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  • 1
    Online Resource
    Online Resource
    Outcome and management of decompressive hemicraniectomy in malignant hemispheric stroke following cardiothoracic surgery
    Springer Science and Business Media LLC ; 2023
    In:  Scientific Reports Vol. 13, No. 1 ( 2023-08-10)
    Details
    In: Scientific Reports, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2023-08-10)
    Abstract: Management of malignant hemispheric stroke (MHS) after cardiothoracic surgery (CTS) remains difficult as decision-making needs to consider severe cardiovascular comorbidities and complex coagulation management. The results of previous randomized controlled trials on decompressive surgery for MHS cannot be generally translated to this patient population and the expected outcome might be substantially worse. Here, we analyzed mortality and functional outcome in patients undergoing decompressive hemicraniectomy (DC) for MHS following CTS and assessed the impact of perioperative coagulation management on postoperative hemorrhagic and cardiovascular complications. All patients that underwent DC for MHS resulting as a complication of CTS between June 2012 and November 2021 were included in this observational cohort study. Outcome was determined according to the modified Rankin Scale (mRS) score at 1 and 3–6 months. Clinical and demographic data, anticoagulation management and postoperative hemorrhagic and thromboembolic complications were assessed. In order to evaluate a predictive association between clinical and radiological parameters and the outcome, we used a multivariate logistic regression analysis. Twenty-nine patients undergoing DC for MHS after CTS with a female-to-male ratio of 1:1.9 and a median age of 60 (IQR 49–64) years were identified out of 123 patients undergoing DC for MHS. Twenty-four patients (83%) received pre- or intraoperative substitution. At 30 days, the in-hospital mortality rate and neurological outcome corresponded to 31% and a median mRS of 5 (5–6), which remained stable at 3–6 months [Mortality: 42%, median mRS: 5 (4–6)]. Postoperatively, 15/29 patients (52%) experienced new hemorrhagic lesions and Bayesian logistic regression predicting mortality (mRS = 6) after imputing missing data demonstrated a significantly increased risk for mortality with longer aPPT (OR = 13.94, p = .038) and new or progressive hemorrhagic lesion s after DC (OR = 3.03, p = .19). Notably, all but one hemorrhagic lesion occurred before discontinued anticoagulation and/or platelet inhibition was re-initiated. Despite perioperative discontinuation of anticoagulation and/or platelet inhibition, no coagulation-associated cardiovascular complications were noted. In conclusion, Cardiothoracic surgery patients suffering MHS will likely experience severe neurological disability after DC, which should remain a central aspect during counselling and decision-making. The complex coagulation situation after CTS, however, should not per se rule out the option of performing life-saving surgical decompression.
    Type of Medium: Online Resource
    ISSN: 2045-2322
    URL: Article
    DOI: 10.1038/s41598-023-40202-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2615211-3
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  • 2
    Online Resource
    Online Resource
    Reduction in wound healing complications and infection rate by lumbar CSF drainage after decompressive hemicraniectomy
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2022
    In:  Journal of Neurosurgery ( 2022-12-01), p. 1-9
    Details
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), ( 2022-12-01), p. 1-9
    Abstract: Wound healing disorders and surgical site infections are the most frequently encountered complications after decompressive hemicraniectomy (DHC). Subgaleal CSF accumulation causes additional tension of the scalp flap and increases the risk of wound dehiscence, CSF fistula, and infection. Lumbar CSF drainage might relieve subgaleal CSF accumulation and is often used when a CSF fistula through the surgical wound appears. The aim of this study was to investigate if early prophylactic lumbar drainage might reduce the rate of postoperative wound revisions and infections after DHC. METHODS The authors retrospectively analyzed 104 consecutive patients who underwent DHC from January 2019 to May 2021. Before January 2020, patients did not receive lumbar drainage, whereas after January 2020, patients received lumbar drainage within 3 days after DHC for a median total of 4 (IQR 2–5) days if the first postoperative CT scan confirmed open basal cisterns. The primary endpoint was the rate of severe wound healing complications requiring surgical revision. Secondary endpoints were the rate of subgaleal CSF accumulations and hygromas as well as the rate of purulent wound infections and subdural empyema. RESULTS A total of 31 patients died during the acute phase; 34 patients with and 39 patients without lumbar drainage were included for the analysis of endpoints. The predominant underlying pathology was malignant hemispheric stroke (58.8% vs 66.7%) followed by traumatic brain injury (20.6% vs 23.1%). The rate of surgical wound revisions was significantly lower in the lumbar drainage group (5 [14.7%] vs 14 [35.9%] , p = 0.04). A stepwise linear regression analysis was used to identify potential covariates associated with wound healing disorder and reduced them to lumbar drainage and BMI. One patient was subject to paradoxical herniation. However, the patient’s symptoms rapidly resolved after lumbar drainage was discontinued, and he survived with only moderate deficits related to the primary disease. There was no significant difference in the rate of radiological herniation signs. The median lengths of stay in the ICU were similar, with 12 (IQR 9–23) days in the drainage group compared with 13 (IQR 11–23) days in the control group (p = 0.21). CONCLUSIONS In patients after DHC and open basal cisterns on postoperative CT, lumbar drainage appears to be safe and reduces the rate of surgical wound revisions and intracranial infection after DHC while the risk for provoking paradoxical herniation is low early after surgery.
