Ocular Involvement in Selected Rheumatic Diseases - Clinical Manifestation in Adulthood

Ocular manifestations of rheumatic diseases are common and contribute significantly to the morbidity and reduced quality of life of affected patients. Knowledge of typical clinical manifestations is important for the rheumatologist in order to support the reference of patients with corresponding symptoms for ophthalmological consultation at an early stage of disease, or to initiate regular screening examinations (e.g. in patients with Behçet's syndrome). Conversely, a (possibly urgent) rheumatological assessment is crucial for certain ophthalmological diseases, in order not to overlook a (possibly fatal) systemic associated disease. Patients with rheumatic or inflammatory ocular diseases should always be informed by the treating physician about possible symptoms of other organ manifestations, in order to avoid a delayed diagnosis. "Classic" associations for uveitis are (HLA-B27-associated) spondyloarthritis and acute anterior uveitis, as well as retinal vasculitis with or without panuveitis and Behçet's syndrome. In patients with rheumatoid arthritis or ANCA-associated vasculitis, however, scleritis (with or without peripheral ulcerative keratitis) typically occurs, but a variety of other findings are also possible. Close interdisciplinary collaboration, particularly regarding therapeutic decisions, is crucial to ensuring a good prognosis for the patient.

Effect of albumin substitution on pharmacokinetics of piperacillin/tazobactam in patients with severe burn injury admitted to the ICU

BACKGROUND

Pathophysiological changes in severely burned patients alter the pharmacokinetics (PK) of anti-infective agents, potentially leading to subtherapeutic concentrations at the target site. Albumin supplementation, to support fluid resuscitation, may affect pharmacokinetic properties by binding drugs. This study aimed to investigate the PK of piperacillin/tazobactam in burn patients admitted to the ICU before and after albumin substitution as total and unbound concentrations in plasma.

PATIENTS AND METHODS

Patients admitted to the ICU and scheduled for 4.5 g piperacillin/tazobactam administration and 200 mL of 20% albumin substitution as part of clinical routine were included. Patients underwent IV microdialysis, and simultaneous arterial plasma sampling, at baseline and multiple timepoints after drug administration. PK analysis of total and unbound drug concentrations under steady-state conditions was performed before and after albumin supplementation.

RESULTS

A total of seven patients with second- to third-degree burns involving 20%-60% of the total body surface were enrolled. Mean (SD) AUC0-8 (h·mg/L) of total piperacillin/tazobactam before and after albumin substitution were 402.1 (242)/53.2 (27) and 521.8 (363)/59.7 (32), respectively. Unbound mean AUC0-8 before and after albumin supplementation were 398.9 (204)/54.5 (25) and 456.4 (439)/64.5 (82), respectively.

CONCLUSIONS

Albumin supplementation had little impact on the PK of piperacillin/tazobactam. After albumin supplementation, there was a numerical increase in mean AUC0-8 of total and unbound piperacillin/tazobactam, whereas similar Cmax values were observed. Future studies may investigate the effect of albumin supplementation on drugs with a higher plasma protein binding.

Excellent efficacy and beneficial safety during observational 5-year follow-up of rapid steroid withdrawal after renal transplantation (Harmony FU study)

BACKGROUND

We previously reported excellent efficacy and improved safety aspects of rapid steroid withdrawal (RSWD) in the randomized controlled 1-year "Harmony" trial with 587 predominantly deceased-donor kidney transplant recipients randomized either to basiliximab or rabbit antithymocyte globulin induction therapy and compared with standard immunosuppressive therapy consisting of basiliximab, low tacrolimus once daily, mycophenolate mofetil and corticosteroids.

METHODS

The 5-year post-trial follow-up (FU) data were obtained in an observational manner at a 3- and a 5-year visit only for those Harmony patients who consented to participate and covered clinical events that occurred from the second year onwards.

RESULTS

Biopsy-proven acute rejection and death-censored graft loss rates remained low and independent of RSWD. Rapid steroid withdrawal was an independent positive factor for patient survival (adjusted hazard ratio 0.554, 95% confidence interval 0.314-0.976; P = .041).The reduced incidence of post-transplantation diabetes mellitus in RSWD patients during the original 1-year study period was not compensated by later incidences during FU. Incidences of other important outcome parameters such as opportunistic infections, malignancies, cardiovascular morbidity/risk factors, donor-specific antibody formation or kidney function did not differ during FU period.

CONCLUSIONS

With all the limitations of a post-trial FU study, the Harmony FU data confirm excellent efficacy and beneficial safety aspects of RSWD under modern immunosuppressive therapy over the course of 5 years after kidney transplantation in an immunologically low-risk, elderly population of Caucasian kidney transplant recipients. Trial registration: Clinical trial registration number: Investigator Initiated Trial (NCT00724022, FU study DRKS00005786).

Silicon- and Germanium-Functionalized Perylene Diimides: Synthesis, Optoelectronic Properties, and Their Application as Non-fullerene Acceptors in Organic Solar Cells

Organic solar cells have been continuously studied and developed through the last decades. A major step in their development was the introduction of fused-ring non-fullerene electron acceptors. Yet, beside their high efficiency, they suffer from complex synthesis and stability issues. Perylene-based non-fullerene acceptors, in contrast, can be prepared in only a few steps and display good photochemical and thermal stability. Herein, we introduce four monomeric perylene diimide acceptors obtained in a three-step synthesis. In these molecules, the semimetals silicon and germanium were added in the bay position, on one or both sides of the molecules, resulting in asymmetric and symmetric compounds with a red-shifted absorption compared to unsubstituted perylene diimide. Introducing two germanium atoms improved the crystallinity and charge carrier mobility in the blend with the conjugated polymer PM6. In addition, charge carrier separation is significantly influenced by the high crystallinity of this blend, as shown by transient absorption spectroscopy. As a result, the solar cells reached a power conversion efficiency of 5.38 %, which is one of the highest efficiencies of monomeric perylene diimide-based solar cells recorded to date.

Solution-Processable Cu3BiS3 Thin Films: Growth Process Insights and Increased Charge Generation Properties by Interface Modification

Cu3BiS3 thin films are fabricated via spin coating of precursor solutions containing copper and bismuth xanthates onto planar glass substrates or mesoporous metal oxide scaffolds followed by annealing at 300 °C to convert the metal xanthates into copper bismuth sulfide. Detailed insights into the film formation are gained from time-resolved simultaneous small and wide angle X-ray scattering measurements. The Cu3BiS3 films show a high absorption coefficient and a band gap of 1.55 eV, which makes them attractive for application in photovoltaic devices. Transient absorption spectroscopic measurements reveal that charge generation yields in mesoporous TiO2/Cu3BiS3 heterojunctions can be significantly improved by the introduction of an In2S3 interlayer, and long-lived charge carriers (t50% of 10 μs) are found.

Bio-Polyester/Rubber Compounds: Fabrication, Characterization, and Biodegradation

Biobased and biodegradable polymers (BBDs) such as poly(3-hydroxy-butyrate), PHB, and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) are considered attractive alternatives to fossil-based plastic materials since they are more environmentally friendly. One major problem with these compounds is their high crystallinity and brittleness. In order to generate softer materials without using fossil-based plasticizers, the suitability of natural rubber (NR) as an impact modifier was investigated in PHBV blends. Mixtures with varying proportions of NR and PHBV were generated, and samples were prepared by mechanical mixing (roll mixer and/or internal mixer) and cured by radical C-C crosslinking. The obtained specimens were investigated with respect to their chemical and physical characteristics, applying a variety of different methods such as size exclusion chromatography, Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), thermal analysis, XRD, and mechanical testing. Our results clearly indicate that NR-PHBV blends exhibit excellent material characteristics including high elasticity and durability. Additionally, biodegradability was tested by applying heterologously produced and purified depolymerases. pH shift assays and morphology analyses of the surface of depolymerase-treated NR-PHBV through electron scanning microscopy confirmed the enzymatic degradation of PHBV. Altogether, we prove that NR is highly suitable to substitute fossil-based plasticizers; NR-PHBV blends are biodegradable and, hence, should be considered as interesting materials for a great number of applications.

