Self-organized nanocrack networks: a pathway to enlarge catalytic surface area in sputtered ceramic thin films, showcased for photocatalytic TiO2.

Sputter deposited photocatalytic thin films offer high adherence and mechanical stability, but typically are outperformed in their photocatalytic properties by colloidal TiO2 nanostructures, which in turn typically suffer from problematic removal. Here we report on thermally controlled nanocrack formation as a feasible and batch applicable approach to enhance the photocatalytic performance of well adhering, reactively sputtered TiO2 thin films. Networks of nanoscopic cracks were induced into tailored columnar TiO2 thin films by thermal annealing. These deep trenches are separating small bundles of TiO2 columns, adding their flanks to the overall catalytically active surface area. The variation of thin film thickness reveals a critical layer thickness for initial nanocrack network formation, which was found to be about 400 nm in case of TiO2. The columnar morphology of the as deposited TiO2 layer with weak bonds between respective columns and with strong bonds to the substrate is of crucial importance for the formation of nanocrack networks. A beneficial effect of nanocracking on the photocatalytic performance was experimentally observed. It was correlated by a simple geometric model for explaining the positive impact of the crack induced enlargement of active surface area on photocatalytic efficiency. The presented method of nanocrack network formation is principally not limited to TiO2 and is therefore seen as a promising candidate for utilizing increased surface area by controlled crack formation in ceramic thin films in general.

[Sepsis detection in emergency medicine : Results of an interprofessional survey on sepsis detection in prehospital emergency medicine and emergency departments]. / Sepsis erkennen im Rettungsdienst : Ergebnisse einer interprofessionellen Befragung zur präklinischen und frühen innerklinischen Sepsiserkennung.

BACKGROUND: Sepsis is associated with a high mortality, which can be reduced by starting screening, diagnostics and treatment as early as possible. Due to multiple educational programs and increased awareness, a decreased sepsis mortality on intensive care units has been achieved. Many patients with sepsis are admitted by the prehospital emergency service to hospital emergency departments. Thus, prehospital emergency services and emergency departments provide an opportunity to start screening, diagnosis and treatment earlier. OBJECTIVES: To detect sepsis it is paramount that emergency personnel are aware of the disease and have a profound knowledge regarding symptoms, screening and diagnostics. The objective of this survey was to examine the state of knowledge regarding sepsis among staff working in emergency medicine. MATERIAL AND METHODS: To assess the awareness and knowledge, a paper-based, anonymous survey was conducted among prehospital and emergency department personnel from May to August 2017 in northeastern Germany. Testing of significance was carried out using the χ2-testand Fisher's exact test. RESULTS: Out of 411 persons polled 212 answered (response rate 51.6%) and 24 questionnaires were incomplete and thus excluded. A total of 188 questionnaires were included covering 55 emergency physicians, 23 nurses, 82 paramedics and 19 emergency dispatchers. On a 4-point Likert scale 100% of emergency doctors, 96% of nurses, 84% of paramedics and 84% of emergency dispatchers considered early initiation of sepsis treatment to be important. Additionally, 92% of emergency physicians and 65% of nurses had attended educational programs on sepsis within the last year, which is significantly higher than among paramedics (19%, p < 0.01) and emergency dispatchers (21%, p = 0.025). In addition, 38% of paramedics and 47% of emergency dispatchers had never attended lectures on sepsis. The quick sequential (sepsis-related) organ failure assessment (qSOFA) was known by 80% of emergency doctors, thus, significantly more often than by nurses (26%), paramedics (29%) and emergency dispatchers (29%, p < 0.01). The emergency personnel were asked to tick all symptoms they associated with sepsis from a display of 14 symptoms. Among all occupation groups the majority selected "increased body temperature", "drop in blood pressure" and "altered breathing". In relation to "increased body temperature" the symptom "altered mental status" was selected significantly more frequently by emergency doctors than by nurses and paramedics (p = 0.02 and p < 0.01, respectively). The combination of at least all 3 qSOFA parameters was selected significantly more often by emergency doctors (62%) than by nurses (13%) and paramedics (10%, p = 0.017 and p < 0.01, respectively). CONCLUSION: Although emergency personnel rated an early initiation of sepsis treatment as important, sepsis knowledge was limited. While the majority of emergency doctors and many nurses had attended educational programs on sepsis within the last year, an alarmingly high percentage of paramedics and emergency dispatchers had never received sepsis education. Emergency personnel are mostly unfamiliar with the qSOFA score and did not associate an altered mental status with sepsis. In light of the high sepsis morbidity and mortality, further achievements might be made by initiating sepsis screening and diagnostics in the prehospital setting. Analogous to advancements in intensive care units, increased educational programs for emergency personnel might lead to an earlier detection and improved prognosis of sepsis.