    Type of Medium: Online Resource
    ISSN: 0022-3085 , 1933-0693
    URL: Article
    DOI: 10.3171/2022.10.JNS221589
    RVK:
    XA 10000
    RVK:
    XA 55270
    Language: Unknown
    Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
    Publication Date: 2022
    detail.hit.zdb_id: 2026156-1
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  • 3
    Online Resource
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    Fortifying a meal with oyster mushroom powder beneficially affects postprandial glucagon-like peptide-1, non-esterified free fatty acids and hunger sensation in adults with impaired glucose tolerance: a double-blind randomized controlled crossover trial
    Springer Science and Business Media LLC ; 2022
    In:  European Journal of Nutrition Vol. 61, No. 2 ( 2022-03), p. 687-701
    Details
    In: European Journal of Nutrition, Springer Science and Business Media LLC, Vol. 61, No. 2 ( 2022-03), p. 687-701
    Abstract: Impaired glucose tolerance (IGT) is a pathophysiological condition characterized by insulin resistance with known metabolic consequences such as postprandial hyperglycemia and hypertriglyceridemia. We hypothesized that fortifying a meal with mushrooms rich in β -glucans may diminish glucose and triglyceride responses by improving postprandial gastrointestinal hormone release. Methods In a randomized controlled crossover study, 22 subjects with IGT ingested a meal either enriched with 20 g powder (8.1 g β -glucans) of oven-dried Pleurotus ostreatus (enriched meal, EN) or without enrichment (control meal, CON). Blood was collected before and repeatedly within 4 h after the meal to determine AUC of glucose (primary outcome), insulin, triglycerides, non-esterified free fatty acids (NEFAs), glucagon-like peptide-1 (GLP-1), gastric inhibitory polypeptide (GIP) and ghrelin. Appetite sensations (hunger, satiety, fullness, and desire to eat) were assessed before and after meal consumption by visual analog scales. Results Postprandial glucose, insulin, triglycerides, GIP and ghrelin concentrations as well as the corresponding AUCs did not differ between EN and CON. NEFAs-AUC was 14% lower ( P  = 0.026) and GLP-1-AUC 17% higher ( P  = 0.001) after EN compared to CON. Appetite ratings did not differ between treatments, except for hunger (AUC 22% lower after EN vs. CON; P  = 0.031). Conclusion The observed immediate postprandial metabolic changes indicate that an easily manageable fortification of a single meal with powder from dried oyster mushrooms as β -glucan source may improve postprandial metabolism. If the effect is preserved long term, this measure can diminish the risk for further development of overweight/obesity and type 2 diabetes in subjects with IGT. Clinical trial registration German Clinical Trial Register on 09/08/2018; trial-ID: DRKS00015244.
    Type of Medium: Online Resource
    ISSN: 1436-6207 , 1436-6215
    URL: Article
    DOI: 10.1007/s00394-021-02674-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1463312-7
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  • 4
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    Online Resource
    Sediment dynamics and hydrologic events affecting small lacustrine systems on the southern-central Tibetan Plateau – the example of TT Lake
    SAGE Publications ; 2015
    In:  The Holocene Vol. 25, No. 3 ( 2015-03), p. 508-522
    Details
    In: The Holocene, SAGE Publications, Vol. 25, No. 3 ( 2015-03), p. 508-522
    Abstract: A sedimentological, geochemical, micropaleontological, and palynological study of a lacustrine sediment record from the small TT Lake (southern-central Tibetan Plateau) shows that the background sedimentation was frequently interrupted by event-related deposits. These event-related deposits are interpreted as the result of hydrologic events that are triggered by above-average precipitation events. In total, 11 events were recorded in the TT Lake sequence. Two types can be differentiated: fluvial runoff events caused by precipitation that carried sediment in suspension into the lake and a sediment mass transport caused by torrential precipitation. The hydrologic events appear to be decoupled from long-term climate and environmental variations, but there is evidence that anthropogenic impact, in terms of pastoralism, might have favored the runoff events. The multi-proxy approach proved to be valuable and allowed for a detailed study of sedimentary processes within the lake and its watershed in order to assess their triggering processes and dynamics. The findings show the complexity of these sedimentary processes and their controlling factors, and the study aims to improve their understanding. This study is the first effort to investigate event-related deposits and sedimentary processes on the Tibetan Plateau and its triggering processes and dynamics by utilizing lacustrine sediment records.