Low-cost and automated phenotyping system "Phenomenon" for multi-sensor in situ monitoring in plant in vitro culture

BACKGROUND

The current development of sensor technologies towards ever more cost-effective and powerful systems is steadily increasing the application of low-cost sensors in different horticultural sectors. In plant in vitro culture, as a fundamental technique for plant breeding and plant propagation, the majority of evaluation methods to describe the performance of these cultures are based on destructive approaches, limiting data to unique endpoint measurements. Therefore, a non-destructive phenotyping system capable of automated, continuous and objective quantification of in vitro plant traits is desirable.

RESULTS

An automated low-cost multi-sensor system acquiring phenotypic data of plant in vitro cultures was developed and evaluated. Unique hardware and software components were selected to construct a xyz-scanning system with an adequate accuracy for consistent data acquisition. Relevant plant growth predictors, such as projected area of explants and average canopy height were determined employing multi-sensory imaging and various developmental processes could be monitored and documented. The validation of the RGB image segmentation pipeline using a random forest classifier revealed very strong correlation with manual pixel annotation. Depth imaging by a laser distance sensor of plant in vitro cultures enabled the description of the dynamic behavior of the average canopy height, the maximum plant height, but also the culture media height and volume. Projected plant area in depth data by RANSAC (random sample consensus) segmentation approach well matched the projected plant area by RGB image processing pipeline. In addition, a successful proof of concept for in situ spectral fluorescence monitoring was achieved and challenges of thermal imaging were documented. Potential use cases for the digital quantification of key performance parameters in research and commercial application are discussed.

CONCLUSION

The technical realization of "Phenomenon" allows phenotyping of plant in vitro cultures under highly challenging conditions and enables multi-sensory monitoring through closed vessels, ensuring the aseptic status of the cultures. Automated sensor application in plant tissue culture promises great potential for a non-destructive growth analysis enhancing commercial propagation as well as enabling research with novel digital parameters recorded over time.

Synthesis of a fluorene and quinoxaline-based co-polymer for organic electronics

Quinoxaline has recently gained interest as monomer in conjugated copolymers because of its easy synthetic accessibility and successful use in highly efficient organic solar cells. In this contribution, we introduce a quinoxaline–fluorene-co-polymer, PFQ10, synthesized by copolymerization of 5,8-dibromo-6,7-difluoro-2-[(2-hexyldecyl)oxy]quinoxaline and 9,9-dioctyl-9H-9-fluorene-2,7-bis(boronic acid pinacol ester) using the Suzuki–Miyaura reaction. By optimization of the reaction conditions, polymers with molecular weights up to 17.2 kDa and a low dispersity of 1.3 were obtained. PFQ10 showed blue photoluminescence with an emission maximum at 459 nm and a relative fluorescence quantum yield of 0.37. As proof of principle, PFQ10 was employed in organic light-emitting diodes and showed a blue–green electroluminescence.

Graphical abstract

Simulation and Optimization of FAPbI3 Perovskite Solar Cells with a BaTiO3 Layer for Efficiency Enhancement

Since the addition of BaTiO₃ in perovskite solar cells (PSCs) provides a more energetically favorable transport route for electrons, resulting in more efficient charge separation and electron extraction, in this work we experimentally prepared such a PSC and used a modeling approach to point out which simulation parameters have an influence on PSC characteristics and how they can be improved. We added a layer of BaTiO₃ onto the TiO₂ electron transport layer and prepared a PSC, which had an FTO/TiO₂/BaTiO₃/FAPbI₃/spiro-OMeTAD/Au architecture with a power conversion efficiency (PCE) of 11%. Further, we used the simulation program SCAPS-1D to investigate and optimize the device parameters (thickness of the BaTiO₃ and absorber layers, doping, and defect concentration) resulting in devices with PCEs reaching up to 15%, and even up to 20% if we assume an ideal structure with no interlayer defects. Our experimental findings and simulations in this paper highlight the promising interplay of multilayer TiO₂/BaTiO₃ ETLs for potential future applications in PSCs.

Stimulation of adventitious root formation by laser wounding in rose cuttings: A matter of energy and pattern

Adventitious root (AR) formation is the basis of vegetative propagation in rose, be it via stem cuttings or via stenting. During this process, wounding plays a pivotal role since cell reprogramming takes place at the tissue adjacent to the wound. We investigated the effects of wounding on AR formation on leafy single-node stem cuttings of the rose rootstock R. canina 'Pfänder' (codes R02-3 and R02-6) and the cut rose cultivar Rosa 'Tan09283' (Registration name 'Beluga'). Laser wounding treatments were based on the assisted removal of tissue layers located in the bark. The positioning of wounding was studied based on two marking directions: along the cutting base (strip pattern) and around the cutting base (ring pattern). Additionally, the effects of external supply of indole-butyric acid (IBA 1 mg L^-1) on rooting were analyzed. Results showed that in order to remove specific tissue layers, the calculation of the laser energy density (J cm^-2) in terms of cutting diameter was necessary. Interestingly, the application of energy densities from 2.5 J cm^-2 up to approximately 8.5 J cm^-2 were sufficient to expose the tissue layers of epidermis up to regions of phloem. Regarding AR formation for R. canina 'Pfänder', characterized by a low rooting response, an increase in the rooting percentage was registered when the laser treatment eliminated the tissue up to phloem proximities. Analysis of the nodal position showed that bud location was a preferential place for AR formation independently of wounding treatment. In case of Rosa 'Tan09283', laser treatments did not reduce its high rooting capacity, but an apparent reduction in rooting quality due to an investment in tissue healing was observed when wounding reached deeper layers such as parenchyma and sclerenchyma. Results also showed a strong AR formation directly from wounded regions in case of Rosa 'Tan09283' specifically when the wound was located below the axillary bud. In conclusion, wounding by assisted-elimination of layers by laser can induce positive effects on AR formation of single-node stem cuttings of the rose if energy applied is able to expose phloem proximities, a longitudinal orientation, and relative position to the axillary bud are considered.

Holistic Equivalent Circuit Model for Capacitive Extracellular Stimulation

Capacitive extracellular stimulation is a common method in implanted stimulation electrodes. The basis for investigating the transmission of stimuli from an electrode to adhered cells are in vitro experiments using calcium imaging or patch clamp measurements. Computational spatial models are used to simulate the mechanism of signal transmission at the cell-electrode interface but require high computing power. In this work, the Stern model to characterize the electrochemical double-layer (EDL) formation and a modified two-domain model are combined into a holistic equivalent circuit modelling capacitive cell stimulation. The described parameters can be directly associated with physicochemical effects. A simulation of the involved control and measurement systems allows the validation of the model with in vitro patch clamp recordings. The relationship of the cell’s distance to the electrode and efficacy of signal transmission could be observed. With this concept we aim to convert different complex approaches into a simple model and thus give an overview of the mechanisms of stimulation. We want to facilitate the interpretation of measured signals especially in voltage clamp measurements.

Glycol bearing perylene monoimide based non-fullerene acceptors with increased dielectric permittivity

Perylene monoimide based electron acceptors have great properties for use in organic solar cells, like thermal stability, strong absorption, and simple synthesis. However, they typically exhibit low values for the dielectric permittivity. This hinders efficient exciton dissociation, limiting the achievable power conversion efficiencies. In this work, we present the synthesis and utilization of two new acceptor-donor-acceptor (A-D-A) molecules, comprising perylene monoimide as electron withdrawing A unit. Oligo ethylene glycol side chain modified carbazole (PMI-[C-OEG]) and fluorene (PMI-[F-OEG]) linkers were used as electron rich D units, respectively. The polar side chains are expected to increase the polarizability of the molecules and, thus, their permittivity according to the Clausius-Mossotti relationship. We found that the incorporation of glycol chains improved the dielectric properties of both materials in comparison to the reference compounds with alkyl chains. The permittivity increased by 18% from 3.17 to 3.75 for the carbazole-based non-fullerene acceptor PMI-[C-OEG] and by 12% from 3.10 to 3.47 for the fluorene-based acceptor PMI-[F-OEG]. The fabricated solar cells revealed power conversion efficiencies of 3.71 ± 0.20% (record 3.92%) with PMI-[C-OEG], and 1.21 ± 0.06% (record 1.51%) with PMI-[F-OEG].

