bluuebunny/crossref_metadata_2025_split huggingface dataset:
Entwicklung und Validierung eines vollautomatischen, experimentellen Set-ups zur Ex-vivo-Berstungsdruckmessung nach chirurgischem Gefäßverschluss
Authors: Wallimann Herbert , Menges Pia , Hausen Bernard , Linder Albert 
Published: June 2017

Zusammenfassung
Hintergrund Die steigende Anzahl an endoskopischen Operationen zeitigt verschiedene Ansprüche an das operative Instrumentarium. Der wohl wichtigste Qualitätsparameter für Klammernahtgeräte ist der Berstungsdruck. Zu dessen Bestimmung finden sich in der Literatur verschiedene experimentelle Aufbauten. All diese Set-ups zeigen jedoch beträchtliche Kritikpunkte. Mit dieser Studie stellen wir ein vollautomatisches und untersucherunabhängiges Berstungsdruckmesssystem vor, das die Situation in vivo weitgehend imitiert. Das experimentelle Set-up zeichnet sich insbesondere dadurch aus, dass nicht nur ein komplettes Bersten registriert, sondern zuverlässig bereits eine sehr frühe – jedoch interventionspflichtige – Leckage detektiert wird (NID = niedrigster interventionspflichtiger Druck).
Material und Methode Die Berstungsdruckmessung erfolgte an Gefäßsegmenten von porcinen Aa. carotides communes, der Gefäßverschluss mit dem Klammernahtgerät MicroCutter XCHANGE® der Firma DexteraSurgical. Vor Verschluss wurde das Gefäßsegment mit Flüssigkeit bis zu einem Druck von 80 mmHg gefüllt. Die Flüssigkeit aus 56% Wasser und 44% Glyzerin ergab eine blutähnliche Viskosität von 4,31 ± 0,03 cP. Die Druckerhöhung nach Verschluss erfolgte mit einer definierten Flussrate von 5 ml/min. Eine interventionspflichtige Leckage wurde automatisch detektiert bei einer Abflachung der Druckkurve auf weniger als 5 mmHg/s.
Ergebnisse der Validierung Zur Validierung des Softwaresystems wurden insgesamt 30 Klammernahtreihen untersucht. Der visuell durch 2 unabhängige Untersucher ermittelte mittlere Berstungsdruck (mittlere NID) betrug 515,8 mmHg ± 236,3 mmHg. Der maximale lag bei 911 mmHg und der minimale bei 80 mmHg. Der elektronische Berstungsdruck betrug im Mittel 511,8 mmHg ± 239,1 mmHg. Der maximale Druck betrug 911 mmHg und der minimale 80 mmHg. Statistisch zeigte sich eine signifikante Korrelation zwischen dem visuellen und dem elektronischen Berstungsdruck.
Schlussfolgerung Mit dem hier vorgestellten Testaufbau gelingt erstmals eine systematische Berstungsdruckmessung, die komplett automatisiert und untersucherunabhängig ist. Der definierte intravasale Druck vor dem Verschluss und die Flüssigkeit mit blutähnlicher Viskosität erlauben es, die intraoperativen Gegebenheiten weitgehend zu imitieren. Durch Definition des Berstungsdrucks als erstes Auftreten einer interventionspflichtigen Leckage (= niedrigster interventionspflichtiger Druck, NID) und nicht als komplettes Bersten lassen sich die Ergebnisse auf den chirurgischen Alltag übertragen.
Was sind Barrieren der Ernährungstherapie bei mangelernährten, hospitalisierten Patienten der Inneren Medizin?
Authors: Tribolet Pascal , Fehr Rebecca , Bächli Valerie , Geiser Martina , Toplak Hermann , Stanga Zeno , Schuetz Philipp 
Published: June 2017

