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A turbine array is an adjustable flow resistanceR placed in a tidal channel. Ideally, it is designedand operated to maximise energy yield. Garrett & Cummins(2005), using optimal control theory applied to the RCelementchannel (R) and basin (C), showed: the energyextraction from the flow PT + PD is maximised when theflow rate is slowed down by a factor of 1/√3. This resultis independent of the ratio of the extracted mechanicalpower PT to the total power extraction including the powerloss PD due to the mixing of the bypass flows within theturbine field. The optimisation task for turbine arrays ismaximising PT. This objective raises two questions: ”Whatis the maximum power PT that can be extracted, and what isthe optimal design (size, topology) and operation to achievethis output?” When addressing them, the literature stilluses the Betz ‘limit’ as a reference. The work presentedhighlights two major problems. First, the Betz ’limit’ isnot a constant upper bound for open channel flow. Thisproblem has been discussed and solved by the first author(2011, 2020). Second and more importantly, the presentedpaper points out the misconception under which severalresearch studies referred to array topologies as ‘optimal’with regard to design and operation. Hereby, the presentedpaper contributes to the advancement of tidal power on anaxiomatic basis. The misleading by Betz and overvaluingof transient effects is made transparent in a scientificdiscourse.

Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020. Background eHealth solutions may be used for personalized care and to provide assistance for disease control to CAD patients over the compendium of the disease. TIMELY is the first artificial intelligence-driven eHealth approach based on cardiac rehabilitation (CR) components connected with internet of things devices. For usability and acceptance of the TIMELY eHealth solution, patients are actively involved in development through a Living Lab approach. Purpose To define patients’ needs for an eHealth-based self-care support CR maintenance program. Methods The Living Lab used a guided survey among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to use of technology and patients’ opinion on usefulness of suggested eHealth features. Importance/usefulness was rated on a 5-point Likert scale (median score). Results 79 CAD patients (20% female) participated (Spain, n=30; Germany, n=49). Patients’ mean age was 57 years (range 37–79), educational level was 87% ≤high school. All patients owned a smartphone also used for information (76%) and documentation (43%). Patients rated the importance of CR components (diet, stress management, regular exercise, risk factor reduction, smoking cessation) along the continuum of care as "very high" (5/5), with no difference between the two centers. Individual support for regular exercise after structured CR was rated "high" (4/5). Renewal of recommended training intensity (heart rate), evaluation of training progress, and suggestions on activities were rated "useful" (4/5) to "very useful" (5/5). The importance of support for stress management, risk factor management, diet, and medication adherence was rated 3/5. Usefulness of an education platform was rated 4/5, motivational messages scored 3/5. Individual feedback by a person was rated over feedback by a virtual agent (4/5 vs. 3/5). The availability of electronic health records was evaluated as "very useful" (5/5) remote blood pressure management and ECG monitoring were rated as "useful" (4/5). All items ranged between 1-5, indicating large interindividual differences. No differences between nationalities were detected for exercise-/medical-related features. For other CR features, overall progression documentation was significantly rated as more useful by German patients compared to Spanish patients (5/5 vs. 4/5, p Conclusions Patients expressed a strong need for individual support of physical exercise and updated training recommendations during CR maintenance. The observed inter-individual differences regarding usefulness and acceptance indicate the need for an adaptive system to reduce barriers for eHealth access. Patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD.

Background eHealth innovations have set the stage to optimize personalized care and provide assistance for disease control to patients with CAD. TIMELY is the first artificial intelligence (AI)-driven eHealth approach that employs internet of things devices and is based on cardiac rehabilitation (CR) components. To guarantee acceptance and usability of eHealth solutions, patients are actively participating in development through a Living Lab approach. Purpose To define patients' needs for an eHealth-based lifestyle intervention and self-care support. Methods The Living Lab approach included a guided survey conducted among CAD patients at CR centers in Germany and Spain during inpatient or outpatient CR, respectively. Questions referred to current use of technology and patients' opinion on the usefulness of suggested features of a future eHealth application. Ratings for usefulness/importance were recorded on a 5-point Likert scale reported as median score. Results 79 patients (20% female) were interviewed (DE, n=49; ES, n=30). Patients' mean age was 57 years (range 37–79), educational level was 87% ≤ high school and 13% > high school. All patients owned a smartphone that they also used for information (76%) and documentation (43%). Patients rated the importance of all CR components (regular exercise, healthy diet, stress management, smoking cessation, risk factor reduction) along the continuum of care as “very high” (5/5). Individual need for regular exercise support after structured CR was rated “high” (4/5). Exercise reminders, suggestions on activities, update of recommended training heart rate, evaluation of training progress, and achieved goals were rated “useful” (4/5) to “very useful” (5/5). The importance of support for diet, stress management, overall risk factor management, and medication was rated 3/5. Usefulness of a learning/education tool was rated 4/5, while motivational messages scored 3/5 and individual feedback of a person or virtual agent scored 4/5 and 3/5, respectively. The availability of electronic health records was evaluated as “very useful” (5/5) remote ECG monitoring and blood pressure management were rated as “useful” (4/5). The range of all items accessed was 1–5, indicating large interindividual differences. No significant differences existed between female and male patients or German and Spanish patients, though the importance of sharing training progress with family/ friends was rated higher by men (3/5) compared to women (1/5) and higher by Spanish (4/5) compared to German patients (2/5). Conclusions CR patients expressed a strong need for individual support of regular physical exercise and updated training recommendations. The observed inter-individual differences regarding usefulness and acceptance indicate the need for a highly adaptive system to prevent exclusion from eHealth access. CR patients from Germany and Spain showed equally high acceptance of eHealth components for the management of CAD. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Commission Horizon 2020

