Search

Background: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global crisis challenging the worldwide healthcare systems. Many patients present with a mismatch of profound hypoxemia and few signs of respiratory distress (i.e., silent hypoxemia). This particular clinical presentation is often cited, but data are limited. Main Body: We describe dyspnea sensation as assessed by using the BORG scale in pulmonary patients admitted to the emergency room during a 4-week period and transferred to the respiratory department of Siloah Hospital, Hannover, Germany. From October 1 to November 1, 2020, 82 patients with hypoxemia defined as oxygen demand to achieve an oxygen saturation (SpO2) ≥92% were included. In 45/82 (55%) patients, SARS-CoV-2 was detected by PCR on admission. Among non-COVID patients, exacerbation of COPD was the main diagnosis (15/37, 41%). All subjects rated their perceived dyspnea using the modified Borg CR10 scale. Patients in the non-COVID group suffered from more dyspnea on the modified Borg CR10 scale (median 1, IQR: 0–2 vs. median 5, IQR: 3–6, p < 0.001). In multivariate analysis, “silent hypoxemia” as defined by the dyspnea Borg CR10 scale ≥5 was independently associated with COVID-19 and presence of severe hypocapnia with an odds ratio of 0.221 (95% confidence interval 0.054, 0.907, p 0.036). Conclusion: Among pulmonary patients with acute hypoxemia defined as oxygen demand, patients suffering from COVID-19 experience less dyspnea compared to non-COVID patients. “Silent” hypoxemia was more common in COVID-19 patients.

This is a type of manuscript that does not require an abstract

Interactivity is among the main characteristics of online journalism because it helps to build bridges between the media, journalists and the users to whom the news is directed. This article, based on in-depth interviews with 35 journalists, examines the concept of interaction as understood by media sources in Colombia, Peru and Ecuador. These three countries are culturally and historically similar and have similar levels of Internet access. Most of the journalists indicated that they have adjusted their practice to incorporate some aspects of Internet-based interaction, such as social network presence and increased transparency to users. However, the media organizations for which they work have adopted few such procedures and maintain limited capacity to manage online participation. The journalists expressed their desire for the development of further ways to facilitate interaction with users.

The climactic Los Chocoyos (LCY) rhyolitic eruption from Atitlán caldera (Guatemala) is a key chronostratigraphic marker for the Late Quaternary period that has been widely used for relative dating of paleoenvironmental, paleoclimate, and volcanic events throughout Central America and adjacent marine basins in the Pacific Ocean, the Caribbean Sea, and the Gulf of Mexico. Despite LCY tephra being an important marker horizon, a radioisotopic age for this eruption has remained elusive. LCY tephra has been dated at ca. 84 ka BP based on its occurrence in marine sediments with model δ18O ages, but this inferred age has not been independently confirmed through radioisotopic methods. This is due to the inherent limitations of radiocarbon dating (which is practically limited to ˂50 ka) and a lack of suitable materials for 40Ar/39Ar analysis in LCY tephra. To overcome this limitation, we applied 238U-230Th and (U-Th)/He zircon double-dating (ZDD). Due to zircon being alteration-resistant this method establishes absolute chronologies for and correlations between silicic tephra deposits, which are unaffected by glass alteration or complex compositional signatures within a single eruption. 238U-230Th zircon crystallization rim ages were obtained from LCY proximal tephras (~17 km from Atitlán caldera) including sub-units that may bear distinct glass compositions (e.g., fallout, ignimbrite, surge) as well as ultra-distal fallout tephra samples (~300 km from source) collected from drill cores at Petén Itzá Lake (ICDP) and the Pacific Ocean (IODP). All samples yielded zircon with statistically indistinguishable 238U-230Th zircon rim age spectra. These reveal continuous zircon crystallization from ca. 160 ka to ca. 74 ka, with peaks in zircon crystallization between 90-100 ka. ZDD eruption ages from two LCY fallout and one ignimbrite deposit are indistinguishable with error-weighted averages of 75.1 ± 3.2 ka (1σ; n = 16; MSWD = 4.1), 76.0 ± 2.5 ka (n = 16; MSWD = 2.5), and 72.8 ± 3.5 ka (n = 16; MSWD = 3.7). Considering all individual zircon results as a single population, a weighted average ZDD age of 74.8 ± 1.7 (1σ; n = 48; MSWD = 3.3) is obtained and considered as the best estimate for LCY eruption age. GIS-based reassessment of LCY eruptive volume uses thickness information from new 113 outcrops including 6–10 m thick pyroclastic density currents in Chiapas, Mexico (>130 km from the source) and suggests a minimum estimate volume of ~1200 km3, confirming the LCY eruption as the first‐ever recognized supereruption in Central America. The new ZDD age of 74.8 ± 1.7 ka for the LCY eruption is significantly younger than the commonly cited O-isotope stratigraphic age of 84 ± 5 ka. This age is close to the voluminous (2,800-5,600 km3) Young Toba Tuff (YTT) supereruption at ca. 73.8 ± 0.3 ka from Toba Caldera, Indonesia. Both YTT and LCY eruptions have been previously linked to prominent Quaternary climate excursions. Based on the new LCY eruption age, climate-forcing effects that are usually attributed to YTT may in fact be exacerbated by another supereruption occurring within a short time window of the YTT event.

