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Hurvitz S, Schott A, Ma C, Hamilton E, Nanda R, Zahrah G, Hunter N, Tan A, Telli M, Mesias J, Jeselsohn R, Munster P, Lu H, Gedrich R, Mather C, Parameswaran J, Han H, Wirth S. P253 ARV-471, a PROTAC® estrogen receptor (ER) degrader in advanced ER+/human epidermal growth factor receptor 2 (HER2)- breast cancer: phase 2 expansion (VERITAC) of a phase 1/2 study. Breast 2023. [DOI: 10.1016/s0960-9776(23)00371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
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2
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Ale Crivillero MV, Rößler S, Granovsky S, Doerr M, Cook MS, Rosa PFS, Müller J, Wirth S. Magnetic and electronic properties unveil polaron formation in Eu[Formula: see text]In[Formula: see text]Sb[Formula: see text]. Sci Rep 2023; 13:1597. [PMID: 36709384 PMCID: PMC9884272 DOI: 10.1038/s41598-023-28711-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/23/2023] [Indexed: 01/30/2023] Open
Abstract
The intermetallic compound Eu[Formula: see text]In[Formula: see text]Sb[Formula: see text], an antiferromagnetic material with nonsymmorphic crystalline structure, is investigated by magnetic, electronic transport and specific heat measurements. Being a Zintl phase, insulating behavior is expected. Our thermodynamic and magnetotransport measurements along different crystallographic directions strongly indicate polaron formation well above the magnetic ordering temperatures. Pronounced anisotropies of the magnetic and transport properties even above the magnetic ordering temperature are observed despite the Eu[Formula: see text] configuration which testify to complex and competing magnetic interactions between these ions and give rise to intricate phase diagrams discussed in detail. Our results provide a comprehensive framework for further detailed study of this multifaceted compound with possible nontrivial topology.
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Affiliation(s)
| | - Sahana Rößler
- Max-Planck-Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, 01187 Dresden, Germany
| | - S. Granovsky
- Institute for Solid State and Materials Physics, Technical University Dresden, 01062 Dresden, Germany
| | - M. Doerr
- Institute for Solid State and Materials Physics, Technical University Dresden, 01062 Dresden, Germany
| | - M. S. Cook
- Los Alamos National Laboratory, Los Alamos, NM 87545 USA
| | | | - J. Müller
- Institute of Physics, Goethe-University Frankfurt, 60438 Frankfurt (M), Germany
| | - S. Wirth
- Max-Planck-Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, 01187 Dresden, Germany
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3
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Dieterich F, Perras J, Popp W, Ahrens M, Wirth S. [Robotic-assisted mobilization for an effective mobilization in a COVID-19 patient with ECMO treatment]. Anaesthesiologie 2022; 71:959-964. [PMID: 36149467 PMCID: PMC9510451 DOI: 10.1007/s00101-022-01205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 12/13/2022]
Abstract
An effective (early) mobilization in COVID-19 intensive care patients with ECMO treatment is very important. Sedation, extracorporeal procedures with the danger of circuit malfunction, large lumen ECMO cannulas with a risk of dislocation and a very severe neuromuscular weakness are factors that could deem mobilization beyond stage 1 of the ICU mobility score (IMS) in some cases difficult or impossible; however, early mobilization is a key point of the ABCDEF bundle to counteract pulmonary complications, neuromuscular dysfunction and enable recovery. The case of a 53-year-old, previously healthy and active male patient with a severe and complicated course of COVID-19 and pronounced ICU-acquired weakness is described. While receiving ECMO the patient could be mobilized using a robotic system. Due to severe and rapidly progressing pulmonary fibrosis, additional low-dose methylprednisolone therapy (Meduri protocol) was implemented. Under this multimodal treatment the patient was successfully weaned from the ventilator and decannulated. Robotic-assisted mobilization has the potential to be a novel and safe therapeutic option for a customized and highly effective mobilization in ECMO patients.
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Affiliation(s)
- F Dieterich
- Abteilung für Anästhesie, Intensiv- und Schmerzmedizin, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland.
| | - J Perras
- Abteilung für Anästhesie, Intensiv- und Schmerzmedizin, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - W Popp
- Abteilung für Anästhesie, Intensiv- und Schmerzmedizin, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - M Ahrens
- Abteilung für Anästhesie, Intensiv- und Schmerzmedizin, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland
| | - S Wirth
- Abteilung für Anästhesie, Intensiv- und Schmerzmedizin, BG Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Deutschland
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Cieciera M, Sutter R, Wirth S, Götschi T, Farshad-Amacker N. Bone Marrow Edema on MRI Predicts Immediate Outcome of Joint Infiltrations of the Foot. Semin Musculoskelet Radiol 2022. [DOI: 10.1055/s-0042-1750678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Preuße M, Kirigin A, Mboma O, Wirth S. [Recommendations for action in the diagnostics and pharmaceutical treatment of children and adolescents with a SARS-CoV-2 infection]. Monatsschr Kinderheilkd 2021; 169:542-545. [PMID: 34024941 PMCID: PMC8129956 DOI: 10.1007/s00112-021-01215-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Affiliation(s)
- M. Preuße
- Zentrum für Kinder- und Jugendmedizin, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstr. 40, 42283 Wuppertal, Deutschland
| | - A. Kirigin
- Zentrum für Kinder- und Jugendmedizin, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstr. 40, 42283 Wuppertal, Deutschland
| | - O. Mboma
- Zentrum für Kinder- und Jugendmedizin, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstr. 40, 42283 Wuppertal, Deutschland
| | - S. Wirth
- Zentrum für Kinder- und Jugendmedizin, Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Heusnerstr. 40, 42283 Wuppertal, Deutschland
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Notohamiprodjo S, Roeper KM, Treitl KM, Hoberg B, Wanninger F, Verstreepen L, Mueck FG, Maxien D, Fischer F, Peschel O, Wirth S. Image quality is resilient against tube voltage variations in post-mortem skeletal radiography with a digital flat-panel detector. Sci Rep 2021; 11:7701. [PMID: 33833315 PMCID: PMC8032833 DOI: 10.1038/s41598-021-87294-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/24/2021] [Indexed: 11/09/2022] Open
Abstract
In recent phantom studies low-contrast detectability was shown to be independent from variations in tube voltage in digital radiography (DR) systems. To investigate the transferability to a clinical setting, the lower extremities of human cadavers were exposed at constant detector doses with different tube voltages in a certain range, as proposed in the phantom studies. Three radiologists independently graded different aspects of image quality (IQ) in a comparative analysis. The grades show no correlation between IQ and kV, which means that the readers were not able to recognize a significant IQ difference at different kV. Signal-to-noise and contrast-to-noise ratios showed no significant differences in IQ despite the kV-setting variations. These findings were observed from a limited kV range setting. Higher kV-settings resulted in lowest patient exposure at constant IQ. These results confirm the potential of DR-systems to contribute to standardization of examination protocols comparable to computed tomography. This may prevent the trend to overexpose. Further investigations in other body regions and other DR-systems are encouraged to determine transferability.
