University of Duisburg-Essen

Purpose The significance of the posterior tibial slope (PTS) has increasingly come into focus in anterior cruciate ligament (ACL) reconstruction being a risk factor for ACL graft failure. Nevertheless, inconsistent data on the critical value of the PTS exist. The purpose of this study was to define a cut‐off value for the PTS in ACL surgery. Methods In a retrospective cohort study, 350 revision ACL reconstructions (ACL‐RR) with a failed ACL hamstring graft and 350 primary ACL reconstructions (ACL‐R) were matched according to age, gender, concomitant injuries and graft characteristics and compared to a healthy control group. Using the proximal anatomic axis, lateral knee radiographs were evaluated for the PTS, interrater reliability was defined, ROC curves, Fischer's exact test and Baptista–Pike method were applied to define specificity and the odds ratio for a critical PTS value. Results Radiographic evaluation proved excellent interrater reliability (intraclass correlation coefficient 0.969). Evaluation of the PTS revealed 10.0 ± 2.2 (5–15) degrees in the ACL‐RR group, 7.8 ± 1.8 (4.2–13) degrees in the ACL‐R group and 6.6 ± 1.9 (3.6–12) degrees in the control group with significant differences between the groups ( p < 0.001). A PTS value of 10.1 degrees proved a specificity of 98% for the prediction of an ACL graft failure and indicated an 11‐fold risk for a retear of the ACL. Conclusion A PTS exceeding 10.1 degrees carries an 11‐fold risk for ACL graft failure and, therefore, should be considered in ACL reconstruction. These findings might serve as a cut‐off value for the indication of a slope‐reducing high tibial osteotomy in ACL surgery. Level of Evidence Level III.

Necrotizing fasciitis (NF) is a rapidly progressing condition with a high mortality rate. The poor prognosis is often due to delayed diagnosis, which is typically made clinically or radiologically. This case report highlights a rare instance of fulminant NF with an atypical presentation—no initial clinical signs and an unusual radiological appearance. Both the localization and microbiological findings (non-resistant Klebsiella pneumoniae) were uncommon for NF. The patient presented with no suspicious skin changes, pain, or medical history indicative of NF. A computed tomography scan revealed entrapped air, a pathognomonic sign of NF; however, the air was predominantly located in the abdomen, leading to an initial suspicion of hollow organ perforation because this is an unusual location for NF. Subsequently, NF was suspected based on the computed tomography findings combined with laboratory results. Despite prompt surgical intervention and broad-spectrum antibiotic therapy, the patient died of multi-organ failure within 16 hours. This case underscores the importance of recognizing the subtle and varied presentations of NF and using tools such as the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score. Healthcare providers must maintain a high index of suspicion for NF, even when clinical, radiological, and laboratory findings seem inconspicuous.

How the Internet is used and any negative outcomes of engagement with it—especially with regards to children—is a topic of great interest, bearing legitimate investigation. Proposed identifiers of problematic internet use(PIU) include aspects of use in correlation with distress or impairment across biological, psychological, sociological, and/or occupational/academic functioning. Adolescents and those with vulnerabilities across developmental or sociological domains are particularly susceptible. Although validated instruments have been utilized to assess PIU, concerns surrounding the methodology, currency, and some validation measures of existing and cross-sectional screening tools and a lack of those with true external validity and variance, combined with some disagreement surrounding PIU, have impeded its diagnostic acceptance. Current investigative approaches to PIU include clarifying problematic gambling and gaming criteria, psychotherapeutic therapy, pharmacological interventions, and non-invasive neurostimulation therapies targeting cortical brain regions. As child screen time appears to be increasing, further research, ethical health/social policy changes, and digital literacy programs are strongly endorsed. To avoid online engagement dysregulating or harming children, digital policy youth user protection standards, pragmatic key player dialogues, transparent reassessments of digital-centric business models without compromising less resourced countries, and even globally agreed child online safety regulations are also recommended.