Background: The inclusion of facial and bodily cues (clinical gestalt) in machine learning (ML) models improves the assessment of patients' health status, as shown in genetic syndromes and acute coronary syndrome. It is unknown if the inclusion of clinical gestalt improves ML-based classification of acutely ill patients. As in previous research in ML analysis of medical images, simulated or augmented data may be used to assess the usability of clinical gestalt.Objective: To assess whether a deep learning algorithm trained on a dataset of simulated and augmented facial photographs reflecting acutely ill patients can distinguish between healthy and LPS-infused, acutely ill individuals.Methods: Photographs from twenty-six volunteers whose facial features were manipulated to resemble a state of acute illness were used to extract features of illness and generate a synthetic dataset of acutely ill photographs, using a neural transfer convolutional neural network (NT-CNN) for data augmentation. Then, four distinct CNNs were trained on different parts of the facial photographs and concatenated into one final, stacked CNN which classified individuals as healthy or acutely ill. Finally, the stacked CNN was validated in an external dataset of volunteers injected with lipopolysaccharide (LPS).Results: In the external validation set, the four individual feature models distinguished acutely ill patients with sensitivities ranging from 10.5% (95% CI, 1.3–33.1% for the skin model) to 89.4% (66.9–98.7%, for the nose model). Specificity ranged from 42.1% (20.3–66.5%) for the nose model and 94.7% (73.9–99.9%) for skin. The stacked model combining all four facial features achieved an area under the receiver characteristic operating curve (AUROC) of 0.67 (0.62–0.71) and distinguished acutely ill patients with a sensitivity of 100% (82.35–100.00%) and specificity of 42.11% (20.25–66.50%).Conclusion: A deep learning algorithm trained on a synthetic, augmented dataset of facial photographs distinguished between healthy and simulated acutely ill individuals, demonstrating that synthetically generated data can be used to develop algorithms for health conditions in which large datasets are difficult to obtain. These results support the potential of facial feature analysis algorithms to support the diagnosis of acute illness.

Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent and intractable form of cardiac decompensation commonly associated with diastolic dysfunction. Here, we show that diastolic dysfunction in patients with HFpEF is associated with a cardiac deficit in nicotinamide adenine dinucleotide (NAD+). Elevating NAD+ by oral supplementation of its precursor, nicotinamide, improved diastolic dysfunction induced by aging (in 2-year-old C57BL/6J mice), hypertension (in Dahl salt-sensitive rats), or cardiometabolic syndrome (in ZSF1 obese rats). This effect was mediated partly through alleviated systemic comorbidities and enhanced myocardial bioenergetics. Simultaneously, nicotinamide directly improved cardiomyocyte passive stiffness and calcium-dependent active relaxation through increased deacetylation of titin and the sarcoplasmic reticulum calcium adenosine triphosphatase 2a, respectively. In a long-term human cohort study, high dietary intake of naturally occurring NAD+ precursors was associated with lower blood pressure and reduced risk of cardiac mortality. Collectively, these results suggest NAD+ precursors, and especially nicotinamide, as potential therapeutic agents to treat diastolic dysfunction and HFpEF in humans. This study was thankfully supported by the European Research Area Network on Cardiovascular Diseases (ERACVD) through the MINOTAUR consortium: S.S. (The Austrian Science Fund – FWF, I3301-B31), G.K. (Agence National de la Recherche – ANR), W.A.L. (Bundesministerium für Bildung und Forschung – BMBF), J.A.C. (Instituto de Salud Carlos III – ISCIII, AC16/00045) and A.L.M. (Portuguese Foundation for Science and Technology – FCT). M. Abdellatif acknowledges funding received from the European Society of Cardiology in form of an ESC Research Grant and from the Austrian Society of Cardiology (Präsidentenstipendium der ÖKG). The Austrian Science Fund supports S.F. (P27166-B23), A.P. (I3165, P29328-B26) and F.M. (P27893, P31727). S.S., J.V., F.M. and S.L.H. acknowledge support from the BioTechMed–Graz. G.K. is supported by the Ligue contre le Cancer (équipe labellisée); Association pour la recherche sur le cancer (ARC); Association Ruban Rose, Cancéropôle Ile-de-France; Chancelerie des universités de Paris (Legs Poix), Fondation pour la Recherche Médicale (FRM); Institut National du Cancer (INCa); Inserm (HTE); Inserm Transfert; Institut Universitaire de France; LeDucq Foundation; the LabEx Immuno-Oncology (ANR-18-IDEX-0001); the SIRIC Stratified Oncology Cell DNA Repair and Tumor Immune Elimination (SOCRATE); the SIRIC Cancer Research and Personalized Medicine (CARPEM). J.A.C. acknowledges funding from the Ministerio de Ciencia e Innovación (MCIN) through grant BIO2017-83640-P (AEI/FEDER, UE) and the Comunidad de Madrid (consortium Tec4Bio-CM, S2018/ NMT-4443, FEDER). A.S. acknowledges support from BioPersMed Graz. S.K. receives funding from the Austrian Research Promotion Agency FFG (VASCage; Nr. 868624). The Bruneck Study was supported by the Pustertaler Verein zur Prävention von Herz-und Hirngefäßerkrankungen, Gesundheitsbezirk Bruneck, and the Assessorat für Gesundheit, Province of Bolzano, Italy. Sí

Setting Hookah smoking among young adults remains a public health threat. Increasing research has uncovered the deleterious effects of hookah smoking, including both acute and chronic health conditions. Due to the current lack of regulation, hookah bars/lounges lack protocols for equipment sanitation. Objectives To examine evidence of bacterial contamination in hookah pipes due to a lack of sanitation regulations. Design For this field/laboratory study, 10 hookah bars/lounges were studied. Isolated bacteria were characterized and identified by species using 16S ribosomal RNA gene sequencing. Results At the 10 hookah bars sampled, the mouthpiece had the highest bacterial prevalence and diversity. Some of the bacterial isolates were found to be antibiotic-resistant. Ten of the isolated bacteria were Gram-positive and two were identified as Gram-negative. Conclusion Levels of bacterial contamination vary widely from one hookah bar to the next, and reflect a lack of industry standards for cleaning these devices. Bacterial contamination of hookah pipes may represent a fomite for transmission of infectious diseases. Our results warrant future surveillance of hookahs to monitor for potential human pathogens.