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1007/s00706-022-02956-2.

Beneficial Effect of Upadacitinib in an Adult Patient with Juvenile Idiopathic Arthritis-associated Uveitis after Unsatisfactory Response to Tofacitinib: A Case Report

OBJECTIVE

Several case reports have been published on the effect of janus kinase inhibitors (JAK-I) on juvenile idiopathic arthritis-associated uveitis (JIAU). Both tofacitinib and baricitinib have been described as therapeutically effective in JIAU.

METHODS

We here present a case of a 24-years-old female with refractory course of JIAU receiving upadacitinib therapy.

RESULTS

After failing multiple conventional and biologic disease-modifying antirheumatic drugs, the patient finally achieved clinical remission on upadacitinib monotherapy, despite a previously unsatisfactory clinical response of both arthritis and uveitis to tofacitinib monotherapy.

CONCLUSION

This case suggests that switching JAK-I might be a successful strategy in the treatment of JIAU, despite previously incomplete response to other preparations.

Phenylene-Bridged Perylene Monoimides as Acceptors for Organic Solar Cells: A Study on the Structure-Property Relationship

A series of non-fullerene acceptors based on perylene monoimides coupled in the peri position through phenylene linkers were synthesized via Suzuki-coupling reactions. Various substitution patterns were investigated using density functional theory (DFT) calculations in combination with experimental data to elucidate the geometry and their optical and electrochemical properties. Further investigations of the bulk properties with grazing incidence wide angle X-ray scattering (GIWAXS) gave insight into the stacking behavior of the acceptor thin films. Electrochemical and morphological properties correlate with the photovoltaic performance of devices with the polymeric donor PBDB-T and a maximum efficiency of 3.17 % was reached. The study gives detailed information about structure-property relationships of perylene-linker-perylene compounds.

Januskinase-Inhibitoren: Next-Generation-Therapie der Uveitis

Viele PatientInnen mit visusgefährdender nicht infektiöser Uveitis bedürfen, um eine Remission ihrer Uveitis zu erreichen, einer Behandlung mit DMARDs. Obwohl herkömmliche DMARD-Therapien in einem großen Teil dieser PatientInnen eine hochpotente Therapie darstellen, ist in einzelnen Fällen aufgrund eines unzureichenden Ansprechens oder unerwünschter Wirkungen ein Therapiewechsel erforderlich. Januskinase-Inhibitoren (JAKI) sind in der Rheumatologie, Gastroenterologie und Dermatologie bereits für mehrere autoimmune Erkrankungen zugelassen. Nun steht ein Zulassungsprozess für ausgewählte Uveitisentitäten an. Wirkmechanismus: JAKI üben ihre Wirkung über die Hemmung der Phosphorylierung von Transmembranproteinen, den Januskinasen aus. Dies führt zu einer fehlenden Aktivierung von Transkriptionsfaktoren und damit zur verminderten Zytokinexpression und Entzündungshemmung. JAKI stellen in der Rheumatologie, Gastroenterologie und Dermatologie einen äußerst effektiven neuen therapeutischen Ansatz dar. Sie sind zur Behandlung bei rheumatoider Arthritis, Psoriasis-Arthritis, ankylosierender Spondylitis, Colitis ulcerosa und dem atopischen Ekzem bereits zugelassen. In bisherigen Vergleichsstudien zu etablierten Biologika konnte teilweise ein besseres therapeutisches Ansprechen beschrieben werden. Aus publizierten Fallberichten wurde auch bei Uveitispatienten, die auf klassische und biologische DMARDs unzureichend ansprachen, eine Kortisoneinsparung und Reizfreiheit erzielt. Zulassungsstudien bei JIA-assoziierter und ANA-positiver anteriorer Uveitis sind im Prozess. Zusammenfassend stellen JAKI eine innovative Therapieoption bei Patienten mit nicht infektiöser Uveitis dar, bei denen Kontraindikationen gegen die Verwendung oder ein unzureichender Effekt von DMARDs bestehen.

Wide-bandgap organic solar cells with a novel perylene-based non-fullerene acceptor enabling open-circuit voltages beyond 1.4 V

A perylene-based acceptor (PMI-FF-PMI), consisting of two perylene monoimide (PMI) units bridged with a dihydroindeno[1,2-b]fluorene molecule was developed as a potential non-fullerene acceptor (NFA) for organic solar cells (OSCs). The synthesized NFA was combined with the high-performance donor polymer D18 to fabricate efficient OSCs. With an effective bandgap of 2.02 eV, the D18:PMI-FF-PMI blend can be categorized as a wide-bandgap OSC and is an attractive candidate for application as a wide-bandgap sub-cell in all-organic triple-junction solar cell devices. Owing to their large effective bandgap, D18:PMI-FF-PMI solar cells are characterized by an extremely high open-circuit voltage (V _OC) of 1.41 V, which to the best of our knowledge is the highest reported value for solution-processed OSCs so far. Despite the exceptionally high V _OC of this blend, a comparatively large non-radiative voltage loss (ΔV ^non-rad _OC) of 0.25 V was derived from a detailed voltage loss analysis. Measurements of the electroluminescence quantum yield (ELQY) of the solar cell reveal high ELQY values of ∼0.1%, which contradicts the ELQY values derived from the non-radiative voltage loss (ΔV ^non-rad _OC = 0.25 V, ELQY = 0.0063%). This work should help to raise awareness that (especially for BHJ blends with small Δ_HOMO or Δ_LUMO offsets) the measured ELQY cannot be straightforwardly used to calculate the ΔV ^non-rad _OC. To avoid any misinterpretation of the non-radiative voltage losses, the presented ELQY discrepancies for the D18:PMI-FF-PMI system should encourage OPV researchers to primarily rely on the ΔV ^non-rad _OC values derived from the presented voltage loss analysis based on EQE_PV and J-V measurements.

Real-time colorectal polyp detection using a novel computer-aided detection system (CADe): a feasibility study

BACKGROUND AND AIMS

Colonoscopy aims to early detect and remove precancerous colorectal polyps, thereby preventing development of colorectal cancer (CRC). Recently, computer-aided detection (CADe) systems have been developed to assist endoscopists in polyp detection during colonoscopy. The aim of this study was to investigate feasibility and safety of a novel CADe system during real-time colonoscopy in three European tertiary referral centers.

METHODS

Ninety patients undergoing colonoscopy assisted by a real-time CADe system (DISCOVERY; Pentax Medical, Tokyo, Japan) were prospectively included. The CADe system was turned on only at withdrawal, and its output was displayed on secondary monitor. To study feasibility, inspection time, polyp detection rate (PDR), adenoma detection rate (ADR), sessile serrated lesion (SSL) detection rate (SDR), and the number of false positives were recorded. To study safety, (severe) adverse events ((S)AEs) were collected. Additionally, user friendliness was rated from 1 (worst) to 10 (best) by endoscopists.

RESULTS

Mean inspection time was 10.8 ± 4.3 min, while PDR was 55.6%, ADR 28.9%, and SDR 11.1%. The CADe system users estimated that < 20 false positives occurred in 81 colonoscopy procedures (90%). No (S)AEs related to the CADe system were observed during the 30-day follow-up period. User friendliness was rated as good, with a median score of 8/10.

CONCLUSION

Colonoscopy with this novel CADe system in a real-time setting was feasible and safe. Although PDR and SDR were high compared to previous studies with other CADe systems, future randomized controlled trials are needed to confirm these detection rates. The high SDR is of particular interest since interval CRC has been suggested to develop frequently through the serrated neoplasia pathway.

CLINICAL TRIAL REGISTRATION

The study was registered in the Dutch Trial Register (reference number: NL8788).

