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In patients with normal plasmatic coagulation and bleeding tendency, platelet function defect can be assumed. Congenital platelet function defects are rare. Much more commonly they are acquired. The clinical bleeding tendency of platelet function defects is heterogeneous, which makes diagnostic approaches difficult. During the years, a large variety of tests for morphological phenotyping and functional analysis have been developed. The diagnosis of platelet function defects is based on standardized bleeding assessment tools followed by a profound morphological evaluation of the platelets. Platelet function assays like light transmission aggregation, luminoaggregometry, and impedance aggregometry followed by flow cytometry are commonly used to establish the diagnosis in these patients. Nevertheless, despite great efforts, standardization of these tests is poor and in most cases, quality control is lacking. In addition, these tests are still limited to specialized laboratories. This review summarizes the approaches to morphologic phenotyping and platelet testing in patients with suspected platelet dysfunction, beginning with a standardized bleeding score and ending with flow cytometry testing. The diagnosis of a functional defect requires a good collaboration between the laboratory and the clinician.

Extracorporeal circulation (ECC) is frequently used in intensive care patients with impaired lung or cardiac function. Despite being a life-saving therapeutic option, ECC is associated with increased risk for both bleeding and thrombosis. The management of bleeding and thromboembolic events in ECC patients is still challenging partly due to the lack of information on the pathophysiological changes in hemostasis and platelet function during the procedure. Using a combination of an ex vivo model for shear stress and a sensitive and easy-to-use laboratory method, we analyzed platelet responsiveness during ECC. After shear stress simulation in an ex vivo closed-loop ECC model, we found a significantly decreased response of α-granules after activation with adenosine diphosphate and thrombin receptor activating peptide (TRAP-6) and CD63 expression after activation with TRAP-6. Mepacrine uptake was also significantly reduced in the ex vivo shear stress model.In the same line, platelets from patients under ECC with venovenous systems and venoarterial systems showed impaired CD62P degranulation after stimulation with ADP and TRAP-6 compared with healthy control on day 1, 6, and 10 after implantation of ECC. However, no correlation between platelet degranulation and the occurrence of bleeding or thromboembolic events was observed.The used whole blood flow cytometry with immediate fixation after drawing introduces a sensitive and easy-to-use method to determine platelet activation status and our data confirm that increased shear stress conditions under ECC can cause impaired degranulation of platelet.

Die geringe Marktdurchdringung von wasserstoffbetriebenen Flurförderzeugen in Intralogistikanwendungen in Europa sorgt für fehlende Erfahrungen zum Wasserstoffbezug und beim Aufbau der notwendigen Infrastruktur. Diese Unsicherheiten wiederum hemmen den Einsatz von Brennstoffzellen. Eine Betrachtung technisch möglicher Aufbauformen ist erforderlich, um mit dem entwickelten Vorgehen zur Dimensionierung der Komponenten der Betankungsanlage eine Orientierung in der Planung und Entscheidung für den Einsatz zu schaffen.

In the multi-lingual world of the Cairo Genizah, Arabic (including Judaeo-Arabic), Hebrew and Aramaic were used in legal documents and letters. Jewish scribes excelled in Hebrew and Arabic penmanship. The mixing of Hebrew and Arabic alphabets in documents by particular writers affords important sociolinguistic insights. This article presents case studies of two Genizah writers, Daniel b. ʿAzaryah (11th century) and Ḥalfon b. Manasse (12th century), who were both highly innovative and exceptional in their use of scripts and vocalisation signs. Their scribal habits and decisions allow us to understand attitudes of writers towards the two scripts, and levels of literacy within the Jewish scriptorium, and provide an important contribution to our understanding of medieval allography and script-switching.

ZusammenfassungDie Ursache von Thrombozytenfunktionsstörungen kann erblich bedingt sein, aber auch infolge von Begleiterkrankungen und Arzneimittelwirkungen auftreten. Die Thrombozytenfunktionsuntersuchung ist jedoch komplex und kaum standardisiert. Die Bestimmung der Thrombozytenzahl und die morphologische Untersuchung der Blutplättchen sind auch für eine erste Beurteilung der Thrombozytenfunktion extrem hilfreich. Bei Patienten mit Verdacht auf eine Thrombozytenfunktionsstörung sollte nach Bestimmung der Thrombozytenzahl und der ersten morphologischen Untersuchung die Lichttransmissionsaggregometrie (LTA) und wenn möglich die Sekretionsanalyse z.B. in der Durchflusszytometrie bzw. die Immunfluoreszenzmikroskopie durchgeführt werden. Bei auffälligen Befunden können weitere spezialisierte Verfahren wie z.B. die Elektronenmikroskopie und genetische Untersuchungen zielführend sein. Hierbei ist eine Vereinheitlichung von Thrombozytenfunktionsanalysen und Antikörperuntersuchungen zwischen den verschiedenen Laboren extrem wichtig, um die Diagnostik auf diesem Gebiet zu optimieren. Wir möchten uns in diesem Artikel auf die angeborene Thrombozytenfunktionsstörung und die derzeit aktuellen Labormethoden fokussieren, um die zugrunde liegenden molekularen und genetischen Defekte genauer bestimmen zu können. Ziel ist es, eine optimale Anwendung des diagnostischen und therapeutischen Ansatzes für die Behandlung von Patienten mit erblichen Thrombozytenfunktionsstörungen zu ermöglichen.

