[PIMS-a new pediatric challenge]. / PIMS ­ eine neue pädiatrische Herausforderung: 9-Jahre alter Knabe mit SARS-CoV-2 assoziiertem hyperinflammatorischem Schocksyndrom.

The boy of Egyptian origin was previously healthy. After a history of fever for 7 days, abdominal pain, vomiting and dry cough resistant to treatment with oral antibiotics, he was admitted to hospital. The clinical examination showed a slightly red throat, a tense abdomen and erythema. The blood tests revealed leukocytosis and significantly increased inflammatory parameters. The abdominal ultrasound showed thickened intestinal loops in the left lower abdomen and the echocardiography showed minimal mitral regurgitation, a narrow pericardial effusion lamella over both ventricles and normal coronary arteries. Accordingly, cardiac enzymes were elevated. The day after admission, the boy developed an increasing rash and was transferred to the PICU because of septic shock refractory to high volume resuscitation, requiring hemodynamic support with noradrenaline and noninvasive respiratory assistance. The initial testing for SARS-CoV­2 on nasopharyngeal aspirates was negative twice; however, serum IgG antibodies were positive. Other viral and bacterial infections were excluded as the cause of the symptoms.The patient received IVIG, ASS, furosemide and methylprednisolone and the antibiotic treatment was continued. The dosage of the catecholamine could be reduced according to the patient's condition and the serially performed echocardiographic findings. The patient recovered in his general condition and was discharged from the PICU after 8 days. With the help of a detailed family history, we were able to figure out that the whole family, including the patient himself, had symptoms of a cold about 1 month earlier. Hence, SARS-CoV­2 antibody tests carried out showed a positive result for all of them.Pediatric inflammatory multisystem syndrome (PIMS) can quickly lead to manifest shock symptoms, necessitating close monitoring. A PICU background is crucial to treat possibly occurring symptoms and complications. High-dose steroids are used therapeutically alongside supportive therapies.

Long-Term Respiratory Support for Children and Adolescents in Austria: A National Survey.

BACKGROUND: Population-based data on pediatric patients on long-term respiratory support (LTRS) in Austria are lacking. This study aimed to record the pediatric departments active in this field, as well as number and characteristics of patients on LTRS. METHODS: A national cross-sectional study was carried out by means of questionnaires sent to all pediatric departments in Austria. RESULTS: All departments answered to the questionnaires. On June 1st, 2013, the reference day for this study, 12 of the 41 pediatric departments in Austria were active in the field. At this time, these centers were caring for 143 patients, 111 (77.6%) of them under 18 years, which corresponds to a prevalence of 7.4 per 100 000. The patients suffered from neuromuscular disorders (44%), other neurological disorders (18.9%), disorders of respiratory drive (9.1%), obstructive sleep apnea (8.4%), thoracal and spinal diseases (8.4%), pulmonary disorders (4.9%) and other diseases (6.3%). Continuous positive airway pressure was used in 6.3%, non-invasive ventilation in 60.1% and invasive ventilation in 33.6% of the patients, respectively. LTRS was performed at home in 92.3%. CONCLUSION: LTRS represents a common management strategy in children and adolescents with a variety of disorders. Census reports such as this one provide the basis for appropriate planning of resource allocation. The age distribution of our patients shows the need for structured transition into adult care.

Experimental verification of carrier multiplication in graphene.

We report on the first direct experimental observation of carrier multiplication in graphene reaching a multiplication factor of up to 2 and persisting on a picoseconds time scale. Exploiting multicolor pump-probe measurement techniques, the excited nonequilibrium carrier distribution is retrieved on an ultrafast time scale. This provides access to the temporal evolution of the optically excited carrier density and thus allows quantitative conclusions on possible carrier multiplication. Microscopic time- and momentum-resolved calculations on the ultrafast relaxation dynamics of optically excited carriers confirm the observation of carrier multiplication under corresponding experimental conditions, suggesting graphene as a promising material for novel high-efficiency photodetection devices.

The burden of pneumococcal meningitis in Austrian children between 2001 and 2008.