The aim of this study was to determine the mineral composition of 10 plants especially Alchornea cordifolia, Alternanthera bettzickiana, Annona senegalensis, Cyttaranthus congolensis, Dissotis brazzae, Justicia secunda, Harungana madagascariensis, Hura crepitans, Hypoxis angustifolia and Vigna unguiculata used in the management of sickle cell disease by traditional practitioners in Kwilu Province. The Plants collection was done at Kwilu province, sample were evaluated through fluorescence spectrometric analysis. These plants were harvested in Kwilu province in the Democratic Republic of Congo The mineral composition analysis was carried out using the fluorescence spectrometric method. This study revealed presence of Twenty-three (23) mineral elements, in each of these plants among others: Potassium (K), Phosphorus (P), Calcium (Ca), Sodium (Na), Magnesium (Mg), Sulphur (S), Chlorine (Cl) and trace elements such as: Aluminum (Al), Silicon (Si), Vanadium (V), Chromium (Cr), Manganese (Mn), Iron (Fe), Nickel (Ni), Copper (Cu), Zinc (Zn), Selenium (Se), Bromine (Br), Molybdenum (Mo), Tin (Sn), Iodine (I), Barium (Ba) and Lead (Pb). Iron, Zinc (Zn), Selenium (Se), Copper (Cu), Calcium (Ca), Magnesium (Mg) and Manganese (Mn) are mineral elements that are related to sickle cell disease. Of all these elements, Potassium and Calcium were in a higher content while Lead, Tin, Bromine, Copper and Nickel are in trace amounts. The correlation coefficients obtained between the mineral elements are significant. The presence of some mineral elements like Fe, Zn, mg and Se can be useful for sickle cell disease patients.

International audience; Bacillus Calmette-Guerin (BCG) remains the only FDA-approved first-line therapy in patients with high-risk non-muscle invasive bladder cancer. Recurrences, even after adequate BCG therapy, are common and the efficacy of second-line therapies remains modest. Therefore, early identification of patients likely to recur and treatment after recurrence remain critical unmet needs in the clinical care of bladder cancer patients. To address these deficits, a better understanding of the mechanisms of resistance to BCG-therapy is needed. The virtual update of the International Bladder Cancer Network (IBCN) on the biology of response to BCG focused on potential mechanisms and markers of resistance to intravesical BCG therapy. The insights from this meeting will be highlighted and put into context of previously reported mechanisms of resistance to BCG in this review.

Numerous experiments on laser-driven proton acceleration in the MeV range have been performed with a large variety of laser parameters since its discovery around the year 2000. Both experiments and simulations have revealed that protons are accelerated up to a maximum cut-off energy during this process. Several attempts have been made to find a universal model for laser proton acceleration in the target normal sheath acceleration regime. While these models can qualitatively explain most experimental findings, they can hardly be used as predictive models, for example, for the energy cut-off of accelerated protons, as many of the underlying parameters are often unknown. Here we analyze experiments on laser proton acceleration in which scans of laser and target parameters were performed. We derive empirical scaling laws from these parameter scans and combine them in a scaling law for the proton energy cut-off that incorporates the laser pulse energy, the laser pulse duration, the focal spot radius, and the target thickness. Using these scaling laws, we give examples for predicting the proton energy cut-off and conversion efficiency for state-of-the-art laser systems.