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Affiliation(s)
- S Notohamiprodjo
- Department of Nuclear Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - K M Roeper
- Department of Ophtalmology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - K M Treitl
- Department of Radiology, University Hospital of Munich, LMU Munich, Munich, Germany
| | - B Hoberg
- Agfa HealthCare Germany GmbH, Bonn, Germany
| | - F Wanninger
- Agfa-Gevaert HealthCare GmbH, Munich, Germany
| | | | - F G Mueck
- Department of Radiology, HELIOS Klinikum München West, Munich, Germany
| | - D Maxien
- Radiologie Zentrum München, Munich, Germany
| | - F Fischer
- Institute of Forensic Medicine, LMU Munich, Munich, Germany
| | - O Peschel
- Institute of Forensic Medicine, LMU Munich, Munich, Germany
| | - S Wirth
- Institute of Radiology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
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Berndt MT, Maegerlein C, Boeckh-Behrens T, Wunderlich S, Zimmer C, Wirth S, Mück FG, Mönch S, Friedrich B, Kaesmacher J. Microstructural Integrity of Salvaged Penumbra after Mechanical Thrombectomy. AJNR Am J Neuroradiol 2019; 41:79-85. [PMID: 31857324 DOI: 10.3174/ajnr.a6364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/24/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There are sparse data on the microstructural integrity of salvaged penumbral tissue after mechanical thrombectomy of large-vessel occlusions. The aim of the study was to analyze possible microstructural alteration in the penumbra and their association with clinical symptoms as well as angiographic reperfusion success in patients undergoing mechanical thrombectomy. MATERIALS AND METHODS All patients who underwent mechanical thrombectomy for large-vessel occlusions in the anterior circulation and who received an admission CT perfusion together with postinterventional DTIs were included (n = 65). Angiographic reperfusion success by means of modified Thrombolysis in Cerebral Infarction (mTICI) scale and clinical outcome were recorded. Microstructural integrity was assessed by DTI evaluating the mean diffusivity index within the salvaged gray matter of the former penumbra. RESULTS The mean diffusivity index was higher in completely recanalized patients (mTICI 3: -0.001 ± 0.034 versus mTICI <3: -0.030 ± 0.055, P = .03). There was a positive correlation between the mean diffusivity index and NIHSS score improvement (r = 0.49, P = .003) and the mean diffusivity index was associated with midterm functional outcome (r = -0.37, P = .04) after adjustment for confounders. In mediation analysis, the mean diffusivity index and infarction growth mediated the association between reperfusion success and clinical outcomes. CONCLUSIONS The macroscopic salvaged penumbra included areas of microstructural integrity changes, most likely related to the initial hypoperfusion. These abnormalities were found early after mechanical thrombectomy, were dependent on angiographic results, and correlated with the clinical outcome. When confirmed, these findings prompt the evaluation of therapies for protection of the penumbral tissue integrity.
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Affiliation(s)
- M T Berndt
- From the Departments of Neuroradiology (M.T.B., C.M., T.B.-B., C.Z., S.M., B.F.), and
| | - C Maegerlein
- From the Departments of Neuroradiology (M.T.B., C.M., T.B.-B., C.Z., S.M., B.F.), and
| | - T Boeckh-Behrens
- From the Departments of Neuroradiology (M.T.B., C.M., T.B.-B., C.Z., S.M., B.F.), and
| | - S Wunderlich
- Neurology (S.W.), Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - C Zimmer
- From the Departments of Neuroradiology (M.T.B., C.M., T.B.-B., C.Z., S.M., B.F.), and
| | - S Wirth
- Department of Radiology (S.W., F.G.M.), Donauisar Hospital, Deggendorf, Germany
| | - F G Mück
- Department of Radiology (S.W., F.G.M.), Donauisar Hospital, Deggendorf, Germany
| | - S Mönch
- From the Departments of Neuroradiology (M.T.B., C.M., T.B.-B., C.Z., S.M., B.F.), and
| | - B Friedrich
- From the Departments of Neuroradiology (M.T.B., C.M., T.B.-B., C.Z., S.M., B.F.), and
| | - J Kaesmacher
- Department of Neuroradiology (J.K.), Inselspital, University Hospital Bern, University Bern, Bern, Switzerland
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Liu XH, Chang CF, Tjeng LH, Komarek AC, Wirth S. Large magnetoresistance effects in Fe 3O 4. J Phys Condens Matter 2019; 31:225803. [PMID: 30836348 DOI: 10.1088/1361-648x/ab0cf4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We investigated the magnetoresistance (MR) of a single crystal of magnetite, Fe3O4. In an effort to distinguish between different contributions to the MR the samples were prepared in two different initial magnetic states, i.e. by either zero-field or by field cooling from room temperature. The different magnetic structures in this sample have a dramatic effect on the magnetoresistance: for initially zero-field-cooled conditions a negative MR of about -20% is observed just below the Verwey transition at [Formula: see text] K. For decreasing temperature the MR increases, changes sign at ∼78 K and reaches a record positive value of ∼45% at around 50 K. This behavior is completely absent in the field-cooled sample. Magnetization measurements corroborate an alignment of the easy magnetization direction in applied magnetic fields below [Formula: see text] as a cause of the strong effects observed in both, magnetization and MR. Our results point to a complex interplay of structural and magnetocrystalline effects taking place upon cooling Fe3O4 through [Formula: see text].
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Affiliation(s)
- X H Liu
- Max-Planck-Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, 01187 Dresden, Germany. State Key Laboratory of Superlattices and Microstructures, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083, People's Republic of China
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Abstract
Concept cells in the human hippocampus encode the meaning conveyed by stimuli over their perceptual aspects. Here we investigate whether analogous cells in the macaque can form conceptual schemas of spatial environments. Each day, monkeys were presented with a familiar and a novel virtual maze, sharing a common schema but differing by surface features (landmarks). In both environments, animals searched for a hidden reward goal only defined in relation to landmarks. With learning, many neurons developed a firing map integrating goal-centered and task-related information of the novel maze that matched that for the familiar maze. Thus, these hippocampal cells abstract the spatial concepts from the superficial details of the environment and encode space into a schema-like representation.
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Abstract
BACKGROUND In patients with multiple trauma, abdominal involvement is a particularly relevant injury pattern. Depending on the intensity and manner of injury, heterogeneous but often typical organ manifestations result. Knowledge of these injury patterns is essential for targeted diagnostics and treatment. OBJECTIVE This review provides a presentation of typical forms of abdominal injury with appropriate radiological techniques and where applicable treatment. MATERIAL AND METHODS Experiences and case examples from a supraregional trauma center are presented and discussed with the results of a Medline literature search and relevant parts of the german S3 guidelines on polytrauma. RESULTS Traumatic abdominal injuries are subdivided into blunt and penetrating injuries. Among these groups, blunt trauma with splenic injury being most frequent followed by liver and kidney involvement. In penetrating abdominal injuries hollow visceral organs are most frequently affected. For diagnosis, ultrasound and with escalating injury severity, multidetector computed tomography (MDCT) are the most important methods. For years there has been an ongoing trend towards conservative management and interventional hemorrhage control. This is driven by improvements in imaging that enable a more precise classification and indications for subsequent treatment. CONCLUSION Progress in radiology has led to an increasingly more important role for radiology in the management of traumatic abdominal injury. Therefore, it is crucial for the radiologist to gain interdisciplinary knowledge of the relevant trauma mechanisms and injury patterns of the severely injured patient in order to provide a treatment process that provides the optimal outcome.
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Affiliation(s)
- A Gäble
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - F Mück
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - M Mühlmann
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - S Wirth
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
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Wirth S. Mythen in der pädiatrischen Gastroenterologie und Ernährung. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seiro S, Jiao L, Kirchner S, Hartmann S, Friedemann S, Krellner C, Geibel C, Si Q, Steglich F, Wirth S. Evolution of the Kondo lattice and non-Fermi liquid excitations in a heavy-fermion metal. Nat Commun 2018; 9:3324. [PMID: 30127442 PMCID: PMC6102236 DOI: 10.1038/s41467-018-05801-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 07/24/2018] [Indexed: 11/13/2022] Open
Abstract
Strong electron correlations can give rise to extraordinary properties of metals with renormalized Landau quasiparticles. Near a quantum critical point, these quasiparticles can be destroyed and non-Fermi liquid behavior ensues. YbRh2Si2 is a prototypical correlated metal exhibiting the formation of quasiparticle and Kondo lattice coherence, as well as quasiparticle destruction at a field-induced quantum critical point. Here we show how, upon lowering the temperature, Kondo lattice coherence develops at zero field and finally gives way to non-Fermi liquid electronic excitations. By measuring the single-particle excitations through scanning tunneling spectroscopy, we find the Kondo lattice peak displays a non-trivial temperature dependence with a strong increase around 3.3 K. At 0.3 K and with applied magnetic field, the width of this peak is minimized in the quantum critical regime. Our results demonstrate that the lattice Kondo correlations have to be sufficiently developed before quantum criticality can set in.