We investigated the effect of center-specific variables on overall survival (OS) after allogeneic hematopoietic cell transplantation (alloHCT) in acute myeloid leukemia (AML). Eligible were adult patients reported to DRST registry receiving first alloHCT for AML from a related or matched (>= 9/10 HLA-match) unrelated donor 2015-2021. Primary endpoint was OS at 12 months from alloHCT. Univariable and multivariable analyses after best subset selection was performed. Of 5328 patients, 83% received alloHCT in a high-volume center (≥40 alloHCT/year); 90% in a university hospital; 90% in a center performing alloHCT for ≥10 years; and 73% in a Joint Accreditation Committee IHCT-Europe and EBMT (JACIE) accredited center. 52% of the patients were in CR1, and ELN risk was adverse in 37% and intermediate in 42%. On multivariable analysis, center-specific factors predicting adverse 12-month OS were program duration

Introduction Interventional radiology procedures and endoscopies are performed commonly worldwide, often necessitating pharmacological sedation to optimise patient comfort. It is unclear to what extent non‐anaesthetists should provide procedural sedation. Methods We studied adult patients who previously lived independently and underwent a non‐ambulatory interventional radiology or gastroenterology procedure under anaesthetist‐directed or non‐anaesthetist‐directed sedation at a large healthcare network. The primary outcomes were postprocedural adverse discharge to a nursing home and postprocedural duration of hospital stay. Results Among 22,868 patients included, 15,168 (66.3%) and 7700 (33.7%) underwent anaesthetist‐directed sedation and non‐anaesthetist‐directed sedation, respectively. Of all patients receiving anaesthetist‐directed sedation, 9.2% experienced adverse discharge to a nursing home compared with 21.3% undergoing non‐anaesthetist‐directed sedation. Anaesthetist‐directed sedation was associated with reduced risk of adverse discharge to a nursing home (adjusted relative risk 0.54, 95%CI 0.45–0.63, p < 0.001, adjusted risk difference ‐4.6%, 95%CI ‐5.8 to ‐3.4, p < 0.001) and a shorter postprocedural duration of hospital stay (median (IQR [range]) 2 (1–6 [0–315]) days vs. 5 (2–12 [0–268]) days; adjusted model estimate 0.84, 95%CI 0.79–0.89, p < 0.001). The lower risk of adverse discharge to a nursing home and shorter duration of hospital stay in patients undergoing anaesthetist‐directed sedation was reproduced in an instrumental variable analysis (adjusted risk difference ‐4.3%, 95%CI ‐8.4 to ‐0.1, p = 0.043; and ‐1.41 days, 95%CI ‐1.43 to ‐1.41 days, p < 0.001, respectively). Among patients undergoing anaesthetist‐directed sedation the mean (SD) proportion of missing blood pressure measurements was lower (0.7 (4.9) % vs. 8.0 (14.6) %, p < 0.001), which mediated the effect of anaesthetist‐directed sedation on adverse discharge. Discussion Among patients undergoing a non‐ambulatory interventional radiology procedure or a gastrointestinal endoscopy, anaesthetist‐directed sedation is associated with a reduced risk of adverse discharge to a nursing home and a shorter duration of hospital stay.

Zusammenfassung Bronchoskopiekurse sollten einen festen Bestandteil der bronchoskopischen Ausbildung darstellen. Kursabsolventen sollen nach dem Bronchoskopiekurs mit den Indikationsfeldern, Voraussetzungen und technischen Möglichkeiten der Bronchoskopie vertraut sein. Neben theoretischen Inhalten werden in Kleingruppen am Bronchoskopiemodell unter Supervision praktische bronchoskopische Fertigkeiten vermittelt und am Simulationsmodell trainiert. Die Grundlage der vermittelten Inhalte sind dabei die aktuellen Leitlinien und Empfehlungen der DGP sowie die geltenden Richtlinien und KRINKO-Empfehlungen. Die Vereinheitlichung zentraler Kurselemente dient der flächendeckenden Qualitätssicherung, dennoch sollen lokale standortspezifische Schwerpunktsetzungen explizit unterstützt werden.