A 45-year-old female with hypokalemic rhabdomyolysis due to VIP-producing composite pheochromocytoma.

The watery diarrhea, hypokalemia and achlorhydria (WHDA) syndrome due to vasoactive intestinal polypeptide (VIP)-producing extra-pancreatic tumors is rare. We report on a 45-year-old woman who suffered from persistent secretory diarrhea for six years and who was admitted to hospital with complaints of muscular weakness and myalgia. Biochemical testing revealed pronounced rhabdomyolysis due to severe hypokalemia. Gastrointestinal evaluation of long-standing diarrhea including endoscopy of the upper and lower gastrointestinal tract and the small intestine did not show any pathologies. An abdominal computed tomography scan revealed a mass of 4 × 5 cm in the left adrenal gland demonstrating a strong uptake in the 123I-labelled metaiodobenzylguanidine scintigraphy. Plasma levels of chromogranin A, calcitonin, parathormone, basal renin and most prominently VIP were increased in line with a increased 24 hour urinary secretion of noradrenaline, dopamine, normetanephrine and vanillymandelic acid. A WDHA (watery diarrhea, hypokalaemia, achlorhydria) syndrome with hypokalemic rhabdomyolysis due to a VIP-producing adrenal tumor was diagnosed that was removed surgically. The histological evaluation demonstrated a composite pheochromocytoma. Diarrhea stopped immediately after surgery together with a normalization of laboratory parameters. In conclusion, this case report focuses on the rare clinical presentation of secretory diarrhea and electrolyte disturbances in combination with hypokalemic rhabdomyolysis which was caused by a VIP-producing composite pheochromocytoma.

Physicochemical characterization of tetraether lipids from Thermoplasma acidophilum. V. Evidence for the existence of a metastable state in lipids with acyclic hydrocarbon chains.

The main glycophospholipid of Thermoplasma acidophilum, grown at 39 degrees C, is composed of a di-isopranol-2,3-glycerotetraether. It has been characterized in hydrated systems by calorimetry. Unlike its equivalent grown at 59 degrees C, it shows complex phase properties, which include at least three different phases, (1) a liquid-analogue state (C), which is stable above 20 degrees C, (2) a metastable solid-analogue state (A) formed by supercooling of the liquid-analogue state (C) and (3) a stable solid-analogue state (B), which is slowly formed and may include a close chain packing of lipids and a network of hydrogen bonds between the headgroups. A high fraction of acyclic isopranol chains seems to be a prerequisite for the formation of state (B). A phase diagram, displaying the observed states and the transitions between them is proposed.

Atrioventricular dissociation detected by suprasternal M-mode echocardiography: a clue to the diagnosis of ventricular tachycardia.

Twenty-two patients were studied by suprasternal M-mode echocardiography during ventricular tachycardia (VT). Adequate echocardiograms were obtained from 19 patients. Thirteen patients showed atrioventricular (AV) dissociation and 6 patients a ventriculoatrial contraction pattern according to the left atrial (LA) contraction obtained from the suprasternal notch. In 1 of these 6 patients, a 2:1 block retrograde was found by echocardiography. In another patient, an intermittent block occurred in the retrograde direction. In 4 patients, a constant relation between the QRS complex and LA contraction soon after the beginning of the QRS complex was seen, demonstrating a 1:1 ventriculoatrial conduction. According to the LA contraction obtained from the suprasternal echocardiogram, 13 patients showed AV dissociation and 6 patients a retrograde conduction to the LA. From the analysis of the 12-lead standard electrocardiogram obtained simultaneously during VT, AV dissociation could be recognized in only 3 patients. Thus, AV dissociation during VT is more easily diagnosed with suprasternal M-mode echocardiography than with the standard electrocardiogram.

Hemodynamics during PEEP ventilation in patients with severe left ventricular failure studied by transesophageal echocardiography.