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Affiliation(s)
- S Seiro
- Max Planck Institute for Chemical Physics of Solids, 01187, Dresden, Germany
- Institute for Solid State Physics, IFW-Dresden, Helmholtzstrasse 20, 01069, Dresden, Germany
| | - L Jiao
- Max Planck Institute for Chemical Physics of Solids, 01187, Dresden, Germany
| | - S Kirchner
- Zhejiang Institute for Modern Physics, Zhejiang University, 310027 Hangzhou, PR China
| | - S Hartmann
- Helmholtz-Zentrum Dresden-Rossendorf, 01328, Dresden, Germany
| | - S Friedemann
- School of Physics, University of Bristol, Bristol, BS8 1TH, UK
| | - C Krellner
- Institute of Physics, Goethe-University Frankfurt, 60438, Frankfurt/Main, Germany
| | - C Geibel
- Max Planck Institute for Chemical Physics of Solids, 01187, Dresden, Germany
| | - Q Si
- Department of Physics and Astronomy, Rice University, Houston, TX, 77005, USA
| | - F Steglich
- Max Planck Institute for Chemical Physics of Solids, 01187, Dresden, Germany
| | - S Wirth
- Max Planck Institute for Chemical Physics of Solids, 01187, Dresden, Germany.
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Spaeth J, Daume K, Goebel U, Wirth S, Schumann S. Increasing positive end-expiratory pressure (re-)improves intraoperative respiratory mechanics and lung ventilation after prone positioning. Br J Anaesth 2018; 116:838-46. [PMID: 27199315 DOI: 10.1093/bja/aew115] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Turning a patient prone, changes the respiratory mechanics and potentially the level of positive end-expiratory pressure (PEEP) that is necessary to prevent alveolar collapse. In this prospective clinical study we examined the impact of PEEP on the intratidal respiratory mechanics and regional lung aeration in the prone position. We hypothesized that a higher PEEP is required to maintain compliance and regional ventilation in the prone position. METHODS After ethical approval, 45 patients with healthy lungs undergoing lumbar spine surgery were examined in the supine position at PEEP 6 cm H2O and in the prone position at PEEP (6, 9 and 12 cm H2O). Dynamic compliance (CRS) and intratidal compliance-volume curves were determined and regional ventilation was measured using electrical impedance tomography. The compliance-volume curves were classified to indicate intratidal derecruitment, overdistension, or neither. RESULTS CRS did not differ between postures and PEEP levels (P>0.28). At a PEEP of 6 cm H2O a compliance-volume profile indicating neither derecruitment nor overdistension was observed in 38 supine, but only in 20 prone positioned patients (P<0.001). The latter increased to 33 and 37 (both P<0.001) when increasing PEEP to 9 and 12 cm H2O, respectively. Increasing PEEP from 6 to 9 cm H2O in the prone position increased peripheral ventilation significantly. CONCLUSIONS Respiratory system mechanics change substantially between supine and prone posture, which is not demonstrated in routine measurements. The intratidal compliance analysis suggests that in most patients a PEEP above commonly used settings is necessary to avoid alveolar collapse in the prone position. CLINICAL TRIAL REGISTRATION DRKS 00005692.
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Affiliation(s)
- J Spaeth
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Str. 55, Freiburg, Germany
| | - K Daume
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Str. 55, Freiburg, Germany
| | - U Goebel
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Str. 55, Freiburg, Germany
| | - S Wirth
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Str. 55, Freiburg, Germany
| | - S Schumann
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Str. 55, Freiburg, Germany
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Younossi ZM, Stepanova M, Schwarz KB, Wirth S, Rosenthal P, Gonzalez-Peralta R, Murray K, Henry L, Hunt S. Quality of life in adolescents with hepatitis C treated with sofosbuvir and ribavirin. J Viral Hepat 2018; 25:354-362. [PMID: 29193603 DOI: 10.1111/jvh.12830] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/05/2017] [Indexed: 12/11/2022]
Abstract
Chronic HCV infection has been associated with impairment of HRQL in both adults and paediatric patients. Our aim was to assess the HRQL of HCV-positive children treated with SOF + RBV. The data for this post hoc analysis were collected in a phase 2 open-label multinational study that evaluated safety and efficacy of SOF (400 mg/day) plus RBV (weight-based up to 1400 mg/day) for 12 or 24 weeks in adolescents with chronic HCV (GS-US-334-1112). Patients and their parents/guardians completed the PedsQL-4.0-SF-15 questionnaire at baseline, at the end of treatment and in post-treatment follow-up. We included 50 adolescents with HCV genotype 2 and 3 without cirrhosis (14.8 ± 1.9 years; male: 58%; treatment-naïve: 82%; vertically transmitted HCV: 70%). After treatment, 100% of patients with HCV genotype 2 and 95% with genotype 3 achieved SVR-12. During treatment with SOF + RBV, there were no significant decrements in any of patients' self-reported or parent-proxy-reported PRO scores regardless of treatment duration (all P > .05). After treatment cessation, we recorded a statistically significant improvement in patients' self-reported Social Functioning score by post-treatment week 12: on average, +4.8 points on a 0-100 scale (P = .02). By post-treatment week 24, parent-proxy-reported School Functioning score increased by, on average, +13.0 points (P = .0065). In multivariate analysis, history of abdominal pain and psychiatric disorders were predictive of impaired HRQL in adolescents with HCV (P < .05). Adolescents with HCV do not seem to experience any HRQL decrement during treatment with SOF + RBV and experience some improvement of their HRQL scores after achieving SVR.
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Affiliation(s)
- Z M Younossi
- Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA.,Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA
| | - M Stepanova
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - K B Schwarz
- Johns Hopkins Medical Center, Baltimore, MD, USA
| | - S Wirth
- Children's Hospital, Heusnerstt, Germany
| | - P Rosenthal
- University of California, San Francisco, CA, USA
| | | | - K Murray
- Seattle Children's Hospital, Seattle, WA, USA
| | - L Henry
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
| | - S Hunt
- Center for Outcomes Research in Liver Diseases, Washington, DC, USA
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Notohamiprodjo S, Verstreepen L, Wanninger F, Hoberg B, Röper KM, Mück FG, Treitl KM, Maxien D, Wirth S. Dependence of low contrast detail on exposure dose and tube voltage in digital flat-panel detector radiography—a pre-clinical phantom study. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aa9b8a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mydeen K, Kasinathan D, Koz C, Rößler S, Rößler UK, Hanfland M, Tsirlin AA, Schwarz U, Wirth S, Rosner H, Nicklas M. Pressure-Induced Ferromagnetism due to an Anisotropic Electronic Topological Transition in Fe_{1.08}Te. Phys Rev Lett 2017; 119:227003. [PMID: 29286759 DOI: 10.1103/physrevlett.119.227003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Indexed: 06/07/2023]
Abstract
A rapid and anisotropic modification of the Fermi-surface shape can be associated with abrupt changes in crystalline lattice geometry or in the magnetic state of a material. We show that such an electronic topological transition is at the basis of the formation of an unusual pressure-induced tetragonal ferromagnetic phase in Fe_{1.08}Te. Around 2 GPa, the orthorhombic and incommensurate antiferromagnetic ground state of Fe_{1.08}Te is transformed upon increasing pressure into a tetragonal ferromagnetic state via a conventional first-order transition. On the other hand, an isostructural transition takes place from the paramagnetic high-temperature state into the ferromagnetic phase as a rare case of a "type-0" transformation with anisotropic properties. Electronic-structure calculations in combination with electrical resistivity, magnetization, and x-ray diffraction experiments show that the electronic system of Fe_{1.08}Te is instable with respect to profound topological transitions that can drive fundamental changes of the lattice anisotropy and the associated magnetic order.
