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The optimal treatment for patients with asymptomatic carotid artery stenosis is under debate. Since best medical treatment (BMT) has improved over time, the benefit of carotid endarterectomy (CEA) or carotid artery stenting (CAS) is unclear. Randomised data comparing the effect of CEA and CAS versus BMT alone are absent. We aimed to directly compare CEA plus BMT with CAS plus BMT and both with BMT only.SPACE-2 was a multicentre, randomised, controlled trial at 36 study centres in Austria, Germany, and Switzerland. We enrolled participants aged 50-85 years with asymptomatic carotid artery stenosis at the distal common carotid artery or the extracranial internal carotid artery of at least 70%, according to European Carotid Surgery Trial criteria. Initially designed as a three-arm trial including one group for BMT alone (with a randomised allocation ratio of 2·9:2·9:1), the SPACE-2 study design was amended (due to slow recruitment) to become two substudies with two arms each comparing CEA plus BMT with BMT alone (SPACE-2a) and CAS plus BMT with BMT alone (SPACE-2b); in each case in a 1:1 randomisation. Participants and clinicians were not masked to allocation. The primary efficacy endpoint was the cumulative incidence of any stroke or death from any cause within 30 days or any ipsilateral ischaemic stroke within 5 years. The primary safety endpoint was any stroke or death from any cause within 30 days after CEA or CAS. The primary analysis was by intention-to treat, which included all randomly assigned patients in SPACE-2, SPACE-2a, and SPACE-2b, analysed using meta-analysis of individual patient data. We did two-step hierarchical testing to first show superiority of CEA and CAS to BMT alone then to assess non-inferiority of CAS to CEA. Originally, we planned to recruit 3640 patients; however, the study had to be stopped prematurely due to insufficient recruitment. This report presents the primary analysis at 5-year follow-up. This trial is registered with ISRCTN, number ISRCTN78592017.513 patients across SPACE-2, SPACE-2a, and SPACE-2b were recruited and surveyed between July 9, 2009, and Dec 12, 2019, of whom 203 (40%) were allocated to CEA plus BMT, 197 (38%) to CAS plus BMT, and 113 (22%) to BMT alone. Median follow-up was 59·9 months (IQR 46·6-60·0). The cumulative incidence of any stroke or death from any cause within 30 days or any ipsilateral ischaemic stroke within 5 years (primary efficacy endpoint) was 2·5% (95% CI 1·0-5·8) with CEA plus BMT, 4·4% (2·2-8·6) with CAS plus BMT, and 3·1% (1·0-9·4) with BMT alone. Cox proportional-hazard testing showed no difference in risk for the primary efficacy endpoint for CEA plus BMT versus BMT alone (hazard ratio [HR] 0·93, 95% CI 0·22-3·91; p=0·93) or for CAS plus BMT versus BMT alone (1·55, 0·41-5·85; p=0·52). Superiority of CEA or CAS to BMT was not shown, therefore non-inferiority testing was not done. In both the CEA group and the CAS group, five strokes and no deaths occurred in the 30-day period after the procedure. During the 5-year follow-up period, three ipsilateral strokes occurred in both the CAS plus BMT and BMT alone group, with none in the CEA plus BMT group.CEA plus BMT or CAS plus BMT were not found to be superior to BMT alone regarding risk of any stroke or death within 30 days or ipsilateral stroke during the 5-year observation period. Because of the small sample size, results should be interpreted with caution.German Federal Ministry of Education and Research (BMBF) and German Research Foundation (DFG).

This study comprises the analysis and the interpretation of the coherent and the noncoherent parts of a coherent-on-receive microwave radar at grazing incidence conditions. The Doppler measurement is an extension of standard civil marine radar technology. While intensity images require interpretation based on understanding the underlying imaging mechanism, the Doppler signal measures the motion of an area of sea surface and is therefore closely related to the wave physics. Both the measured Doppler signal and the backscatter intensity signal are suitable for surface inversion and give almost identical surface elevations. A statistical comparison with a nearby buoy showed good correlation for the significant wave height and the peak period. By comparing the Doppler signal and the amplitude in the backscatter, the study amends the understanding of imaging mechanisms in marine radars at grazing incidence. This research was originally published in Journal of Atmospheric and Oceanic Technology. © 2018 American Meteorological Society