Background Perfusion MRI by Arterial Spin Labeling (ASL) and Dynamic Susceptibility Contrast (DSC) has shown its potential for differentiating tumor progression from pseudo-progression in glioblastoma patients. The ASL scans can be affected by arterial transit time (ATT) delays, which could be caused by treatment effects due to concomitant radiochemotherapy. A prolonged ATT is present as apparent signal increase in the large arteries due to labeled spins still residing within the vasculature, leading to underestimation of tissue perfusion and thus potentially affecting clinical decision-making. The research questions were: 1) Do delayed ATTs lead to a difference in the visual assessment of ASL perfusion (normal/increased) maps compared to DSC-MRI?; 2) Does the radiological evaluation (progression vs. pseudo-progression) of ASL and DSC perfusion maps differ when ATT artifacts are present?; 3) Do delayed ATTs affect the predictive value of ASL-MRI scans 3 months post-radiotherapy for detecting true disease progression? Material and Methods This retrospective, single-center study included 68 adult patients with histologically confirmed glioblastoma who received postoperative radio(chemo)therapy. ASL and DSC scans were acquired 3 months post-radiotherapy as part of routine clinical follow-up. The perfusion data were visually scored by a neuroradiologist who determined presence/absence of ATT artifacts and their severity (%), perfusion of the enhancing tumor lesion and the radiological evaluation of tumor progression versus pseudo-progression. Presence of true disease progression was determined by follow-up of clinical data until 9 months post-radiotherapy available for 49/68 patients. Logistic regression was performed with gender, age, treatment type and tumor genetic status as covariates to assess the predictive value of ASL. Results In 78% of the patients ATT artifacts were present. No statistically significant association between the agreement of the perfusion maps and presence of ATT artifacts was found, but presence of ATT artifacts lowered the agreement between the DSC and ASL radiological evaluation. The logistic regression analysis showed that the ASL-based radiological score could not predict true disease progression, whereas higher age and unmethylated MGMT gene were associated with progression. Presence of ATT artifacts was not associated with tumor progression. Conclusion The presence of delayed ATT in ASL data seems to impact the radiological evaluation of ASL data, steering interpretation towards tumor progression (as compared to the DSC evaluation), whereas in patients without ATT artifacts ASL and DSC provide more similar radiological scores. Therefore, it is highly recommended to consider these artifacts when interpreting ASL perfusion MRI to differentiate between tumor progression and pseudo-progression in glioblastoma patients.

BACKGROUND Gliomas can be highly heterogeneous on brain MRI, especially at higher grades. These tumors often include a low-grade component and/or surrounding edema. Both these components appear as hyperintense regions on clinical T2-weighted MR images and cannot be accurately distinguished. Ultrahigh field 7T MR systems have the potential for a higher sensitivity due to its increase signal-to-noise ratio (SNR). This could allow for enhanced detailed visualization of gliomas. Therefore our goal was to assess the difference in extent of T2 hyperintense regions in glioma patients between clinical (1.5T/3T) and 7T MR images. MATERIAL AND METHODS We prospectively scanned 6 glioma patients (3 glioblastomas (GBM) WHO grade IV post-operative, 1 anaplastic diffuse glioma (ADG) WHO grade III, 1 biopsied oligodendroglioma (OD) WHO grade II and 1 suspected low-grade glioma (LGG); 4 Females, mean age: 56.8 years and 2 Males, mean age: 45.5 years) on a routine clinical MRI scanner (3T or 1.5T) and on a 7T MRI scanner (Philips Achieva). Resolution of the T2-weighted image at 7T, 3T and 1.5T: 0.75mm3, 3mm3 and 5mm3, respectively. T2-weighted scans were visually assessed by an independent researcher and experienced neuro-radiologist. The T2 hyperintense regions were measured in 3 directions and compared brain structures as reference points between the clinical and 7T scans (e.g. brain stem, gyri), also considering differences in slice thickness and spatial resolution. RESULTS T2 hyperintensity lesion measurements in the AP direction were as follows: GBM: 114.7mm (clinical field strength) vs 115.56mm (7T); ADG: 45mm vs 58.87mm and 24.7mm vs 25.55mm; OD: 45.1mm vs 48.5mm; GBM: 45.3mm vs 44.75mm; suspected LGG: 47.4mm vs 51.57mm; GBM: 105.8mm vs 114.5mm. We observed the largest difference between 3T and 7T T2 hyperintense region measurement to be 13.87mm (30%), belonging to a GBM WHO grade IV patient. For all patients the T2 hyperintense region was measured on average 8.3% larger at 7T MRI compared to the routine clinical MRI scan. Overall the T2 hyperintense regions at 7T appeared sharper and tumor boundaries were better defined. Likewise, the contrast between the tumor and healthy tissue was enhanced, most likely because of the increase in spatial resolution. CONCLUSION In gliomas the T2 hyperintense regions were more extensive at 7T MRI compared to the routine clinical MRI. These preliminary results might indicate that at clinical field strength the extent of the lesion is underestimated and that 7T MRI can potentially aid in detecting this more extensive disease process. Therefore, 7T MRI scan in gliomas might have a future role in treatment decisions regarding the extent of tumor resection and radiotherapy planning.

Spectroscopic analysis of different body fluids has been realized by using tapered flat silver halide fiber elements as infrared biosensors. Here, a specially functionalized sensor is presented, which had been prepared by an Nhydroxysuccinimide (NHS) ester derivative containing a reactive thiol group. NHS esters are often used as coupling agents to covalently bind amine-containing biomolecules (e.g., enzymes, antibodies or peptides) for the preparation of bioanalytical sensors of high selectivity. Recently, an immuno-infrared-sensor for Alzheimer disease (AD) screening has been presented based on infrared ATR-measurements with antibody-immobilized Ge-element surfaces for the extraction and analysis of Amyloid-beta (Aβ)-monomers, oligomers, and fibrils from blood plasma and cerebrospinal fluid (CSF). Thereby the biomarker amide I maximum frequency was used for AD classification. Here, for functionalizing the silver halide surfaces different procedures have been investigated, which consider the exchange reaction of the halogen atoms by the thiol-group as one option. Other preparation methods use the chemical reduction of silver ions, either from aqueous salt solutions or of the fiber material itself. A further method uses a first printing of silver nanoparticles on top of the flattened fiber sections. The combination of specific protein immobilization via functionalized silver halide fibers with recently introduced quantum cascade laser spectrometers is very promising for device miniaturization suited for implementation into hospital laboratories or general practitioners’ offices.

