University Hospital München

The individual heterogeneity of the aortic arch morphology and pathologies places high demands on endovascular treatment strategies. Over the past decades surgical debranching strategies in combination with thoracic endovascular aortic repair (TEVAR) and complex endovascular arch repair have emerged as viable alternatives to open aortic arch replacement. Recent systematic reviews demonstrated high technical success rates for complex endovascular procedures coupled with a relatively low perioperative risk of mortality in a multimorbid patient cohort. Despite these positive outcomes, the risk of stroke and reinterventions range from 5–10% and therefore remain a significant challenge. Elective cases can be successfully treated with customized prosthetic devices, whereas surgeon-modified or in situ fenestrated prostheses offer alternatives for urgent interventions. Parallel grafts can be used as a bail-out option but carry an increased risk of endoleaks and reinterventions. Technical advances, such as multibranched or fenestrated stent grafts, have expanded the treatment possibilities; however, due to significantly shorter proximal landing zones women have fewer endovascular treatment options compared to men. The aim of developing a standardized off-the-shelf endoprosthesis for the aortic arch has gained in importance. Future research is focused on further refining standardized designs while maintaining safety and efficacy, further supporting the growing trend towards more liberal indications.

Hintergrund Die chronische spontane Urtikaria (CSU) beeinträchtigt die Lebensqualität der Patienten erheblich. Trotz Fortschritten bei Diagnose und Therapie ist die Behandlung immer noch unzureichend. Die Telemedizin bietet eine vielversprechende Lösung zur Verbesserung der Behandlung. Diese Pilotstudie bewertet die Akzeptanz und Nutzung eines digitalen Gesundheitskonzepts für die CSU, untersucht dessen Auswirkungen auf das Krankheitsmanagement und zeigt technische Herausforderungen auf. Patienten und Methodik In diese prospektive Pilotstudie wurden CSU-Patienten einer Universitätsklinik in Deutschland einbezogen. Über einen Zeitraum von 12 Monaten interagierten die Teilnehmer mit Ärzten über eine telemedizinische Plattform, welche die studienspezifische Intervention darstellte. Nach jeder dreimonatigen digitalen Visite wurden die Symptome und die Lebensqualität anhand von digitalen patientenberichteten Ergebnissen (ePROs) und Online-Fragebögen bewertet. Am Ende bewerteten Patienten und Ärzte die allgemeine Zufriedenheit, die Benutzerfreundlichkeit der Plattform und die technischen Herausforderungen. Ergebnisse 24 Patienten nahmen an der Studie teil. Die Mehrheit (92%) gab an, dass das digitale Konzept eine vielversprechende Alternative zu herkömmlichen Beratungsgesprächen sein könnte. Die Analyse von Beginn Ende der Studie ergab, dass die Krankheitskontrolle stabil blieb, während sich die Lebensqualität verbesserte. Alle Ärzte empfanden die digitale Anwendung als zuverlässig und zeitsparend. Schlussfolgerungen Diese Pilotstudie zeigt die Machbarkeit und hohe Akzeptanz eines digitalen Gesundheitskonzepts für das Management von CSU. Weitere Forschungen mit größeren Kohorten sind erforderlich, um eine breitere Anwendbarkeit zu ermitteln.

To date, most optical materials are derived from petrochemicals, facing problems like renewability, sustainability, and biocompatibility. Fluorescent materials derived from natural products with unique structures, stimuli-responsive photophysical properties, and superior compatibility are of extraordinary significance for biomedical applications. In this work, a nature-inspired electron acceptor with a steroid-like structure (DABT) has been constructed based on the tricyclic diterpene skeleton of natural rosin. Through substitution with variable electron donors, red-shifted and twisted intramolecular charge transfer can be realized. In particular, the dimethyl amino substituted compound, DABT-DMA, can be applied as a polarity-dependent bio-sensor with a dual responsiveness of distinct fluorescence wavelength and lifetime due to its outstanding solvent effect. In addition to the advantageous biocompatibility and steroid-like structure of DABT-DMA, successful lipid droplet-targeted imaging at dual channels can be achieved. Further investigations prove that dysfunction of lipid droplets induced by Aβ protein can result in the accumulation of cholesterol analogs, further exacerbating the pathological features of Alzheimer’s disease. This work not only proposes a novel natural electron acceptor with a steroid-like structure possessing both biocompatibility and targeting capability but also offers new insights into Alzheimer’s disease-related pathophysiological mechanisms, paving the way toward potential diagnostics.