Im Erdbau werden zunehmend hydraulische Bindemittel eingesetzt, um Damme, Hinterfullungen und Erdplanien in Einschnitten zu stabilisieren. Durch die Stabilisierung konnen auch Schuttmaterialien geringer und mittlerer Gute verwendet werden. Die hohere Festigkeit des Dammes gleicht Setzungsunterschiede aus, was insbesondere am Ubergang zu Bauwerken Setzungsmulden und Setzungssprunge verhindert. Die Steifigkeit kann soweit erhoht werden, das auch die Lasteinleitung in Pfahle ohne Zugbander (z. B. Geogitter) moglich wird. Die Anwendungsmoglichkeiten des bindemittelstabilisierten Erdbaus werden am Beispiel eines Anschlusdammes der ICE-Neubaustrecke Erfurt–Leipzig/Halle erlautert. Der 13m hohe Anschlusdamm ist aufgrund einer machtigen Braunkohleschicht auf Rammpfahlen gegrundet. Die Last wird durch eine Lastverteilschicht aus bindemittelstabilisiertem Boden direkt und ohne Geogitter auf die Rammpfahle abgetragen. In dem mit Braunkohlefilterasche stabilisierten Kerndamm sind ein Widerlager und eine Eisenbahnuberfuhrung uber einen Wirtschaftsweg eingebettet. Binder stabilized earthwork on the new high-speed railway line Erfurt–Leipzig/Halle. There is an increasing utilization of hydraulic binders to stabilize embankments, fillings and subgrades in cuts. Due to the stabilization, fill materials of lower and medium quality may be used. The higher stiffness of the embankment evens out settlement differences, thus preventing settling moulds and settlement drops especially at the transition to structures. The shear strength of the embankment can be increased in a way that a load transfer into piles without ties (e.g. geogrids) becomes possible. The application of binder stabilized earthwork is described with the example of an embankment of the high-speed railway Erfurt–Leipzig/Halle. Due to a thick brown-coal layer in the subsoil, the 13m high embankment is founded on driven piles. The load is being transferred to the piles by load distribution layer of binder stabilized soil built directly and without geogrid on pile heads. A shallow founded abutment and the crossing of a country road over the railway are embedded in the embankment, the core of which has been stabilized with brown-coal filter ashes.

Purpose Contrast-enhanced magnetic resonance imaging (MRI) of the central nervous system (CNS) with gadolinium-based contrast agents (GBCAs) is standard of care for CNS imaging and diagnosis because of the visualization of lesions that cause blood–brain barrier breakdown. Gadobutrol is a macrocyclic GBCA with high concentration and high relaxivity. The objective of this study was to compare the safety and efficacy of gadobutrol 1.0 M vs unenhanced imaging and vs the approved macrocyclic agent gadoteridol 0.5 M at a dose of 0.1 mmol/kg bodyweight. Materials and Methods Prospective, multicenter, double-blind, crossover trial in patients who underwent unenhanced MRI followed by enhanced imaging with gadobutrol or gadoteridol. Three blinded readers assessed the magnetic resonance images. The primary efficacy variables included number of lesions detected, degree of lesion contrast-enhancement, lesion border delineation, and lesion internal morphology. Results Of the 402 treated patients, 390 patients received study drugs. Lesion contrast-enhancement, lesion border delineation, and lesion internal morphology were superior for combined unenhanced/gadobutrol-enhanced imaging vs unenhanced imaging ( P < 0.0001 for all). Compared with gadoteridol, gadobutrol was non-inferior for all primary variables and superior for lesion contrast-enhancement, as well as sensitivity and accuracy for detection of malignant disease. The percentage of patients with at least one drug-related adverse event was similar for gadobutrol (10.0%) and gadoteridol (9.7%). Conclusion Gadobutrol is an effective and well-tolerated macrocyclic contrast agent for MRI of the CNS. Gadobutrol demonstrates greater contrast-enhancement and improved sensitivity and accuracy for detection of malignant disease than gadoteridol, likely because of its higher relaxivity.