The endoscopic totally extraperitoneal (TEP) mesh repair is nowadays a well-established tension-free method for inguinal hernia repair. Mainly based on animal studies and case reports, a concern about the risk of postoperative infertility was expressed. This clinical study aimed to evaluate the risk of infertility due to obstructive azoospermia in men of fertile age who underwent a bilateral hernia repair. Over 3 years (2005–2008) 59 male patients, 18–60 years of age, underwent a bilateral TEP repair. Twenty-one of them were prospectively (“light mesh”) and 38 retrospectively (“heavy mesh”) evaluated for testicular volume and perfusion, serum levels of sexual hormones, ejaculate volume, and number of spermatic cells. Those parameters were determined preoperatively (prospective group) and not earlier than 3 months postoperatively (both groups). No significant difference between pre- and postoperative values was detected in the prospectively studied group. All postoperative parameters were within the normal range in the retrospective group. There was no evidence of impaired fertility in any patient due to the operation. The standardized TEP technique for simultaneous bilateral inguinal hernia repair in male patients was not associated with a higher risk for postoperative infertility after mesh implantation. The use of heavy-weight meshes had no negative effect on fertility.

Background and objectives Angulated projections are standard in conventional radiography of the cervical spine, but rarely used in magnetic resonance imaging (MRI). As neuroforaminal pathology plays an important role in the etiology of radicular syndromes and may influence an operative approach, the utility of coronal oblique slices in MRI is explored. Materials and methods In a retrospective setting, 25 consecutive patients with neurologically diagnosed cervical monoradiculopathy were identified. T2-weighted sagittal, coronal oblique, and transversal slice orientations were anonymized. Two radiologists and two neurosurgeons independently assessed the cases. Criteria were site, cause, and grading of the neuroforaminal stenosis and the level of confidence on a 100-point visual analog scale (VAS). We computed interrater agreement, sensitivity, and t tests. Results Using only one slice orientation, the sensitivity in detecting the relevant neuroforamen was 0.40 for transversal, 0.68 for sagittal, and 0.64 for coronal oblique scans. A combination of the different angulations increased sensitivity and in 4 cases only the coronal oblique scans proved diagnostic. The readers felt significantly more confident in attributing the cause of the pathology on coronal oblique planes (a mean of 72 VAS points, p = 0.0003 vs 58 (sagittal) vs 64 (transversal)). Interrater agreement was significantly better for experienced (kappa 0. 48) than for inexperienced readers (0.32, p = 0.02). Conclusions Adding coronal oblique planes in cervical spine MRI increases sensitivity and confidence in attributing the cause of neuroforaminal pathology. They are regarded as useful by all the readers.

One of the main design decisions in the development of low-speed axial fans is the right choice of the blade loading versus rotational speed, since a target pressure rise could either be achieved with a slow spinning fan and high blade loading or a fast spinning fan with less flow turning in the blade passages. Both the blade loading and the fan speed have an influence on the fan performance and the fan acoustics and there is a need to find the optimum choice in order to maximize efficiency while minimizing noise emissions. The present paper addresses this problem by investigating five different fans with the same pressure rise but different rotational speeds in the design point. In the first part of the numerical study, the fan design is described and steady-state Reynolds-averaged Navier-Stokes (RANS) simulations are conducted in order to identify the performance of the fans in the design point and in off-design conditions. The investigations show the existence of an optimum in rotational speed regarding fan efficiency and identify a flow separation on the hub causing a deflection of the outflow in radial direction as the main loss source for slow spinning fans with high blade loadings. Subsequently, Large Eddy Simulations (LES) along with the acoustic analogy of Ffowcs Williams and Hawkings (FW-H) are performed in the design point to identify the main noise sources and to determine the far-field acoustics. The identification of the noise sources within the fans in the near-field is performed with the help of the power spectral density of the pressure. In the far-field, the sound power level is computed using different parts of the fan surface as FW-H sources. Both methods show the same trends regarding noise emissions and allow for a localization of the noise sources. The flow separation on the hub is one of the main noise sources along with the tip vortex with an increase in its strength towards lower rotational speeds and higher loading. Furthermore, a horseshoe vortex detaching from the rotor leading edge and impinging on the pressure side as well as the turbulent boundary layer on the suction side represent significant noise sources. In the present investigation, the maximum in efficiency coincides with the minimum in noise emissions.