Zusammenfassung
Hintergrund Die Mangelernährung ist im Spitalalltag ein zentrales Problem und korreliert mit Komplikationen, längeren Spitalaufenthalten und schlechteren Outcomes. Zur Reduktion dieser negativen Aspekte ist ein Ernährungsmanagement bei Risikopatienten sinnvoll, doch die Effizienz dieser Maßnahme ist variabel und es existieren verschiedene Barrieren zur optimalen Umsetzung von Ernährungsinterventionen im Alltag. Das Ziel dieser Studie ist es, die Umsetzbarkeit eines neu etablierten Ernährungsalgorithmus im klinischen Spitalalltag zu überprüfen und potenzielle Barrieren einer Ernährungstherapie aufzuzeigen.
Methode Dies ist eine Beobachtungssubstudie des EFFORT-Trials, eine schweizweite, multizentrische, randomisierte, kontrollierte Interventionsstudie, welche den Effekt der Ernährungstherapie auf den Krankheitsverlauf von mangelernährten, hospitalisierten, medizinischen Patienten untersucht. Die untersuchte Population wurde anhand eines klar definierten Ernährungsalgorithmus behandelt, mit dem Ziel, eine bedarfsdeckende Energie- und Proteinzufuhr zu gewährleisten. Anhand von Essprotokollen wurde die Energie- und Proteinzielerreichung berechnet. Um die Assoziation zwischen dem Nichterreichen der Energie- und Proteinziele und vordefinierten Prädiktoren aufzuzeigen, wurde eine multivariate, logistische Regression durchgeführt.
Ergebnisse 581 Patienten wurden in die Analyse eingeschlossen. Die Ernährungsziele wurden insgesamt gut erreicht: 83,3 % aller eingeschlossenen Patienten erreichten an mindestens 1 der ersten 5 Spitaltage die Energieziele und 78,7 % die Proteinziele. In der multivariaten Regressionsanalyse war die Zielerreichung in Abhängigkeit von Alter, Geschlecht, Hauptdiagnose und Komorbiditäten nicht unterschiedlich. Lediglich die positive Antwort auf den Appetitverlust hat sich bei der Energiezielerreichung als protektiver Faktor gezeigt (Odds Ratio [OR] Appetitverlust: 0,53; 95 %-KI: 0,3 – 0,94; p = 0,03). Bei den Proteinzielen war der höhere BMI ein Risikofaktor für das Nichterreichen der Ziele (OR pro BMI-Einheit [kg/m2]: 1,05; 95 %-KI: 1,01 – 1,09; p = 0,02).
Schlussfolgerungen Der vorgeschlagene Ernährungsalgorithmus ist in der Praxis gut anwendbar und eine Großzahl von hospitalisierten Patienten der medizinischen Abteilung konnten die Ernährungsziele mit rein oralen Maßnahmen (Spitalküche und orale Supplemente), ohne Notwendigkeit einer Eskalation auf enterale oder parenterale Ernährung erreichen. Bei Risikopatienten sollte ein individuelles Assessment stattfinden, um zu klären, wie die Ernährungsziele erreicht werden können.
Knochendichtemessung und osteologische Laborparameter im klinischen Alltag
Authors: Warnecke Katja 
Published: June 2017

SummaryEine Osteoporose geht zunächst ohne Symptome einher. Bei Patienten mit Rückenschmerzen, Körpergrößeneinbuße, Frakturen ohne adäquates Trauma oder entsprechendem Risikoprofil sollte an eine Osteoporose gedacht werden. Die klinische Untersuchung, Bildgebung, Basislabor und Knochendichtemessung bilden die diagnostische Basis. Die Knochendichtemessung sowie die weiterführende Diagnostik und die leitliniengerechte spezifische osteologische Therapie sollten in erfahrenen Zentren durchgeführt werden.Der Refresher gibt einen Überblick zu den diagnostischen Maßnahmen, einen Ausblick auf die Therapie sowie den Eckpfeilern der Osteoporoseprophylaxe, die ebenso selbstverständlich werden sollte wie die Primärprävention kardiovaskulärer Erkrankungen.
„Wir sollten voneinander lernen“
Authors: Niklas Anke 
Published: June 2017

SummaryProf. Karin Kraft hat seit 2002 die Stiftungsprofessur für Naturheilkunde an der Universitätsmedizin Rostock inne. Im zkm-Gespräch erzählt die Internistin u. a., warum dauerhaft stiftungsfinanzierte Lehrstühle für Naturheilkunde in Deutschland keine gute Entwicklung sind, welche Probleme die Abgabe von Phytoextrakten in Form von Botanicals mit sich bringt und wie ein Kur- und Heilwald therapeutisch genutzt werden kann.
Exosomes purified from a single cell type have diverse morphology
Authors: Zabeo Davide , Cvjetkovic Aleksander , Lässer Cecilia , Schorb Martin , Lötvall Jan , Höög Johanna L 
Published: June 2017