Neighborhoods are important spaces where people participate in social interactions, and existing research has demonstrated that the social and physical environment plays a pivotal role in shaping residents' social and political attitudes. This study investigates the influence of social openness in neighborhoods, defined as residents' perceptions of their co‐residents being open to change, on attitudes toward diversity. Building on existing research on rural–urban differences in socio‐political attitudes, we hypothesize that the link between social openness and pro‐diversity attitudes differs between rural and urban areas. Specifically, we argue that individuals who live in densely populated areas are more frequently exposed to cues of social openness compared to those who live in areas with low population density (even if the average social openness is equal for both). The study leverages data from two large‐N geocoded surveys in Germany to create contextual measures of social openness and assesses their relationship with pro‐diversity attitudes. Empirical results from multilevel models show that social openness is positively related to pro‐diversity attitudes but only in densely populated areas. Our results have important implications for place‐based approaches to immigrant integration and social cohesion more generally.

Ammonia has attracted considerable interest as a hydrogen carrier that can help decarbonize global energy networks. Key to realizing this is the development of low temperature ammonia fuel cells for the on‐demand generation of electricity. However, the efficiency of such systems is significantly impaired by the sluggish ammonia oxidation reaction (AOR) and oxygen reduction reaction (ORR). Here, we report the design of a bifunctional Ag2Pt3TiS6 electrocatalyst that facilitates both reactions at mass activities exceeding that of commercial Pt/C. Through comprehensive density functional theory calculations, we identify that active site motifs composed of Pt and Ti atoms work cooperatively to catalyze ORR and AOR. Notably, in situ shell‐isolated nanoparticle‐enhanced Raman spectroscopy (SHINERS) experiments indicate a decreased propensity for *NOx formation and hence an increased resistance toward catalyst poisoning for AOR. Employing Ag2Pt3TiS6 as both the cathode and anode, we constructed a low temperature ammonia fuel cell with a high peak power density of 8.71 mW cm⁻² and low Pt loading of 0.45 mg cm⁻². Our findings demonstrate a pathway towards the rational design of effective electrocatalysts with multi‐element active sites that work cooperatively.

Wake-induced vibrations (WIV) in multi-cylinder configurations have demonstrated greater energy harvesting efficiency in hydrokinetic applications compared to conventional vortex-induced vibrations (VIV) of a single cylinder. However, the complex fluid-structure interactions make it challenging to identify optimal configurations for maximum power output, as extensive simulations across numerous parameter combinations lead to substantial computational costs with traditional computational fluid dynamics (CFD) methods. To address this challenge, we developed a data-driven model using automated machine learning (AutoML) techniques, focusing on four key parameters: spacing, diameter, damping, and reduced velocity. Trained on comprehensive datasets from validated CFD simulations, this model integrates multiple algorithms to predict the power efficiency of WIV systems with high accuracy. Our approach enables rapid and precise evaluations of power efficiency across a broad range of configurations, significantly reducing the computational burden compared to traditional CFD approaches. The results indicate that optimal configurations, characterized by larger upstream cylinder diameters, higher damping ratios, and ideal spacing ratios, can achieve power generation efficiencies of up to 59.15%. Further analysis of vorticity contours reveals that synchronized interactions between upstream vortex shedding and downstream structure motions enhance WIV, thereby improving energy harvesting efficiency.