Medieval letters from the Cairo Geniza can be broadly classified into private, official, or mercantile correspondence, and all use particular linguistic registers. Official correspondence, for example, shows abundant code switching into Hebrew and the employment of high-style versus lower-style prose. Mercantile letters actively avoid Hebrew and emulate supraconfessional Arabic writing standards. Private letters typically display more colloquial and less standardized forms than other genres and are more often written in crude handwriting. Among these private letters, we find one written by or for women that share common features of colloquiality and less standardization even when they are transcribed by male scribes. Linguistic registers are also influenced by the time and place in which they are written, and comparing Geniza letters from different areas and time periods exposes geographic and chronological characteristics. For example, North African letters tend to be linguistically more conservative, and Babylonian and Egyptian letters show differences in layout and style. Throughout the medieval period, orthographic, grammatical, lexical, and stylistic changes in the letters reflect social and economic evolution over time. The principal trend is a distinct move away from prescriptive Arabic linguistic norms from the late twelfth century on.

Die vorliegende Veröffentlichung befasst sich mit der Auslegung hybrider Querpressverbände, d. h. der Verbindung von Stahlwellen und vollkeramischen Naben, bei Betriebstemperaturen oberhalb der Raumtemperatur. Zunächst wird in einer Einführung auf die Vorteile dieser Verbindung eingegangen. Es folgt ein Überblick über den Stand der Forschung und die erzielten Ergebnisse bei Raumtemperatur. Die zwei bisher vorhandenen Auslegungsverfahren bedienen sich strukturmechanischer bzw. thermomechanischer Simulationen, um die wirkenden Kräfte auf die Fügepartner und die daraus resultierenden Verformungen zu berechnen. Mit den Ergebnissen wird eine neue Wellenform definiert. So gefertigte Wellen führen im Pressverband zu einem annähernd konstanten Fugendruckverlauf. Simulationen zeigen jedoch, dass sich diese Wellen nicht für den Betrieb bei erhöhten Temperaturen eignen. Um einen ähnlich günstigen Spannungszustand zu erreichen und Spannungsspitzen zu vermeiden, muss das Vorgehen modifiziert werden. Die hierfür notwendigen Schritte werden ausführlich beschrieben. Darüber hinaus werden anwendungsnahe Hinweise zur Optimierung der Ergebnisse bzw. geometrischen Gestaltung des Pressverbands gegeben., Projekt DEAL

Using comprehensive cardiac magnetic resonance (CMR) imaging in patients suffering from ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), we sought to investigate the association of admission Q waves with microvascular injury (microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)).This prospective observational study included 195 STEMI patients treated with pPCI. Admission 12-lead electrocardiography was evaluated for the presence of pathological Q waves, defined as a Q wave duration of30 ms and a depth of0.1 mV. CMR was performed at 3 (interquartile range: 2-5) days after pPCI to determine infarct characteristics including MVO (late gadolinium enhancement) and IMH (T2* mapping).Admission Q waves were observed in 53% of patients (n = 104). These patients had a significantly lower BMI (p = 0.005), more frequent left anterior descending artery as culprit lesion (p = 0.005), were less frequent smokers (p = 0.048) and had higher rates of pre-interventional TIMI flow 0 (p = 0.018). Patients with Q waves showed a significantly larger infarct size (19%vs.12% of left ventricular mass,p 0.001), lower ejection fraction (49%vs.54%,p = 0.001), worse global strain parameters (all p 0.005) and more severe microvascular injury (MVO: 68%vs.34%,p 0.001; IMH: 40%vs.20%,p = 0.002). Q waves remained associated with both MVO (odds ratio: 5.23, 95% confidence interval: 2.58 to 10.58,p 0.001) and IMH (odds ratio: 3.94, 95% confidence interval: 1.83 to 8.46,p 0.001) after adjusting for potential confounders (culprit lesion, pre-interventional TIMI flow 0, total ischemia time, ST-segment elevation).Admission Q waves, derived from the readily available ECG, emerged as independent early markers of CMR-determined microvascular injury in STEMI patients undergoing pPCI.