Background Cochlear implants (CIs) are neuroprosthetic devices which restore hearing in severe-to-profound hearing loss through electrical stimulation of the auditory nerve. Current CIs use an externally worn audio processor. A long-term goal in the field has been to develop a device in which all components are contained within a single implant. Here, we present initial clinical results with the totally implantable cochlear implant (TICI). The primary objective of this study was to assess the safety of the device in adults who suffer from bilateral severe-to-profound sensorineural hearing loss. Methods This study used a design with non-randomized single group assignment (trial registration: NCT04571333). Six implantations took place beginning in September 2020. Data collection took place at the two participating CI centers. Adverse events (the primary outcome), speech perception, patient reported outcomes, and device usage statistics were collected over the subsequent 52 weeks. A within-subjects comparison was used in which each participant was evaluated both with the TICI and with an external SONNET audio processor. Results One anticipated serious adverse device effect (ASADE) occurred. After treatment the event resolved without sequelae. No unanticipated serious adverse device effects (USADE) occurred. Speech perception in quiet and in noise scores were comparable between the TICI and the SONNET audio processor. Scores on the validated patient reported outcome instruments HUI3, SSQ-12, and HISQUI-19 all increased over the duration of the study. User satisfaction scores as reported in their daily diary also increased over the duration of the study. Based on device usage metrics, all but one user used the TICI without an external processor the majority of the time. Conclusions The primary outcome of assessing the safety of the device was achieved. The TICI provides high levels of hearing performance, comparable to those of a conventional CI. The development of the TICI expands the range of options for treatment of hearing loss.

Cartilage lesions of the knee are common. Patients often present with nonspecific symptoms like pain and swelling. Depending on the extent of the cartilage damage, various conservative and surgical treatment procedures are available. In order to plan treatment as effectively as possible, comprehensive diagnostics are required. Basic diagnostics, consisting of a detailed anamnesis and clinical examination, are followed by magnetic resonance imaging (MRI) with cartilage-specific sequences, which is the current gold standard to classify and describe cartilage damage. However, MRI is not sufficient to assess the genesis of the cartilage damage. Therefore diagnosis of environmental factors has gained considerable importance in order to identify predisposing factors, for example, an axial deformity, and to treat them. Therefore, the surgical treatment of cartilage damage should be viewed as a concept that includes the treatment of the predisposing factors as well as the cartilage damage. MRI and diagnosis of environmental factors are important in the development of this concept.

The main stakeholders in external quality assessment (EQA) programs are the participants, in whose interests these challenges are ultimately organised. EQA schemes in the medical field contribute to improving the quality of patient care by evaluating the analytical and diagnostic quality of laboratory and point-of-care tests (POCT) by independent third parties and, if necessary, pointing out erroneous measurement results and analytical or diagnostic improvement potential. Other benefits include the option of using EQA samples for other important laboratory procedures, such as the verification or validation of in vitro diagnostic medical devices (IVD-MDs), a contribution to the estimation of measurement uncertainty, a means of training and educating laboratory staff through educational EQA programmes or samples, or even for independent and documented monitoring of staff competence, such as on samples with unusual or even exceptional characteristics. Participation in an EQA scheme for beneficiaries like medical, microbiological and histo- and molecular pathology laboratories, users of POCT and self-testing systems as well as National Metrology Institutes, calibration laboratories and reference laboratories that are dedicated to specific tasks and have particular expectations of the EQA scheme are presented here.

External quality assessment (EQA) cycles are the smallest complete units within EQA programs that laboratories can use to obtain external assessments of their performance. In each cycle, several samples are distributed to the laboratories registered for participation, and ideally, EQA programs not only cover the examination procedures but also the pre- and post-examination procedures. The properties and concentration range of measurands in individual samples are selected with regard to the intended challenge for the participants so that each sample fulfils its purpose. This aims to ensure the most significant possible information gain in every cycle using the lowest possible number of EQA samples and thus, under economically optimal conditions. Participants examine samples and the results are reported to the EQA provider, who compares them with the target values for individual measurands in every sample. The EQA provider assesses the laboratory performance, and finally communicates the assessment results to the participant. The participants evaluate the outcomes of the assessment of their examination results and can draw conclusions in the case of both failing and passing and, if necessary, define improvement measures. After completion, each cycle is evaluated by the provider so that limitations and weaknesses of the EQA program can be identified and appropriate measures taken, or to confirm its continued suitability and appropriateness.