Purpose Left ventricular assist device (LVAD) implantation is an invasive treatment for advanced heart failure. Anticoagulation is required to prevent thrombotic events and subsequently bleeding complications are feared, most commonly gastrointestinal and intracranial. The aim of this analysis was to identify risk factors for severe pulmonary hemorrhage (SPH) after LVAD implantation. Methods We retrospectively analyzed our institutional database of 125 patients who underwent LVAD implantation between 2008 and 2019 and reviewed pre-/ intra-/ and postoperative variables, duration of intensive care unit (ICU) stay, ventilation time and hospital mortality. Results Nine out of 125 patients suffered SPH in their postoperative course. None of them had a known history of lung disease or bleeding disorder. No differences were noted between LVAD device manufacturers, intraoperative management including blood, plasma, platelet and coagulation factor transfusion or pulmonary vasodilator administration. Concomitant aortic valve replacement was statistically more common in the group with SPH (33.3% versus 7.0%, p = 0.034). Postoperatively, patients with SPH developed kidney failure (100% versus 36.7%, p = 0.001) with need for renal replacement more frequently (100% versus 24.7%, p Conclusion SPH is a rare but very serious complication after LVAD implantation and significantly worsens prognosis. Risk factors remain uncertain and may be related to parameters not included in our database, such as frequent suctioning or empiric bronchoscopy causing airway irritation.

Background Due to globally increasing donor organ shortage, investigation of previously described risk factors for utilizing marginal donor hearts is needed. The aim of this study was to determine the impact of elevated donor serum troponin I (TnI) levels on outcome after heart transplantation (HTx). Methods Between January 1996 and August 2013, 161 patients were reviewed for donor TnI serum levels (>0.3 ng/mL was considered elevated), postoperative outcome parameters, 30-day mortality, and 1-, 3-, and 5-year survival. Results TnI levels were elevated in 45 (28.0%) donors. Recipients of hearts with elevated TnI had higher incidence of postoperative systolic dysfunction, prolonged inotropic support, prolonged mechanical ventilation, and longer intensive care unit (ICU) stay (p Conclusions Elevated donor TnI serum concentration seems to be a marker for adverse outcome and increased short- and long-term mortality after HTx. Nevertheless, many other perioperative variables and parameters can be associated with outcome.

Merkel cell carcinoma (MCC) is a rare but aggressive neuroendocrine tumor of the skin with an increasing incidence. The clinical course is variable and reliable prognostic factors are scarce. Tumor angiogenesis has been shown to have prognostic impact in different types of cancer. The aim of our study was to determine potential prognostic factors, including tumor vascularization, for clinical outcome of MCC.The medical records of 46 patients with MCC diagnosed between 1997 and 2010 were analyzed retrospectively. Tissue samples were immune-stained for the lymphatic endothelial vessel marker podoplanin/D2-40 and the panvascular marker CD31. These immunostained sections were analyzed using computer-assisted morphometric image analyses. Aside from the parameters of tumor vascularization, clinicopathologic features were investigated, and progression-free survival (PFS) and tumor-specific survival (TSS) were assessed. Univariate and multivariate analyses were performed to determine prognostic factors.Male sex of the MCC patients and a high cross-sectional whole vessel area (WVA) in relation to the entire tumor area as determined on CD31-stained tumor sections were found to be negative prognostic factors for PFS in a univariate and multivariate regression analysis. Ulceration of the primary tumor was significantly associated with both impaired PFS and TSS.Our results indicate a high prognostic impact of tumor vascularization on the clinical outcome of MCC patients. Male sex and ulceration of the primary MCC were identified as independent unfavorable prognostic markers for the clinical outcome. As an outlook, MCC patients with increased angiogenesis might be identified and subjected to a targeted anti-angiogenic treatment.

Background Acute aortic dissection type A (AADA) is one of the most life-threatening situations and surgical demanding procedures even today. Usually AADA develops spontaneously, but it can be related also to interventional procedures. Methods We analyzed the data of 14 patients surgically treated in our institution with catheter-induced AADA (ciAADA) during coronary angiography between January 2004 and December 2014. Data were compared with overall AADA patients in this time period (n = 288). Results Nine of the 14 patients were female. Subjects were significantly older compared to the AADA patients (69 ± 11 vs. 62 ± 11; p = 0.021). At admission, ciAADA patients were more often hemodynamically instable and mechanically ventilated. Twelve patients underwent replacement of the ascending aorta and two patients received a modified Bentall operation. Cardiopulmonary bypass time (210 ± 92 vs. 172 ± 51 min) and cross-clamp time (122 ± 63 vs. 92 ± 40 min) were significantly longer due to additional coronary artery bypass grafts in 71.4 versus 3.1% due to myocardial ischemia. Operative mortality (7.1 vs. 2.1%, p = 0.29) and 30-day mortality (50.0 vs. 10.7%, p Conclusion Coronary angiography–induced AADA is a rare but severe complication. Due to additional myocardial ischemia and preoperative hemodynamic instability, patients with ciAADA have adverse outcome compared to overall AADA patients.

Background Historically, female patients had worse outcome undergoing heart surgery. No recent data exist on gender-specific outcome after moderate hypothermic circulatory arrest (MHCA). The aim of this large retrospective analysis was to investigate gender disparity in patients undergoing elective surgery of ascending aorta in MHCA at 24°C. Methods We conducted a retrospective review of 905 (33.3% female) cases of elective heart surgery in MHCA for ascending aortic aneurysm (90.9%) or severely calcified aorta (12.5%) between 2001 and 2015. Furthermore, 299 female and 299 male patients matched by propensity score were compared. Patients with dissection of the aorta were excluded. Results Women were older (68.4 ± 9.9 vs. 65.8 ± 11.6 years; p = 0.002), had higher logistic EuroSCORE I (18.4 [11.7; 29.2] vs. 12.3% [7.4; 22.6]; p Conclusion This study supports the hypothesis that female gender is not associated with increased short-term mortality or perioperative adverse events in elective aortic surgery in MHCA.

