Antisolvent Additive Engineering for Boosting Performance and Stability of Graded Heterojunction Perovskite Solar Cells Using Amide-Functionalized Graphene Quantum Dots

Additive and antisolvent engineering strategies are outstandingly efficient in enhancing perovskite quality, photovoltaic performance, and stability of perovskite solar cells (PSCs). In this work, an effective approach is applied by coupling the antisolvent mixture and multi-functional additive procedures, which is recognized as antisolvent additive engineering (AAE). The graphene quantum dots functionalized with amide (AGQDs), which consists of carbonyl, amine, and long hydrophobic alkyl chain functional groups, are added to the antisolvent mixture of toluene (T) and hexane (H) as an efficient additive to form the CH₃NH₃PbI₃ (MAPI):AGQDs graded heterojunction structure. A broad range of analytical techniques, including scanning electron microscopy, X-ray diffraction, X-ray photoelectron spectroscopy, space charge limited current, UV-visible spectroscopy, external quantum efficiency, and time-of-flight secondary ion mass spectrometry, are used to investigate the effect of AAE treatment with AGQDs on the quality of perovskite film and performance of the PSCs. Importantly, not only a uniform and dense perovskite film with hydrophobic property is obtained but also defects on the perovskite surface are significantly passivated by the interaction between AGQDs and uncoordinated Pb²⁺. As a result, an enhanced power conversion efficiency (PCE) of 19.10% is achieved for the champion PSCs treated with AGQD additive, compared to the PCE of 16.00% for untreated reference PSCs. In addition, the high-efficiency PSCs based on AGQDs show high stability and maintain 89% of their initial PCE after 960 h in ambient conditions.

Nanoparticle Wetting Agent for Gas Stream-Assisted Blade-Coated Inverted Perovskite Solar Cells and Modules

Lab-scale perovskite solar cells (PSCs) have recently reached power conversion efficiencies (PCEs) of up to 25.2%. However, a reliable transfer of solution processing from spin coating to scalable printing techniques and a homogeneous deposition on large substrate sizes is challenging also caused by dewetting of the perovskite precursor solution on highly hydrophobic subjacent materials. In this work, we report the utilization of blade-coated nonconductive silicon oxide (SiO₂) nanoparticles (NPs) as wetting agent for the precursor solution to enable the deposition of a homogeneous perovskite layer on the nonwetting hole transport layer (HTL). The NPs enhance the HTL surface energy, thus, wetting and homogeneous spreading of the precursor solution is strongly improved so that pinholes in the perovskite layer are avoided. In addition, we apply this concept for the first time for gas stream-assisted blade coating of PSCs and modules in the inverted (p-i-n) device architecture with poly(triaryl amine) (PTAA) as HTL on large-area substrates. To prevent void formation at the HTL interface of gas stream-assisted blade coated perovskite layers, the effect of blending small amounts of lead chloride (PbCl₂) in the perovskite precursor solution is investigated, which also improves reproducibility and device performance. Following these optimizations, blade coated PSCs with 0.24 cm² active area achieve up to 17.9% PCE. Furthermore, to prove scalability, we show enlarged substrates of up to 9 × 9 cm² and analyze the homogeneity of the perovskite layer in blade coating direction. Moreover, by implementing the blade coated NP wetting agent, we fabricate large-area modules with a maximum PCE of 9.3% on 49.60 cm² aperture area. This represents a further important step bringing solution-processed inverted PSCs closer to application.

Retrolective, comparative, epidemiological cohort study with parallel groups design for evaluation of efficacy and safety of drugs with "well-established use"

The randomized controlled clinical trial (RCT) is accepted as the "golden standard" for the evaluation of efficacy and safety of new drugs. In contrast, to demonstrate efficacy and safety of drugs with "well-established use" that have been on the European Community market for long time, observational comparative epidemiological studies can be used according to the European drug regulation directive. However, because comparative epidemiological cohort studies can share some risk of bias with other nonrandomized observational study designs, there is a need for an approach that could effectively reduce the bias risk in this type of studies.