ABSTRACTExtracellular vesicles (EVs) are produced by all known organisms and are important for cell communication and physiology. Great morphological diversity has been described regarding EVs found in body fluids such as blood plasma, breast milk, and ejaculate. However, a detailed morphological analysis has never been performed on exosomes when purified from a single cell type.In this study we analysed and quantified, via multiple electron microscopy techniques, the morphology of exosomes purified from the human mast cell line HMC‐1. The results revealed a wide diversity in exosome morphology, suggesting that subpopulations of exosomes with different and specific functions may exist. Our findings imply that a new, more efficient way of defining exosome subpopulations is necessary. A system was proposed where exosomes were classified into nine different categories according to their size and shape. Three additional morphological features were also found in exosomes regardless of their morphological classification.These findings show that exosomes purified from a single cell line are also morphologically diverse, similar to previous observations for EVs in body fluids. This knowledge can help to improve the interpretation of experimental results and widen our general understanding of the biological functions of exosomes.
Incorporating Dynamic Assessment of Fluid Responsiveness Into Goal-Directed Therapy: A Systematic Review and Meta-Analysis
Authors: Bednarczyk Joseph M. , Fridfinnson Jason A. , Kumar Anand , Blanchard Laurie , Rabbani Rasheda , Bell Dean , Funk Duane , Turgeon Alexis F. , Abou-Setta Ahmed M. , Zarychanski Ryan 
Published: June 2017

Objective:
Dynamic tests of fluid responsiveness have been developed and investigated in clinical trials of goal-directed therapy. The impact of this approach on clinically relevant outcomes is unknown. We performed a systematic review and meta-analysis to evaluate whether fluid therapy guided by dynamic assessment of fluid responsiveness compared with standard care improves clinically relevant outcomes in adults admitted to the ICU.

Data Sources:
Randomized controlled trials from MEDLINE, EMBASE, CENTRAL, clinicaltrials.gov, and the International Clinical Trials Registry Platform from inception to December 2016, conference proceedings, and reference lists of relevant articles.

Study Selection:
Two reviewers independently identified randomized controlled trials comparing dynamic assessment of fluid responsiveness with standard care for acute volume resuscitation in adults admitted to the ICU.

Data Extraction:
Two reviewers independently abstracted trial-level data including population characteristics, interventions, clinical outcomes, and source of funding. Our primary outcome was mortality at longest duration of follow-up. Our secondary outcomes were ICU and hospital length of stay, duration of mechanical ventilation, and frequency of renal complications. The internal validity of trials was assessed in duplicate using the Cochrane Collaboration’s Risk of Bias tool.

Data Synthesis:
We included 13 trials enrolling 1,652 patients. Methods used to assess fluid responsiveness included stroke volume variation (nine trials), pulse pressure variation (one trial), and stroke volume change with passive leg raise/fluid challenge (three trials). In 12 trials reporting mortality, the risk ratio for death associated with dynamic assessment of fluid responsiveness was 0.59 (95% CI, 0.42–0.83; I
2 = 0%; n = 1,586). The absolute risk reduction in mortality associated with dynamic assessment of fluid responsiveness was –2.9% (95% CI, –5.6% to –0.2%). Dynamic assessment of fluid responsiveness was associated with reduced duration of ICU length of stay (weighted mean difference, –1.16 d [95% CI, –1.97 to –0.36]; I
2 = 74%; n = 394, six trials) and mechanical ventilation (weighted mean difference, –2.98 hr [95% CI, –5.08 to –0.89]; I
2 = 34%; n = 334, five trials). Three trials were adjudicated at unclear risk of bias; the remaining trials were at high risk of bias.

Conclusions:
In adult patients admitted to intensive care who required acute volume resuscitation, goal-directed therapy guided by assessment of fluid responsiveness appears to be associated with reduced mortality, ICU length of stay, and duration of mechanical ventilation. High-quality clinical trials in both medical and surgical ICU populations are warranted to inform routine care.
Targeting activated protein C to treat hemophilia
Authors: Polderdijk Stéphanie G.I. , Baglin Trevor P. , Huntington James A. 
Published: June 2017

Purpose of review
Hemophilia is a debilitating disease, marked by frequent, painful bleeding events, joint deterioration and early death. All current treatments consist of i.v. infusions of replacement factor or other procoagulant factors, and are incompletely effective, due in part to the short half-lives of the proteins. An alternative approach is to rebalance hemostasis by inhibiting natural anticoagulant mechanisms. In this article, we explain why activated protein C (APC) is an appropriate and safe target for the treatment of hemophilia.

Recent findings
A serpin (serine protease inhibitor) was engineered to specifically inhibit APC and was found to rescue hemostasis in a hemophilia mouse model, even after a severe tail clip injury. However, APC is also anti-inflammatory and has cytoprotective activities, raising safety concerns over the use of an APC inhibitor to treat hemophilia. We summarize the molecular basis of the anticoagulant and signaling activities of APC to assess the potential impact of targeting APC.