Interactivity is a factor on which cyber journalism is based and summarizes participation options between a user and the medium, a user with other users, and a user with editors. In this study, we focus on the latter in three countries&mdash, Colombia, Peru, and Ecuador&mdash, which have been identified owing to their technological gap and the emerging importance of online communication for their respective societies. Through 35 in-depth interviews with journalists from these countries, we analyzed the concept of interactivity of these professionals and their relationship with users. The results revealed that the journalists positively valued civic contributions as a space for diagnosis, although they do not perceive its informational value, as they relate them to the context of opinions. These results verify the prevalence of journalism as strongly influenced by conventional offline production routines.

Inflammation is a major driver of cardiac remodeling. Cardiac fibroblasts play an integral role in cardiac inflammation, fibrosis and remodeling. The orphan G-protein-coupled-receptor 5B of family C (GPRC5B) has recently been shown to have pro-inflammatory effects in adipocytes via the NFκB-signaling-pathway. Here, we investigated whether GPRC5B is involved in myocardial inflammation and fibrosis. Using neonatal rat cardiac fibroblasts (NRCF) we show that the transcription and the expression of endogenous GPRC5B is induced by stimulation with TNFα and LPS as well as through cyclic mechanical stretch, while the principle pro-fibrotic factor TGFβ has no effect on the GPRC5B expression. Furthermore, we demonstrate that adenoviral overexpression and siRNA-mediated knockdown of GPRC5B in NRCF significantly alters the transcription level of the pro-inflammatory and pro-fibrotic cytokines TNFα, IL-1β, IL-6 and MCP-1, and extracellular matrix-degrading MMP-9 in vitro. Additionally, in adult GPRC5B-transgenic mice the protein expression of collagen-1A1 is decreased and the production of MMP-9 is increased, indicating remodeling of the extracellular matrix in vivo. Our data show that GPRC5B is up-regulated by inflammatory signals and mechanical stress in NRCF, while GPRC5B modulates the inflammatory response of cardiac fibroblasts and the degradation of extracellular matrix-proteins in the mice heart. Thus, our findings are the first to report a novel role of the orphan receptor GPRC5B in fibroblast-driven myocardial inflammation and cardiac remodeling.

The spectrometer is the most important back-end in single antenna radio astronomy observations. The state-of-the-art designs for this type of instruments propose to reduce the effects of spectral leakage by using the Polyphase Filter Bank (PFB) technique and to achieve wideband and high resolution by using digital, reconfigurable, and high-performance computing hardware, such as commercial-available FPGA and GPU. We herein describe the development of a prototype PFB spectrometer using an integrated hardware and software development environment from National Instruments (Nl), along with FlexRIO FPGA technology for acquisition and CUDA-enabled GPU card for intensive processing. The results show that the proposed design, configured as a 4-tap PFB with 222 channels and 200MHz instantaneous bandwidth, is 95 times faster than a CPU implementation. It can be concluded that the hardware and software design approach used to prototype the spectrometer in this paper must be further studied within radio astronomy applications.

BACKGROUND: Epilepsy in the cat is a serious medical condition. To date there are no licensed treatments for feline epilepsy and no well-controlled clinical studies on the efficacy or safety of antiepileptic drugs in cats. The aim of this study was to collect tolerability data and first exploratory efficacy data of imepitoin in both healthy and epileptic cats. RESULTS: In two tolerability studies, 30 healthy cats received imepition twice daily in doses of 0, 30, 40 or 80 mg/kg bodyweight for 30 days. No serious adverse events were observed in any of the dose groups. In the imepitoin treated groups, emesis was observed in some animals temporarily and intermittently mainly in the second and third weeks of treatment. In a small, single-arm, open label, uncontrolled clinical trial eight cats suffering from idiopathic epilepsy were treated with imepitoin twice daily at doses of 30 mg/kg bodyweight for 30 days. Four of these cats (50%) achieved seizure freedom for at least 8 weeks under treatment. Adverse events, mostly lethargy, decreased appetite and emesis, were often mild and transient. CONCLUSION: In summary, imepitoin was well tolerated in healthy and epileptic cats and showed in a pilot trial indication for efficacy in treating feline epilepsy.

Aims Veno-arterial extracorporeal life support (ECLS) is an established method to stabilize acute circulatory failure. Parameters and data on when to ideally wean circulatory support are limited. Bilirubin is a marker of end-organ damage. Therefore, the purpose of this large study was to evaluate the impact of dynamic changes of elevated bilirubin levels on survival in patients on ECLS. Methods and results We reviewed 502 consecutive cases of ECLS from 2007 to 2015. Bilirubin levels were recorded before implantation and until six days after explantation. Dynamic bilirubin changes, and hemodynamic and laboratory outcome parameters were compared in survivors and nonsurvivors. Reason for ECLS implantation was cardiac arrest with ongoing resuscitation in 230 (45.8%), low cardiac output in 174 (34.7%) and inability to wean off cardiopulmonary bypass in 98 (19.5%) patients. 307 (61.2%) patients were weaned off ECLS, however, 206 (41.0%) survived. Mean duration of ECLS was 3 (2–6) days, and survivors received significantly longer ECLS (5 vs 3 days, p < 0.001). Survivors had significantly lower baseline bilirubin levels (p = 0.003). Bilirubin started to rise from day 2 in all patients. In survivors, bilirubin levels had trended down on the day of ECLS explantation and stayed at an acceptable level. However, in weaned patients who did not survive and patients who died on ECLS bilirubin levels continued to rise during the recorded period. Conclusion ECLS support improves survival in patients with acute circulatory failure. Down trending bilirubin levels on veno-arterial ECLS indicate improved chances of successful weaning and survival in hemodynamically stable patients.