The effects of mechanical ventilation with PEEP were investigated in five patients with normal cardiopulmonary function (group A) and in 11 patients with severe left ventricular failure (group B). Cross-sectional area of the right and left atrium (RA/LA), left ventricle (LV), and right ventricle (RV) was determined at EDA/ESA using transesophageal echocardiography. Hemodynamic parameters and transesophageal pressure were measured simultaneously at PEEP levels 0, 4, 8, 12, and 16 cm H2O. End-diastolic area of the right atrium decreased significantly in both groups. The RA pressure increased, while transmural pressure remained unaltered. The CI decreased in both groups. The decrease in cardiac output by PEEP ventilation was related to the decrease in RV filling volume by external compression. In patients with congestive heart failure, PEEP ventilation with 8 to 10 cm H2O did not worsen LV function.

A gene cluster closely related to type II secretion pathway operons of gram-negative bacteria is located on the large plasmid of enterohemorrhagic Escherichia coli O157 strains.

Analysis of 14.162 kb of DNA derived from plasmid pO157 of enterohemorrhagic Escherichia coli (EHEC) O157:H7 strain EDL933, extending in the 5' direction of the recently described EHEC-hly operon, revealed 13 open reading frames (ORF) which showed great similarities to genes of members of the type II pathway secretion systems of Gram-negative bacteria. We named the ORFs etpC to etpO for EHEC type II secretion pathway. In addition, an IS911-like insertion element was found to separate the etp genes from the EHEC-hlyC gene. Hybridization experiments with a specific etp probe and various categories of enteric E. coli pathotypes revealed that the etp gene cluster occurred in all 30 EHEC strains of serogroup O157 (100%) tested and is distributed sporadically among other EHEC serogroups (60%). In addition, the etp genes were rarely detected in STEC isolated from bovine feces (10%). Moreover, it was found not to occur in enteropathogenic E. coli, enteroaggregative E. coli, enterotoxigenic E. coli and enteroinvasive E. coli. The results obtained with the etp probe were confirmed by a PCR approach to specifically detect an internal fragment of the etpD gene.

Attempt to modify Rauscher-virus leukemogenesis by modulation of lymphoreticular and hematopoietic tissue.

Rauscher erythroleukemia virus of the mouse was originally isolated from an animal bearing a lymphocytic neoplasm. In order to control extraneous influences on leukemia development, we modulated thymus-dependent and bursa-dependent lymphatic tissues and the granulopoietic and erythropoietic components of hemoreticular tissues during the latent period of leukemia development. In all experiments the same type of erythroleukemia was found with some variation in the course of the disease.

Mitral valve aneurysm revealed by cross-sectional echocardiography in a patient with mitral valve prolapse.

We report a cerebral ischemia in a 23-year-old woman, in whom a mitral valve aneurysm with thrombotic masses was diagnosed by cross-sectional echocardiography. A prolapsing mitral leaflet was also visualized.

Standardized noninvasive assessment of myocardial free fatty acid kinetics by means of 15-(p-iodo-phenyl) pentadecanoic acid (123I-pPPA) scintigraphy: II. Clinical results.

Our results establish that myocardial regions supplied by a significantly stenosed coronary vessel can be distinguished with high statistical significance from healthy regions on account of changes in the myocardium/background ratio, i.e. a reduction of regional uptake of 15-(p-iodo-phenyl) pentadecanoic acid (pPPA). The statistical significance applies to patients with coronary artery disease (CAD), to all examined CAD areas without areas of infarction as well as to infarcted regions. Our results also confirm the suitability of labelled fatty acids, such as pPPA, for the visualization of damaged myocardial regions. The results further indicate that pPPA practically is of comparable value to 201Tl with regard to their respective qualities as 'static' imaging agents for the heart muscle. This study, with the help of a simultaneous analysis of regional myocardial perfusion rates (rMBF) and of a parameter for the metabolism of fatty acids, practised here for the first time, could demonstrate interindividual differences between patients and groups of patients with a correlation between perfusion and the utilization of pPPA in patients with CAD. The reciprocal of the rMBF, the mean transit time (MTT), was significantly prolonged after stress in patients with CAD (P less than 0.05), suggesting impaired 'microcirculation' in the patient group. The determination of elimination half-lives (T1/2) contributes little if any information towards delineation of cardiac disease entities. The wide overlap of T1/2 values between various clinical syndromes and entities with extreme standard deviations remained an annoying problem in our studies. Nevertheless, certain trends in T1/2 behaviour could be recorded, but they did not yield any statistical significances, because of the high degree of individual variability. A considerable variability of T1/2 values among healthy controls was recorded as well as intra-individually in different regions of the heart muscle. The wide range of 'normal' values rendered statistical evaluation almost, if not entirely, impossible. It appears that the high degree of variability results amongst others, from technical shortcomings in the external recording instruments, i.e. gamma cameras, as well as from the presence of interfering alternate substrates such as glucose and lactate. Nevertheless, the wide range of measured results in healthy control subjects suggests the presence of a considerable regional intra-individual heterogeneity of cardiac substrate metabolism. One must therefore accept, at least in our opinion, that T1/2 values are not sufficiently reliable as an indicator of myocardial metabolism and are of little value with respect to clinical diagnostic considerations and to prognosis as well. Possible explanations for this finding are offered and discussed in this paper.