Recent Progress in the Design of Fused-Ring Non-Fullerene Acceptors-Relations between Molecular Structure and Optical, Electronic, and Photovoltaic Properties

Organic solar cells are on the dawn of the next era. The change of focus toward non-fullerene acceptors has introduced an enormous amount of organic n-type materials and has drastically increased the power conversion efficiencies of organic photovoltaics, now exceeding 18%, a value that was believed to be unreachable some years ago. In this Review, we summarize the recent progress in the design of ladder-type fused-ring non-fullerene acceptors in the years 2018-2020. We thereby concentrate on single layer heterojunction solar cells and omit tandem architectures as well as ternary solar cells. By analyzing more than 700 structures, we highlight the basic design principles and their influence on the optical and electrical structure of the acceptor molecules and review their photovoltaic performance obtained so far. This Review should give an extensive overview of the plenitude of acceptor motifs but will also help to understand which structures and strategies are beneficial for designing materials for highly efficient non-fullerene organic solar cells.

Simulating the Performance of a Formamidinium Based Mixed Cation Lead Halide Perovskite Solar Cell

With the aim of decreasing the number of experiments to obtain a perovskite solar cell (PSC) with maximum theoretical efficiency, in this paper, PSC performance was studied using the program solar cell capacitance simulator (SCAPS-1D). The PSC with the architecture ITO/TiO₂/perovskite/spiro-MeOTAD/Au was investigated, while the selected perovskite was mixed cation Rb_0.05Cs_0.1FA_0.85PbI₃. The analysis was based on an experimentally prepared solar cell with a power conversion efficiency of ~7%. The PSC performance, verified by short-circuit current density (J_sc), open-circuit voltage (V_oc), fill factor (FF) and power conversion efficiency (PCE), was studied by optimization of the simulation parameters responsible for improvement of the cell operation. The optimized parameters were absorber layer thickness, doping, defect concentration and the influence of the resistivity (the net effect of ohmic loss, R_s and the leakage current loss represented by the resistivity, R_shunt). The results of SCAPS-1D simulations estimated the theoretical power conversion efficiency of 15% for our material. We have showed that the main contribution to improvement of solar cell efficiency comes with lowering ohmic resistivity of the cell as well as doping and defect concentration, because their concentration is proportional to recombination rate.

Reconstruction of traumatic and non-traumatic lower extremity defects with local or free flaps

Background

Despite continuous surgical advances, reconstruction of complex lower extremity wounds remains challenging. The indication of local flaps or microsurgical free tissue transfer depends on the anatomical location and size of the defect, as well as the comorbidities and general condition of the patient. In this study, local and free flap reconstruction of distal lower extremity defects was assessed, and postoperative complications and limb salvage were analyzed.

Methods

A total of 34 patients were included in this retrospective study. Distal lower extremity defects were of traumatic (29%) and non-traumatic (71%) etiologies. Patient characteristics, flap selection, postoperative complications, and limb preservation within the first 12 months were assessed and compared by reconstructive treatment concept. Statistical analysis included parametric and non-parametric tests. The two-sided alpha was set at 5% for all statistical tests.

Results

While 21 patients were treated with local flaps, 13 patients underwent microsurgical free flap reconstruction. The most common comorbidities were peripheral vascular disease and diabetes. Local flaps included the gastrocnemius muscle flap, soleus flap, sural flap, and plantaris medialis flap. The most commonly used free flaps for soft tissue reconstruction were latissimus dorsi and gracilis muscle flaps. The overall lower extremity preservation rate was 94.1%. There was one case of below-knee amputation 1 month after free flap reconstruction, and one case of first-ray amputation of the foot after local flap coverage.

Conclusion

Reconstruction of lower extremity defects can be achieved by local or free flap reconstruction. Flap selection is influenced by anatomical location, defect size, and patient factors.

The impact of certolizumab pegol treatment on the incidence of anterior uveitis flares in patients with axial spondyloarthritis: 48-week interim results from C-VIEW

Background

Acute anterior uveitis (AAU) is the most common extra-articular manifestation in patients with axial spondyloarthritis (axSpA). C-VIEW investigates the impact of the Fc-free TNF inhibitor certolizumab pegol (CZP) on AAU flares in patients with active axSpA at high risk of recurrent AAU.

Methods

C-VIEW (NCT03020992) is a 96-week ongoing, multicentre, open-label, phase 4 study. Included patients had an axSpA diagnosis, a history of recurrent AAU (≥2 AAU flares, ≥1 flare in the year prior to study entry), HLA-B27 positivity, active disease, and failure of ≥2 non-steroidal anti-inflammatory drugs. Patients received CZP 400 mg at Weeks 0/2/4, then 200 mg every 2 weeks up to 96 weeks. This 48-week pre-planned interim analysis compares AAU flare incidence in the 48 weeks before and after initiation of CZP treatment, using Poisson regression to account for possible within-patient correlations.

Results

In total, 89 patients were included (male: 63%; radiographic/non-radiographic axSpA: 85%/15%; mean axSpA disease duration: 8.6 years). During 48 weeks’ CZP treatment, 13 (15%) patients experienced 15 AAU flares, representing an 87% reduction in AAU incidence rate (146.6 per 100 patient-years (PY) in the 48 weeks pre-baseline to 18.7 per 100 PY during CZP treatment). Poisson regression analysis showed that the incidence rate of AAU per patient reduced from 1.5 to 0.2 (p<0.001). No new safety signals were identified.

Conclusions

There was a significant reduction in the AAU flare rate during 48 weeks of CZP treatment, indicating that CZP is a suitable treatment option for patients with active axSpA and a history of recurrent AAU.

Reduction of anterior uveitis flares in patients with axial spondyloarthritis on certolizumab pegol treatment: final 2-year results from the multicenter phase IV C-VIEW study

Introduction:

Acute anterior uveitis (AAU), affecting up to 40% of patients with axial spondyloarthritis (axSpA), risks permanent visual deficits if not adequately treated. We report 2-year results from C-VIEW, the first study to prospectively investigate certolizumab pegol (CZP) on AAU in patients with active axSpA at high risk of recurrent AAU.

Patients and methods:

C-VIEW (NCT03020992) was a 104-week (96 weeks plus 8-week safety follow-up), open-label, multicenter study. Eligible patients had active axSpA, human leukocyte antigen-B27 (HLA-B27) positivity and a history of recurrent AAU (⩾2 AAU flares in total; ⩾1 in the year prior to baseline). Patients received CZP 400 mg at weeks 0, 2 and 4, then 200 mg every 2 weeks to week 96. The primary efficacy endpoint was the AAU flare event rate during 96 weeks’ CZP versus 2 years pre-baseline.

Results:

Of 115 enrolled patients, 89 initiated CZP (male: 63%; radiographic/non-radiographic axSpA: 85%/15%; mean disease duration: 9.1 years); 83 completed week 96. There was a significant 82% reduction in AAU flare event rate during CZP versus pre-baseline [rate ratio (95% confidence interval): 0.18 (0.12–0.28), p < 0.001]. One hundred percent and 59.6% of patients experienced ⩾1 and ⩾2 AAU flares pre-baseline, respectively, compared to 20.2% and 11.2% during treatment. Age, sex and axSpA population subgroup analyses were consistent with the primary analysis. There were substantial improvements in axSpA disease activity with no new safety signal identified.

Conclusion:

CZP treatment significantly reduced AAU flare event rate in patients with axSpA and a history of AAU, indicating CZP is a suitable treatment option for patients at risk of recurrent AAU.

Trial Registration ClinicalTrials.gov:

NCT03020992, URL: https://clinicaltrials.gov/ct2/show/NCT03020992

Renal Function and Patient-Reported Outcomes in Stable Kidney Transplant Patients Following Conversion From Twice-Daily Immediate-Release Tacrolimus to Once-Daily Prolonged-Release Tacrolimus: A 12-Month Observational Study in Routine Clinical Practice in Germany (ADAGIO)

INTRODUCTION

This 12-month, noninterventional study on routine clinical practice in Germany evaluated renal function in stable kidney transplant recipients converted from immediate-release tacrolimus (IR-T) to prolonged-release tacrolimus (PR-T).

METHODS

Renal function was assessed in 183 patients by estimated glomerular filtration rate using the modification of diet in renal disease-4 formula. Self-reported gastrointestinal health-related quality of life, adherence, satisfaction with PR-T, suspected rejection episodes, and safety were also assessed at conversion and at 3, 6, and 12 months.