UNLABELLED: The present study was conducted to evaluate the burden of pneumococcal meningitis in Austrian children between 2001 and 2008. Clinical outcome was retrospectively analyzed both on discharge and on follow-up investigations. This study was based on a prospective multicentre surveillance study on hospitalized invasive pneumococcal infections in Austrian children with a total annual "study population" of about 399,000 children aged below 5 years per year. Between 2001 and 2008, 74 cases of pneumococcal meningitis were identified in children aged below 5 years. The mean annual incidence rate for pneumococcal meningitis was 2.3 per 100,000 children in this age group. In 57/74 children (mean age on admission 14.5 ± 13.3 months), outcome data on hospital discharge were available: 5 deaths (8.8%), 20 children (35.1%) with sequelae and 32 children (56.1%) without sequelae were observed. Sequelae on discharge included motor impairment in 8 children (14.0%), hearing impairment in 9 children (15.8%) and/or other complications in 14 children (24.6%). In 7/8 children with motor deficits, matching cerebral lesions were identified by neuroimaging: cerebral infarction in five children, cerebral vasculitis and cerebral abscess in one child each. In 40/57 children, long-term outcome (18.9 ± 20.2 months after discharge) could be assessed: 1 child (2.5%) died 9 months after hospital discharge, 11 children (27.5%) had one or two long-term sequelae and 28 children (70.0%) had no sequelae. Long-term sequelae included motor impairment in three children (7.5%), hearing impairment in nine children (22.5%) and other deficits in two children (5.0%). CONCLUSION: Our study confirms that pneumococcal meningitis causes high mortality and severe long-term sequelae. On long-term follow-up, we observed improvements of motor impairment, but not of hearing impairment.

[IT systems in radiology and IT systems for radiologists]. / IT-Systeme in der Radiologie und IT-Systeme für den Radiologen.

Radiology plays an important role in introduction and use of information technology (IT) systems in the daily clinical routine. The radiology information system (RIS) and picture archiving and communication system (PACS) are the main systems used in a digital radiology department. In this article the basic principles and functions of these systems and trends in development are described.

Current saturation and voltage gain in bilayer graphene field effect transistors.

The emergence of graphene with its unique electrical properties has triggered hopes in the electronic devices community regarding its exploitation as a channel material in field effect transistors. Graphene is especially promising for devices working at frequencies in the 100 GHz range. So far, graphene field effect transistors (GFETs) have shown cutoff frequencies up to 300 GHz, while exhibiting poor voltage gains, another important figure of merit for analog high frequency applications. In the present work, we show that the voltage gain of GFETs can be improved significantly by using bilayer graphene, where a band gap is introduced through a vertical electric displacement field. At a displacement field of -1.7 V/nm the bilayer GFETs exhibit an intrinsic voltage gain up to 35, a factor of 6 higher than the voltage gain in corresponding monolayer GFETs. The transconductance, which limits the cutoff frequency of a transistor, is not degraded by the displacement field and is similar in both monolayer and bilayer GFETs. Using numerical simulations based on an atomistic p(z) tight-binding Hamiltonian we demonstrate that this approach can be extended to sub-100 nm gate lengths.

High on/off ratios in bilayer graphene field effect transistors realized by surface dopants.

The unique property of bilayer graphene to show a band gap tunable by external electrical fields enables a variety of different device concepts with novel functionalities for electronic, optoelectronic, and sensor applications. So far the operation of bilayer graphene-based field effect transistors requires two individual gates to vary the channel's conductance and to create a band gap. In this paper, we report on a method to increase the on/off ratio in single gated bilayer graphene field effect transistors by adsorbate doping. The adsorbate dopants on the upper side of the graphene establish a displacement field perpendicular to the graphene surface breaking the inversion symmetry of the two graphene layers. Low-temperature measurements indicate that the increased on/off ratio is caused by the opening of a mobility gap.

Near-field investigation of THz surface-wave emission from optically excited graphite flakes.