Context Patients with Cushing's syndrome (CS) suffer from metabolic and cardiovascular comorbidities caused by hypercortisolism. The human gut microbiome responds to different pathological conditions. Objective The aim of our study was to analyze the effect of chronic endogenous cortisol excess on the gut microbiome. Methods We prospectively recruited 18 patients with endogenous CS of different etiologies (mainly pituitary CS, n = 13). Patients provided a stool sample during active CS and 1 to 2 years after successful surgical treatment being in biochemical remission. In addition, 36 patients, in whom CS was excluded, served as an obese control group and 108 samples from healthy lean students were used as a reference group. Amplicons of the V3/V4 region of the 16S ribosomal RNA gene, from every sample, were sequenced and clustered into operational taxonomic units. The microbial profiles of CS patients were then compared to the control and reference groups using R scripts. Results In comparison to lean references, the gut microbiome of patients with florid CS demonstrated a disturbed microbial profile. Microbial dysbiosis of patients with CS was maintained even after biochemical remission following curative surgery. Conclusion Patients with CS have a distinct and disturbed gut microbiome that persists even after surgery, indicating a possible target for additional probiotic interventions to accelerate convergence to a healthy microbiome.

Seit vielen Jahren werden durchflusszytometrische Methoden für das zelluläre Immunmonitoring eingesetzt. Das epigenetische Immunmonitoring kann Aufschluss darüber geben, welche Gene in einer Zelle aus- bzw. angeschaltet sind. In bestimmten Situationen könnte sie die aufwendigere Durchflusszytometrie in Zukunft ersetzen.

We consider a notion of rationalizability, where the rationalizing relation may depend on the set of feasible alternatives. More precisely, we say that a choice function is locally rationalizable if it is rationalized by a family of rationalizing relations such that a strict preference between two alternatives in some feasible set is preserved when removing other alternatives. It is known that a choice function is locally rationalizable if and only if it satisfies Sen’s $\gamma$. We expand the theory of local rationalizability by proposing a natural strengthening of $\gamma$ that precisely characterizes local rationalizability via PIP-transitive relations. Local rationalizability permits a unified perspective on social choice functions that satisfy $\gamma$, including classic ones such as the top cycle and the uncovered set as well as new ones such as two-stage majoritarian choice and split cycle. We give simple axiomatic characterizations of some of these using local rationalizability and propose systematic procedures to define social choice functions that satisfy $\gamma$.

Zusammenfassung Operationsziel Das Ziel dieser Operation ist es, eine mehrfragmentäre und undislozierte Talusfraktur (Corpus und Hals) navigiert und minimalinvasiv mittels Schraubenosteosynthese gegen eine sekundäre Dislokation abzusichern. Indikation Aufgrund des jungen Alters des Patienten im Beispielfall und auch der Gefahr einer möglichen sekundären Dislokation wurde die Entscheidung zur Operation getroffen. Kontraindikationen Weichteilschwellung, Wundinfektion und Allergien gegen das Osteosynthesematerial. Operationstechnik In dem Online verfügbaren Video (auf Englisch) erfolgt eine detaillierte Darstellung der einzelnen Operationsschritte. Präoperative CT-Bildgebung und Schraubenplanung. Befestigung der Referenzeinheit. 1. CBCT-Scan, Bildfusion und Fusionskontrolle. Planung der minimalinvasiven Hautschnitte. Hautschnitt, navigierte Bohrungen und Einführen der Kirschner(K)-Drähte. 2. CBCT-Scan und Lagekontrolle der K‑Drähte, wenn nötig Feinjustierung dieser. Einbringen der Schrauben. 3. CBCT-Scan mit anschließender Lagekontrolle der Schrauben, wenn nötig, ein Nachziehen dieser. Durchgeführt in der „Robotic Suite“ (Brainlab, München, Deutschland) unter der Verwendung folgender Elemente: Navigationseinheit „Curve Navigation System“, fahrbarer robotischer 3D-Computertomograph (CBCT), „Loop-X“ und der Wandmonitor „BUZZ“. Weiterbehandlung Postoperatives Röntgen und CT zur Lagekontrolle der Implantate. Teilbelastung des Fußes mit 10 kg bei Sohlenkontakt für 6 Wochen. Physiotherapie mit aktiver und passiver Gelenkmobilisation. Thromboseprophylaxe mit Enoxaparin-Natrium. Metallentfernung fakultativ nach ca. einem Jahr. Evidenz Navigierte Operationen sind Routine, bisher v. a. im Bereich der Wirbelsäule. Dieser Beitrag zeigt, dass navigierte Eingriffe an den Extremitäten erfolgreich in Hybrid-OP durchgeführt werden können.