[The intra-operative proof of occlusion of the tubes in tubal sterilizations (author's transl)]. / Sofortiger intraoperativer Nachweis der Sicherheit der Tubensterilisation.

In tubal sterilization operations with a plastic clip failures with subsequent pregnancies become only known by misplacement of the clips. Failures are more frequent when the clips are placed through a posterior colpotomy. In 163 laparoscopic tubal sterilization with the Tuplar-clip during the last 2 1/2 years no subsequent pregnancy was observed. The carbon-dioxide pertubation or the chromo-pertubation after occlusion of the tubes with a clip permits an immediate intra-operative proof of secure bilateral tubal occlusion. A pregnancy due to faulty placement of the clip is then no longer possible. Other advantages of this method of tubal sterilization are mentioned.

PIP: 2 peroperative methods are described for determining whether a sterilization operation to effect tubal occlusion with clips is successful. CO2 pertubation was tested successfully in vitro and in vivo for use in conjunction with laparoscopic clip application. Chromopertubation with indigo carmine dye is also possible. Such methods to insure tubal occlusion are used only when uncertainty exists as to the success of the operation or if the patient requests it. Of 163 sterilizations performed by laparoscopy and use of tubal clips, no pregnancies occurred.

[Ultrasound diagnosis of pathologic changes of the uterine tube]. / Die ultrasonographische Diagnostik pathologischer Veränderungen der Tuba uterina.

The possibilities of sonographic diagnosis of pathologic changes in the uterine tube are examined by means of a computerised automatic real-time scanner with a statistical B-scan of high resolution. It is not possible to isolate sonographically the anatomically unchanged tube or the tube obliterated as a result of salpingitis. Nevertheless, it is possible to effect an indirect diagnosis if the tube is at least unilaterally patent or if it is bilaterally occluded, by means of an extended form of sonography within the scope of a sonographically controlled hydropertubation via a phenomenon which the author describes an "positive" or "negative" "phenomenon of Douglas". Hence, sonographically monitored hydropertubation, together with hysterosalpingography or laparoscopic chromopertubation--with reservations--is a valuable diagnostic tool to help in clarifying the cause of sterility. Pathological changes of the tubes in the sense of a sactosalpinx of different contents (retained secretions) can be differentiated by sonography. A characteristic sonographic echo pattern is also seen if the tubes are conglutinated with an extremely low amount of liquid collected in the tube. Various pathological changes of the tube can be recognised sonographically directly and indirectly by means of sonography extended in this manner.

[Amniocentesis under permanent sonographic surveillance]. / Amniozentese unter permanenter sonographischer Sicht.