RESULTS

Conversion from IR-T to PR-T resulted in stable kidney function over 12 months, with a difference in estimated glomerular filtration rate between the first and final visits of 0.1 mL/min/1.73 m² (95% confidence interval, -1.6, 1.8). Eight patients experienced an acute rejection episode (4.4%). At each assessment, gastrointestinal health-related quality of life was low and adherence was high. Most patients reported that they were very satisfied (69.8%) or satisfied (28.1%) with PR-T at the final visit. Among patients reporting a preference, 78.4% preferred PR-T, 2.2% preferred IR-T, and 19.4% reported no preference. The safety profile of PR-T was consistent with that previously described.

CONCLUSION

Conversion of stable kidney transplant recipients from IR-T to PR-T provided stable kidney and graft function over 12 months (Verband Forschender Arzneimittelhersteller--registered study: NIS ADV-02).

A pyrrolopyridazinedione-based copolymer for fullerene-free organic solar cells

This study deals with the synthesis and thorough characterization of the conjugated polymer T-EHPPD-T-EHBDT, which shows promising performance in polymer/non-fullerene acceptor organic solar cells.

Benefits of direct electron detection and PCA for EELS investigation of organic photovoltaics materials

Electron energy-loss spectroscopy (EELS) is a powerful tool for imaging chemical variations at the nanoscale. Here, we investigate a polymer/organic small molecule-blend used as absorber layer in an organic solar cell and employ EELS for distinguishing polymer donor and small molecule acceptor domains in the nanostructured blend based on elemental maps of light elements, such as nitrogen, sulfur or fluorine. Especially for beam sensitive samples, the electron dose needs to be limited, therefore optimized acquisition and data processing strategies are required. We compare data acquired on a post-column energy filter with a direct electron detection camera to data from a conventional CCD camera on the same filter and we investigate the impact of statistical data processing methods (principal components analysis, PCA) on acquired spectra and elemental maps extracted from spectrum images. Our work shows, that the quality of spectra on a direct electron detection camera is far superior to conventional CCD imaging, and thereby allows clear identification of ionization edges and the fine structure of these edges. For the quality of the elemental maps, the application of PCA is essential to allow a clear separation between the donor and acceptor phase in the bulk heterojunction absorber layer of a non-fullerene organic solar cell.

Synthesis and characterization of zinc di(O-2,2-dimethylpentan-3-yl dithiocarbonates) bearing pyridine or tetramethylethylenediamine coligands and investigation of their thermal conversion mechanisms towards nanocrystalline zinc sulfide

Metal xanthates are versatile single source precursors for the preparation of various metal sulfides. In this study, we present the synthesis of the two novel zinc xanthate complexes bis(O-2,2-dimethylpentan-3-yl-dithiocarbonato)(N,N,N',N'-tetramethylethylenediamine)zinc(ii) and bis(O-2,2-dimethylpentan-3-yl-dithiocarbonato)(pyridine)zinc(ii). A thorough investigation of these compounds revealed distinct differences in their structural and thermal properties. While in the complex containing the chelating tetramethylethylenediamine, the xanthate groups coordinate in a monodentate way, they are bidentally coordinated to the zinc atom in the pyridine containing complex. Both compounds show a two-step thermal decomposition with an onset temperature of 151 °C and 156 °C for the tetramethylethylenediamine and pyridine containing complex, respectively. Moreover, different mechanisms are revealed for the two phases of the decomposition based on high resolution mass spectrometry investigations. By the thermal conversion process nanocrystalline zinc sulfide is produced and the coligand significantly influences its primary crystallite size, which is 4.4 nm using the tetramethylethylenediamine and 11.4 nm using the pyridine containing complex for samples prepared at a temperature of 400 °C.

THU0379 REDUCTION OF ANTERIOR UVEITIS FLARES IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS FOLLOWING ONE YEAR OF TREATMENT WITH CERTOLIZUMAB PEGOL: 48-WEEK INTERIM RESULTS FROM A 96-WEEK OPEN-LABEL STUDY

Background:

Acute anterior uveitis (AAU), inflammation of the anterior uveal tract, is reported in up to 40% of patients (pts) with axial spondyloarthritis (axSpA).1AAU is associated with significant clinical burden; symptoms include blurred vision, photophobia and pain.2Previous studies have shown that TNF inhibitors (TNFi) can reduce AAU flare incidence in pts with radiographic axSpA,3-5but few have focused on pts across the full axSpA spectrum.

Objectives:

To analyse the impact of certolizumab pegol (CZP) treatment on AAU in pts with active radiographic and non-radiographic axSpA and a recent history of AAU.

Methods:

C-VIEW (NCT03020992) is an ongoing multicentre, open-label, phase 4 study. Pts had active axSpA according to the ASAS classification, a history of recurrent AAU (≥2 AAU flares in total and ≥1 AAU flare in the year prior to study entry), were HLA-B27 positive, and were eligible for TNFi treatment (previous failure of ≥2 NSAIDs, biologic naïve or had failed ≤1 TNFi). Pts received CZP 400 mg at Weeks (Wks) 0/2/4, then 200 mg every two wks (Q2W) to Wk 96. The primary variable was incidence of AAU flares compared to historic rates. A pre-specified interim analysis compared AAU incidence in the 48 wks prior to CZP treatment with the 48 wks of treatment, using Poisson regression adjusted for possible within-pt correlations, with period (pre- and post-baseline) and axSpA disease duration as covariates. Incidence rates (IR) were calculated based on the number of cases/pts at risk over 48 wks. Observed data are reported.

Results:

Of 115 enrolled pts, 89 initiated CZP treatment; 85 completed Wk 48. Baseline characteristics are shown in the Table. The 48-wk interim analysis revealed significantly fewer AAU flares/pt during CZP treatment vs before treatment (Figure; Poisson-adjusted IR: 0.2 vs 1.5, p<0.001). The number of pts experiencing 1 and ≥2 AAU flares (64.0% and 31.5% respectively) substantially reduced during CZP treatment (12.4% and 2.2%). After 48 wks CZP treatment, disease activity improved substantially (mean ± SD Ankylosing Spondylitis Disease Activity Score [ASDAS]: 2.0 ± 0.9; Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]: 3.3 ± 2.1), with 31.4% pts achieving ASAS partial remission and 29.1% ASDAS major improvement. No new safety signals were identified.

Table.

Baseline characteristics

CZP 200 mg Q2W (N=89)Age (years), mean ± SD46.5 ± 11.2Male, n (%)56 (62.9)Racial group, n (%) Caucasian87 (97.8) Other2 (2.2)Diagnosis, n (%) Radiographic axSpA76 (85.4) Non-radiographic axSpA13 (14.6)Duration of axSpA (years), mean ± SD8.6 ± 8.4Time since onset of first uveitis flare (years), mean ± SD9.9 ± 9.0ASDAS, mean ± SD3.5 ± 0.9BASDAI, mean ± SD6.5 ± 1.5

Conclusion:

In this open-label study, AAU flare rate significantly reduced in axSpA pts with a history of recurrent AAU during the first 48 wks of CZP. Pts also experienced substantial improvements in axSpA disease activity.

References:

[1]Martin TM. Curr Opin Rheumatol 2002;14:337–41

[2]Bacchiega ABS. Rheumatology (Oxford) 2017;56:2060–7

[3]van der Heijde D. Rheumatology (Oxford) 2017;56:1498–509

[4]van Bentum RE. J Rheumatol 2019;46:153–9

[5]van Denderen JC. J Rheumatol 2014;41:1843–8

Acknowledgments:

This study was funded by UCB Pharma. Editorial services were provided by Costello Medical.