STUDY OBJECTIVES

The purpose of the study was to evaluate the therapeutic efficacy and safety of a long-term complementary therapy of primary, non-metastatic breast carcinoma patients treated with standardized European mistletoe extract Iscador("mistletoe") in addition to the conventional adjuvant oncologic therapy, and compared to the control group treated with the conventional therapy alone.

METHODS

The multicenter, comparative, retrolective, pharmaco-epidemiological cohort study with parallel groups design and randomly selected centers that routinely used both treatments was carried out according to Good Epidemiological Practice rules under a standard operating procedure control. The test group patients received the mistletoe extract treatment subcutaneously for at least 3 months, while the control group patients of the same cohort was exclusively treated with the conventional therapy. The patients were followed up for at least 3 years or until death. The primary endpoint of efficacy was the incidence of adverse reactions to the conventional oncologic therapy. Secondary endpoints were change from baseline of the symptoms associated with the disease and treatment as well as overall survival. All endpoints were adjusted to baseline imbalance and confounders. Safety was assessed descriptively by the number of patients with adverse drug reactions (ADRs) attributed to the test treatment.

RESULTS

1442 patients (710 tests and 732 controls) were eligible for the "per protocol" analysis of efficacy and safety. At baseline, the test group had a more advanced disease and worse prognostic factors profile. After a median follow-up of 66 vs. 60 months, and a median mistletoe therapy duration of 52 months, significantly fewer test group patients (16.2%) than control patients (54.0%) developed ADRs attributed to the conventional therapy [adjusted odds ratio, OR (95% confidence interval, CI), OR = 0.47 (0.32-0.67), p < 0.001]. In the test group, the majority of the symptoms disappeared more frequently, and overall mortality hazard was significantly lower [adjusted hazard ratio, HR (95% CI), HR = 0.46 (0.22-0.96), p = 0.038] than in the control group. Systemic ADRs attributed to the test treatment developed in 0.8%, and local ADRs in 17.3% of the patients. ADR severity was mild to intermediate. Tumor enhancement was not observed.

CONCLUSIONS

Complementary therapy of patients with primary, non-metastatic breast carcinoma with the mistletoe extract Iscador was safe and in comparison to the control group within the same study cohort showed considerably fewer ADRs attributed to concurrent conventional therapy, reduced disease symptoms, and suggested a significant improvement of survival. Despite some methodical limitations that require careful study planning and conduction as well as critical interpretation, the applied study design seems suitable to evaluate the efficacy and safety of drugs with "well-established use", particularly in oncology.

Influence of postoperative complementary treatment with lectin-standardized mistletoe extract on breast cancer patients. A controlled epidemiological multicentric retrolective cohort study

This epidemiological study was performed to evaluate the influence of postoperative complementary treatment with lectin-standardized mistletoe extract (sME) on breast cancer patients. The design (retrolective cohort analysis with parallel groups) and conduct of the study were in agreement with current standards for prospectively randomized clinical trials. A cohort of 1,248 breast cancer patients on postoperative chemo-, radio-, hormone-therapy were studied in 27 randomized centers. Patients with complementary medications other than sME were excluded from the evaluation and the final analysis was performed on data of 689 patients. From this cohort 219 patients received a complementary treatment exclusively with sME (therapy group), while 470 patients were without complementary treatment (control group). The median follow-up time was 284 days (therapy group) and 285 days (control group). The primary end-point of the study was to determine the impact of complementary sME treatment on disease- or therapy-induced adverse reactions in breast cancer patients. Imbalances for causal effects (covariates) were adjusted by propensity scores. Final evaluation was performed by estimating the linear regression between change in symptom score and propensity score with all data and using the regression line to calculate the change in symptom score expected for each patient. Tumor-associated events were evaluated by number and time until event. The safety of sME treatment was analysed in terms of number, severity, duration and outcome of adverse reactions. As compared to breast cancer patients without complementary treatment (control group), the administration of sME (therapy group) resulted in a significant reduction of adverse reactions induced by the tumor-destructive therapies (e.g. nausea, gastro-intestinal tract symptoms, depression, fatigue, mental symptoms) and prolonged relapse-free intervals, most pronounced for UICC stages IIa and IIb. The rate of sME-associated adverse reactions was 12.8%. All side-effects were mild to moderate, predominantly local skin reactions and self-limiting without therapeutic intervention. Complementary treatment of breast cancer patients with lectin-standardized mistletoe extract (sME) proved to be a well tolerated optimization of standard tumor-destructive therapies, mainly improving quality of life and relapse-free intervals in defined UICC stages.