Summary
We conclude that the signaling and anticoagulant functions of APC are in spatially and kinetically distinct compartments, and that it is possible to specifically inhibit the anticoagulant activity of APC. Targeting APC with a serpin is remarkably effective and may be safe for long-term prophylactic use in the treatment of hemophilia.
3D Printing: current use in facial plastic and reconstructive surgery
Authors: Hsieh Tsung-yen , Dedhia Raj , Cervenka Brian , Tollefson Travis T. 
Published: June 2017

Purpose of review
To review the use of three-dimensional (3D) printing in facial plastic and reconstructive surgery, with a focus on current uses in surgical training, surgical planning, clinical outcomes, and biomedical research. To evaluate the limitations and future implications of 3D printing in facial plastic and reconstructive surgery.

Recent findings
Studies reviewed demonstrated 3D printing applications in surgical planning including accurate anatomic biomodels, surgical cutting guides in reconstruction, and patient-specific implants fabrication. 3D printing technology also offers access to well tolerated, reproducible, and high-fidelity/patient-specific models for surgical training. Emerging research in 3D biomaterial printing have led to the development of biocompatible scaffolds with potential for tissue regeneration in reconstruction cases involving significant tissue absence or loss. Major limitations of utilizing 3D printing technology include time and cost, which may be offset by decreased operating times and collaboration between departments to diffuse in-house printing costs

Summary
The current state of the literature shows promising results, but has not yet been validated by large studies or randomized controlled trials. Ultimately, further research and advancements in 3D printing technology should be supported as there is potential to improve resident training, patient care, and surgical outcomes.
Motherhood and Risk for Human Immunodeficiency Virus/Sexually Transmitted Infections Among Female Sex Workers in the Mexico-US Border Region
Authors: Servin Argentina E. , Reed Elizabeth , Brouwer Kimberly C. , Magis-Rodriguez Carlos , Boyce Sabrina , Strathdee Steffanie A. , Silverman Jay G. 
Published: June 2017

Background
Globally, female sex workers (FSWs) have been identified as a high-risk group for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). However, as women of reproductive age, FSWs also have children. Few studies have investigated if financial responsibilities associated with motherhood increase women’s vulnerability to HIV and STIs among FSWs.

Methods
From March 2013 to March 2014, 603 FSWs aged ≥18 years were recruited from Tijuana and Ciudad Juarez (Mexico) to participate in a study assessing HIV/STI risk environments.

Results
Findings from logistic regression models indicate that FSWs who reported motherhood were more likely to report (in the past 30 days): a higher client volume (>30 clients) (adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI], 1.27–2.87) and always using alcohol right before or during sex with clients in the past 30 days (AOR, 1.77; 95% CI, 1.19–2.61). In contrast, they were more likely to report consistent condom use for vaginal or anal sex with clients (AOR, 1.68; 95% CI, 1.10–2.55), less likely to report using drugs right before or during sex with clients (AOR, 0.38; 95% CI, 0.26–0.56) and less likely to have tested positive for STIs at baseline (AOR, 0.63; 95% CI, 0.43–0.91).

Conclusions
These results provide a glimpse of the complex relationship between motherhood and women who are sex workers. Understanding the convergence of motherhood and sex work and how this can influence a woman’s decision when engaging in sex work and affect her health is essential to designing effective programs addressing reduce risk for HIV and STIs among FSWs in this region and elsewhere.
Brief Report: Peripheral Monocyte/Macrophage Phenotypes Associated With the Evolution of Cognitive Performance in HIV-Infected Patients
Authors: Fabbiani Massimiliano , Muscatello Antonio , Perseghin Paolo , Bani Marco , Incontri Arianna , Squillace Nicola , Lapadula Giuseppe , Gori Andrea , Bandera Alessandra 
Published: June 2017

Background:
The contribution of monocyte activation in the development of HIV-associated neurocognitive disorders is not completely understood. This study aimed to explore the predictive value of peripheral monocyte/macrophage (M/M) phenotypes on the evolution of cognitive performance in a population of virologically suppressed HIV-infected patients.

Setting:
Prospective, observational, longitudinal study.

Methods:
HIV-1-infected patients with HIV-RNA <50copies/mL for >12 months underwent neuropsychological examination at baseline and after 1 year. Cognitive performance was evaluated using Z-transformed scores, and neurocognitive impairment (NCI) was defined according to Frascati criteria. Peripheral M/M phenotypes (classic CD14++CD16−, intermediate CD14++CD16+, and nonclassic CD14+CD16++) and specific surface activation markers (eg, CD163, CD11b, and CD38) were evaluated using flow cytometry at baseline. Predictive value of peripheral M/M phenotypes on the evolution of cognitive performance over 1-year follow-up was also evaluated.