The existence of light QCD axions, whose mass depends on an additional free parameter, can lead to a new ground state of matter, where the sourced axion field reduces the nucleon effective mass. The presence of the axion field has structural consequences, in particular, it results in a thinner (or even prevents its existence) heat-blanketing envelope, significantly altering the cooling patterns of neutron stars. We exploit the anomalous cooling behavior to constrain previously uncharted regions of the axion parameter space by comparing model predictions with existing data from isolated neutron stars. Notably, this analysis does not require the light QCD axion to be the dark matter candidate. Published by the American Physical Society 2024

Most research works have focused on studying the postfire (after exposure to high temperatures) mechanical properties of either carbon steel, stainless steel, or aluminum alloy. There are few studies directly comparing the mechanical properties of these structural metals after exposure to high temperatures, and there is no universal predictive equation describing their postfire retention factors. Herein, mechanical properties of structural metals (i.e., carbon steel, stainless steel, and aluminum alloy) after exposure to high temperatures are experimentally investigated. The mechanical properties of these structural metals are compared and rigorously analyzed. Existing equations are assessed by comparing their predictions against the corresponding postfire retention factors of the coupon specimens. A unified equation for the postfire mechanical properties of structural metals is developed, proposing different sets of coefficients for various structural metals based on the new test data from this study and the existing literature. The unified equation generally provides a safe and convenient assessment method, enabling practical engineers to determine the mechanical properties of metal structures after exposure to high temperatures in terms of Young's modulus, 0.2% proof stress (yield strength), and ultimate strength.

The emission control of harmful compounds and greenhouse gases and the development of alternative, sustainable fuel sources is a major focus in current research. A solution for this problem lies in the development of efficient catalytic materials. Here, gas phase model systems represent prominent examples for obtaining fundamental insights on reaction properties of prospective catalytic systems. In this work, we review results from studies of tantalum clusters and their oxides in the gas phase and discuss insights with a potential relevance for applied systems. We focus on reactions that are essential for sustainable chemistry in the future. In detail, we address the activation of methane, which may enable the transformation of a greenhouse gas to a chemical feedstock, and we discuss the activation of NH3, which may function as an alternative energy carrier whose unwanted emission needs to be curbed in future applications. Finally, we consider the activation of N2 as a third reaction, since reducing the high energy demand of ammonia synthesis still bears significant challenges. While tantalum may be an interesting catalytic material, the discussed studies may also serve as benchmark for investigations of other materials.

The induction of chirality on pristine fullerenes through non‐covalent embedding in an asymmetric nano‐confinement has only been rarely reported. Bringing molecules with such a unique electronic structure and broad application range into a chiral environment is particularly appealing for the development of chiroptical materials, enantioselective photoredox catalysts and systems showing chirality‐induced spin selectivity (CISS). In this study, we report the formation of a chiral, configurationally stable Pd2L4 capsule assembled from a C2‐symmetric, ‘ribbon‐shaped’ ligand with a Tröger's base naphthalimide (TbNaps) backbone, easily synthesized in three steps from commercially available compounds. Embedding chirality directly into the ligand backbone ensures a relatively lightweight receptor design whose aromatic panels create a strongly shielded inner cavity of about 700 ų volume. Fullerenes C60 and C70, as well as a pair of corannulenes, can be bound in acetonitrile (where unsubstituted fullerenes are insoluble) and X‐ray structures of host‐guest complexes were obtained. Tight interactions between the chiral host and the fullerene guests leads to the induction of a circular dichroism (CD) on the characteristic absorption bands of the forbidden π–π* transitions of the fullerenes, backed up by sTDA TD‐DFT calculations and detailed investigation of the electronic excited states.