Intraspecific agonistic encounters in snapping shrimp (Alpheus heterochaelis) were analyzed using single-frame video analysis. The pair of conspecifics in such an encounter are designated as the snapper, which emits a fast water jet by very rapid closure, or snap, of the large modified snapper claw, and the receiver, which is the target of the water jet. The behavior of both snapper and receiver was evaluated before, during, and after the snap. Interactions between two intact shrimp (experimental series I) were compared with those between an intact shrimp and a "deprived" opponent (one with mechanosensory occlusion produced by coating the setae on the snapper claw with clear lacquer) (experimental series II). The behavior of the receiver is significantly changed by the occlusion, but that of the snapper is not. Intact and deprived opponents usually face each other during snapping, which is often preceded by touching of frontal appendages. The mean duration of claw cocking before snapping is about 500 ms. More than 50% of all snaps (and especially initial snaps) are directed towards the opponent, the water jet usually hitting the snapper claw of the receiver from a mean distance of 0.9 cm. Male shrimp show longer cocking durations, keep a shorter distance, and hit their opponents more often than do females. Intact and deprived snappers usually retreat immediately after snapping, but intact receivers usually approach. In contrast, deprived receivers retreat in most cases and show significantly prolonged latencies compared to intact receivers. Thus, mechanoreceptors on the snapper claw of the receiver play a significant role in intraspecific agonistic encounters.

Die meisten Frauen mit Epilepsie bekommen gesunde Kinder. Junge Frauen mit Epilepsie sollten jedoch fruhzeitig uber die Auswirkungen ihrer Medikation auf eine Schwangerschaft aufgeklart werden. Dies sollte idealerweise bereits bei der Ersteinstellung, auf jeden Fall aber mindestens ein Jahr vor konkretem Kinderwunsch geschehen. Die gunstigsten Medikamente sind nach aktuellem Kenntnisstand Lamotrigin und Levetiracetam. Valproat sollte moglichst vermieden werden, da es mit einer hohen Fehlbildungsrate der Kinder vergesellschaftet ist, die kognitive Entwicklung der Kinder beeintrachtigen kann und mit Autismus-Spektrum-Storungen verbunden ist. Moglichst sollte eine Monotherapie angestrebt werden, da die Einnahme mehr als eines Medikamentes mit einer erhohten kindlichen Fehlbildungsrate verbunden ist. Gunstig sind auch retardierte Praparate und die Einnahme in mehreren Einzeldosen. Frauen, die Antiepileptika einnehmen, sollten bereits prakonzeptionell 5 mg Folsaure taglich einnehmen, die Einnahme sollte bis zum Ende des ersten Trimenons fortgesetzt werden. Da die Serumspiegel von Lamotrigin, Levetiracetam und Oxcarbazepin in der Schwangerschaft absinken, sollten diese bereits vor der Schwangerschaft bestimmt und dann engmaschig kontrolliert werden. Haufig ist ein Aufdosieren erforderlich, um Anfalle zu vermeiden. Wahrend der Schwangerschaft ist zudem eine fruhe Ultraschallfeindiagnostik empfohlen. Sofern gynakologisch keine Komplikationen bestehen, sollte die Entbindung als vaginale Entbindung unter ublicher, bedarfsadaptierter Schmerzmedikation geplant werden. Stillen ist auch unter Antiepileptika zu empfehlen, die Kinder sollten in der ersten Zeit auf Sedierung oder Trinkschwache beobachtet werden. Sofern Lamotrigin, Levetiracetam oder Oxcarbazepin wahrend der Schwangerschaft aufdosiert wurden, sollte nach der Geburt auf Uberdosierungserscheinungen geachtet werden.

Die Bildgebung mittels Magnetresonanztomographie (MRT) gewinnt auch in der Traumatologie immer grosere Bedeutung und hilft, die Therapieoptionen optimal anzupassen. Fur eine zielgerichtete Therapie ist zum einen eine gute Kommunikation zwischen Traumatologen und Radiologen unerlasslich, so dass die Sequenzen durch den Radiologen spezifisch auf den Traumamechanismus und die angenommenen Verletzungen abgestimmt werden konnen. Zum anderen ist aber auch fur den Chirurgen eine Grundkenntnis der MR-Bildgebung essentiell, um den Informationszugewinn aus der Bildgebung optimal nutzen zu konnen. Dieser Artikel hat das Ziel, die Basistechnik der MRT in der Traumatologie mit Wichtungen und Sequenzen verstandlich zu machen.

In this diary study, we examined the associations between daily work-related smartphone use and daily psychological detachment and daily work-related exhaustion within a group of smartphone owners. In addition, we studied the role of the perceived segmentation norm at the workplace as a moderator of the link between work-related smartphone use and detachment. A total of 70 employees using smartphones on initiative of their employer completed a diary questionnaire on 4 successive workdays (N = 268 data points). We hypothesized that work-related smartphone use is negatively related to psychological detachment and that psychological detachment, in turn, is negatively related to work-related exhaustion. Finally, we expected that especially employees who perceive a high segmentation norm at their workplace have difficulties to psychologically detach from work on days that they use their smartphone more intensively. Overall, the results of multilevel analyses supported these hypotheses. The findings emphasize the importance of a clear organizational policy regarding work-related smartphone use outside of work hours.