THz emission from an unbiased graphite flake after optical sub-ps pulse inter-band excitation is measured using a novel micro-machined photoconductive probe-tip. Oscillatory behavior of the measured THz near-field emission is shown to originate from electromagnetic eigenmode resonances of the laterally limited graphite flake. The excitation efficiency of the lowest order eigenmode resonances strongly dependents on optical pump location. From this data a radial symmetric charge carrier translocation at the pump location is revealed as the dominating THz surface-wave emission effect. Measurements show good agreement with numerical field simulations of the eigenmode center frequencies and the spectral response expected for THz emission through basal plane oriented radial current surge excitation.

Experience with the use of palivizumab together with infection control measures to prevent respiratory syncytial virus outbreaks in neonatal intensive care units.

Respiratory syncytial virus (RSV) frequently causes nosocomial outbreaks in general paediatric wards and occasionally in neonatal intensive care units (NICUs). Conventional infection control measures often fail to prevent the spread of RSV, and it can cause significant morbidity especially in preterm and young infants. We report our experience in preventing an outbreak on a NICU after RSV had been detected in a premature infant. The index case was a 34-day-old premature infant who presented with clinical infection and RSV was detected in a clinical specimen. There were 11 patients in the ward at the time including the index case. The RSV-positive patient was isolated, the ward closed to admissions and infection control measures were implemented. Two patients were transferred to another hospital. Palivizumab 15 mg/kg i.m. was given to all patients and no further cases occurred. All subsequent RSV tests on nasal secretions were negative. Palivizumab combined with conventional infection control measures appeared to prevent the spread of RSV in this NICU. Strategies for the prevention of RSV outbreaks on NICUs all recommend the reinforcement of routine infection control measures. Recommendations concerning the use of palivizumab range from monthly prophylaxis to all infants at risk, to prophylaxis of selected cases only. Currently there are no guidelines for the use of palivizumab in NICUs or for the control of RSV outbreaks.

High-resolution optical coherence tomography as a non-destructive monitoring tool for the engineering of skin equivalents.

BACKGROUND: Three dimensional skin equivalents are widely used in dermatopharmacological and toxicological studies and as autologous transplants in wound healing. In pharmacology, there is tremendous need for monitoring the response of engineered skin equivalents to external treatment. Transplantation of skin equivalents for wound healing requires careful verification of their quality prior to transplantation. Optical coherence tomography (OCT) is a non-contact, non-destructive imaging technique for living tissues offering the potential to fulfill these needs. This work presents an analysis of OCT for high-resolution monitoring of skin equivalents at different stages during the culture process. METHODS: We developed a high-resolution OCT imaging setup based on a commercially available OCT system. A broadband femtosecond laser light source replaces the original superluminescence diode. Tomograms of living skin equivalents were recorded with an axial resolution of 3 mum and correlated with histology and immunofluorescence images. Comparison with standard low-resolution OCT is presented to emphasize the advantages of high-resolution OCT for this application. RESULTS: OCT is particularly able to distinguish between different layers of skin equivalents including stratum corneum, epidermal and dermal layer as well as the basement membrane zone. The high-resolution OCT scans correlate closely with two key benchmarks, histology and immunofluorescence imaging. CONCLUSIONS: This study clearly demonstrates the benefits of high-resolution OCT for identifying living tissue structure and morphology. Compared with the current gold standard histology, OCT offers non-destructive tissue imaging, enabling high-resolution evaluation of living tissue morphology and structure as it evolves.

Subchondral bone trauma causes cartilage matrix degeneration: an immunohistochemical analysis in a canine model.