Patients with left ventricular assist devices (LVADs) who develop stage IV sacral pressure sores (SPS) have an increased procedural risk. We present the complications, including severe intra- and postoperative bleeding, diarrhea with metabolic acidosis, volume loss and acute on chronic renal failure, flap dehiscence and late LVAD outflow cannula thrombosis, in a 54-year-old male who underwent diverting ileostomy (DI) and subsequent fasciocutaneous flap (FCF) surgery for stage IV SPS while supported with an LVAD. Our experience suggests that, despite continuous heparinization, life-threatening thrombotic complications, such as device clotting, can occur. Therefore, the benefit of intervention has to outweigh the risk of bleeding, which should be managed with meticulous surgical technique and substitution of red blood cells rather than the reversal of heparinization or the substitution of clotting factors. Continuation of double anti-platelet therapy should also be considered.

The paper presents an overview of the finite element (FE) analyses on the trim coils (TCs) and tests performed at IPP, and focuses on some specific aspects of the TC assembly. Global FE models (GM) of two types of TCs predicted the coil deformations and reaction forces on the supports. Dead weight, temperature rise during operation up to 80 °C, electromagnetic loads of 19 field configurations, and outer vessel (OV) deformations have been taken into account. In addition, local models were created for the critical winding pack (WP) regions as well as for each support clamp, and were analyzed with boundary conditions determined by the GM. The detailed WP sub-models were developed to verify the insulation strength against local stresses. The simulations were supported by various mechanical tests under static and cyclic loads. Aim of these experiments was to determine the time dependent behavior of the silicone rubber pads which are used as interfaces between TC and supports, and to check and optimize the assembly tools as well as procedures for the TCs and their supports.

Advanced age is a known risk factor for morbidity and mortality after coronary artery bypass grafting (CABG). Minimized extracorporeal circulation (MECC) has been shown to reduce the negative effects associated with conventional extracorporeal circulation (CECC). This trial assesses the impact of MECC on the outcome of elderly patients undergoing CABG. Eight hundred and seventy-five patients (mean age 78.35 years) underwent isolated CABG using CECC (n=345) or MECC (n=530). The MECC group had a significantly shorter extracorporeal circulation time (ECCT), cross-clamp time and reperfusion time and lower transfusion needs. Postoperatively, these patients required significantly less inotropic support, fewer blood transfusions, less postoperative hemodialysis and developed less delirium compared to CECC patients. In the MECC group, intensive care unit (ICU) stay was significantly shorter and 30-day mortality was significantly reduced [2.6% versus 7.8%; p

— The Wendelstein 7-X (W7-X) modular stellarator is in the assembly phase at the Max-Planck-Institut fur Plasmaphysik in Greifswald, Germany. The design of the “basic machine”, i.e. without in-vessel components, diagnostics and periphery, is largely completed, structural parameters such as bolt preload, initial conditions for contact elements, etc. are defined, and most of the components are manufactured and partly assembled. Therefore, the focus of structural analysis was shifted towards fast analyses of nonconformities, changes in the assembly procedure, and exploration of operational limits. Assembly-related work is expected to continue until commissioning of the machine, however, with decreasing intensity. In parallel the analysis requirements for in-vessel components, diagnostics and periphery will increase. This paper focuses on the most remarkable results, on special problems which had to be solved, on strategic issues like parameterization, complex finite element model structuring and benchmarking with alternative models in different codes, on assumptions of reasonable safety margins and expected tolerances, and on confirmation of analysis results by tests. Finally it highlights some lessons learned so far, which might be relevant also for other large fusion machines, and gives an outlook on future work. Keywords: Stellarator, Wendelstein 7-X, Finite-element analysis, Magnet system, Cryostat system

The thermal insulation of Wendelstein 7-X cryostat consists of multi-layer insulation (MLI) and a thermal shield. The shield is cooled by helium gas flowing in pipes which are attached to the shields via copper strips or braids. The paper presents the basic thermal and mechanical layout of the thermal shield. The design is strongly influenced by the tight design space. Main mechanical loads on the shield are electromagnetic forces resulting from rapid shut down of the magnet system and the self weight. Design and calculations were performed iteratively. Copper and brass were checked in combination with different electrical isolation variants. The induced eddy currents will be reduced if the upper and the lower half shells of the cryostat are electrically isolated against each other. The cryostat shield and the port shields are made of brass. The expected heat loads on the shield were estimated. The resulting temperature distribution was then calculated for brass and copper shield panels. The average shield temperature is below 85 K and fulfills the thermal requirements.

Radiotherapy alone is the most common treatment for metastatic spinal cord compression (MSCC) from relatively radioresistant tumors such as renal cell carcinoma, colorectal cancer, and malignant melanoma. However, the results of the "standard" regimen 30 Gy/10 fractions need to be improved with respect to functional outcome. This study investigated whether a dose escalation beyond 30 Gy can improve treatment outcomes.A total of 91 patients receiving 30 Gy/10 fractions were retrospectively compared to 115 patients receiving higher doses (37.5 Gy/15 fractions, 40 Gy/20 fractions) for motor function and local control of MSCC. Ten further potential prognostic factors were evaluated: age, gender, tumor type, performance status, number of involved vertebrae, visceral or other bone metastases, interval from tumor diagnosis to radiotherapy, pretreatment ambulatory status, and time developing motor deficits before radiotherapy.Motor function improved in 18% of patients after 30 Gy and in 22% after higher doses (p = 0.81). On multivariate analysis, functional outcome was associated with visceral metastases (p = 0.030), interval from tumor diagnosis to radiotherapy (p = 0.010), and time developing motor deficits (p0.001). The 1-year local control rates were 76% after 30 Gy and 80% after higher doses, respectively (p = 0.64). On multivariate analysis, local control was significantly associated with visceral metastases (p = 0.029) and number of involved vertebrae (p = 0.043).Given the limitations of a retrospective study, escalation of the radiation dose beyond 30 Gy/10 fractions did not significantly improve motor function and local control of MSCC in patients with relatively radioresistant tumors.