Resume Introduction Les chronologies operatoires des malformations labio-maxillo-palatines ne font pas l’objet d’un consensus international. Depuis 20 ans, nous proposons a nos patients une prise en charge precoce que nous argumentons avec une correction chirurgicale plus immediate de la malformation de la levre qui permet une meilleure integration du bebe au niveau familial. De recentes etudes tendent a remettre en cause cette pratique neonatale. Patients et methode Nous avons tenu a verifier lors d’une etude retrospective, l’innocuite des interventions precoces au niveau anesthesique et chirurgical, ainsi que les resultats obtenus par cette pratique pendant les 20 dernieres annees pour une serie de 42 enfants operes de la levre avant le 28e jour apres leur naissance. Tous ont ete operes par le meme chirurgien senior. Resultats Les bebes sont operes generalement au cinquieme jour de vie. Le temps d’intervention chirurgical est de 45 minutes pour les fentes unilaterales et de 70 minutes pour les atteintes bilaterales. L’alimentation par voie orale est reprise le soir du jour operatoire. La duree d’hospitalisation mediane est de quatre jours. Les resultats nous montrent l’absence de complication anesthesique. Quatre enfants ont beneficie d’une correction secondaire de la levre. Conclusion Le risque anesthesique et chirurgical des interventions labiales precoces est tres limite a condition de pouvoir beneficier d’un environnement medico-soignant multidisciplinaire, specialise dans la prise en charge des enfants operes en periode neonatale et pouvant assurer une surveillance postoperatoire adequate. Le taux de complications est tres faible.

Epilepsie ist eine haufige Erkrankung. Epilepsiekranke Frauen mit Kinderwunsch haben einen erhohten Beratungsbedarf bezuglich einer Schwangerschaft. Die meisten dieser Frauen bekommen gesunde Kinder. Dennoch ist die Fehlbildungsrate ihrer Kinder erhoht. Gunstig ist eine so niedrig wie moglich dosierte Monotherapie, idealerweise mit Lamotrigin oder Levetiracetam. Nichtempfehlenswert ist Valproat. Polytherapien erhohen das Risiko fur Fehlbildungen. Wahrend der Schwangerschaft sollte insbesondere unter Lamotrigin- und Oxcarbazepingabe der Serumspiegel engmaschig kontrolliert werden, da es haufig zu einem Abfall der Serumkonzentration und hierdurch zu Anfallsrezidiven kommt. Bereits vor der Empfangnis sollten Frauen, die Antiepileptika einnehmen, taglich 5 mg Folsaure einnehmen. Die Epilepsie ist kein Grund fur einen Kaiserschnitt. Die Geburt sollte aber in einem Haus mit Neonatologie und Neurologie erfolgen. Stillen ist auch unter Antiepileptika zu empfehlen. Nach der Geburt sollte auf Uberdosierungserscheinungen bei Mutter der geachtet werden, insbesondere wenn sie Lamotrigin, Oxcarbazepin oder Levetiracetam einnimmt.

Two phase III trials of photodynamic therapy (PDT) with BF-200 ALA, a recently approved nanoemulsion formulation of 5-aminolaevulinic acid (ALA) demonstrated high clearance rates in mild-to-moderate actinic keratosis (AK). The comparison to a registered methyl aminolaevulinate (MAL) cream demonstrated significantly superior total patient clearance rates.To evaluate long-term efficacy and safety of PDT for AK 6 and 12 months after the last PDT with BF-200 ALA, MAL or placebo.The follow-up phase (FUP) was performed with patients of two phase III studies. Both studies compared BF-200 ALA with placebo, one of the studies additionally with MAL. Overall recurrence rates and various subgroups (light source, lesion severity, lesion location, complete responders after first PDT) were assessed 6 and 12 months after the last PDT.Recurrence rates were similar for BF-200 ALA and MAL, with a tendency to lower recurrence rates for BF-200 ALA. The proportion of patients who were fully cleared during PDT and remained completely clear for at least 12 months after PDT were 47% for BF-200 ALA (both studies) and 36% for MAL treatment. The subgroup that was illuminated with narrow wavelength LED lamps reached 69% and 53% for BF-200 ALA (both studies, respectively) and 41% for MAL. No safety concerns were reported.The FUP data confirmed the high efficacy and safety of PDT with BF-200 ALA. The slightly lower recurrence rates after BF-200 ALA treatment compared with MAL treatment enhanced the better treatment outcome due to the significantly superior efficacy.

In recent years there is a growing number of patients suffering from pneumonia, chronic obstructive pulmonary disease or asthma. In these situations, the application of Continuous Positive Airway Pressure (commonly known as CPAP) is indicated by clinicians. It is a noninvasive means of healthcare used widely. As a more advanced technique, the positive airway pressure may follow a time-cycled change between two preset pressure values. This technique is known as BPAP (Bi-level Positive Airway Pressure). The devices are used mainly during sleep at home. Hence the aeroacoustic requirements are critical. In addition the devices must be portable and compact. Furthermore, the high frequency of pressure change required in BPAP devices poses additional demands on the design. Due to the complexity of the overall design problem, it may be solved efficiently by multi objective optimization. The pressure head in these devices is generated by radial fans. For the aerodynamic optimization, we utilize a RANS solver. For the aeroacoustic optimization we use the Lattice-Boltzmann Method (LBM). Both are operating on a parametric geometric model of the fan and housing. For the propagation of sound waves into the far-field, we develop algorithmic strategies for using the Ffowcs Williams-Hawkings (FW-H) equation with the LBM. The constrained multi objective optimization is driven by a variant of the NSGA-II algorithm. We outline the complete optimization procedure for a BPAP device. Our numerical results are compared with physical tests. To analyze the contribution of selected geometric features to the emitted sound pressure, we perform a sensitivity study. The new algorithmic arrangement has shown to drastically cut development costs and time.