UNLABELLED: Joint instability was believed to be the main cause of osteoarthritis following non-fracture articular trauma. However, sudden high impact load through articular cartilage onto subchondral bone may also cause osteoarthritic changes. OBJECTIVE: We asked whether early osteoarthritic changes following transarticular impact may be depicted using immunofluorescence on unfixed cryosections to contribute to a more detailed understanding of degenerative processes of joint impaction. DESIGN: Transarticular impacts were applied to patellofemoral joints of 12 skeletally mature beagle dogs (age: 15-16 months) using a drop tower. Biopsies of impact areas were sampled after 6 months and processed for standard light microscopy on formalin-fixed sections and for immunofluorescence for collagen type I (col I), type II (col II) and aggrecan (AC) on unfixed cryosections. Gross morphology and immunofluorescence on cryosections were documented using a semi-quantitative scaling system, compared to healthy controls and to standard light microscopy. RESULTS: Four biopsies showed almost entirely fibrocartilaginous morphology, four appeared to be of preserved hyaline morphology with only minor signs of fibrocartilaginous remodelling and four showed preserved hyaline appearance. We found decrease in col II and AC expression in highly degenerative specimens as well as increase of col I expression. Increased col I expression in the pericellular matrix could even be depicted in specimens with intact hyaline morphology. DISCUSSION/CONCLUSION: Observations suggest that joint impaction causes early osteoarthritic changes after 6 months. Collagen network disruption seems to lead to AC loss, although other researchers found isolated AC loss without denaturation of col II using immunofluorescence in formalin-fixed specimens. This is the first study on effects of transarticular impact using immunofluorescence on unfixed cryosections.

All-optical switching of the transmission of electromagnetic radiation through subwavelength apertures.

Unprecedented optical control of the surface plasmon polariton assisted transmission of terahertz radiation through subwavelength apertures is rendered possible by carrier-induced changes to the dielectric properties of a semiconductor grating. Although the study presented is static, the extension of our approach to dynamic switching and tuning is deemed straightforward, opening the way for the realization of ultrafast surface plasmon based devices.

Asynchronous optical sampling for high-speed characterization of integrated resonant terahertz sensors.

Two femtosecond Ti:sapphire lasers with slightly different repetition rates near 1 GHz are coupled to implement high-speed asynchronous optical sampling. The application of this technique is successfully demonstrated in the field of terahertz time-domain spectroscopy (TDS). A time delay of 1 ns is scanned at a frequency of 5 kHz without moving mechanical parts. Compared with that of conventional TDS schemes based on lock-in detection and moving mirrors, the readout time of integrated resonant THz sensors is reduced by a factor of 20, opening the way for high-throughput THz sensing in marker-free DNA analysis.

Frequency-dependent characterization of THz Sommerfeld wave propagation on single-wires.

In this work, measurements and numerical field simulations highlighting the characteristic propagation behavior of THz surface-wave pulses along bare and dielectrically coated metal wires are presented. An optoelectronic time-domain measurement setup with a freely-positionable probe-tip is used for detection of electrical field transients after different propagation lengths along the wires. Frequency-dependent attenuation and dispersion parameters are determined in the range of 0.02 THz to 0.4 THz. Our results are in good agreement with numerical field simulations considering the propagation of an axial Sommerfeld surface-wave with metallic and dielectric losses. We discuss the influence of wire radius on wave propagation behavior and the application of THz single-wires for sensing.

Thermal switching of the enhanced transmission of terahertz radiation through subwavelength apertures.

We demonstrate that the extraordinary transmission of terahertz radiation through semiconductor gratings of subwavelength apertures can be switched completely by varying the temperature. The enhanced transmission, which is due to the resonant tunneling of surface plasmon polaritons that can be excited in semiconductors at terahertz frequencies, is controlled by thermally modifying the density of free carriers. The transmission through metal gratings cannot be switched in the same way since the carrier density is temperature independent. Thus semiconductors offer an interesting alternative to metals in enhancing the transmission of electromagnetic radiation.

Double-blind, randomized study of the efficacy and safety of oral pharmacokinetically enhanced amoxicillin-clavulanate (2,000/125 milligrams) versus those of amoxicillin-clavulanate (875/125 milligrams), both given twice daily for 7 days, in treatment of bacterial community-acquired pneumonia in adults.

