciplinary Patterns of Failure for Olfactory Neuroblastoma: The Ohio State Experience
Authors: Wolfe Adam R. , Blakaj Dukagjin , London Nyall , Blakaj Adriana , Klamer Brett , Pan Jeff , Wakely Paul , Prevedello Luciano , Bonomi Marcelo , Bhatt Aashish , Raval Raju , Palmer Joshua , Prevedello Daniel , Gamez Mauricio , Carrau Ricardo
Published: June 2019

Purpose Olfactory neuroblastoma (ONB) is a rare head and neck cancer believed to be originated from neural crest cells of the olfactory membrane located in the roof of the nasal fossa. This study evaluates clinical outcomes and failure patterns in ONB patients of those patients treated with surgical resection at a high-volume tertiary cancer center.

Methods and Materials Thirty-nine ONB patients who underwent surgical resection at our institution from 1996 to 2017 were retrospectively identified. Univariate, multivariate, and survival analysis were calculated using Cox regression analysis and Kaplan–Meier log-rank.

Results Median follow-up time was 59 months (range: 5.2–236 months). The median overall survival (OS) and disease-free survival (DFS) for the entire cohort were 15 and 7.6 years, respectively. The 5-year cumulative OS and DFS were 83 and 72%, respectively. The 5-year OS for low Hyams grade (LHG) versus high Hyams grade (HHG) was 95 versus 61% (p = 0.041). LHG was found in 66% of the early Kadish stage patients compared with 28% in the advanced Kadish stage patients (p = 0.057). On multivariate analysis, HHG and positive node status predicted for worse OS and only HHG predicted for worse DFS. Of note, five patients (all Kadish stage A) who received surgical resection alone had no observed deaths or recurrences with a median follow-up of 44 months (range: 5–235 months).

Conclusion In this retrospective cohort, patients with positive nodes or HHG have significantly worse clinical outcomes. Future studies should explore treatment intensification for HHG or positive nodes.
Klinikneubau Bremen-Mitte: „Ich hoffe auf den Elbphilharmonie-Effekt“
Authors: Doelfs Guntram
Published: June 2019

Fünf Jahre zu spät und teurer als geplant, wurde nun der Klinikneubau Bremen-Mitte eröffnet. Jutta Dernedde, Vorstandssprecherin des Trägers Gesundheit Nord, spricht über die Vorteile des neuen Hauses, Sturzbäche im Rohbau – und hanseatische Vorbilder.
Europäischer Gesundheitskongress München: Faszination Gesundheitswesen
Authors: Hillebrand Ralf-Thomas
Published: June 2019

Der Europäische Gesundheitskongress München 2019 steht unter dem Motto: „Faszination Gesundheitswesen: Auch für die nächste Generation!“. Es ist ein Aufruf, daran mitzuwirken, was in der Gesundheitsversorgung gerade möglich wird – etwa im Hinblick auf Künstliche Intelligenz, Big Data und personalisierte Medizin.
Viele Professionen, ein Patient: Der geriatrische Patient im Krankenhaus
Authors: Heeser Alexandra
Published: June 2019

Laut Statistischem Bundesamt ist rund jeder fünfte Deutsche älter als 65 Jahre. Das kann zum Problem werden, gerade bei einem Krankenhausaufenthalt. Denn diese häufig multimorbide Patientengruppe bedarf dort einer individualisierten, spezifisch altersmedizinischen Behandlung – und viel Zuwendung, gerade bei der Nebendiagnose Demenz.
Interview mit Prof. Dr. Hubert Otten: Benchmark-Studie zeigt Kostenfallen beim Transportdienst in Kliniken
Authors: Grether Thomas
Published: June 2019

Prof. Dr. Ing. Hubert Otten verglich in einer Benchmark-Studie zwölf Kliniken der Maximalversorgung und wie sie logistisch aufgestellt sind. In dieser Studie entwickelte Otten auch Handlungsempfehlungen, wie solche Kliniken in ihrer Logistik besser werden können.
Patientenerleben im Smart Hospital: In guten Händen
Authors: Gerigk Monja
Published: June 2019

Die Digitalisierung im Alltag weckt bei Krankenhauspatienten schon heute gewisse Erwartungen. Wie ein durchgehend IT-gestützter Aufnahmeprozess ablaufen könnte, veranschaulicht eine fiktive Schilderung auf der Basis von Äußerungen realer Patienten.