To clarify the predictive power of the Glasgow coma score (GCS) after traumatic brain injury (TBI) and in the context of brain stem lesions.In 143 patients who had suffered severe TBI, the GCS was correlated to brain damage as visualized by cranial magnetic resonance imaging (MRI). This technique evaluates the damage to the brain stem in particular. The Brussels coma score (BCS) was also used.The GCS was not significantly correlated to brain stem lesions when it was only scored at the time of admission. When MRI was not used later on, the GCS showed a poor ability to predict the outcome. After 24 h, and on the day of MRI screening, the GCS was significantly correlated with two parameters: outcome (the higher the GCS, the better the outcome) and the frequency of patients without injuries to the brainstem in MRI (the higher the GCS, the higher this frequency). These correlations were much more evident when the BCS was used. The prognostic power of the GCS was found to vary over time; for example: a GCS of 3 at admission was associated with a favorable prognosis; a GCS of 4 signified a poor prognosis, irrespective of the time point at which the GCS was scored; and the prognostic power of a GCS of 5 deteriorated from the day of the MRI onwards, whereas the prognostic power of a GCS of 6 or 7 varied little over time.We only recommend the use of the GCS for prognostic evaluation in a multidimensional model. Study protocols should contain additional brain stem function parameters (BCS, pupil condition, MRI).

Psychiatrische Storungen komplizieren haufig den Verlauf einer Epilepsie und konnen die Lebensqualitat von Patienten und deren Angehorigen erheblich beeintrachtigen. Dieser Artikel beschaftigt sich primar mit Psychosen, Depressionen und psychiatrischen Nebenwirkungen von Antiepileptika. Dabei liegt der Schwerpunkt auf praxisrelevanten Problemen der Diagnosestellung und Therapie.

Charcot-Marie-Tooth disease type 4C (CMT4C) is an autosomal recessive demyelinating neuropathy associated with SH3TC2 mutations. More than 60 variants including nonsense, frameshift, and splice site variants have been reported in families of different ethnic origins as well as in sporadic patients. CMT4C is clinically characterised by early onset neuropathy, cranial nerve involvement and spine deformities. We present a family from Kuwait with a novel deletion of exons 13 and 14 in the SH3TC2 gene combined with a novel homozygous mutation in the DPYD gene. The 40 year-old male patient had foot deformities in infancy and delayed walking after the age of two. He first required walking aids when ten years old and became wheelchair-bound since the age of 18. He had progressive hearing loss over five years. Walking difficulties and wheelchair-dependency were reported in his father as well as a cousin of his mother while there were no symptoms reported in his own siblings and child. Clinical examination showed hypoacusis requiring the use of hearing aids, marked widespread symmetric muscular atrophies with weakness, and areflexia. He could walk a few steps with bilateral support. He had sensory neuropathy with skin atrophy and loss of hair on the lower legs. Spinal examination and X-ray showed slight hyperkyphosis of the thoracic spine but no signs of kyphoscoliosis. Electrophysiological studies showed severe motor and sensory neuropathy with very low amplitudes, markedly prolonged distal motor latencies and very slow motor nerve conduction velocities in the ulnar nerve. Needle electromyography detected fibrillations, positive sharp waves and complex repetitive discharges. High resolution sonography of the median nerve at the wrist showed a few enlarged fascicles with only moderately raised cross sectional area. Creatin kinase levels were constantly and significantly raised. Genetic testing revealed a homozygous large deletion in the SH3TC2 gene comprising exons 13 and 14 that had not been described before. Furthermore a second homozygous novel mutation (c.680+1G>T;p.?) was found in the DPYD gene. The same combination in heterozygous form was detected in the asymptomatic eight year old daughter. This newly described family with CMT4C broadens the spectrum of genetic causes and underlines the clinical variability of phenotypes as the absence of scoliosis does not exclude mutations in the SH3TC2 gene even in patients with severe disabling Azzedine et al., 2006 , Azzedine et al., 2016 , Varley et al., 2015 , Inherited Peripheral Neuropathies Mutation Database, 2016 .