81 amniocenteses were carried out during the second trimenon for the purpose of prenatal diagnosis under permanent sonographic surveillance without any complications. Sonographic surveillance means that a sectorial scanner was used (RA1 and Combison 202 R) by the real-time process with a 110 degrees or 60 degrees sectorial field soundhead for closely observing the movements of the amniocentesis needle already in the subcutis. The progress of the needle through the individual layers can be observed continuously. As a matter of fact, the gradual progress of the needle from the extra-amnial to the intra-amnial area can be followed step by step and millimetre by millimetre. If the site of puncture is occupied by the foetus, the procedure can be stopped or interrupted. Depth of penetration of the needle into the amnion can be limited to a few millimetres. This puncture technique will usually eliminate anyl risk of injury to the foetus. Any danger of infection which may be attributed to the needle touching the soundhead or contact jelly, is also eliminated since the amniocentesis needle (sternal puncture needle 0.8 X 90 mm, preferably CSF puncture needle 20 G 3 1/2") is entered into the cutis at a distance of 8 cm from the soundhead. Hence, the only risk involved in amniocentesis which cannot be predicted in advance, would be haemorrhage due to injury to a vessel, mainly in the myometrium or, if transplacental puncture becomes necessary, a possible formation of a haematoma leading to abortion. This possible complication, however, had not been observed by us so far.

Properties and applications of the (2-nitrofluoren-9-yl)methoxycarbonyl group.

This paper presents a new protecting group, the (2-nitrofluoren-9-yl)methoxycarbonyl group. Investigations on the properties of this new modification of the Fmoc-system, such as the solvent-dependent photochemical cleavage, and enhanced lability towards bases, are described, as well as UV-kinetic measurements of the cleavage reaction. In addition, the incorporation of the (2-nitrofluoren-9-yl)methoxycarbonyl group into two peptides, and a sequence-dependent photochemical cleavage reaction are reported.

[Is tubal sterilization with the Tupla-clip a reversible method?]. / Ist die Tubensterilisation mit dem Tupla-Clip eine reversible Methode?

Between 1976 and 1981 402 tubal sterilizations were performed with Tupla-clip most of them by laparoscopic application. 11 tubes were removed between 15 and 47 months following the sterilization with the Tupla-clip. The local changes both macroscopically and microscopically to the tupla-clip were evaluated. The possibility of tubal patency following removal of the clips was tested by carbon dioxide pertubation. The tubal-occlusion with the tupla-clip is definitive since all tubes had a fibrous tissue strand where the clip had been applied which still carried blood vessels. No tube was patent with the carbon dioxide pertubation. The intra-operative testing of correct application of the clip and the documentation of this correct application is again mentioned. This is especially important in view of the recent judgements of the federal supreme court regarding liability in failed tubal sterilizations. The excellent chance of reversal by tubal anastomosis and the 100% success rate of this method of sterilization within the 6 years under observation will increase the acceptance of the tupla-clip as a method for tubal sterilizations.

PIP: Between 1976-81, 402 tubal sterilizations were performed with the Tupla clip, most of them by laparoscopy. 11 tubes were removed between 15-47 months after the Tupla clip sterilization. The local changes both macroscopically and microscopically to the Tupla clip were evaluated. The possiblity of tubal patency following removal of the clips was tested by carbon dioxide pertubation. The tubal occlusion with the clip is definitive since all tubes had a fibrous tissue strand where the clip had been applied and which still carried blood vessels. No tube was patent with the carbon dioxide pertubation. The intraoperative testing of correct application of the clip and the documentation of this correct application is mentioned again. This is especially important in view of the recent judgements of the federal supreme court regarding liability in failed tubal sterilizations. The excellent chance of reversal by tubal anastomosis and the 100% success rate of this sterilization method within the 6 years under observation will increase the acceptance of the Tupla clip as a method for tubal sterilization. (author's)

Monitoring of solid phase peptide synthesis by FT-IR spectroscopy.

Aggregation phenomena of growing peptides on the resin have seldom been investigated. We report here how conformations are determined by FT-IR spectroscopy. Therefore the sequence 80-99 of HIV 1-protease was synthesized. After every coupling a resin sample was taken out of the reaction column and a FT-IR spectrum recorded. The results were compared with the UV monitoring obtained from another synthesis of the same peptide.

Stereo-random synthesis of highly functionalized proline analogues by azomethine cycloaddition.

Highly substituted proline analogues were synthesized on Wang-resin bearing bisprotected histidine as starting material. The proline analogues (1,5-diazabicyclo[3.3.0]octane-2-carboxylic acid) were generated by 1,3-dipolar cycloaddition of azomethine ylides with maleimides, thus creating a library of maximum stereochemical diversity. Every compound set with the same empirical formula can theoretically consist of four diastereomers and can be tested in biological assays as mixture. Additionally different methods for the acylation of the proline nitrogen were evaluated.