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Affiliation(s)
- K Mydeen
- Max-Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - D Kasinathan
- Max-Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - C Koz
- Max-Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - S Rößler
- Max-Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - U K Rößler
- Leibniz-Institut für Festkörper- und Werkstoffforschung IFW, Helmholtz Straße 20, 01171 Dresden, Germany
| | - M Hanfland
- ESRF, BP 220, F-38043 Grenoble Cedex 9, France
| | - A A Tsirlin
- Experimental Physics VI, Center for Electronic Correlations and Magnetism, Institute of Physics, University of Augsburg, 86135 Augsburg, Germany
| | - U Schwarz
- Max-Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - S Wirth
- Max-Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - H Rosner
- Max-Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
| | - M Nicklas
- Max-Planck Institute for Chemical Physics of Solids, Nöthnitzer Straße 40, 01187 Dresden, Germany
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Bruch R, Chatelle C, Kling A, Rebmann B, Wirth S, Schumann S, Weber W, Dincer C, Urban G. Clinical on-site monitoring of ß-lactam antibiotics for a personalized antibiotherapy. Sci Rep 2017; 7:3127. [PMID: 28600499 PMCID: PMC5466632 DOI: 10.1038/s41598-017-03338-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/26/2017] [Indexed: 01/07/2023] Open
Abstract
An appropriate antibiotherapy is crucial for the safety and recovery of patients. Depending on the clinical conditions of patients, the required dose to effectively eradicate an infection may vary. An inadequate dosing not only reduces the efficacy of the antibiotic, but also promotes the emergence of antimicrobial resistances. Therefore, a personalized therapy is of great interest for improved patients' outcome and will reduce in long-term the prevalence of multidrug-resistances. In this context, on-site monitoring of the antibiotic blood concentration is fundamental to facilitate an individual adjustment of the antibiotherapy. Herein, we present a bioinspired approach for the bedside monitoring of free accessible ß-lactam antibiotics, including penicillins (piperacillin) and cephalosporins (cefuroxime and cefazolin) in untreated plasma samples. The introduced system combines a disposable microfluidic chip with a naturally occurring penicillin-binding protein, resulting in a high-performance platform, capable of gauging very low antibiotic concentrations (less than 6 ng ml-1) from only 1 µl of serum. The system's applicability to a personalized antibiotherapy was successfully demonstrated by monitoring the pharmacokinetics of patients, treated with ß-lactam antibiotics, undergoing surgery.
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Affiliation(s)
- R Bruch
- Department of Microsystems Engineering, University of Freiburg, 79110, Freiburg, Germany
| | - C Chatelle
- Faculty of Biology, University of Freiburg, 79104, Freiburg, Germany.,BIOSS Centre for Biological Signalling Studies, University of Freiburg, 79104, Freiburg, Germany
| | - A Kling
- Department of Biosystems Science and Engineering, ETH Zurich, 4058, Basel, Switzerland
| | - B Rebmann
- Faculty of Biology, University of Freiburg, 79104, Freiburg, Germany.,BIOSS Centre for Biological Signalling Studies, University of Freiburg, 79104, Freiburg, Germany
| | - S Wirth
- Department of Anaesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - S Schumann
- Department of Anaesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany
| | - W Weber
- Faculty of Biology, University of Freiburg, 79104, Freiburg, Germany.,BIOSS Centre for Biological Signalling Studies, University of Freiburg, 79104, Freiburg, Germany
| | - C Dincer
- Department of Microsystems Engineering, University of Freiburg, 79110, Freiburg, Germany. .,Freiburg Materials Research Center, University of Freiburg, 79104, Freiburg, Germany.
| | - G Urban
- Department of Microsystems Engineering, University of Freiburg, 79110, Freiburg, Germany.,Freiburg Materials Research Center, University of Freiburg, 79104, Freiburg, Germany
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Mück F, Wirth K, Muggenthaler M, Kanz KG, Kreimeier U, Maxien D, Linsenmeier U, Mutschler W, Wirth S. [Pretreatment mass casualty incident workflow analysis : Comparison of two level 1 trauma centers]. Unfallchirurg 2017; 119:632-41. [PMID: 27351989 DOI: 10.1007/s00113-016-0200-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Mass casualty incidents (MCI) have particularly high demands on patient care processes but occur rather rarely in daily hospital routine. Therefore, it is common to use simulations to train staff and to optimize institutional processes. OBJECTIVES Aim of study was to compare the pre-therapeutic in-house workflow of two differently structured level 1 trauma sites in the case of a simulated mass casualty incident (MCI). MATERIALS AND METHODS A MCI of 70 patients was simulated by actors in a manner that was as realistic as possible. The on-site triage assigned 7 cases to trauma site A with relatively long in-house distances and 4 patients to an independent trauma site B in which these distances were relatively short. During in-house treatment, time intervals for reaching milestones were measured and compared using the Mann-Whitney U test. RESULTS As no simultaneous patient arrival occurred, the Patient Distribution Matrix proved to be effective. Site A needed more time (minutes) from admission to endpoints (A: 31.85 ± 7.99; B: 21.62 ± 4.76; p = 0.059). In detail, the time intervals were particularly longer for both patient stay in trauma room (A: 8.46 ± 3.02; B: 2.73 ± 0.78, p < 0.01) and transfer time to the CT room (A: 1.81 ± 0.62; B: 0.06 ± 0.03, p < 0.01). A shorter stay in the CT room did not compensate these effects (A: 8.86 ± 1.84; B: 10.40 ± 2.89, p = 0.571). For both sites, image calculation and distribution were relatively time consuming (17.36 ± 3.05). CONCLUSIONS Although short in-house distances accelerated pretherapeutic treatment processes significantly, both sites remained clearly within the "golden hour". The strongest potential bottleneck was the time interval until images were available at the endpoints.
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Affiliation(s)
- F Mück
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland.
| | - K Wirth
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - M Muggenthaler
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - K G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - U Kreimeier
- Klinik für Anästhesiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - D Maxien
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - U Linsenmeier
- Institut für Interventionelle und Diagnostische Radiologie, HELIOS Klinikum München West, Steinerweg 5, 81241, München, Deutschland
| | - W Mutschler
- Klinik für Allgemeine, Unfall-, Hand- und Plastische Chirurgie, Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
| | - S Wirth
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland
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Wirth S, Krupp J, Bolzer M, Reiser M, Fischer M. Thoraxradiografie: Güte von Befundung, Beurteilung und Selbsteinschätzung in Abhängigkeit von Fallschwierigkeit, realem Vorgehen während der Bildbefundung (eye-tracking) und des Weiterbildungsstands. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- S Wirth
- Ludwigs-Maximilians-Universität München, Institut für Klinische Radiologie, München
| | - J Krupp
- Ludwigs-Maximilians-Universität München, Institut für Klinische Radiologie, München
| | - M Bolzer
- Ludwigs-Maximilians-Universität München, Institut für medizinische Didaktiv und Ausbildungsforschung, München
| | - M Reiser
- Ludwigs-Maximilians-Universität München, Institut für Klinische Radiologie, München
| | - M Fischer
- Ludwigs-Maximilians-Universität München, Institut für medizinische Didaktiv und Ausbildungsforschung, München
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Notohamiprodjo S, Stahl R, Braunagel M, Kazmierczak P, Thierfelder K, Treitl K, Wirth S, Reiser M, Notohamiprodjo M. Diagnostic Accuracy of Contemporary Multidetector Computed Tomography for the Detection of Lumbar Disk Herniation. Semin Musculoskelet Radiol 2017. [DOI: 10.1055/s-0037-1600891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Notohamiprodjo
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Germany
| | - R. Stahl
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Germany
| | - M. Braunagel
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Germany
| | - P.M. Kazmierczak
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Germany
| | - K.M. Thierfelder
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Germany
| | - K.M. Treitl
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Germany
| | - S. Wirth
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Germany
| | - M.F. Reiser
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Germany
| | - M. Notohamiprodjo
- Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
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Notohamiprodjo S, Stahl R, Braunagel M, Kazmierczak PM, Thierfelder KM, Treitl KM, Wirth S, Notohamiprodjo M. Diagnostic accuracy of contemporary multidetector computed tomography (MDCT) for the detection of lumbar disc herniation. Eur Radiol 2016; 27:3443-3451. [PMID: 27988890 DOI: 10.1007/s00330-016-4686-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/23/2016] [Accepted: 11/29/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of multidetector CT (MDCT) for detection of lumbar disc herniation with MRI as standard of reference. METHODS Patients with low back pain underwent indicated MDCT (128-row MDCT, helical pitch), 60 patients with iterative reconstruction (IR) and 67 patients with filtered back projection (FBP). Lumbar spine MRI (1.5 T) was performed within 1 month. Signal-to-noise ratios (SNR) of cerebrospinal fluid (CSF), annulus fibrosus (AF) and the spinal cord (SC) were determined for all modalities. Two readers independently rated image quality (IQ), diagnostic confidence and accuracy in the diagnosis of lumbar disc herniation using MRI as standard of reference. Inter-reader correlation was assessed with weighted κ. RESULTS Sensitivity, specificity, precision and accuracy of MDCT for disc protrusion were 98.8%, 96.5%, 97.1%, 97.8% (disc level), 97.7%, 92.9%, 98.6%, 96.9% (patient level). SNR of IR was significantly higher than FBP. IQ was significantly better in IR owing to visually reduced noise and improved delineation of the discs. κ (>0.90) was excellent for both algorithms. CONCLUSION MDCT of the lumbar spine yields high diagnostic accuracy for detection of lumbar disc herniation. IR improves image quality so that the provided diagnostic accuracy is principally equivalent to MRI. KEY POINTS • MDCT is an accurate alternative to MRI in disc herniation diagnosis. • By IR enhanced image quality improves MDCT diagnostic confidence similar to MRI. • Advances in CT technology contribute to improved diagnostic performance in lumbar spine imaging.