Influence of a complementary treatment with oral enzymes on patients with colorectal cancers--an epidemiological retrolective cohort study

PURPOSE

To evaluate the impact of postoperative treatment with an oral enzyme (OE) preparation given complementary to an antineoplastic therapy in patients with all stages of colorectal cancer.

METHODS

The design of this epidemiological study was a retrolective cohort analysis with parallel groups. Design and conduct of the study were performed to current standards for prospective, controlled clinical trials. Of a cohort of 1,242 patients with colorectal cancer (documented in 213 centres), 616 had received complementary treatment with OE (182 OE only, 405 other complementary drugs, 29 protocol violators) and 626 had not received OE (368 control only, 229 other complementary drugs, 29 protocol violators). Of 1,162 patients who had undergone primary surgery, 526 received adjuvant chemotherapy and 218 radiotherapy. The median follow-up time for the OE group was 9.2 months and for the control group 6.1 months. The primary test criterion of efficacy for OE treatment was the multivariate effect size of the changes from baseline of the disease- and therapy-associated signs and symptoms (nausea, vomiting, changes in appetite, stomach pain or stomach disorder, tiredness, depression, memory or concentration disorder, sleep disturbance, dizziness, irritability, dyspnoea at rest, dyspnoea during activity, headache, tumour pain, cachexia, skin disorders and infections). Tumour-related events, e.g. death, were evaluated by the number of events observed and time to event. Safety of treatment with OE was analysed in terms of number and severity of adverse events, their duration, treatment and outcome.

RESULTS

A significant reduction in disease-associated signs and symptoms was observed in patients treated with OE alone, but not in those receiving OE in addition to other complementary treatments. Adverse reactions to chemo- and radiotherapy were diminished in all patients receiving OE. Analysis of survival did not demonstrate a reduced number of deaths in the OE group. However, a trend to prolongation of survival was demonstrated, particularly in the patients with disease stage Dukes' D, in the subgroup receiving OE in addition to other complementary treatments. Similar but less-pronounced trends were observed for disease stages Dukes' B and C. In the OE group, 21 of 616 patients (3.4%) experienced OE-associated adverse reactions, all of them mild to moderate gastrointestinal symptoms.

CONCLUSION

Complementary treatment of colorectal cancer patients with OE improves their quality of life by reducing both the signs and symptoms of the disease and the adverse reactions associated with adjuvant antineoplastic therapies. This epidemiological retrolective cohort analysis provides evidence that patients may also benefit by a prolongation of survival time. OE were generally well tolerated.

Retrolective cohort study of an additive therapy with an oral enzyme preparation in patients with multiple myeloma

PURPOSE

To evaluate the impact of an additive therapy with an oral enzyme (OE) preparation given for more than 6 months additionally to standard combination chemotherapy (vincristine/melphalan/cyclophosphamide/prednisone (VMCP)- or methylprednisolone/ vincristine/CCNU/cyclophosphamide/melphalan (MOCCA)-regimen) in the primary treatment of patients with multiple myeloma stages I-III.

METHODS

A cohort of 265 patients with multiple myeloma stages I-III was consecutively treated at our institution in two parallel groups (control group (n = 99): chemotherapy +/-OE for less than 6 months; OE-group (n = 166): chemotherapy + OE for more than 6 months). The median follow-up time in the stages I, II, and III for the OE-group was 61, 37, and 46.5 months, respectively; for the control group the respective values were 33, 51.5, and 31.5 months. The primary endpoint of the study was disease-specific survival. Secondary endpoints were response to therapy, duration of first response and side effects. The chosen method for evaluation was the technique of a retrolective cohort analysis with a concurrent control group. Survival analysis was performed by the Kaplan-Meier method and multivariate analysis was done with the Cox proportional hazards model.