Disclosure of Interests:

Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Rianne van Bentum: None declared, Frank Verbraak Grant/research support from: Bayer, Novartis, IDxDR, UCB Pharma, Consultant of: Bayer, Novartis, IDxDR, UCB Pharma, Thomas Rath Grant/research support from: AbbVie, Bristol-Myers Squibb, Chugai, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma, James Rosenbaum Consultant of: AbbVie, Corvus, Eyevensys, Gilead, Novartis, Janssen, Roche, UCB Pharma; royalties from UpToDate, Maria Misterska-Skora: None declared, Bengt Hoepken Employee of: UCB Pharma, Oscar Irvin-Sellers Employee of: UCB Pharma, Brenda VanLunen Employee of: UCB Pharma, Lars Bauer Employee of: UCB Pharma, Martin Rudwaleit Consultant of: AbbVie, BMS, Celgene, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Roche, UCB Pharma

[Ocular Syphilis - Update]

Syphilis is a bacterial infectious disease transmitted by the spirochaete Treponema pallidum. The rate of infection has increased during the last decade. Ocular syphilis is an underestimated presentation of the disease, and it is increased in HIV-positive patients. Even though every part of the eye may be affected, syphilis most commonly occurs with posterior or panuveitis. A distinctive pattern is acute syphilitic placoid chorioretinitis, with typical features in multimodal imaging. If syphilis is suspected, specific and nonspecific Treponema pallidum serological diagnostic tests are mandatory. Clinical outcome, or morphology and vision are commonly improved if antibiotic therapy (penicillin is the drug of choice) is instituted early. Additional corticosteroids are carefully applied according to individual need, and should be initiated after the start of antibiotics.

Phenotype of Innate Immune Cells in Uveitis Associated with Axial Spondyloarthritis- and Juvenile Idiopathic Arthritis-associated Uveitis

Purpose: To analyze circulating immune cells in patients with anterior uveitis (AU) associated to axial spondyloarthritis (SpA), or juvenile idiopathic arthritis (JIA).Methods: Venous blood samples were collected from healthy controls (n = 16), and either SpA (n = 19) or JIA (n = 23) patients with associated anterior uveitis (AU) during active flare, or after ≥3 months of inactivity. Frequencies of CD56⁺, MHC-I⁺, and S100A9⁺ monocytes, CCR7⁺ dendritic cells, CD56^+dim natural killer (NK) cells and CD3⁺CD56^bright T-cells were analyzed via flow cytometry. Serum S100A8/A9 levels were determined via ELISA.Results: SpA patients showed a reduced frequency of CD56^+dim NK cells during uveitis activity, a constitutively activated monocyte phenotype, and elevated S100A8/A9 serum levels. In contrast, JIAU patients showed elevated frequencies of CD56⁺ monocytes and CCR7⁺ DC.Conclusion: Phenotype of peripheral immune cells differ between patients, probably contributing to different courses of acute onset AU in SpA and insidious onset AU in JIAU patients.Abbreviations: AU: anterior uveitis, AR: arthritis, JIA: juvenile idiopathic arthritis, SpA: axial spondyloarthritis.

Dependence of material properties and photovoltaic performance of triple cation tin perovskites on the iodide to bromide ratio

Abstract

In this work, the influence of a partial introduction of bromide (x = 0–0.33) into MA0.75FA0.15PEA0.1Sn(BrxI1−x)3 (MA: methylammonium, FA: formamidinium, PEA: phenylethylammonium) triple cation tin perovskite on the material properties and photovoltaic performance is investigated and characterized. The introduction of bromide shifts the optical band gap of the perovskite films from 1.29 eV for the iodide-based perovskite to 1.50 eV for the perovskite with a bromide content of x = 0.33. X-ray diffraction measurements reveal that the size of the unit cell is also gradually reduced based on the incorporation of bromide. Regarding the photovoltaic performance of the perovskite films, it is shown that already small amounts of bromide (x = 0.08) in the perovskite system increase the open circuit voltage, short circuit current density and fill factor. The maximum power conversion efficiency of 4.63% was obtained with a bromide content of x = 0.25, which can be ascribed to the formation of homogeneous thin films in combination with higher values of the open circuit voltage. Upon introduction of a higher amount of bromide (x = 0.33), the perovskite absorber layers form pinholes, thus reducing the overall device performance.

Graphic abstract

Preformed Donor-Specific HLA Antibodies in Living and Deceased Donor Transplantation: A Multicenter Study

BACKGROUND AND OBJECTIVES

The prognostic value of preformed donor-specific HLA antibodies (DSA), which are only detectable by sensitive methods, remains controversial for kidney transplantation.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

The outcome of 4233 consecutive kidney transplants performed between 2012 and 2015 in 18 German transplant centers was evaluated. Most centers used a stepwise pretransplant antibody screening with bead array tests and differentiation of positive samples by single antigen assays. Using these screening results, DSA against HLA-A, -B, -C, -DRB1 and -DQB1 were determined. Data on clinical outcome and possible covariates were collected retrospectively.

RESULTS

Pretransplant DSA were associated with lower overall graft survival, with a hazard ratio of 2.53 for living donation (95% confidence interval [95% CI], 1.49 to 4.29; P<0.001) and 1.59 for deceased donation (95% CI, 1.21 to 2.11; P=0.001). ABO-incompatible transplantation was associated with worse graft survival (hazard ratio, 2.09; 95% CI, 1.33 to 3.27; P=0.001) independent from DSA. There was no difference between DSA against class 1, class 2, or both. Stratification into DSA <3000 medium fluorescence intensity (MFI) and DSA ≥3000 MFI resulted in overlapping survival curves. Therefore, separate analyses were performed for 3-month and long-term graft survival. Although DSA <3000 MFI tended to be associated with both lower 3-month and long-term transplant survival in deceased donation, DSA ≥3000 MFI were only associated with worse long-term transplant survival in deceased donation. In living donation, only strong DSA were associated with reduced graft survival in the first 3 months, but both weak and strong DSA were associated with reduced long-term graft survival. A higher incidence of antibody-mediated rejection within 6 months was only associated with DSA ≥3000 MFI.

CONCLUSIONS

Preformed DSA were associated with an increased risk for graft loss in kidney transplantation, which was greater in living than in deceased donation. Even weak DSA <3000 MFI were associated with worse graft survival. This association was stronger in living than deceased donation.

Synthesis of a tetrazine-quaterthiophene copolymer and its optical, structural and photovoltaic properties

Herein, we report the synthesis of a novel, tetrazine-based conjugated polymer. Tetrazines have the benefit of being strong electron acceptors, while little steric hindrance is imposed on the flanking thiophene rings. Conversion of a suitably substituted nitrile precursor led to 3,6-bis(5-bromo-4-(2-octyldodecyl)thiophen-2-yl)-1,2,4,5-tetrazine (2OD-TTz). Palladium-catalyzed copolymerization of 2OD-TTz with a bithiophene monomer yielded an alternating tetrazine-quaterthiophene copolymer (PTz4T-2OD). The polymer PTz4T-2OD showed an optical band gap of 1.8 eV, a deep HOMO energy level of - 5.58 eV and good solubility. In combination with the non-fullerene acceptor ITIC-F, solar cells with power conversion efficiencies of up to 2.6% were obtained.

Ligand-free preparation of polymer/CuInS2 nanocrystal films and the influence of 1,3-benzenedithiol on their photovoltaic performance and charge recombination properties

Bulk heterojunction solar cells based on conjugated polymer donors and fullerene-derivative acceptors have received much attention in the last decade. Alternative acceptors like organic non-fullerene acceptors or inorganic nanocrystals have been investigated to a lesser extent; however, they also show great potential. In this study, one focus is set on the investigation of the in situ growth of copper indium sulfide nanocrystals in a conjugated polymer matrix. This preparation method allows the fabrication of a hybrid active layer without long-chain ligands, which could hinder charge separation and transport. In contrast, surfactants for the passivation of the nanocrystal surface are missing. To tackle this problem, we modified the absorber layer with 1,3-benzenedithiol and investigated the influence on charge transfer and solar cell performance. Using ToF-SIMS measurements, we could show that 1,3-benzenedithiol is successfully incorporated and homogeneously distributed in the absorber layer, which significantly increases the power conversion efficiency of the corresponding solar cells. This can be correlated to an improved charge transfer between the nanocrystals and the conjugated polymer as revealed by transient absorption spectroscopy as well as prolonged carrier lifetimes as disclosed by transient photovoltage measurements.

Hot injection synthesis of CuInS2 nanocrystals using metal xanthates and their application in hybrid solar cells

Copper indium sulfide nanocrystals with sizes of 3–4 nm were synthesized from metal xanthates in a hot injection reaction. After ligand exchange, their performance as acceptors in polymer/nanocrystal hybrid solar cells was evaluated.

