Time course of hospitalizations in patients with heart failure and chronic obstructive pulmonary disease around sleep-disordered-breathing diagnosis

Purpose In heart failure (HF) and chronic obstructive pulmonary disease (COPD) populations, sleep-disordered breathing (SDB) is associated with impaired health outcomes. We evaluated whether in patients with HF, concomitant HF and COPD or COPD, the number of hospitalizations would be reduced in the year after testing for SDB with and without treatment initiation compared to the year before. Methods We performed a multicentre retrospective study of 390 consecutive sleep-clinic patients who had a primary diagnosis of chronic HF, HF and COPD or COPD and a secondary diagnosis of SDB. The date of SDB-testing was defined as the index date. Data on healthcare utilization was extracted for the 12-month period prior to and after this date. Results The initiation of adaptive servoventilation (ASV) and non-invasive ventilation (NIV) treatment resulted in a statistically significant reduction in the number of hospitalisations. While continuous positive airway pressure (CPAP) treatment also demonstrated a reduction in hospitalisations, the observed effect did not reach the level of statistical significance. After accounting for demographics and comorbidities in multivariable regression analyses, only NIV was significantly associated with a reduction in hospitalizations, while CPAP or ASV were not. NIV appears to be underutilized in COPD. Conclusions Our data indicate, that patients with HF or COPD and concomitant SDB may benefit from the initiation of appropriate PAP-therapy. Whether treating SDB in HF- and COPD-patients influences healthcare utilization merits further investigation

Janus graphene nanoribbons with localized states on a single zigzag edge

Topological design of π electrons in zigzag-edged graphene nanoribbons (ZGNRs) leads to a wealth of magnetic quantum phenomena and exotic quantum phases1,2,3,4,5,6,7,8,9,10. Symmetric ZGNRs typically show antiferromagnetically coupled spin-ordered edge states1,2. Eliminating cross-edge magnetic coupling in ZGNRs not only enables the realization of a class of ferromagnetic quantum spin chains11, enabling the exploration of quantum spin physics and entanglement of multiple qubits in the one-dimensional limit3,12, but also establishes a long-sought-after carbon-based ferromagnetic transport channel, pivotal for ultimate scaling of GNR-based quantum electronics1,2,3,9,13. Here we report a general approach for designing and fabricating such ferromagnetic GNRs in the form of Janus GNRs (JGNRs) with two distinct edge configurations. Guided by Lieb’s theorem and topological classification theory14,15,16, we devised two JGNRs by asymmetrically introducing a topological defect array of benzene motifs to one zigzag edge, while keeping the opposing zigzag edge unchanged. This breaks the structural symmetry and creates a sublattice imbalance within each unit cell, initiating a spin-symmetry breaking. Three Z-shaped precursors are designed to fabricate one parent ZGNR and two JGNRs with an optimal lattice spacing of the defect array for a complete quench of the magnetic edge states at the ‘defective’ edge. Characterization by scanning probe microscopy and spectroscopy and first-principles density functional theory confirms the successful fabrication of JGNRs with a ferromagnetic ground-state localized along the pristine zigzag edge

Diurnal timing of physical activity in relation to obesity and diabetes in the German National Cohort (NAKO)