Summary Background Photodynamic therapy (PDT) with 5-aminolaevulinic acid (ALA) or its methylester [methyl-5-aminolaevulinate (MAL) or 5-amino-4-oxopentanoate] was recently ranked as first-line therapy for the treatment of actinic keratosis (AK) and is an accepted therapeutic option for the treatment of neoplastic skin diseases. BF-200 ALA (Biofrontera Bioscience GmbH, Leverkusen, Germany) is a gel formulation of ALA with nanoemulsion for the treatment of AK which overcomes previous problems of ALA instability and improves skin penetration. Objectives To evaluate the efficacy and safety of PDT of AKs with BF-200 ALA in comparison with a registered MAL cream and with placebo. Methods The study was performed as a randomized, multicentre, observer-blind, placebo-controlled, interindividual trial with BF-200 ALA, a registered MAL cream and placebo in a ratio of 3 : 3 : 1. Six hundred patients, each with four to eight mild to moderate AK lesions on the face and/or the bald scalp, were enrolled in 26 study centres in Germany, Austria and Switzerland. Patients received one PDT. If residual lesions remained at 3 months after treatment, PDT was repeated. Results PDT with BF-200 ALA was superior to placebo PDT with respect to patient complete clearance rate (78·2% vs. 17·1%; P

In Europa sind etwa 0,5% aller Frauen an einer aktiven Epilepsie erkrankt. Viele Epilepsiepatientinnen sind verunsichert, welche Risiken mit einer Schwangerschaft bei Epilepsie und antikonvulsiver Medikation einhergehen. Ziel des internationalen EURAP („European Registry of Antiepileptic drugs in Pregnancy“, europaisches Register fur Schwangerschaften unter Antiepileptikatherapie) ist es, die verschiedenen Antiepileptika bezuglich der Sicherheit sowie der Haufigkeit kongenitaler Fehlbildungen und pranataler Wachstumsverzogerungen zu vergleichen. Im Mai 2011 waren 7555 Schwangerschaften bei EURAP registriert. Die Rate groser Fehlbildungen bei Kindern nach intrauteriner Antiepileptikaexposition liegt insgesamt bei etwa 6% und ist im Vergleich zur Normalbevolkerung zwei- bzw. dreifach erhoht [1, 2]. Lamotrigin scheint kein erhohtes teratogenes Risiko zu haben. Fur diese neueren Antiepileptika ist die Studienlage noch zu durftig, um eine sichere Beurteilung hinsichtlich der Teratogenitat vorzunehmen [1]. Leider sind nach wie vor nur unter 20% aller schwangeren Frauen, die Antiepileptika einnehmen, bei EURAP registriert. Als modernes Netzwerk einer globalen Welt ist EURAP angewiesen auf die Hilfe der korrespondierenden Arzte, die Schwangerschaften unter Antiepileptika registrieren konnen.

BACKGROUND: Cranial magnetic resonance imaging (MRI) was performed in 250 patients who had been unconscious post-trauma for at least 24 hours. The frequency and the characteristics of injuries to the upper cervical myelon were determined. PATIENTS AND METHODS: Between 1996 and 2009, MRI was carried out within 8 days of trauma. RESULTS: No lesions of the upper cervical medulla were found without accompanying damage to the medulla oblongata. Two groups were found to have a lesion in the upper cervical myelon. (i) In 3.2 % of the patients in a state of deep coma MRI revealed lesions in the entire brain stem. These died without waking from coma. (ii) 2 % of the patients were found to have additional damage to the distal medulla oblongata. These victims of high-speed traumas awoke from coma after 2-3 days. They revealed frontal contusions of the brain and traumatic subarachnoidal hemorrhages. Injuries to the bony upper cervical spine and/or the skull base were frequent. Four of them died, one patient survived with severe disabilities. CONCLUSION: Two types of lesions involving the upper cervical myelon could be differentiated, both of which occur only in association with lesions in the medulla oblongata. Language: de

Objective: To determine the extent that demographics, clinical characteristics, comorbidities, and complications contribute to the risk of in-hospital mortality and morbidity in acute stroke. Methods: Data of consecutive patients admitted to 14 stroke units cooperating within the Berlin Stroke Register were analyzed. The association of demographics, clinical characteristics, comorbidities, and complications with the risk of in-hospital death and poor outcome at discharge was assessed, and independent attributable risks were calculated, applying average sequential attributable fractions. Results: In a 3-year period, 16,518 consecutive patients with ischemic or hemorrhagic stroke were documented. In-hospital mortality was 5.4%, and 45.7% had a poor outcome (modifed Rankin Scale score ≥3). In patients with length of stay (LOS) ≤7 days, 37.5% of in-hospital deaths were attributed to stroke severity, 23.1% to sociodemographics (age and prestroke disability), and 28.9% to increased intracranial pressure (iICP) and other complications. In those with LOS >7 days, age and stroke severity accounted for 44.1%, whereas pneumonia (12.2%), other complications (12.6%), and iICP (8.3%) contributed to one-third of in-hospital deaths. For poor outcome, attributable risks were similar for prestroke disability, stroke severity, pneumonia, and other complications regardless of the patient9s LOS. Conclusions: Approximately two-thirds of early death and poor outcome in acute stroke is attributed to nonmodifiable predictors, whereas main modifiable factors are early complications such as iICP, pneumonia, or other complications, on which stroke unit treatment should focus to further improve the prognosis of acute stroke.