The pivotal role of antibody-producing B cells in controlling hepatitis B virus (HBV) infection is well-established. However, the antiviral role of B cells extends beyond antibody production, which has been insufficiently studied for HBV infection. Using an HBV hydrodynamic injection (HDI) mouse model with B cell depletion or functional blockade, we detected HBV infection markers and assessed T cell function through enzyme-linked immunosorbent assay, RT-PCR and flow cytometry. We observed significantly delayed serum and intrahepatic HBV clearance in permanently B cell-deficient and transiently B cell-depleted mice as well as mice with a functional B cell blockade. Blocking B cell function prior to or soon after HBV HDI resulted in delayed HBV clearance indicating that B cells contribute to initiating anti-HBV immune responses after following HBV exposure. Additionally, we also found an early activation of B cells following HBV exposure, characterized by an upregulation of MHC-II, CXCR5, and PD-1. Critically, the proliferation and activation of both CD4 + and CD8 + T cells were impaired after B cell depletion prior to HBV challenge. Consistently, depleting B cells reduced the generation of Th1, Th2, and Th17 cells in the spleen and hindered HBV-specific CD8 + T cell responses in the liver. Along these lines, the HBV-exposed B cells were more efficient in inducing HBcAg-specific CD8 + T cell responses in vitro. Collectively, our data indicate that B cells, in addition to antibody production, are essential for the development of anti-HBV cellular responses and intrahepatic HBV clearance during the early stage of HBV antigen exposure.

This paper examines the variation between -n and -s in the genitive singular inflection of determiners for masculine and neuter nouns as can be observed in Herbst diesen Jahres vs. Herbst dieses Jahres ‘autumn of this year’. So far, the discussion of this phenomenon has focused on the demonstrative determiner dies-, where the -n inflection is regarded as a new, non-standard variant. The results of our corpus study of newspaper texts show that the -n inflection occurs across the entire determiner system and is supported by the decreasing prototypicality of individual determiners: the less prototypical a determiner is, the more frequently it exhibits the -n inflection. The least prototypical determiner class is formed by indefinite determiners such as jed-, which predominantly exhibit -n inflection (e. g., Menschen jeden Alters). The majority of demonstratives fulfil the prototypical features of determiners. Here, the -n inflection represents a rare variant of the -s inflection. Finally, possessive determiners are located in the prototypical centre of the determiners and consistently exhibit -s inflection with a few exceptions. Our study also shows that genitive noun phrases introduced by determiners exhibiting -n inflection have less paradigmatic depth and block adjectival attribution. Although the contexts in which -n occurs are restricted, it is always interchangeable with -s. We therefore classify these two forms as allomorphs.

Background Resistant and refractory migraine are commonly encountered in specialized headache centers. Several comorbidities, mostly psychiatric conditions, have been linked to migraine worsening; however, there is little knowledge of the comorbidity profile of individuals with resistant and refractory migraine. Methods REFINE is a prospective observational multicenter international study involving individuals with migraine from 15 headache centers. Participants were categorized into three groups based on the European Headache Federation criteria: non-resistant and non-refractory (NRNRM), resistant (ResM), and refractory (RefM). We explored the prevalence of 20 comorbidities at baseline in the three groups. Results Of the 689 included patients (82.8% women), 262 (38.0%) had ResM, 73 (10.4%) had RefM and 354 (51.4%) NRNRM. A higher prevalence of psychiatric comorbidities, trigger points, temporomandibular joint disorders, thyroiditis, and cerebrovascular diseases was observed in the RefM group, followed by ResM and NRNRM. Multiple comorbidities were more common in the RefM group, followed by the ResM group and by the NRNRM group (41.6% vs. 24.5% vs. 14.1% respectively; p < 0.001). At the sensitivity analysis, exploring participants with chronic migraine, significant differences among the NRNRM, ResM, and RefM groups were found in the prevalence of anxiety (p < 0.001), asthma and rhinitis (p = 0.013), bipolar and other psychiatric disorders (p = 0.049), cerebrovascular diseases (p < 0.001), depression (p < 0.001), obesity (p = 0.002), thyroiditis (p < 0.001), and trigger points (p = 0.008). Conclusion REFINE data indicate that individuals with ResM and RefM have a higher burden of comorbidities than those with NRNRM. It can be postulated that those comorbidities may have an impact on the progression of migraine from a form that is easy to treat to a form that is resistant or refractory to treatments. Longitudinal studies are needed to understand the direction of the association between ResM or RefM and those comorbidities and if proper treatment of comorbidities might help overcome treatment resistance or refractoriness.