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Affiliation(s)
- S Notohamiprodjo
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany.
| | - R Stahl
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - M Braunagel
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - P M Kazmierczak
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - K M Thierfelder
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - K M Treitl
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - S Wirth
- Institute for Clinical Radiology, University Hospital of Munich, LMU Munich, Nussbaumstr. 20, 80336, Munich, Germany
| | - M Notohamiprodjo
- Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
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Jiao L, Rößler S, Kim DJ, Tjeng LH, Fisk Z, Steglich F, Wirth S. Additional energy scale in SmB 6 at low-temperature. Nat Commun 2016; 7:13762. [PMID: 27941948 PMCID: PMC5159841 DOI: 10.1038/ncomms13762] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 10/31/2016] [Indexed: 11/09/2022] Open
Abstract
Topological insulators give rise to exquisite electronic properties because of their spin-momentum locked Dirac-cone-like band structure. Recently, it has been suggested that the required opposite parities between valence and conduction band along with strong spin-orbit coupling can be realized in correlated materials. Particularly, SmB6 has been proposed as candidate material for a topological Kondo insulator. Here we observe, by utilizing scanning tunnelling microscopy and spectroscopy down to 0.35 K, several states within the hybridization gap of about ±20 meV on well characterized (001) surfaces of SmB6. The spectroscopic response to impurities and magnetic fields allows to distinguish between dominating bulk and surface contributions to these states. The surface contributions develop particularly strongly below about 7 K, which can be understood in terms of a suppressed Kondo effect at the surface. Our high-resolution data provide insight into the electronic structure of SmB6, which reconciles many current discrepancies on this compound.
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Affiliation(s)
- L. Jiao
- Max-Planck-Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, 01187 Dresden, Germany
| | - S. Rößler
- Max-Planck-Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, 01187 Dresden, Germany
| | - D. J. Kim
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - L. H. Tjeng
- Max-Planck-Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, 01187 Dresden, Germany
| | - Z. Fisk
- Department of Physics and Astronomy, University of California, Irvine, CA 92697, USA
| | - F. Steglich
- Max-Planck-Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, 01187 Dresden, Germany
- Center for Correlated Matter, Zhejiang University, Hangzhou 310058, China
- Institute of Physics, Chinese Academy of Sciences, Beijing 100190, China
| | - S. Wirth
- Max-Planck-Institute for Chemical Physics of Solids, Nöthnitzer Str. 40, 01187 Dresden, Germany
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Wirth S, Kreysing M, Spaeth J, Schumann S. Intraoperative compliance profiles and regional lung ventilation improve with increasing positive end-expiratory pressure. Acta Anaesthesiol Scand 2016; 60:1241-50. [PMID: 27405798 DOI: 10.1111/aas.12767] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/30/2016] [Accepted: 06/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anaesthesia and mechanical ventilation can lead to impaired lung. Intraoperative positive end-expiratory pressure (PEEP) should prevent intratidal recruitment/derecruitment without causing overdistension. The intratidal compliance profile indicates both unwanted phenomena. We hypothesized that a higher than usual PEEP improves the intratidal compliance and the regional lung ventilation of patients with healthy lungs. METHODS After ethics approval, 30 adult patients scheduled for limb surgery were investigated at PEEP 5, 7 and 9 cm H2 O during mechanical ventilation. We calculated the dynamic compliance of the respiratory system (CRS ) and the intratidal volume-dependent CRS curve. The CRS curve indicated intratidal recruitment/derecruitment and/or overdistension. Regional ventilation was measured using electrical impedance tomography. RESULTS At PEEP 5, 7 and 9 cm H2 O, intratidal recruitment/derecruitment was observed in 92%, 84% and 46% (P < 0.05) of the patients respectively. Increasing PEEP was associated with recruitment in the dorsal regions of the lungs (P < 0.001). At PEEP 9 cm H2 O, lung overdistension was indicated in two patients. With PEEP levels up to 9 cm H2 O, no significant effects on haemodynamic variables were found. CONCLUSION We conclude that in most patients, the often applied PEEP of 5 cm H2 O is insufficient to prevent intratidal recruitment/derecruitment and that few patients show overdistension at high PEEP levels. To establish optimal pressure-volume relationships in the respiratory system, the analysis of the individual intratidal compliance profiles could be a means for individualized perioperative PEEP titration.
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Affiliation(s)
- S. Wirth
- Department of Anesthesiology and Intensive Care Medicine; University Medical Center Freiburg; Freiburg Germany
| | - M. Kreysing
- Department of Anesthesiology and Intensive Care Medicine; University Medical Center Freiburg; Freiburg Germany
| | - J. Spaeth
- Department of Anesthesiology and Intensive Care Medicine; University Medical Center Freiburg; Freiburg Germany
| | - S. Schumann
- Department of Anesthesiology and Intensive Care Medicine; University Medical Center Freiburg; Freiburg Germany
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Wirth S, Seywert L, Spaeth J, Schumann S. Compensating Artificial Airway Resistance via Active Expiration Assistance. Respir Care 2016; 61:1597-1604. [DOI: 10.4187/respcare.04817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Langgartner S, Strube W, Oviedo T, Hansbauer M, Karch S, Wirth S, Falkai P, Hasan A. Treatment-resistant Schizophrenia and Global Cortical Atrophy in a Patient with Turner Syndrome. Pharmacopsychiatry 2016; 49:262-263. [PMID: 27458742 DOI: 10.1055/s-0042-111207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- S Langgartner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - W Strube
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - T Oviedo
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - M Hansbauer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - S Karch
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - S Wirth
- Department of Clinical Radiology, Ludwig-Maximilians University, Munich
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
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Wirth S, Zepp F. Lebererkrankungen im Säuglings-, Kindes- und Jugendalter. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Langer T, Zapf T, Wirth S, Meyer B, Wiegand A, Timmen H, Gupta SJ, Schuster S, Geraedts M. [How are Pediatric Hospitals in North-Rhine Westfalia Prepared to Overcome Language Barriers? A Pilot Study Exploring The Structural Quality of Inpatient Care]. Gesundheitswesen 2016; 79:535-541. [PMID: 27144710 DOI: 10.1055/s-0042-102349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background In Germany, 35% of all children are considered to have a "migration background", and in the state of North-Rhine-Westfalia 43%. Frequently, one or both parents of a patient with a migration background have limited German language proficiency. Communication barriers due to a language difference can have a negative impact on quality of care, patient safety and costs of care. In this study, we investigate how children's hospitals are prepared to meet the challenges associated with language barriers. Methods We surveyed all children's hospitals in the state of North-Rhine-Westfalia, Germany. The questionnaire was based on the "Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS)" and was adapted to circumstances in Germany. Results Thirty-eight hospitals participated (51%) in this survey. Language barriers occurred frequently (75% of respondents mentioned language difficulties in more than 10% of the patient population). 82% of respondents rated their hospital to be "less than well prepared" to overcome language barriers. In the majority of hospitals (62%), the need for an interpreter was determined on a case-to-case basis and not according to any set protocol. In most cases bilingual staff was used for interpreting. However, only 38% of respondents found a list of available bilingual staff to be a sufficient resource. 42% of respondents did not know the monthly costs for professional interpreting services. In the remaining cases, costs were less than € 500/month. Conclusion To overcome language barriers, hospitals rely on local resources. The majority of respondents did not find them to be appropriate and sufficient. The development of quality standards and the provision of financial resources are necessary to mobilize this potential for improvement. Therefore, other disciplines and sectors of healthcare need to be analyzed in order to provide the evidence for a constructive discussion with decision makers in policy and health insurance.