    Type of Medium: Online Resource
    ISSN: 0959-6836 , 1477-0911
    URL: Article
    DOI: 10.1177/0959683614561885
    RVK:
    RA 1000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2027956-5
    SSG: 14
    SSG: 3,4
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  • 5
    Online Resource
    Online Resource
    One hour electrical stimulation accelerates functional recovery after femoral nerve repair
    Elsevier BV ; 2007
    In:  Experimental Neurology Vol. 208, No. 1 ( 2007-11), p. 137-144
    Details
    In: Experimental Neurology, Elsevier BV, Vol. 208, No. 1 ( 2007-11), p. 137-144
    Type of Medium: Online Resource
    ISSN: 0014-4886
    URL: Article
    DOI: 10.1016/j.expneurol.2007.08.005
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2007
    detail.hit.zdb_id: 1466932-8
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  • 6
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    Online Resource
    Long-term field experiments in Germany: classification and spatial representation
    Copernicus GmbH ; 2020
    In:  SOIL Vol. 6, No. 2 ( 2020-11-26), p. 579-596
    Details
    In: SOIL, Copernicus GmbH, Vol. 6, No. 2 ( 2020-11-26), p. 579-596
    Abstract: Abstract. The collective analysis of long-term field experiments (LTFEs), here defined as agricultural experiments with a minimum duration of 20 years and research in the context of sustainable soil use and yield, can be used for detecting changes in soil properties and yield such as those induced by climate change. However, information about existing LTFEs is scattered, and the research data are not easily accessible. In this study, meta-information on LTFEs in Germany is compiled and their spatial representation is analyzed. The study is conducted within the framework of the BonaRes project, which, inter alia, has established a central access point for LTFE information and research data. A total of 205 LTFEs which fit to the definition above are identified. Of these, 140 LTFEs are ongoing. The land use in 168 LTFEs is arable field crops, in 34 trials grassland, in 2 trials vegetables and in 1 trial pomiculture. Field crop LTFEs are categorized into fertilization (n=158), tillage (n=38) and crop rotation (n=32; multiple nominations possible) experiments, while all grassland experiments (n=34) deal with fertilization. The spatial representation is analyzed according to the climatic water balance of the growing season (1 May to 31 October) (CWBg), the Müncheberg Soil Quality Rating (MSQR) and clay content. The results show that, in general, the LTFEs well represent the area shares of both the CWBg and the MSQR classes. Eighty-nine percent of the arable land and 65 % of the grassland in Germany are covered by the three driest CWBg classes, hosting 89 % and 71 % of the arable and grassland LTFEs, respectively. LTFEs cover all six MSQR classes but with a bias towards the high and very high soil quality classes. LTFEs on arable land are present in all clay content classes according to the European Soil Data Centre (ESDAC) but with a bias towards the clay content class 4. Grassland LTFEs show a bias towards the clay content classes 5, 6 and 7, while well representing the other clay content classes, except clay content class 3, where grassland LTFEs are completely missing. The results confirm the very high potential of LTFE data for spatially differentiated analyses and modeling. However, reuse is restricted by the difficult access to LTFE research data. The common database is an important step in overcoming this restriction.