Five-year outcomes in kidney transplant patients randomized to everolimus with cyclosporine withdrawal or low-exposure cyclosporine versus standard therapy

HERAKLES was a 1-year randomized, multicenter trial. Patients were randomized at 3 months after kidney transplantation to remain on cyclosporine-based therapy, switch to everolimus without a calcineurin inhibitor (CNI), or switch to everolimus with low-exposure cyclosporine. Overall, 417 of 497 (83.9%) patients from the core study entered a 4-year extension study. The randomized regimen was continued to year 5 in 75.9%, 41.9% and 24.6% of patients in the standard-CNI, CNI-free and low-CNI groups, respectively. Adjusted estimated GFR at year 5 was significantly higher in the CNI-free group versus standard CNI (difference 7.2 mL/min/1.73 m² , P < .001) or low CNI (difference 7.6 mL/min/1.73 m² , P < .001). For patients who continued randomized therapy for 5 years, differences were 14.4 mL/min/1.73 m²  and 10.1 mL/min/1.73 m² , respectively. Biopsy-proven acute rejection occurred during the 4-year extension study in 7.6%, 8.6%, and 9.0% of patients in the standard-CNI, CNI-free and low-CNI groups, respectively (P = .927). In conclusion, conversion to a CNI-free everolimus regimen 3 months after kidney transplantation improved long-term graft function, particularly in patients who continued the CNI-free regimen. Low CNI with everolimus did not improve renal function. Efficacy was comparable between groups but frequent immunosuppression changes should be taken into account.

[Current challenges in the treatment of paediatric burn patients: a retrospective experience at a Viennese burn unit]

BACKGROUND

Burn trauma in paediatric patients continues to be highly relevant socio-economically since the number of inpatients treated per year has not declined over the past few decades. The treatment of paediatric burn victims places high demands on medical staff and the use of wound dressings and surgical techniques. This study aimed to give a current overview of the inpatient management and treatment methods for paediatric burn patients at a specialised burn centre in Vienna.

PATIENTS/MATERIAL AND METHODS

All children and adolescents who were treated at the children's ward of the Division of Plastic and Reconstructive Surgery at the Medical University of Vienna between 2012 and 2016 due to a recent burn trauma were retrospectively analysed.

RESULTS

115patients were treated due to a recent burn trauma. Median age was 2 years (0-18). Scalds accounted for 74 % of traumas. Median affected body surface area was 5 % (1-40 %). Conservative treatment of superficial partial-thickness wounds (62 %) was performed with MepilexAg in 98 % of cases and required a median healing time of 11 days (4-34). 38 % (n = 44) of patients had deep partial-thickness or full-thickness burns . The use of Suprathel after tangential excision of the burn eschar in more superficial deep partial-thickness burns led to satisfying healing times.

CONCLUSION

The use of modern dressings in the conservative treatment of superficial partial-thickness burns allows for atraumatic dressing changes and fast recoveries. The use of Suprathel in more superficial deep partial-thickness burns is a reliable and safe alternative to autologous skin grafting. Scar prophylaxis and regular follow-up examinations are crucial to prevent secondary morbidity due to scar contractures. It is important to raise awareness among parents in order to decrease the number of paediatric burn patients in the future.

A Zero-Dimensional Mixed-Anion Hybrid Halogenobismuthate(III) Semiconductor: Structural, Optical, and Photovoltaic Properties

In this contribution, we present the synthesis and characterization of the mixed-anion halogenobismuthate(III) (CH₃NH₃)₆BiI_5.22Cl_3.78 (MBIC) as an alternative lead-free perovskite-type semiconductor, and discuss its optical, electronic, and photovoltaic properties in comparison to the methylammonium bismuth iodide (CH₃NH₃)₃Bi₂I₉ (MBI) compound. The exchange of iodide with chloride during synthesis leads to the formation of an orthorhombic A₆BX₉-type crystal structure ( Cmma, No. 67) with isolated BiX₆ octahedra and methylammonium chloride interlayers. The experimentally found optical indirect band gap of 2.25 eV is in good agreement with the calculated value of 2.50 eV derived from DFT simulations. The valence band maximum and the conduction band minimum were determined to be at -6.2 eV and -4.0 eV vs vacuum. Similar to MBI, thin films of MBIC are composed of microcrystalline platelets. Time-resolved photoluminescence measurements show electron transfer of MBIC to mesoporous TiO₂. The photovoltaic behavior of both compounds is compared in solar cells with the following device architecture: glass/ITO/compact TiO₂/mesoporous TiO₂/MBIC or MBI/spiro-OMeTAD/Au. Despite the zero-dimensional structure of MBIC, a maximum power conversion efficiency of 0.18% and a high fill factor of almost 60% were obtained with this material as absorber layer. When stored under inert conditions, these solar cells show an excellent long-term stability over the investigated period of more than 700 days.

Prospective randomized study of conversion from tacrolimus to cyclosporine A to improve glucose metabolism in patients with posttransplant diabetes mellitus after renal transplantation

Tacrolimus (TAC) increases the risk of posttransplant diabetes (PTDM) compared with cyclosporine A (CYC). The present 12-month, multicenter, investigator-driven, prospective, randomized study was designed to assess whether conversion from tacrolimus to CYC can reverse PTDM after renal transplantation. Predominantly white patients with PTDM according to the 2005 American Diabetes Association criteria were randomized to either replacement of TAC with CYC or continuation of their TAC-based regimen after stratification for type of glucose-lowering therapy, steroid therapy, and hepatitis C status. At 12 months, 14 of 41 patients with complete data in the CYC arm (34%; 95%CI 19%-49%) were free of diabetes, whereas this was the case in only 4 of 39 patients (10%; 95%CI 3%-20%) in the TAC arm (P = .01). At 12 months, 39% of patients in the CYC arm were off glucose-lowering medication vs 13% of patients in the TAC arm (P = .01). The CYC group decreased glycated hemoglobin level during the 12-month follow-up, resulting in significantly lower levels compared with the TAC group (6.0 ± 0.9% vs 7.1 ± 1.7% at 12 months; P = .002). In conclusion, replacement of TAC with CYC significantly improves glucose metabolism and has the potential to reverse diabetes during the first year after conversion. (EU Clinical Trials Register No. 2006-001765-42).

Are we bound to our scores? a 74-year-old patient with an abbreviated burn severity index of 14

We report a case of a 74-year-old female patient who was involved in a car accident. The patient suffered deep dermal and full thickness burns and the probability of survival calculated with the Abbreviated Burn Severity Index (ABSI) was extremely low. The patient showed sufficient cardiorespiratory and renal function for the entire treatment period. An epifascial necrosectomy of all four limbs was performed on day three after admission. Wound coverage was performed using the MEEK technique and split skin grafts. The patient was bedded in a FluidAir bed, which enabled the burn wounds on the back to dry and heal in large part. After four surgical procedures and four months of treatment at the burn ICU, the patient was sufficiently mobilized for transfer to a hospital in her home region. The aim of the following case report is to demonstrate that burn patients with very low chances of survival can be treated successfully.

Quality of life and functional assessment of facial palsy patients: A questionnaire study

BACKGROUND

Facial palsy leads to functional and aesthetic deficits, which impair the quality of life of affected patients. General health-related and disease-specific questionnaires are available for quality of life assessment. In this study, observer-based analysis of facial function (Sunnybrook Facial Grading Scale) was compared patient-based to facial palsy-specific gradings (Facial Clinimetric Evaluation Scale and Facial Disability Index), and general health-related quality of life questionnaires (SF-36). We hypothesized that only facial palsy-specific instruments capture functional and social impairments of affected patients.

METHODS

Thirty facial palsy patients treated at a tertiary referral centre were included in this study. Inclusion criteria were unilateral facial palsy with stable facial function, age over 18 years and fluency in German. Facial function was assessed with general and disease-specific patient-reported outcome measures and subsequently evaluated by the treating facial plastic surgeon. Statistical analysis included descriptive statistics for all assessed measurements. Correlations were calculated to compare general and facial palsy-specific instruments, as well as observer-based grading.