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Affiliation(s)
- T Langer
- Klinik für Neuropädiatrie und Muskelerkrankungen, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Freiburg
| | - T Zapf
- Zentrum für Kinder- und Jugendmedizin, Universität Witten/Herdecke, Helios Klinikum Wuppertal, Wuppertal
| | - S Wirth
- Zentrum für Kinder- und Jugendmedizin, Universität Witten/Herdecke, Helios Klinikum Wuppertal, Wuppertal
| | - B Meyer
- FB 06, Arbeitsbereich Interkulturelle Kommunikation, Johannes-Gutenberg-Universität Mainz, Germersheim
| | - A Wiegand
- Philip Klee-Institut für Klinische Pharmakologie, Helios Klinikum Wuppertal, Wuppertal
| | - H Timmen
- Diakonie Wuppertal, Sprint Wuppertal, Migrationsdienste, Wuppertal
| | - S J Gupta
- Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Datteln
| | - S Schuster
- Frauenklinik, Universitätsspital Basel, Basel, Schweiz
| | - M Geraedts
- Fakultät für Gesundheit, Institut für Gesundheitssystemforschung, Witten
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Weber K, Trinter T, Stahl R, Zielinski P, Wirth S. Vergleich verschiedener Varianten der Leistungsbewertung am Beispiel der Computertomografie einer universitären Radiologie. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wirth S, Wirth K, Mück F, Muggenthaler M, Reiser M. Simulation eines Massenanfalls von Verletzten (MANV) mit einem Vergleich des radiologischen Workflow in zwei Traumazentren der höchsten Versorgungsstufe. ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grimmer F, Roskopf M, Wirth S, Heusch A, Hensel K. Subclinical Alterations of LV Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wirth S, Schumann S. Reply from the authors. Individualized ventilatory strategy: ameliorate lung injury while preserving physiology. Br J Anaesth 2016; 116:439-40. [PMID: 26865145 DOI: 10.1093/bja/aew016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Spaeth J, Ott M, Karzai W, Grimm A, Wirth S, Schumann S, Loop T. Double-lumen tubes and auto-PEEP during one-lung ventilation. Br J Anaesth 2016; 116:122-30. [DOI: 10.1093/bja/aev398] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hashem A, Abd Allah EF, Alqarawi AA, Al Huqail AA, Egamberdieva D, Wirth S. Alleviation of cadmium stress in Solanum lycopersicum L. by arbuscular mycorrhizal fungi via induction of acquired systemic tolerance. Saudi J Biol Sci 2015; 23:272-81. [PMID: 26981010 PMCID: PMC4778590 DOI: 10.1016/j.sjbs.2015.11.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/26/2015] [Accepted: 11/04/2015] [Indexed: 10/24/2022] Open
Abstract
Experiments were conducted to evaluate cadmium (Cd) stress-induced changes in growth, antioxidants and lipid composition of Solanum lycopersicum with and without arbuscular mycorrhizal fungi (AMF). Cadmium stress (50 μM) caused significant changes in the growth and physio-biochemical attributes studied. AMF mitigated the deleterious impact of Cd on the parameters studied. Cadmium stress increased malonaldehyde and hydrogen peroxide production but AMF reduced these parameters by mitigating oxidative stress. The activity of antioxidant enzymes enhanced under Cd treatment and AMF inoculation further enhanced their activity, thus strengthening the plant's defense system. Proline and phenol content increased in Cd-treated as well as AMF-inoculated plants providing efficient protection against Cd stress. Cadmium treatment resulted in great alterations in the main lipid classes leading to a marked change in their composition. Cadmium stress caused a significant reduction in polyunsaturated fatty acids resulting in enhanced membrane leakage. The present study supports the use of AMF as a biological means to ameliorate Cd stress-induced changes in tomato.
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Affiliation(s)
- Abeer Hashem
- Botany and Microbiology Department, Faculty of Science, King Saud University, P.O. Box. 2460, Riyadh 11451, Saudi Arabia; Mycology and Plant Disease Survey, Plant Pathology Research Institute, Agriculture Research Center, Giza, Egypt
| | - E F Abd Allah
- Department of Plant Production, Faculty of Food & Agricultural Sciences, King Saud University, P.O. Box. 2460, Riyadh 11451, Saudi Arabia
| | - A A Alqarawi
- Department of Plant Production, Faculty of Food & Agricultural Sciences, King Saud University, P.O. Box. 2460, Riyadh 11451, Saudi Arabia
| | - Asma A Al Huqail
- Botany and Microbiology Department, Faculty of Science, King Saud University, P.O. Box. 2460, Riyadh 11451, Saudi Arabia
| | - D Egamberdieva
- Institute for Landscape Biogeochemistry, Leibniz Centre for Agricultural Landscape Research (ZALF), 15374 Müncheberg, Germany
| | - S Wirth
- Institute for Landscape Biogeochemistry, Leibniz Centre for Agricultural Landscape Research (ZALF), 15374 Müncheberg, Germany
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Materne P, Koz C, Rössler UK, Doerr M, Goltz T, Klauss HH, Schwarz U, Wirth S, Rössler S. Solitonic Spin-Liquid State Due to the Violation of the Lifshitz Condition in Fe(1+y)Te. Phys Rev Lett 2015; 115:177203. [PMID: 26551139 DOI: 10.1103/physrevlett.115.177203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Indexed: 06/05/2023]
Abstract
A combination of phenomenological analysis and Mössbauer spectroscopy experiments on the tetragonal Fe(1+y)Te system indicates that the magnetic ordering transition in compounds with higher Fe excess, y≥0.11, is unconventional. Experimentally, a liquidlike magnetic precursor with quasistatic spin order is found from significantly broadened Mössbauer spectra at temperatures above the antiferromagnetic transition. The incommensurate spin-density wave order in Fe(1+y)Te is described by a magnetic free energy that violates the weak Lifshitz condition in the Landau theory of second-order transitions. The presence of multiple Lifshitz invariants provides the mechanism to create multidimensional, twisted, and modulated solitonic phases.