    Type of Medium: Online Resource
    ISSN: 2199-398X
    URL: Article
    DOI: 10.5194/soil-6-579-2020
    Language: English
    Publisher: Copernicus GmbH
    Publication Date: 2020
    detail.hit.zdb_id: 2834892-8
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  • 7
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    Online Resource
    Inter- and Intraobserver Agreement for Gastroesophageal Reflux Detection in Infants Using Multiple Intraluminal Impedance
    S. Karger AG ; 2004
    In:  Neonatology Vol. 85, No. 1 ( 2004), p. 11-14
    Details
    In: Neonatology, S. Karger AG, Vol. 85, No. 1 ( 2004), p. 11-14
    Abstract: The multiple intraluminal impedance (MII) technique is a new method that allows pH-independent gastroesophageal reflux detection via changes in impedance caused by a liquid bolus inside the esophagus. We wanted to know whether this technique yields objective and reproducible results. Twenty 3- to 6-hour recordings of MII from 19 preterm infants (median gestational age at birth 30 weeks, range 24–34 weeks; age at study 26 days, range 13–93 days) were divided into 23-second segments and analyzed for reflux episodes by three investigators; one investigator analyzed the data set twice. Observer agreement was assessed using kappa statistics. Each investigator analyzed 16,627 23-second segments, with a median of 854 (range 486–979) segments per recording. Median kappa values for the 20 recordings were 0.79, 0.83, and 0.83 for the three pairs of investigators and 0.84 for the repeated scoring procedure. MII recordings could be analyzed with a high level of inter- and intraobserver agreement.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000074951
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2004
    detail.hit.zdb_id: 2403535-X
    SSG: 12
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  • 8
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    False alarms in very low birthweight infants: comparison between three intensive care monitoring systems
    Wiley ; 2007
    In:  Acta Paediatrica Vol. 89, No. 5 ( 2007-01-02), p. 571-576
    Details
    In: Acta Paediatrica, Wiley, Vol. 89, No. 5 ( 2007-01-02), p. 571-576
    Type of Medium: Online Resource
    ISSN: 0803-5253
    URL: Article
    DOI: 10.1111/j.1651-2227.2000.tb00341.x
    Language: English
    Publisher: Wiley
    Publication Date: 2007
    detail.hit.zdb_id: 1492629-5
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  • 9
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    Holocene lake level history of the Tangra Yumco lake system, southern-central Tibetan Plateau
    SAGE Publications ; 2016
    In:  The Holocene Vol. 26, No. 2 ( 2016-02), p. 176-187
    Details
    In: The Holocene, SAGE Publications, Vol. 26, No. 2 ( 2016-02), p. 176-187
    Abstract: Massive carbonate banks representing ancient lacustrine deposits are exposed in the catchment of the lake Tangra Yumco (southern-central Tibetan Plateau) and nearby lake Xuru Co. Nine sediment samples were taken below and above these lacustrine deposits to determine periods of changing lake level using optically stimulated luminescence (OSL) applying a multiple-aliquot regeneration (MAR) protocol. According to facies and stratigraphy, samples below the carbonate banks indicate a rising and samples from above a falling lake level. The results indicate that the rising lake level of Tangra Yumco passed the sampling location at 10.5 and 2.1 ka while a falling lake level passed the sampling location at 0.9 ka. The rising lake level of Xuru Co passed the sampling location at 7.9 and 1.7 ka and a falling lake level at 0.5 ka showing a similar trend as at Tangra Yumco. Combining these results with recalculated cosmogenic nuclide ages and previously published feldspar luminescence data allows the establishment of a Holocene lake level reconstruction for Tangra Yumco, which is unique for the southern-central Tibetan Plateau. The lake level of Tangra Yumco crested a lake level highstand of 181–183 m above the recent lake level prior to 8.5 ka and has generally fallen after 8.5 ka, with a minor lake level rise at 2.1 ka. Lake level variations at Tangra Yumco occur simultaneously with other lakes on the Tibetan Plateau indicating that variations were controlled by monsoonal dynamics with a moist early Holocene and a successive reduction of available moisture thereafter. The average rate of the lake level rise between 10.5 and 8.5 ka is at least 0.05 m a −1 (compared with a modern value of 0.38 m a −1 ), providing valuable insights in the monsoonal impact on lake level change on the southern-central Tibetan Plateau.
    Type of Medium: Online Resource
    ISSN: 0959-6836 , 1477-0911
    URL: Article
    DOI: 10.1177/0959683615596840
    RVK:
    RA 1000
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2027956-5
    SSG: 14
    SSG: 3,4
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  • 10
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    PET-guided omission of radiotherapy in early-stage unfavourable Hodgkin lymphoma (GHSG HD17): a multicentre, open-label, randomised, phase 3 trial
    Elsevier BV ; 2021
    In:  The Lancet Oncology Vol. 22, No. 2 ( 2021-02), p. 223-234
    Details
    In: The Lancet Oncology, Elsevier BV, Vol. 22, No. 2 ( 2021-02), p. 223-234
    Type of Medium: Online Resource
    ISSN: 1470-2045
    URL: Article
    DOI: 10.1016/S1470-2045(20)30601-X
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2049730-1
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