RESULTS

Significantly higher overall response rates and longer duration of remissions were observed in the OE-group. Primary responders showed a longer mean survival time than non-responders. Additive therapy with OE given for more than 6 months decreased the hazard of death for patients at all stages of disease by approximately 60%. Observation time was not long enough to estimate the median survival for patients at stages I and II; for stage III patients it was 47 months in the control group versus 83 months for the patients treated with OE (P = 0.0014) which means a 3-year gain of survival time. Significant prognostic factors for survival, in the Cox regression analysis, were stage of disease and therapy with OE. The OE-therapy was generally well tolerated (3.6% of patients with mild to moderate gastrointestinal symptoms).

CONCLUSION

OEs represent a promising new additive therapy in multiple myeloma which will be further evaluated in a randomized phase III trial in the USA.

Impact of complementary oral enzyme application on the postoperative treatment results of breast cancer patients--results of an epidemiological multicentre retrolective cohort study

PURPOSE

[corrected] To evaluate the impact of postoperative treatment with an oral enzyme (OE) preparation given complementary to an antineoplastic therapy in patients with breast cancer.

METHODS

The design of this epidemiological study was a retrolective cohort analysis with parallel groups. Design and conduct of the study were performed to current standards for prospective, controlled clinical trials. A cohort of 2,339 breast cancer patients undergoing surgical intervention and radio-, chemo- or hormonal therapy were studied in 216 centres. Of the 2,339 patients, 1,283 received complementary treatment with OE and 1,056 did not receive OE. Patients with other complementary medications were excluded and the final analysis was performed with the data from 649 patients, of whom 239 (37%) were additionally treated with OE (test group) and 410 (63%) without OE (control group). The median follow-up time for the test group was 485 days and for the control group 213 days. The primary endpoint of the study was to determine whether complementary treatment with OE can reduce typical disease- or therapy-associated signs and symptoms (gastrointestinal symptoms, mental symptoms, dyspnoea, headache, tumour pain, cachexia, skin disorders, infections, and side effects associated with the antineoplastic therapy) in patients with breast cancer. Imbalances for causal effects (covariates) were adjusted for by means of the propensity score. Outcome analysis was performed by estimating the linear regression between change in symptom score and propensity score with all data and using this regression line to calculate the change in symptom score which would be expected for each patient. Tumour-associated events (recurrence, metastasis, and death) were evaluated in terms of the number of events observed and time to event. The safety of treatment with OE was analysed in terms of the number and severity of adverse events, their duration, treatment and outcome.

RESULTS

For all symptoms except tumour pain, the adjusted mean improvement in symptom scores was larger in the test group than in the control group. The adjusted difference was statistically significant for all symptoms, except tumour pain and infections. The results show that the typical disease- and therapy-associated signs and symptoms in patients on complementary therapy with OE during postoperative treatment were significantly less. For 75% of the test group and 55% of the control group the physician recorded "no signs and symptoms". A clear reduction in the side effects of radiotherapy and chemotherapy was documented in 74% of the test group and 55% of the control group. Analysis of survival, recurrence, and metastasis demonstrated a reduced number of events in the test group. There was evidence of a beneficial influence of OE on time to event, although the median observation time was too short in these breast cancer patients to draw definite conclusions. The safety component was judged in 98% of the test group and 76% of the control group as "very good" or "good". In the total sample of 2,339 patients, the rate of OE-associated adverse reactions was 3.2%. All side effects were mild to moderate gastrointestinal symptoms.

CONCLUSION

Complementary treatment of breast cancer patients with OE improves the quality of life by reducing signs and symptoms of the disease and the side effects of adjuvant antineoplastic therapies. This epidemiological retrolective cohort analysis provides evidence that the patients may also gain benefit by a prolongation of the time to event for cancer recurrence, metastasis and survival. OE was generally well tolerated.

Double-blind pilot-study on the efficacy of enzyme therapy in advanced colorectal cancer

All tested variables showed a tendency in favor for Wobe-Mugos E therapy as addition to standard therapy. Enzymes improve the quality of life by reducing cancer disease typical symptoms, they reduce side effects of chemo-/radiotherapy and they have a potential of prolonging life (preliminary data only).