Results:
Overall, 54 patients [85.2% men, median age 50 years (range 27–60 years), 27.8% hepatitis C virus coinfected, 48.1% with past AIDS-defining events, median nadir CD4 83 cells/μL (range 1–334), median baseline CD4 547 cells/μL (range 136–1652)] were enrolled. Proportion of patients with NCI was low, accounting for 13% at baseline and 16.5% after 1 year (P = 0.687). Memory was the only single domain in which decreased performance after 1 year was observed (−0.25 Z-score, P = 0.025). In patients with significant decrease (≥0.5 SD) in memory performance (n = 20), significantly lower CD14++CD16+CD163+ (% CD14++CD16+) (P = 0.038) and higher CD14+CD38+ (% CD14+) (P = 0.030) levels were observed.

Conclusions:
In virologically suppressed HIV-infected patients, the evolution of memory performance could be linked to the expression of certain peripheral activated M/M phenotypes. Such associations should be verified in larger populations over the long term.
The Optimization of Short-Term Hepatocyte Preservation Before Transplantation
Authors: Fukuoka Kengo , Inagaki Akiko , Nakamura Yasuhiro , Matsumura Muneyuki , Yoshida Satoru , Imura Takehiro , Igarashi Yasuhiro , Miyagi Shigehito , Ohashi Kazuo , Enosawa Shin , Kamei Takashi , Unno Michiaki , Ohuchi Noriaki , Satomi Susumu , Goto Masafumi 
Published: June 2017

Background
No optimal methods for short-term hepatocyte preservation have been established. We have recently developed a prominent oxygen-permeable bag (Tohoku Device [TD]) for pancreatic islet culture and transplantation. In this study, we investigated whether TD is also effective for hepatocyte preservation and tried to optimize other conditions.

Methods
Hepatocytes were preserved in the following conditions, and their outcomes were observed. First, the effectiveness of TD was investigated. Second, hepatocyte medium (HM) and organ preservation solutions with or without fetal bovine serum (FBS) were compared. Third, as supplementations, FBS and human serum albumin (HSA) were compared. Fourth, low, room and high temperature were compared. And finally, hepatocytes preserved in various conditions were transplanted into the subrenal capsule space of nonalbumin rats and engrafted areas were assessed.

Results
The survival rate of hepatocytes preserved in TD tended to be higher and their viability and function were maintained significantly greater than those of non-TD group. Irrespective of FBS supplementation, the survival rate of HM group was significantly higher than those of organ preservation solution group while viabilities and plating efficiency were similar among them. Although survival rates of groups without FBS were extremely low, results of HSA supplemented group were not inferior to FBS supplemented group. Hepatocytes preserved at high temperature had the worst results. The engrafted area of TD group tended to be higher than those of other groups.

Conclusions
TD is effective for short-term hepatocyte preservation. HSA is a useful substitute for FBS, and preserving in HM at low temperature is recommended.
Computational studies of peptide-induced membrane pore formation
Authors: Lipkin Richard , Lazaridis Themis 
Published: June 2017

A variety of peptides induce pores in biological membranes; the most common ones are naturally produced antimicrobial peptides (AMPs), which are small, usually cationic, and defend diverse organisms against biological threats. Because it is not possible to observe these pores directly on a molecular scale, the structure of AMP-induced pores and the exact sequence of steps leading to their formation remain uncertain. Hence, these questions have been investigated via molecular modelling. In this article, we review computational studies of AMP pore formation using all-atom, coarse-grained, and implicit solvent models; evaluate the results obtained and suggest future research directions to further elucidate the pore formation mechanism of AMPs.
This article is part of the themed issue ‘Membrane pores: from structure and assembly, to medicine and technology’.
Real-time dynamics of carbon nanotube porins in supported lipid membranes visualized by high-speed atomic force microscopy
Authors: Zhang Yuliang , Tunuguntla Ramya H. , Choi Pyung-On , Noy Aleksandr 
Published: June 2017

In-plane mobility of proteins in lipid membranes is one of the fundamental mechanisms supporting biological functionality. Here we use high-speed atomic force microscopy (HS-AFM) to show that a novel type of biomimetic channel—carbon nanotube porins (CNTPs)—is also laterally mobile in supported lipid membranes, mimicking biological protein behaviour. HS-AFM can capture real-time dynamics of CNTP motion in the supported lipid bilayer membrane, build long-term trajectories of the CNTP motion and determine the diffusion coefficients associated with this motion. Our analysis shows that diffusion coefficients of CNTPs fall into the same range as those of proteins in supported lipid membranes. CNTPs in HS-AFM experiments often exhibit ‘directed’ diffusion behaviour, which is common for proteins in live cell membranes.
This article is part of the themed issue ‘Membrane pores: from structure and assembly, to medicine and technology’.