In this paper, we introduce the customer-insight based approach that Deutsche Post DHL adopted to improve its global express delivery business. DHL has used the operations research based brand assessment tool in more than 20 large countries on four continents since 2004. The tool supports local brand managers in allocating marketing resources to activities that grow the global brand in their country market. Its application led to an estimated increase in brand value of USD 1.32 billion over five years. This corresponds to a return on investment of 38 percent and an internal rate of return of 24 percent. The tool's implementation also had a major impact on DHL's strategy and organization.

We aimed to determine the diagnostic performance of biomarkers in predicting myocardial fibrosis assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) in patients with hypertrophic cardiomyopathy (HCM). LGE CMR was performed in 40 consecutive patients with HCM. Left and right ventricular parameters, as well as the extent of LGE were determined and correlated to the plasma levels of midregional pro-atrial natriuretic peptide (MR-proANP), midregional pro-adrenomedullin (MR-proADM), carboxy-terminal pro-endothelin-1 (CT-proET-1), carboxy-terminal pro-vasopressin (CT-proAVP), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1) and interleukin-8 (IL-8). Myocardial fibrosis was assumed positive, if CMR indicated LGE. LGE was present in 26 of 40 patients with HCM (65%) with variable extent (mean: 14%, range: 1.3-42%). The extent of LGE was positively associated with MR-proANP (r = 0.4; P = 0.01). No correlations were found between LGE and MR-proADM (r = 0.1; P = 0.5), CT-proET-1 (r = 0.07; P = 0.66), CT-proAVP (r = 0.16; P = 0.3), MMP-9 (r = 0.01; P = 0.9), TIMP-1 (r = 0.02; P = 0.85), and IL-8 (r = 0.02; P = 0.89). After adjustment for confounding factors, MR-proANP was the only independent predictor associated with the presence of LGE (P = 0.007) in multivariate analysis. The area under the ROC curve (AUC) indicated good predictive performance (AUC = 0.882) of MR-proANP with respect to LGE. The odds ratio was 1.268 (95% confidence interval 1.066-1.508). The sensitivity of MR-proANP at a cut-off value of 207 pmol/L was 69%, the specificity 94%, the positive predictive value 90% and the negative predictive value 80%. The results imply that MR-proANP serves as a novel marker of myocardial fibrosis assessed by LGE CMR in patients with HCM.

Radiotherapy alone is the most common treatment for metastatic spinal cord compression (MSCC). Patients with relatively radioresistant tumors and oligometastatic disease may benefit from more intensive therapies (surgery, high-precision radiotherapy). If such therapies are not available, one can speculate whether patients benefit from dose escalation beyond the standard regimen 30 Gy in ten fractions. Of 206 patients with MSCC from relatively radioresistant tumors (renal cell carcinoma, colorectal cancer, malignant melanoma), 51 had oligometastatic disease (no visceral or other bone metastases, involvement of only one to three vertebrae). In this subset, 21 patients receiving 30 Gy in ten fractions were retrospectively compared to 30 patients receiving higher doses. Seven further potential prognostic factors were investigated: age, gender, tumor type, performance status, interval from tumor diagnosis to radiotherapy of MSCC, pretreatment ambulatory status, and time developing motor deficits before radiotherapy. Motor function improved in 52% of patients after 30 Gy and 40% after higher doses (p = 0.44). On multivariate analysis, functional outcome was associated with interval from tumor diagnosis to radiotherapy (p = 0.020). 1-year local control rates were 84% after 30 Gy and 82% after higher doses (p = 0.75). No factor was associated with local control. 1-year survival rates were 76% after 30 Gy and 63% after higher doses (p = 0.52). On multivariate analysis, survival was associated with performance status (p = 0.022) and interval from tumor diagnosis to radiotherapy (p = 0.039), and almost with pretreatment ambulatory status (p = 0.069). Dose escalation beyond 30 Gy in ten fractions did not improve motor function, local control, and survival in MSCC patients with oligometastatic disease from relatively radioresistant tumors.

This paper reviews the main aspects of the design, fabrication and characterization of GaAs Gunn diodes intended to be used in advanced driver assistance systems. The corresponding Gunn diode based oscillators operate at the microwave frequency of 77 GHz and deliver an output power up to 19.2 dBm (83.2 mW). To fulfill the high demands of the automotive industry, temperature stability and a high grade of frequency purity, the Gunn diode structure includes a hot electron injector. This is based on the heteroepitaxy of a graded gap AlxGa1-xAs layer and an adjacent thin highly doped GaAs layer. The hot electron injector properties are investigated using dc and rf electrical measurements, including the temperature influence as well. Specific production related data of the cavity oscillators using our Gunn diodes are presented. New alternatives, such as the resonant tunneling emitter as a hot electron injector and the Gunn diode based MMIC as oscillator, are introduced.

A mild swelling of the left periorbital was detected on a routine physical exam of a healthy captive adult peregrine falcon. Despite treatment, the swelling did not subside and within twenty-five days was causing significant exophthalmia and medial deviation of the left globe. A retrobulbar fusiform cell sarcoma was diagnosed with histopathology, then light microscopy and immunohistochemical staining confirmed the diagnosis of a rhabdomyosarcoma.

Internet usage continues to explode across the world with digital becoming an increasingly important source of competitive advantage in both B2C and B2B marketing. A great deal of attention has been focused on the tremendous opportunities digital marketing presents, with little attention on the real challenges companies are facing going digital. In this study, we present these challenges based on results of a survey among a convenience sample of 777 marketing executives around the globe. The results reveal that filling "talent gaps", adjusting the "organizational design", and implementing "actionable metrics" are the biggest improvement opportunities for companies across sectors.