Letters were an essential means of communication for the Jews living under Islam in the Middle Ages. The traditional seats of Jewish learning were in Baghdad and Jerusalem, but their constituencies were scattered across the world. Letters frequently passed between Egypt and Palestine and Egypt and Iraq, as Jews sought halakhic knowledge, rulings, influence, and political advantage from their leaders, and dignitaries sought to govern their distant communities and ensure the continued flow of funding. At a lower level, letters passed between communal officials and prominent citizens, between petitioners and public servants. Jews were heavily involved in trade; a network of traders relied upon the written letter to organize cargoes, settle debts, or discuss political rumours. This chapter outlines the distinct medieval epistolary styles used in Hebrew and Judaeo-Arabic correspondence. The internal development of these letters, choices of language, layout, and style are discussed within their historical and sociolinguistic framework.

This paper investigates code-switching and script-switching in medieval documents from the Cairo Geniza, written in Judaeo-Arabic (Arabic in Hebrew script), Hebrew, Arabic and Aramaic. Legal documents regularly show a macaronic style of Judaeo-Arabic, Aramaic and Hebrew, while in letters code-switching from Judaeo-Arabic to Hebrew is tied in with various socio-linguistic circumstances and indicates how markedly Jewish the sort of text is. Merchants in particular employed a style of writing devoid of Hebrew elements, whereas community dignitaries are much more prone to mixing of Hebrew and Judaeo-Arabic (and Arabic), although the degree of mixing also depends on a number of other factors, such as on the individual education. Analyses show great variation within the repertoire of single authors, as shown on the example of Daniel b. ʿAzariah, according to the purpose of the correspondence, with religious affairs attracting the highest Hebrew content, whereas letters pertaining to trade exhibit the lowest Hebrew content. Script-switching between Hebrew and Arabic may be prompted by convenience of individual writers, or occur as an idiosyncratic quirk, but reveal the close familiarity of the writer with both alphabets.

Background: Salt-sensitive normotensive men exhibit an enhanced pressor and heart rate (HR) response to mental stress. Stress-induced HR acceleration may result from sympathetic activation or vagal withdrawal. We studied the importance of vagal withdrawal for the increased stress responsiveness of salt-sensitive subjects. Methods: We studied cardiovascular reactivity to mental challenge in 17 salt-sensitive healthy white male students and 56 salt-resistant control subjects who were comparable with respect to age, body mass index, and physical fitness. Salt sensitivity was determined by a 2-week dietary protocol (20 mmol v 240 mmol sodium/day). Mental stress was induced by a computerized information-processing task (manometer test). Electrocardiogram and finger blood pressure (BP; Finapres, Ohmeda, Louisville, CO) were registered continuously to determine HR and interbeat-interval length. Time and frequency domain (spectral power) based measures of respiratory-related heart rate variability (HRV) were calculated to estimate vagal cardiac control; diastolic BP reactivity was assessed to estimate peripheral sympathetic effects. Results: Stress-induced increase in HR was higher in salt-sensitive than in salt-resistant subjects. Salt-sensitive subjects, in comparison to salt-resistant subjects, showed significantly reduced respiratory-related HRV during baseline and mental stress conditions (P < .01). The increase in diastolic BP during mental challenge was significantly greater in salt-sensitive subjects (P < .05). Conclusions: Our findings suggest reduced vagal and increased sympathetic tone during mental challenge in salt-sensitive subjects. Altered autonomic nervous system function may contribute to later development of hypertension in salt-sensitive individuals. Am J Hypertens 2003; 16:531-536 @ 2003 American Journal of Hypertension, Ltd

Judeo-Arabic sources from the 15th and 16th centuries are of great interest for research into subordinate syntax, as they are written in a repertoire that echoes the Classical Arabic elements of Medieval Judeo-Arabic as much as the colloquial forms of Late Judeo-Arabic. The most interesting phenomena concern the adverbial clauses, which show a great variation of adverbial connectives. It is also notable that compounds of prepositions and relativizers or complementizers appear to have become very popular, whereas few of the inherited non-prepositional Classical Arabic adverbial connectives occur. This article also raises the possibility that adverbial clauses may have only developed in the course of the codification of the Semitic languages, and perhaps of languages in general. Relative and complement clauses in the 15th- and 16th-century sources are less conspicuous, but in relative clauses, the form ʾan, homophonous with the complementizer and originating from constructions using thetanwīn, may occur as relativizer after indefinite antecedent. A noteworthy point regarding complement clauses is the lack of asyndetical constructions as compared with earlier Judeo-Arabic documentary material.