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Affiliation(s)
- Ph Materne
- Institut für Festkörperphysik, Technische Universität Dresden, 01062 Dresden, Germany
| | - C Koz
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Straß e 40, 01187 Dresden, Germany
| | - U K Rössler
- IFW Dresden, Postfach 270016, 01171 Dresden, Germany
| | - M Doerr
- Institut für Festkörperphysik, Technische Universität Dresden, 01062 Dresden, Germany
| | - T Goltz
- Institut für Festkörperphysik, Technische Universität Dresden, 01062 Dresden, Germany
| | - H H Klauss
- Institut für Festkörperphysik, Technische Universität Dresden, 01062 Dresden, Germany
| | - U Schwarz
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Straß e 40, 01187 Dresden, Germany
| | - S Wirth
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Straß e 40, 01187 Dresden, Germany
| | - S Rössler
- Max Planck Institute for Chemical Physics of Solids, Nöthnitzer Straß e 40, 01187 Dresden, Germany
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Hensel K, Wirth S. [Current shortcomings in the treatment of cryptorchidism - analysis performed by a paediatrician]. Aktuelle Urol 2015; 46:373-7. [PMID: 26378387 DOI: 10.1055/s-0035-1555801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cryptorchidism is the most common disorder in paediatric surgery in the Western world and a major risk factor for subfertility and malignancy. In 2009, German national guidelines were changed to recommend that treatment for undescended testes should be completed by the age of 1 instead of 2. However, the share of boys undergoing orchidopexy for cryptorchidism within the first year of life has only marginally increased in response to the guideline of the Association of the Scientific Medical Societies in Germany (AWMF). The number of orchidopexies performed in children below the age of 1 is too low both in Germany as well as internationally. The majority of primary care physicians treating children do not seem to be aware of this discrepancy between guideline recommendations and average actual age at orchidopexy. Moreover, a considerable number of cryptorchidism cases seem to be due to secondary ascent of the testis - an underappreciated condition that usually occurs at school age. Consequently, the timing of orchidopexy in primary undescended testes must be optimised. Therefore, education of parents and primary care physicians regarding the necessity of early orchidopexy and frequent testicular examinations even beyond infancy is mandatory to improve the prognosis of cryptorchidism regarding subfertility and malignancy. Further studies are needed to clarify the reasons for the large number of late orchidopexies.
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Affiliation(s)
- K. Hensel
- Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Wuppertal, Universität Witten/Herdecke
| | - S. Wirth
- Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Wuppertal, Universität Witten/Herdecke
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Wirth S, Zepp F. Kinder- und Jugendpsychiatrie. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3238-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cherian D, Rößler S, Wirth S, Elizabeth S. Interplay of structure, magnetism, and superconductivity in Se substituted iron telluride with excess Fe. J Phys Condens Matter 2015; 27:205702. [PMID: 25950464 DOI: 10.1088/0953-8984/27/20/205702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We investigated the evolution of the temperature-composition phase diagram of Fe(1+y)Te upon Se substitution. In particular, the effect of Se substitution on the two-step, coupled magneto-structural transition in Fe(1+y)Te single crystals is investigated. To this end, the nominal Fe excess was kept at y = 0.12. For low Se concentrations, the two magneto-structural transitions displayed a tendency to merge. In spite of the high Fe-content, superconductivity emerges for Se concentrations x ⩾ 0.1. We present a temperature-composition phase diagram to demonstrate the interplay of structure, magnetism and superconductivity in these ternary Fe-chalcogenides.
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Affiliation(s)
- Dona Cherian
- Department of Physics, Indian Institute of Science, C V Raman Ave, Bengaluru, Karnataka 560012, India
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Wirth S. Handlungsempfehlung nach der Leitlinie „Diagnostik, Therapie und Verlaufskontrolle der primären angeborenen Hypothyreose“. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ali A, Wirth S, Treitl K, Reiser M, Treitl M. Isolierte endovaskuläre Schaumsklerosierung der männlichen Varikozele: klinischer Erfolg, Komplikationen und Patientenzufriedenheit im Langzeitverlauf. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wirth S. Handlungsempfehlung nach der Leitlinie „Gynäkomastie“. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wirth S, Baur M, Spaeth J, Guttmann J, Schumann S. Intraoperative positive end-expiratory pressure evaluation using the intratidal compliance-volume profile. Br J Anaesth 2014; 114:483-90. [PMID: 25416274 DOI: 10.1093/bja/aeu385] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lung-protective mechanical ventilation during general surgery including the application of PEEP can reduce postoperative pulmonary complications. In a prospective clinical observation study, we evaluated volume-dependent respiratory system compliance in adult patients undergoing ear-nose-throat surgery with ventilation settings chosen empirically by the attending anaesthetist. METHODS In 40 patients, we measured the respiratory variables during intraoperative mechanical ventilation. All measurements were subdivided into 5 min intervals. Dynamic compliance (CRS) and the intratidal volume-dependent CRS curve was calculated for each interval and classified into one of the six specific compliance profiles indicating intratidal recruitment/derecruitment, overdistension or all. We retrospectively compared the occurrences of the respective compliance profiles at PEEP levels of 5 cm H2O and at higher levels. RESULTS The attending anaesthetists set the PEEP level initially to 5 cm H2O in 29 patients (83%), to 7 cm H2O in 5 patients (14%), and to 8 cm H2O in 2 patients (6%). Across all measurements the mean CRS was 61 (11) ml cm H2O(-1) (40-86 ml cm H2O(-1)) and decreased continuously during the procedure. At PEEP of 5 cm H2O the compliance profile indicating strong intratidal recruitment/derecruitment occurred more often (18.6%) compared with higher PEEP levels (5.5%, P<0.01). Overdistension was practically never observed. CONCLUSIONS In most patients, a PEEP of 5 cm H2O during intraoperative mechanical ventilation is too low to prevent intratidal recruitment/derecruitment. The analysis of the intratidal compliance profile provides the rationale to individually titrate a PEEP level that stabilizes the alveolar recruitment status of the lung during intraoperative mechanical ventilation. TRIAL REGISTRATION NUMBER DRKS00004286.
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Affiliation(s)
- S Wirth
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg D-79106, Germany
| | - M Baur
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg D-79106, Germany
| | - J Spaeth
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg D-79106, Germany
| | - J Guttmann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg D-79106, Germany
| | - S Schumann
- Department of Anesthesiology and Intensive Care Medicine, University Medical Center Freiburg, Hugstetter Straße 55, Freiburg D-79106, Germany
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Wirth S, Zepp F. Störungen im Bereich des Bewegungsapparats. Monatsschr Kinderheilkd 2014. [DOI: 10.1007/s00112-013-3023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wirth S, Klodt C, Wintermeyer P, Berrang J, Hensel K, Langer T, Heusch A. Positive or negative fructose breath test results do not predict response to fructose restricted diet in children with recurrent abdominal pain: results from a prospective randomized trial. Klin Padiatr 2014; 226:268-73. [PMID: 25153911 DOI: 10.1055/s-0034-1383653] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To perform a prospective, blinded, randomized interventional trial in patients with recurrent abdominal pain. The primary endpoint was to determine the abdominal pain intensity after 2 weeks of fructose restricted diet. Secondary endpoints were changes of pain frequency and a secondary symptom score (SSS). METHODS 103 individuals with recurrent abdominal pain for more than 3 months were randomized. 51 patients were allocated to group A (diet) and 52 to group B (no diet). 2 weeks later the patients underwent hydrogen breath test and were assigned to the test positive or negative group to identify patients with fructose malabsorption. RESULTS 2 weeks after intervention the pain score decreased significantly from a median 5.5 in group A to 4 and did not change significantly in group B (5.3 to 5). In group A both patients with positive and negative breath tests had a significant lower pain score (-2 and -1.75, respectively). Frequency of abdominal pain decreased in both groups but without significant difference, SSS improved only in group A from median 6 to 3.5. Positive breath test was no predicting factor, neither was abdominal pain during the test. CONCLUSIONS Fructose restricted diet in children and adolescents with recurrent abdominal pain may be of benefit to improve both abdominal pain symptoms and other secondary symptoms. Since a negative breath test result does not exclude a positive response to fructose restriction, the hydrogen breath test does not seem to be the appropriate diagnostic mean to predict the response to the diet.