Background Epicardial ablation concomitant to cardiac surgery is an easy and safe approach to treat atrial fibrillation (AF), but its efficacy in longstanding persistent (LsPe) AF remains intermediate. Although larger left atrial size has been associated with worse outcome after ablation, biochemical predictors of success are not well established. The aim of this study was to evaluate relationship between biochemical marker, echo-characteristic and cardiac rhythm in 6 months follow-up after epicardial ultrasound (HIFU) ablation. Methods We included 78 consecutive patients, who underwent elective cardiac surgery. 42 patients with AF (11.9% paroxysmal, 23.8% persistent, 64.3% LsPeAF) underwent concomitant HIFU ablation (AF ablation group), 16 with AF underwent cardiac surgery without ablation (AF control) and 20 had preoperatively normal sinus rhythm (SR control). We measured plasma ANP secretion before, on postoperative day (POD) 1, POD 7 as well as 3 and 6 months after surgery. Moreover, we estimated cardiac rhythm and atrial mechanical function by Atrial Filling Fraction (AFF) and A-wave velocity in follow-up. Results Baseline ANP levels were higher in patients with LsPeAF, as compared to the paroxysmal and permanent AF and to the SR control group. Patients with LsPeAF (n = 27) who converted to SR had preoperatively smaller left atrial diameter (LAD) and LA area (p < 0.05) and higher ANP level (p = 0.009) than those who remained in AF at 6 months after ablation. Multivariate regression analysis revealed that only preoperative ANP level was an independent predictor of cardiac rhythm after ablation. Patients with LsPeAF and preoperative ANP >7.5 nmol/l presented with SR in 80%, in contrast to those with ANP

The possibilities of obtaining information about interband scattering processes in the bandgap regime of GaN from electron energy-loss spectra, taken in a dedicated scanning transmission electron microscope (STEM), are investigated. With the help of precise simulations of the zero-loss peak it is feasable to process, extract and analyse data in the extreme low-loss regime of a few electronvolts. The accuracy of the results is restricted predominantly by instrumental broadening functions. By modelling these accurately, it is possible to eliminate the effects of the tail of the zero-loss peak and to extract the low-loss spectrum together with the correct value for the bandgap of GaN. Furthermore, differences in the shapes of the low-loss spectra can be revealed, depending on the microstructural features, probed at different beam locations.

The Wendelstein 7-X modular stellarator is in the final assembly phase at the Max Planck Institute for Plasma Physics in Greifswald, Germany. The design and assembly of the “basic machine”, i.e. without in-vessel components, diagnostics and periphery, is completed. Structural parameters such as bolt preload, initial gap widths for contacts between structure elements, final magnet module positions, etc., were specified on the basis of detail numerical modeling and are now implemented. The focus of the numerical analysis has been shifted towards fast consideration of nonconformities and changes in assembly procedures, to preparation of commissioning, assessment of possible field disturbances, and exploration of operational limits. In parallel the analyses of in-vessel components, diagnostics and periphery are being continued. The paper focuses on the development, evolution and realization of analysis strategies, implemented numerical approaches and most remarkable results, and on a few specific issues like parameterization and complex finite element model structuring. Further subjects are reasonable safety margins in relation to expected tolerances and uncertainties, and the confirmation of analysis results by tests as well as their benchmarking with alternative models in different codes. Finally, some lessons learned so far which might be relevant for other large fusion machines are highlighted, and a brief outlook on future work is given.

Diisocyanate-induced asthma is difficult to diagnose since the immunopathological mechanisms and exposure determinants at the workplace are not well defined. The aim of this study was to evaluate the non-invasive methods of nasal lavage fluid (NALF) and induced sputum (IS) to enhance the diagnostic efficiency. Sixty-three diisocyanate-exposed workers with work-related shortness of breath underwent a standardized 4-steps-1-day-whole body exposure test with diisocyanates used at work up to 30 ppb. NALF and IS were collected before, 0.5, and 19 h after the end of exposure. Cellular composition and soluble inflammatory biomarkers were studied in the samples. In addition, ten controls with bronchial hyperresponsiveness, but without prior occupational diisocyanate exposure, were also examined. Twelve out of the 63 subjects (19 %) showed a significant asthmatic reaction (pulmonary responders) after challenge (FEV1 decrease >20 %). NALF samples did not demonstrate significant effects either on cellular composition or on mediator concentrations in the responders, non-responders, or controls at any time point. In contrast, in the IS samples of the pulmonary responders collected 19 h after challenge, the percentage of eosinophils was higher (p = 0.001) compared with baseline before challenge. Eosinophils were also increased 30 min and 19 h after challenge in IS samples of the responders compared with the non-responders or controls. In addition, 19 h after challenge the eosinophilic cationic protein (ECP) concentration was significantly higher in the responders than non-responders (p < 0.04) or controls (p < 0.002). In conclusion, positive asthmatic reactions to diisocyanates are accompanied by an influx of eosinophils into lower airways. Analysis of induced sputum should be implemented in the diagnostic procedure of diisocyanate-related airway diseases.

BACKGROUND: Cervical selective nerve root block (CSNRB) is a well-established, minimally invasive procedure to treat radicular cervical pain. However, the procedure is technically challenging and might lead to major complications. The objective of this study was to evaluate the feasibility of a three-dimensional puncture planning and two-dimensional laser-guidance system for CSNRB in an ex-vivo model. METHODS: Dyna-CT of the cervical spine of an ex-vivo lamb model was performed with the Artis Zee® Ceiling (Siemens Medical Solutions, Erlangen, Germany) to acquire multiplanar reconstruction images. 15 cervical nerve root punctures were planned and conducted with the syngo iGuide® laser-guidance system. Needle tip location and contrast dye distribution were analyzed by two independent investigators. Procedural, planning, and fluoroscopic time, tract length, and dose area product (DAP) were acquired for each puncture. RESULTS: All 15 punctures were rated as successful with 12 punctures on the first attempt. Total procedural time was approximately 5 minutes. Mean planning time for the puncture was 2.03 (±0.39) min. Mean puncture time was 2.16 (±0.32) min, while mean fluoroscopy time was 0.17 (±0.06) min. Mean tract length was 2.68 (±0.23) cm. Mean total DAP was 397.45 (±15.63) µGy m(2). CONCLUSION: CSNRB performed with Dyna-CT and the tested laser guidance system is feasible. 3D pre-puncture planning is easy and fast and the laser-guiding system ensures very accurate and intuitive puncture control.