Background Physical activity supports weight regulation and metabolic health, but its timing in relation to obesity and diabetes remains unclear. We aimed to assess the diurnal timing of physical activity and its association with obesity and diabetes. Methods We cross-sectionally analyzed hip-worn accelerometry data from 61,116 participants aged 20–75 in the German National Cohort between 2015 and 2019. We divided physical activity into sex- and age-standardized quartiles of total morning (06:00–11:59), afternoon (12:00–17:59), evening (18:00–23:59), and nighttime (00:00–06:00) physical activity. Using multivariable logistic regression, we estimated associations of physical activity timing with obesity (BMI ≥ 30.0 kg/m2) and diabetes (self-reported or HbA1c ≥ 6.5%). We accounted for sex, age, study region, education, employment, risky alcohol use, smoking, night shift work, and sleep duration. Results High afternoon (top vs. bottom quartile, OR: 0.36, 95% CI: 0.33–0.38) and evening physical activity (OR: 0.45, 95% CI: 0.42–0.48) showed lower obesity odds than high morning activity (OR: 0.71, 95% CI: 0.66–0.76), whereas nighttime activity increased obesity odds (OR: 1.58, 95% CI: 1.48–1.68). Associations were similar for diabetes, with the lowest odds for afternoon (OR: 0.47, 95% CI: 0.42–0.53), followed by evening (OR: 0.56, 95% CI: 0.50–0.62) and morning activity (OR: 0.80, 95% CI: 0.71–0.89), and higher odds for nighttime activity (OR: 1.43, 95% CI: 1.29–1.58). Findings were not modified by employment status, night shift work, and sleep duration. Conclusions Our cross-sectional findings require longitudinal corroboration but suggest afternoon and evening activity provide greater metabolic health benefits than morning activity, while nighttime activity is discouraged

Elevated plasma soluble lectin-like oxidised low-density lipoprotein receptor 1 as an independent prognostic biomarker in sepsis

Background Soluble lectin-like oxidised low-density lipoprotein receptor 1 (sLOX-1) is overproduced during inflammation, with its expression and release triggered by C-reactive protein (CRP). As CRP levels are typically elevated in sepsis, this study aimed to investigate whether sLOX-1 levels increase in parallel. Methods Plasma sLOX-1 levels of 52 patients with systemic inflammatory response syndrome (SIRS), 45 patients with sepsis, 88 patients with septic shock and 37 controls were measured by ELISA. Associations with CRP, underlying diseases, severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and bacterial infections were analysed. Results Plasma sLOX-1 levels were similarly elevated in patients with SIRS, sepsis, or septic shock compared to controls. Plasma sLOX-1 levels did not differ between male and female controls or patients. Plasma sLOX-1 levels were comparable in patients infected with SARS-CoV-2, Gram-negative bacteria, or Gram-positive bacteria. No association was observed between sLOX-1 levels and underlying liver cirrhosis or pancreatitis. Notably, plasma sLOX-1 levels correlated positively with leukocyte and basophil counts but showed no correlation with CRP or procalcitonin. Of clinical relevance, positive correlations were also found with aspartate aminotransferase (AST) and bilirubin levels. Among the 41 patients who did not survive, sLOX-1, AST, and bilirubin levels were significantly higher compared to those of survivors. Conclusions Plasma levels of sLOX-1 are elevated in patients with SIRS or sepsis and are significantly higher in non-survivors. Of note, they do not correlate with classical inflammatory markers, suggesting that sLOX-1 may function as an independent prognostic biomarker for predicting poor outcomes in patients with SIRS or sepsis

Fallbeispiel Lucy – Fallbeispiel einer Jugendlichen mit Lernschwierigkeiten Version 0.1

Das Fallbeispiel Lucy wurde von Expertinnen in der sonderpädagogischen und inklusiven Praxis entwickelt. Das realitätsnähe, aber fiktive Fallbeispiel kann in der Lehrkräftebildung eingesetzt werden. Es ist in deutscher und englischer Sprache als veränderbares Werk mit Open Access veröffentlicht. Zusätzlich kann das Einzelfallraster für pädagogische Diagnostik (Lutz, 2023) als Strukturierungshilfe verwenden werden, um übersichtlich protektive und Risikofaktoren in Bezug auf das Fallbeispiel und dessen Umfeld darzustellen

A naturally occurring standalone TrpB enzyme provides insights into allosteric communication within tryptophan synthase