This randomized, double-blind, noninferiority trial was designed to demonstrate that pharmacokinetically enhanced amoxicillin-clavulanate (2,000/125 mg) was at least as effective clinically as amoxicillin-clavulanate 875/125 mg, both given twice daily for 7 days, in the treatment of community-acquired pneumonia in adults. In total, 633 clinically and radiologically confirmed community-acquired pneumonia patients (intent-to-treat population) were randomized to receive either oral amoxicillin-clavulanate 2,000/125 mg (n = 322) or oral amoxicillin-clavulanate 875/125 mg (n = 311). At screening, 160 of 633 (25.3%) patients had at least one typical pathogen isolated from expectorated or invasive sputum samples or blood culture (bacteriology intent-to-treat population). Streptococcus pneumoniae (58 of 160, 36.3%), methicillin-susceptible Staphylococcus aureus (34 of 160, 21.3%), and Haemophilus influenzae (33 of 160, 20.6%) were the most common typical causative pathogens isolated in both groups in the bacteriology intent-to-treat population. Clinical success in the clinical per protocol population at test of cure (days 16 to 37), the primary efficacy endpoint, was 90.3% (223 of 247) for amoxicillin-clavulanate 2,000/125 mg and 87.6% (198 of 226) for amoxicillin-clavulanate 875/125 mg (treatment difference, 2.7; 95% confidence interval, -3.0, 8.3). Bacteriological success at test of cure in the bacteriology per protocol population was 86.6% (58 of 67) for amoxicillin-clavulanate 2,000/125 mg and 78.4% (40 of 51) for amoxicillin-clavulanate 875/125 mg (treatment difference, 8.1%; 95% confidence interval, -5.8, 22.1). Both therapies were well tolerated. Amoxicillin-clavulanate 2,000/125 mg twice daily was shown to be as clinically effective as amoxicillin-clavulanate 875/125 mg twice daily for 7 days in the treatment of adult patients with community-acquired pneumonia, without a noted increase in the reported rate of adverse events.

Long-term observations of patients with infantile spinal muscular atrophy with respiratory distress type 1 (SMARD1).

We describe 6 unrelated patients affected by infantile spinal muscular atrophy with respiratory distress type 1 (SMARD1) with prolonged survival upon mechanical ventilation (4.5-11 years), which has not been reported before. Biallelic mutations in the IGHMBP2 gene proved the diagnosis of SMARD1 in all patients. Disease onset was in the first 2 months in the described patients, starting with generalised hypotonia, failure to thrive, and early breathing difficulties. Diaphragmatic palsy was diagnosed and permanent ventilation was initiated 2-8 months after onset. Within months a more distal muscular atrophy became evident associated with joint contractures (talipes), hand drops, and fatty finger pads. Motor development remained minimal, loss of function was observed within the first year after which no further progression was recorded. Voiding dysfunction with reflux nephropathy was observed in 3 patients and has not been reported before. Further evidence of autonomic nerve dysfunction resulting in cardiac arrhythmia, hypertension, and excessive sweating was given in 2 patients. Investigative results were largely compatible with those obtained in classic SMA. However, neurogenic atrophy muscle was more pronounced in distal muscles, if examined, and there was evidence of peripheral nerve involvement at least in some patients.

Propagation of surface plasmon polaritons on semiconductor gratings.

We present time-domain measurements of terahertz surface plasmon polaritons (SPPs) propagating on gratings structured on silicon surfaces. Using single-cycle pulses of terahertz radiation to excite SPPs in a broad frequency range, we observe that the efficient SPPs scattering on the semiconductor periodic structure introduces significant dispersion and modifies the SPPs propagation. A stop gap, or a frequency range where SPPs are Bragg reflected, is formed by the structure. This gap depends strongly on the Si doping density and type. The resonant scattering at the edge of the gap reduces the group velocity by more than a factor of 2. The measurements show a good agreement with our numerical calculations based on the reduced Rayleigh equation.

A functionalized THz sensor for marker-free DNA analysis.

We report on a novel resonant THz sensor for the label-free analysis of DNA molecules. The sensor allows the direct detection of DNA-probe molecules at functionalized electrodes via hybridization. Subsequent time resolved photoconductive sampling of the THz transmission identifies the binding state between probe and target DNA. Integrating neighbouring sensors on a chip, this technique can be extended to a parallel analysis of multiple DNA sequences. A clearly readable sensor response is obtained with less then 40 fmol of 20-mer single-stranded DNA molecules, indicating at least a sevenfold sensitivity increase compared to previous approaches.