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Affiliation(s)
- S Wirth
- Department of Pediatrics, Helios Medical Centre, Witten-Herdecke University, Wuppertal, Germany
| | - C Klodt
- Department of Pediatrics, Helios Medical Centre, Witten-Herdecke University, Wuppertal, Germany
| | - P Wintermeyer
- Department of Pediatrics, Helios Medical Centre, Witten-Herdecke University, Wuppertal, Germany
| | - J Berrang
- Department of Pediatrics, Klinikum Dortmund, Dortmund, Germany
| | - K Hensel
- Department of Pediatrics, Helios Medical Centre, Witten-Herdecke University, Wuppertal, Germany
| | - T Langer
- Department of Pediatrics, Helios Medical Centre, Witten-Herdecke University, Wuppertal, Germany
| | - A Heusch
- Department of Pediatrics, Helios Medical Centre, Witten-Herdecke University, Wuppertal, Germany
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Notohamiprodjo S, Deak Z, Meurer F, Maertz F, Mueck FG, Geyer LL, Wirth S. Image quality of iterative reconstruction in cranial CT imaging: comparison of model-based iterative reconstruction (MBIR) and adaptive statistical iterative reconstruction (ASiR). Eur Radiol 2014; 25:140-6. [DOI: 10.1007/s00330-014-3374-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/09/2014] [Accepted: 07/22/2014] [Indexed: 11/30/2022]
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Geyer LL, Körner M, Linsenmaier U, Wirth S, Reiser MF, Meindl T. The role of follow-up ultrasound and clinical parameters after abdominal MDCT in patients with multiple trauma. Acta Radiol 2014; 55:486-94. [PMID: 23969264 DOI: 10.1177/0284185113499559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Beside its value during the initial trauma work-up (focused assessment with sonography for trauma), ultrasound (US) is recommended for early follow-up examinations of the abdomen in multiple injured patients. However, multidetector CT (MDCT) has proven to reliably diagnose traumatic lesions of abdominal organs, to depict their extent, and to assess their clinical relevance. PURPOSE To evaluate the diagnostic impact of follow-up US studies after MDCT of the abdomen and to identify possible clinical parameters indicating the need of a follow-up US. MATERIAL AND METHODS During a 30-month period, patients with suspected multiple trauma were allocated. Patients with admission to the ICU, an initial abdominal MDCT scan, and an US follow-up examination after 6 and 24 h were included. Two patient cohorts were defined: patients with normal abdominal MDCT (group 1), patients with trauma-related pathologic abdominal MDCT (group 2). In all patients, parameters indicating alteration of vital functions or hemorrhage within the first 24 h were obtained by reviewing the medical charts. RESULTS Forty-four of 193 patients were included: 24 were categorized in group 1 (mean age, 41.1 years; range, 21-90 years), 20 in group 2 (mean age, 36.6 years; range, 16-71 years). In group 1, US did not provide new information compared to emergency MDCT. In group 2, there were no contradictory 6- and 24-h follow-up US findings. In patients with positive MDCT findings and alterations of clinical parameters, US did not detect progression of a previously diagnosed pathology or any late manifestation of such a lesion. In none of the patients with negative abdominal MDCT and pathological clinical parameters US indicated an abdominal injury. CONCLUSION Routine US follow-up does not yield additional information after abdominal trauma. In patients with MDCT-proven organ lesions, follow-up MDCT should be considered if indicated by abnormal clinical and/or laboratory findings.
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Affiliation(s)
- Lucas L Geyer
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - M Körner
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - U Linsenmaier
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - S Wirth
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - MF Reiser
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - T Meindl
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
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Kammer N, Lütke Daldrup C, Coppenrath E, Lechner A, Ferrari U, Reiser MF, Wirth S, Saam T, Hetterich H. Modifizierte mDixon Sequenzen im Vergleich mit H1-Spektroskopien zur Quantifizierung des Leberfettgehalts bei Patientinnen mit Gestationsdiabetes. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mück F, Deak Z, Roesch S, Fischer F, Peschel O, Weber K, Reiser M, Wirth S. The bottom dose limit for soft tissue evaluation in contrast enhanced CT of the chest: A dose finding cadaver study using a model-based iterative image reconstruction approach. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Weber K, Kanz KG, Reiser MF, Wirth S. Wertigkeit der CT unter Reanimation: Ergebnisse nach 27 Patienten. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1372801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Enriquez GF, Bua J, Orozco MM, Wirth S, Schijman AG, Gürtler RE, Cardinal MV. High levels of Trypanosoma cruzi DNA determined by qPCR and infectiousness to Triatoma infestans support dogs and cats are major sources of parasites for domestic transmission. Infect Genet Evol 2014; 25:36-43. [PMID: 24732410 DOI: 10.1016/j.meegid.2014.04.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/31/2014] [Accepted: 04/03/2014] [Indexed: 12/29/2022]
Abstract
The competence of reservoir hosts of vector-borne pathogens is directly linked to its capacity to infect the vector. Domestic dogs and cats are major domestic reservoir hosts of Trypanosoma cruzi, and exhibit a much higher infectiousness to triatomines than seropositive humans. We quantified the concentration of T. cruzi DNA in the peripheral blood of naturally-infected dogs and cats (a surrogate of intensity of parasitemia), and evaluated its association with infectiousness to the vector in a high-risk area of the Argentinean Chaco. To measure infectiousness, 44 infected dogs and 15 infected cats were each exposed to xenodiagnosis with 10-20 uninfected, laboratory-reared Triatoma infestans that blood-fed to repletion and were later individually examined for infection by optical microscopy. Parasite DNA concentration (expressed as equivalent amounts of parasite DNA per mL, Pe/mL) was estimated by real-time PCR amplification of the nuclear satellite DNA. Infectiousness increased steeply with parasite DNA concentration both in dogs and cats. Neither the median parasite load nor the mean infectiousness differed significantly between dogs (8.1Pe/mL and 48%) and cats (9.7Pe/mL and 44%), respectively. The infectiousness of dogs was positively and significantly associated with parasite load and an index of the host's body condition, but not with dog's age, parasite discrete typing unit and exposure to infected bugs in a random-effects multiple logistic regression model. Real-time PCR was more sensitive and less time-consuming than xenodiagnosis, and in conjunction with the body condition index, may be used to identify highly infectious hosts and implement novel control strategies.
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Affiliation(s)
- G F Enriquez
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - J Bua
- National Institute of Parasitology Dr. M. Fatala Chaben, National Administration of Laboratories and Institutes of Health Dr. C.G. Malbrán, Buenos Aires, Argentina
| | - M M Orozco
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - S Wirth
- Laboratory of Agro-Biotechnology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina
| | - A G Schijman
- Laboratory of Molecular Biology of Chagas Disease, Institute for Research on Genetic Engineering and Molecular Biology (INGEBI-CONICET), Argentina
| | - R E Gürtler
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina
| | - M V Cardinal
- Laboratory of Eco-Epidemiology, Faculty of Exact and Natural Sciences, University of Buenos Aires, Argentina; Institute of Ecology, Genetics and Evolution of Buenos Aires (UBA-CONICET), Argentina.
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Sauerbrei A, Langenhan T, Brandstadt A, Schmidt-Ott R, Krumbholz A, Girschick H, Huppertz H, Kaiser P, Liese J, Streng A, Niehues T, Peters J, Sauerbrey A, Schroten H, Tenenbaum T, Wirth S, Wutzler P. Prevalence of antibodies against influenza A and B viruses in children in Germany, 2008 to 2010. ACTA ACUST UNITED AC 2014; 19. [PMID: 24524235 DOI: 10.2807/1560-7917.es2014.19.5.20687] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prevalence of influenza A and B virus-specific IgG was determined in sera taken between 2008 and 2010 from 1,665 children aged 0-17 years and 400 blood donors in Germany. ELISA on the basis of whole virus antigens was applied. Nearly all children aged nine years and older had antibodies against influenza A. In contrast, 40% of children aged 0-4 years did not have any influenza A virus-specific IgG antibodies. Eightysix percent of 0-6 year-olds, 47% of 7-12 year-olds and 20% of 13-17 year-olds were serologically naïve to influenza B viruses. By the age of 18 years, influenza B seroprevalence reached approximately 90%. There were obvious regional differences in the seroprevalence of influenza B in Germany. In conclusion, seroprevalences of influenza A and influenza B increase gradually during childhood. The majority of children older than eight years have basal immunity to influenza A, while comparable immunity against influenza B is only acquired at the age of 18 years. Children aged 0-6 years, showing an overall seroprevalence of 67% for influenza A and of 14% for influenza B, are especially at risk for primary infections during influenza B seasons.
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Affiliation(s)
- A Sauerbrei
- Institute of Virology and Antiviral Therapy, Jena University Clinic, Friedrich Schiller University of Jena, Jena, Germany
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