Allosteric regulation of catalytic activity is a widespread property of multi-enzyme complexes. The tryptophan synthase is a prototypical allosteric enzyme where the constituting α (TrpA) and β (TrpB) subunits mutually activate each other in a manner that is incompletely understood. Experimental and computational studies have shown that LBCA-TrpB from the last bacterial common ancestor contains six residues (Res6) distal from the active site that allow for high stand-alone catalytic activity in the absence of a TrpA subunit. In the present study, a database search revealed that Res6 is also present in the extant plTrpB from Pelodictyon luteolum. The plTrpB enzyme showed a high stand-alone activity and only a moderate activation by plTrpA. The replacement of LBCA-Res6 in plTrpB with the consensus residues from a multiple sequence alignment yielded plTrpB-con, which showed a dramatically decreased stand-alone activity but was strongly stimulated by plTrpA. These findings suggest that the effect of these six key allosteric residues is largely independent of the protein context within a specific TrpB enzyme. Analysis of the conformational landscapes of plTrpB and plTrpB-con revealed that plTrpB in isolation displays efficient closure of both the active site and the communication (COMM) domain. In contrast, these catalytically competent states are destabilized in plTrpB-con but can be recovered by the addition of plTrpA. A correlation-based shortest path map (SPM) analysis reveals that the catalytically and allosterically relevant domains—specifically, the COMM domain in TrpB and loops 2 and 6 in TrpA—are tightly interconnected exclusively in plTrpA:plTrpB-con

Merocyanine-based photoacids as recyclable catalysts in visible-light-driven transformations

Visible light-driven proton transfer is crucial in nature and catalysis. Here, we report that protic merocyanine-based photoswitches act as efficient and recyclable homogeneous Brønsted acid catalysts under blue or green light irradiation. Photo-promoted proton release efficiently enables Friedel–Crafts reactions with easy catalyst recovery and reuse. Furthermore, by leveraging the high two-photon absorption cross-section of merocyanines, we successfully promote the reaction using near-IR light (λ ∼ 975 nm)

Efficient detection of 1H, 15N correlations in hydrogen bonded low molecular catalyst–substrate intermediates without selective 15N-labelling

To date, SOFAST approaches have generally been limited to biomolecules. We present the applicability of SOFAST-HMQC techniques to small molecules in the slow-tumbling regime offering a time-efficient characterization of catalyst substrate hydrogen bonds with nitrogen at natural abundance. This extends NMR access to a broader range of catalyst substrate combinations

Qualitätsindikatoren für den Rettungsdienst in Deutschland

Hintergrund: Qualitätsvergleiche mittels Qualitätsindikatoren sind ein bewährtes Verfahren im Qualitätsmanagement. Ziel der Arbeit: Im Auftrag des Ausschusses Rettungswesen der Bundesländer erarbeitete und konsentierte eine Arbeitsgruppe (AG) Qualitätsindikatoren für ein länderübergreifendes Benchmarking im deutschen Rettungsdienst. Material und Methoden: Ausgehend von übergeordneten Qualitätszielen trug die AG Indikatorkandidaten zusammen, welche in einem iterativen Gruppenprozess anhand von systematischen Gütebewertungen nach der QUALIFY-Methode verfeinert und selektioniert wurden. Im Anschluss fand eine Konsentierung durch die AG statt. Ergebnisse: Neunzig Indikatorkandidaten wurden erstellt, diskutiert und bewertet, wovon 22 Kandidaten vertieft ausgearbeitet wurden. Zwanzig Indikatoren erreichten im Konsensusverfahren die notwendige Zustimmung. Nach weiteren Ausarbeitungen zur praktischen Umsetzung des Benchmarkings einschließlich Rechen- und Operationalisierungsregeln erfolgte eine Überarbeitung und Aktualisierung der Indikatoren gefolgt von einer Neukonsentierung, wobei ein Element in 6 spezifischere Indikatoren aufgesplittet wurde. Die AG schlägt nunmehr einen konsentierten Katalog von 25 Qualitätsindikatoren für den länderübergreifenden Qualitätsvergleich in der Notfallrettung (inklusive Beitrag der Leitstelle) vor. Diskussion: Erstmals stehen länderübergreifend konsentierte Qualitätsindikatoren für den Rettungsdienst in der Bundesrepublik zur Verfügung, die sich jedoch für die länderübergreifende Verwendung noch bewähren müssen. Die organisatorischen Voraussetzungen für eine flächendeckende Umsetzung müssen vielerorts noch geschaffen werden