RESULTS

Observer-based evaluation of facial function correlated well to the patients-based assessment of physical function, however social subscores did not correlate demonstrating the limited correlation of patient distress and facial nerve impairment. Physical function scores of disease-specific instruments did not correlate with general health assessment scores, while social function scores showed moderate to good correlations.

CONCLUSION

Validated disease-specific instruments are essential for the assessment of facial palsy patients. Patient-reported outcome measures like the FaCE Scale and the Facial Disability Index should be applied in addition to standardized observer-based ratings to capture the patients' perspective on functional and social impairments associated with facial palsy to fully assess the burden of disease.

Konventionelle synthetische Immunsuppressiva (DMARDs) für die Therapie der nichtinfektiösen Uveitis

Die Initialtherapie von Uveitiden besteht aus einer topischen und/oder systemischen Kortikosteroidgabe. Zur Erzielung von dauerhafter Reizfreiheit, Prophylaxe von uveitischen Sekundärkomplikationen, Kortisoneinsparung und Vermeidung von kortikosteroidbedingten unerwünschten Arzneimittelwirkungen ist im weiteren Verlauf nicht selten der Einsatz einer krankheitsmodifizierenden Therapie (sog. disease modifying antirheumatic drugs, DMARDs) notwendig. Dieser Beitrag soll eine strukturierte Übersicht über die wichtigsten konventionellen synthetischen DMARDs, deren Indikation, mögliche unerwünschte Arzneimittelwirkungen und das interdisziplinäre Monitoring vermitteln.

3-Tesla MRI-assisted detection of compression points in ulnar neuropathy at the elbow in correlation with intraoperative findings

INTRODUCTION

Releasing the ulnar nerve from all entrapments is the primary objective of every surgical method in ulnar neuropathy at the elbow (UNE). The aim of this retrospective diagnostic study was to validate preoperative 3-Tesla MRI results by comparing the MRI findings with the intraoperative aspects during endoscopic-assisted or open surgery.

METHODS

Preoperative MRI studies were assessed by a radiologist not informed about intraoperative findings in request for the exact site of nerve compression. The localizations of compression were then correlated with the intraoperative findings obtained from the operative records. Percent agreement and Cohen's kappa (κ) values were calculated.

RESULTS

From a total of 41 elbows, there was a complete agreement in 27 (65.8%) cases and a partial agreement in another 12 (29.3%) cases. Cohen's kappa showed fair-to-moderate agreement.

CONCLUSION

High-resolution MRI cannot replace thorough intraoperative visualization of the ulnar nerve and its surrounding structures but may provide valuable information in ambiguous cases or relapses.

Incidence of risk factors for bloodstream infections in patients with major burns receiving intensive care: A retrospective single-center cohort study

OBJECTIVES

The objective was primarily to identify risk factors for bloodstream infections (BSI) caused by different pathogens.

METHODS

A retrospective single-center cohort study was performed on 472 burn patients with an abbreviated burn severity index (ABSI)≥3, a total burn surface area (TBSA)≥10%, and an ICU stay of at least 24h. Risk factors for different BSI pathogens were analyzed by competing risks regression model of Fine and Gray.

RESULTS

A total of 114 burn patients developed 171 episodes of BSIs caused by gram-negative bacteria (n=78;46%), gram-positive bacteria (n=69;40%), and fungi (n=24;14%) median after 14days (range, 1-164), 16days (range, 1-170), and 16days (range, 0-89), respectively. A total of 24/114 patients (21%) had fatal outcomes. Isolation of the most common bloodstream isolates Enterococcus sp. (n=26), followed by Candida sp. and Pseudomonas sp. (n=22 for both) was significantly associated with increased TBSA (p≤0.006) and ABSI (p<0.0001) and need for fasciotomy (p<0.01). The death risk of patients with MDR gram-negative bacteremia was significantly increased by a hazard ratio of 12.6 (95% CI:4.8-32.8; p<0.0001).

CONCLUSIONS

A greater TBSA and ABSI were associated with a significantly higher incidence of BSIs caused by Pseudomonas sp., Enterococcus sp. and Candida sp.

Everolimus with cyclosporine withdrawal or low-exposure cyclosporine in kidney transplantation from Month 3: a multicentre, randomized trial

Background.

Randomized trials have shown that early adoption of everolimus-based immunosuppressive regimens without a calcineurin inhibitor (CNI) improves long-term kidney graft function, but the optimal strategy for CNI minimization remains uncertain.

Methods.

In a prospective, randomized, multicentre, 12-month trial, 499 de novo kidney transplant patients were randomized at Month 3 to (i) remain on standard CNI (cyclosporine) therapy with mycophenolic acid, (ii) convert to everolimus with mycophenolic acid or (iii) start everolimus with reduced CNI and no mycophenolic acid (clinical trials registry: ClinicalTrials.gov-NCT00514514).

Results.

The primary endpoint, change in estimated glomerular filtration rate (eGFR) (Nankivell) from randomization to Month 12, was significantly greater in the CNI-free arm versus standard CNI therapy: mean difference 5.6 mL/min/1.73 m 2 [95% confidence interval (CI) 2.8-8.3 mL/min/1.73 m 2 , P < 0.001]. The improvement in eGFR in the CNI-free arm was also higher than in the low-CNI group (mean difference 5.5 mL/min/1.73 m 2 , 95% CI 2.8-8.2 mL/min/1.73 m 2 , P < 0.001), while results were similar in the low-CNI and standard CNI arms. The post-randomization incidence of biopsy-proven acute rejection was 11.7%, 8.1% and 7.9% in the CNI-free, low-CNI and standard CNI groups, respectively (CNI-free versus standard CNI, P = 0.27; low-CNI versus standard CNI, P = 1.00). Adverse events led to study drug discontinuation in 28.7%, 15.5% and 15.2% of CNI-free, low-CNI and standard CNI patients, respectively.

Conclusions.

Everolimus initiation with CNI withdrawal at Month 3 after kidney transplantation achieves a significant improvement in renal function at 12 months, with a similar rate of acute rejection.

Long-Term Effects of Severe Burn Injury on Bone Turnover and Microarchitecture

Severe burn injury triggers massive alterations in stress hormone levels with a dose-dependent hypermetabolic status including increased bone resorption. This study evaluated bone microarchitecture measured by noninvasive high-resolution peripheral quantitative computed tomography (HR-pQCT). Changes of serum bone turnover markers (BTM) as well as regulators of bone signaling pathways involved in skeletal health were assessed. Standardized effect sizes as a quantitative measure regarding the impact of serum changes and the prediction of these changes on bone microarchitecture were investigated. In total, 32 male patients with a severe burn injury (median total body surface area [TBSA], 40.5%; median age 40.5 years) and 28 matched male controls (median age 38.3 years) over a period of 24 months were included. In patients who had sustained a thermal injury, trabecular and cortical bone microstructure showed a continuous decline, whereas cortical porosity (Ct.Po) and pore volume increased. Initially, elevated levels of BTM and C-reactive protein (CRP) continuously decreased over time but remained elevated. In contrast, levels of soluble receptor activator of NF-κB ligand (sRANKL) increased over time. Osteocalcin, bone-specific alkaline phosphatase (BALP), intact N-terminal type 1 procollagen propeptide (P1NP), and cross-linked C-telopeptide (CTX) acutely reflected the increase of Ct.Po at the radius (R²  = 0.41), followed by the reduction of trabecular thickness at the tibia (R²  = 0.28). In adult male patients, early and sustained changes of markers of bone resorption, formation and regulators of bone signaling pathways, prolonged inflammatory cytokine activities in conjunction with muscle catabolism, and vitamin D insufficiency were observed. These alterations are directly linked to a prolonged deterioration of bone microstructure. The probably increased risk of fragility fractures should be of clinical concern and subject to future interventional studies with bone-protective agents. © 2017 American Society for Bone and Mineral Research.

Hydrogen peroxide (H2O2): a review of its use in surgery

Hydrogen peroxide has been used in medicine for more than 100 years. It is known in surgery as a highly useful irrigation solution by virtue of both its hemostatic and its antimicrobial effects. Due to its possible negative effect on wound healing and its cytotoxic effect in higher concentrations, there are concerns about the safety of its use. The objective of this paper is to review the safety and beneficial effects of hydrogen peroxide.