The method of interferometric cross-correlation is used to obtain precise information about the phase and amplitude of the laser pulse induced interband polarization in semiconductors. With this technique it is possible to study the linear as well as nonlinear response of a sample. The light transmitted through a thin GaAs crystal after excitation with femtosecond pulses near the band gap is measured. The phase shift between the driving laser pulses and the induced polarization is measured in the time domain. The influence of additional pump pulses on the decay of the polarization is studied. The instantaneous frequency of the polarization depends on the laser center frequency, on the pump pulse delay time, and on the relative polarization of the pump pulse with respect to the test pulse

Non-invasive methods to assess inflammation of lower airways are induced sputum (IS), exhaled nitric oxide (eNO), and exhaled breath condensate (EBC). Here we focused on the assessment of airway inflammation with a panel of non-invasive methods in health care workers (HCWs) with suspected latex allergy with and without current allergic respiratory symptoms about 10 years after the latex ban in German health care facilities. Seventy-seven non-smoking subjects were examined by skin prick test and specific IgE measurements, eNO, IS, and EBC. Sensitivity, specificity, and positive and negative predicted values for relevant biomarkers were calculated using current asthma symptoms as the gold standard. Twenty-nine subjects (38%) reported ongoing asthmatic symptoms (AS). In these subjects the EBC concentrations of nitrogen oxides (NOx; p=0.027) and leukotriene B4 (p=0.025) were significantly higher than in subjects without AS. In addition, in the subjects with AS the numbers of eosinophils (p=0.015) and the concentrations of IL-5 (p= 0.021) in IS samples were significantly higher than in the subjects without AS. A good correlation between several inflammatory markers in IS was detected. The maximum Youden Index was reached for IS total eosinophils ≥3.5·104 with a test efficiency of 0.72. In conclusion, non-invasive inflammatory monitoring with EBC and IS may assist the diagnosis of allergic asthma. Self-reported current asthmatic symptoms were reflected by eosinophilic inflammation and the best parameter to support the asthma diagnosis is a total number of eosinophils ≥3.5·104 in IS.

The stellarator fusion experiment Wendelstein 7-X (W7-X) is currently under construction at the Max-Planck-Institut fur Plasmaphysik in Greifswald, Germany. The main magnetic field will be provided by a superconducting magnet system which generates a fivefold toroidal periodic magnetic field. However, not avoidable tolerances can result in small deviations of the magnetic field disturbing the toroidal periodicity. In order to have a tool to influence this field errors additional five normal conducting trim coils were designed to allow a fine tuning of the main magnetic field during plasma operation. The detailed design of the coils and the manufacturing will run within a collaboration program between the Princeton Plasma Physics Laboratory, Oak Ridge National Laboratory, Los Alamos National Laboratory and the Wendelstein 7-X project funded by the U.S. Department of Energy.

The Wendelstein 7-X (W7-X) modular stellarator is under construction at the Max-Planck-Institut fur Plasmaphysik in Greifswald, Germany. The W7-X magnet system contains 70 superconducting (sc) coils which are supported by a massive central steel ring structure via bolted connections and by numerous welded as well as gliding inter-coil elements. Load tests on prototypes of bolted coil to support ring connections whose flanges partially open during high field operation, and of sliding support structures between the coils showed that stick–slip events at their contact surfaces cause shock waves. In order to assess the risk of a shock-induced quench of the superconductor, one of the coils was subjected to impact loads – the so-called mechanical quench (MQ) test – in the course of the cryogenic acceptance tests at CEA in Saclay, France. No quench could be triggered even with the lowest coil stability margin. The paper demonstrates that the amplitudes of the shock waves in the W7-X magnet system are comparable to those generated by the impacts in the MQ tests. For that purpose, finite element (FE) models of both W7-X and the MQ test simulating the dynamic responses were developed and successfully validated against measurements.

International audience; Micro assembly is typically characterized by positioning tolerances below a few micrometers. In the case of the assembly of hybrid micro systems, such as optical systems, micro ball lenses or micro probes for measurement tasks, even positioning accuracies in the sub-micrometer range have to be achieved. The efficiency of the use of automated handling devices is strongly influenced by the flexibility of the equipment and the required application specific customizations. In this context a high precision assembly head is presented. It upgrades conventional robots with the ability to do fine alignment steps in sub-micrometer resolution and 6 DOF. Therefore it is equipped with a universal endeffector structure.

International audience; The development of automated production systems is subdivided in two mayor tasks. One is the development of the processes needed to meet the requirements for the product, the other is the setup of a control system enabling the hardware to perform these processes. Typically the larger amount of the available resources is needed for the setup of hardware and implementation of the required control mechanism, leaving only limited resources for the process development. Especially for small scale and prototype production with a high rate of changes, this is why fully automated solutions don't pay off and manual or partial manually assembly is preferred [1]. This paper introduces an approach how to separate the implementation effort of the hardware specific tasks from the process definition, allowing a fast and easy setup for new automation systems, due to simultaneous development and a high rate of reuse of previous solutions.

In the last years a scientific project was edited by the chair of traffic facility structures of the Bauhaus-Universität Weimar/Germany. Simulations for the actual and the predicted heavy load traffic were made. Based on these analyses it was detected, that the current load model for bridges is not future-proof. A modified load model with higher load values has been developed by several preliminary considerations and it was possible to show, that this load is sufficiently future-proof. With some examples the realized steps of the research work and the determined results are shown in this paper. Finally some suggestions for further necessary scientific research work are shown. The scientific project was executed under the authority of the Federal Ministry of Transport, Building and Urban Affairs (BMVBS) and the Federal Highway Research Institute (BAST) of Germany.