Background Alzheimer’s disease (AD) and Parkinson’s disease (PD) are leading neurodegenerative disorders marked by protein aggregation, with AD featuring amyloid-beta (Aβ) and tau proteins, and PD alpha-synuclein (αSyn). Dementia with Lewy bodies (DLB) often presents with a mix of these pathologies. This study explores naturally occurring autoantibodies (nAbs), including Immunoglobulin (Ig)G, IgM, and IgA, which target αSyn, Aβ and tau to maintain homeostasis and were previously found altered in AD and PD patients, among others. Main text We extended this investigation across AD, PD and DLB patients investigating both the affinities of IgGs and levels of IgGs, IgMs and IgAs towards αSyn, Aβ and tau utilizing chemiluminescence assays. We confirmed that AD and PD patients exhibited lower levels of high-affinity anti-Aβ and anti-αSyn IgGs, respectively, than healthy controls. AD patients also showed diminished levels of high-affinity anti-αSyn IgGs, while anti-tau IgG affinities did not differ significantly across groups. However, DLB patients exhibited increased anti-αSyn IgG but decreased anti-αSyn IgM levels compared to controls and PD patients, with AD patients showing a similar pattern. Interestingly, AD patients had higher anti-Aβ IgG but lower anti-Aβ IgA levels than DLB patients. DLB patients had reduced anti-Aβ IgM levels compared to controls, and anti-tau IgG levels were lower in AD than PD patients, who had reduced anti-tau IgM levels compared to controls. AD patients uniquely showed higher anti-tau IgA levels. Significant correlations were observed between clinical measures and nAbs, with negative correlations between anti-αSyn IgG affinity and levels in DLB patients and a positive correlation with anti-αSyn IgA levels in PD patients. Disease-specific changes in nAb levels and affinity correlations were identified, highlighting altered immune responses. Conclusion This study reveals distinctive nAb profiles in AD, DLB, and PD, pinpointing specific immune deficiencies against pathological proteins. These insights into the autoreactive immune system’s role in neurodegeneration suggest nAbs as potential markers for vulnerability to protein aggregation, offering new avenues for understanding and possibly diagnosing these conditions.

Aims Conventional parameters of right ventricular (RV) function are load‐dependent and therefore do not accurately reflect contractility in patients with relevant tricuspid regurgitation (TR). RV adaptability to load has been characterized using the Dandel's index in patients with heart failure, but its prognostic value in patients undergoing tricuspid transcatheter edge‐to‐edge repair (T‐TEER) has not been investigated so far. Methods and results From the EuroTR registry (2019 to 2022), patients with complete datasets and a minimum of 2‐years of follow‐up were included. RV functional parameters (i.e. tricuspid annular plane systolic excursion [TAPSE], fractional area change [FAC], TAPSE/systolic pulmonary arterial pressure [sPAP]), as well as a echocardiographic RV load adaptation index (Dandel's index) were assessed and their predictive value in terms of all‐cause mortality evaluated using logistic multivariate logistic regression. The majority of the 364 patients had secondary TR (96%) and were severely symptomatic (New York Heart Association class ≥III; 92%). At 2‐year follow‐up, 36% of patients had died. Functional RV parameters (TAPSE: hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.62–0.84; FAC: HR 0.73, 95% CI 0.59–0.91), coupling index (TAPSE/sPAP: HR 0.8, 95% CI 0.65–0.99) and Dandel's index (HR 0.67, 95% CI 0.53–0.85) were all associated with mortality at 2 years in univariable analyses. In a multivariate logistic regression model, the Dandel's index maintained its predictive value ( p < 0.001), along with TAPSE and absence of signs of right heart failure, with an optimal threshold of 20.5 determined by the receiver‐operating characteristic analysis. This threshold also successfully predicted cardiac hospital readmission. A multivariate analysis was conducted to identify parameters linked to RV function and predicting clinical outcomes. Conclusion Assessment of the RV capacity to adjust for changes in loading conditions predicted mortality in patients with severe symptomatic TR undergoing T‐TEER. The use of a multiparametric approach including the Dandel's index to assess RV function had an incremental value for the stratification of patients into subgroups with different prognosis.