[Comparative epidemiological study in patients with rheumatic diseases illustrated in a example of a treatment with non-steroidal anti- inflammatory drugs versus an oral enzyme combination preparation]

To establish the safety and efficacy of an oral enzyme-combination product (OE; Phlogenzym, containing trypsin, bromelain and rutin) in the treatment of rheumatic diseases a retrolective cohort study with parallel groups was undertaken as an epidemiological study, in which the enzyme combination was compared with non steroidal anti-inflammatory drugs (NSAID). Data of 3326 patients treated for rheumatic diseases between January 1993 and the end of March 1995 were registered by 380 physicians. From the patient file age, gender, indication for treatment (diagnostic group), anamnestic data (especially pre-treatment), complaints at the beginning and end of treatment, treatment duration, prescribed drugs (OE, NSAID), additional treatment and adverse events were transferred into case report forms (CRFs). The quality of the data was monitored and additionally checked by internal and external quality audits. Included in the efficacy analysis were 2139 patients which were treated either only with OE or only with NSAID and could be classified unambiguously into one of the following diagnostic groups: joint diseases, spinal diseases, rheumatic soft tissue diseases. As clinically relevant and reliably evaluable criterion freedom from rheumatic complaints at the end of treatment was considered. For evaluation of safety the documented adverse events of all patients were considered. Two thirds of the OE patients received the recommended dose of 6 tablets/day, taken for 23 to 35 days. The respective mean values for NSAID patients were 16 to 25 days, and the patients were treated with the recommended symptomatically effective doses of NSAID. As the allocation of the compared treatment options (OE or NSAID) to the patients was not randomized, a mixing of treatment effects with other factors cannot be excluded. For adjustment of these confounding factors two methods were applied: a) logistic regression of the relative ratio of the main criterion and all confounding factors and b) stratification of data according to the propensity score i.e. the probability of a treatment with OE. Both methods yielded similar results: A 50% higher success rate can be expected in total for OE than for NSAID at comparable initial and treatment situations (95% confidence interval with logistic regression = 1.218-1.96, with stratification according to propensity score = 1.16-1.84). As significant negative indicators for response age over 50 years, pre-treatment with antirheumatic or analgetic drugs, treatment duration more than 30 days and joint diseases or fibromyalgias could be revealed. Since there was no interaction between these indicators and the type of treatment also in patients presenting with these indicators a treatment success (freedom from symptoms) with OE can be expected with a higher probability than with NSAID. OE were well tolerated showing much less adverse events when compared with conventional doses of NSAID.

[Forensic medical expertise in ophthalmologic practice]

The author evaluates 75 cases of his forensic medical expertise as ophthalmologic examiner. He draws attention mostly to those cases which are of interest not only for ophthalmologists but also for other medical specialists. In particular, he investigates the three most frequent groups of cases (questionability of reading capability, injury, detachment of retina), in connection with practical examples. He also discusses questions of defensive medicine as well as the problems of latency between noxa and diagnosis. Besides, he refers to the ophthalmologic aspects of the decreased ability to work.

[Size and distribution of a Blattella germanica population]

The abundance and dispersion of a selected genetic homogeneous and isolated population of Blattella germanica was observed by the method of dry incorporation of radioactive porcellain tracer. Under optimal conditions, a medium density of 130 individuals per cubicmetre volume was found. The fluctuations came to 50% from the middle value. The dispersion is unequal and depends as well on the requisites of the room as on the size and the quality of the existing aggregations. An interchange exists between the aggregations. In this respect males are more active than female cockroaches.

[Radioactive labeling of Blatella germanica]

For ecological investigations in natural populations of Blatella germanica a new method of dry incorporation of a porcelain tracer is developed. The quality of this method in contrast with other non radioactive and at present radioactive methods depends on the stable position of the tracer and the possibility of taking different marking substances for individually marking a large number of experimental animals. The identification bases on the previously investigated half-life values. The new method in combination with the recaptivate method is a good possibility to analyse a population of cockroaches.