Flooding Induced Seismicity in the Ruhr Area – a geomechanics numerical modelling approach

The Ruhr region is characterized by centuries of coal mining at depths reaching more than 1000 meters. After the closure of the last mines, their controlled flooding started. The Floodrisk project investigates ground uplift, stress changes due to pore pressure changes and the reactivation potential of faults to explain induced seismicity. We focused on monitoring the eastern Ruhr area and are investigating in detail the relationship between mine water rise, tectonic stress and induced seismicity in the Haus Aden drainage area. In the region of the former "Bergwerk Ost", which had the highest seismicity in the Ruhr area during active mining, the RUB has installed a network of up to 30 short-period seismic stations. Continuous monitoring of seismicity and mine water levels is available for this region from the active mining phase through the post-mining phase to flooding. The temporal evolution of the mine water level after the pumps were shut down in mid-2019 shows a strong correlation with the temporal evolution of the observed microseismicity. Over 2200 induced events have been located since the beginning of flooding, showing spatial clustering. A comparison of the mine galleries, which today serve as the main underground waterways, with the localizations of the events shows that most of the events occur about 300 m below the main pillars located between the longwall panels. This study provides a compilation of the regional stress state in the eastern Ruhr area based on the mine measurements, which were re-evaluated to derive the regional stress component and compared with stress orientations from independent sources (information on stresses in deep boreholes and earthquake focal mechanisms). The spatial distribution of stress orientations in the Ruhr region shows a rather homogeneous stress pattern with only very few locations where stress orientations differ significantly from the average. Based on the geometry of the pillars, shafts and longwall panels, a generic numerical FE-model was developed using the compiled stress data for model calibration. The results indicate increased vertical stresses within and below the pillars as a result of stress arching. The horizontal stress changes are minor, thus differential stress increases in the vicinity of the event localization

Transient hypoglycemia as a rare cause of recurring transient loss of consciousness: a case report

Background Syncopes and transient loss of consciousness affect a large number of patients. Determining the underlying mechanism of a syncope is key to effectively treating and preventing future events. However, given the broad differential diagnosis of transient loss of consciousness, it can be challenging to determine the exact etiology. Case presentation This case presents a 42-year-old Caucasian female patient with recurrent transient loss of consciousness due to a hitherto undiagnosed impaired glucose tolerance and hyperinsulinism. The patient had been thoroughly tested for all typical causes of syncope without finding any causal explanation. An oral glucose tolerance test confirmed rapidly dropping blood glucose levels associated with rapidly fading consciousness as the underlying cause of transient loss of consciousness. Further diagnostic workup revealed that the patient suffered from impaired glucose tolerance and subsequent hyperinsulinism without overt diabetes mellitus. Nutritional counseling including reduction of glucose intake and frequently eating smaller meal portions led to a significant reduction in the frequency of transient loss of consciousness and overall improvement in quality of life. Conclusions The current European Society of Cardiology (ESC) guideline on syncope does not list hypoglycemia as a cause of transient loss of consciousness. However, this case report stresses that metabolic dysregulation can indeed lead to self-limited transient loss of consciousness. Thus, in the case of recurrent syncope with an unclear underlying mechanism, physicians should consider transient hypoglycemia and metabolic workup as a possible differential diagnosis

Urinary chemerin as a potential biomarker for inflammatory bowel disease

Purpose: Systemic levels of the adipokine chemerin are elevated in different inflammatory conditions such as inflammatory bowel disease (IBD). In IBD, chemerin protein expression in colon mucosa is induced and serum chemerin levels are increased. Aim of this study was to identify chemerin protein in human feces and/or urine and to evaluate a possible association with IBD activity. Materials and methods: Feces and urine of 40 patients with IBD and the respective sera of 34 patients were collected. Chemerin levels were analyzed by immunoblot in feces and urine samples. In addition, enzyme-linked immunosorbent assay (ELISA) was used to measure chemerin in all urine, feces and serum samples of the patients and in urine of 17 healthy controls. Results: Chemerin was not detectable in 80% of the human feces samples by ELISA. Chemerin in human urine was detected by immunoblot and ELISA. Compared to serum levels, urinary concentration was about 6,000-fold lower. Urinary chemerin did not differ between patients with ulcerative colitis (n = 15) and Crohn’s disease (n = 25). Urinary chemerin was not related to its serum levels, did not correlate with serum C-reactive protein level and negatively correlated with serum creatinine. Of note, urinary chemerin of patients with a fecal calprotectin > 500 μg/g was significantly higher compared to patients with lower calprotectin levels and compared to healthy controls. Serum creatinine did not differ between the patient groups. Conclusion: Urinary chemerin might present a novel non-invasive biomarker for monitoring IBD severity and clinical course

To Biopsy or Not to Biopsy: Evaluation of a Large German Cohort of Patients with Abnormal Liver Tests of Unknown Etiology

Background and Aims: Despite increasingly sensitive and accurate blood tests to detect liver disease, liver biopsy remains very useful in patients with atypical clinical features and abnormal liver tests of unknown etiology. The aim was to determine those elevated laboratory liver parameters that cause the clinician to order a biopsy, and whether laboratory tests are associated with pathological findings on histology. Methods: 504 patients with unclear hepatopathy, admitted to the outpatient clinic of a university hospital between 2007 and 2010, were analyzed with respect to laboratory results, clinical data, and the results of liver biopsies. Results: Aspartate aminotransferase (AST) and glutamate dehydrogenase (GLDH) levels above the normal range significantly increased the likelihood of recommending a liver biopsy by 81% [OR with 95% CI 1.81 (1.21-2.71), p = 0.004] and 159% [OR with 95% CI 2.59 (1.70-3.93), p < 0.001], respectively. AST values above normal were associated with fibrosis (63 vs. 40% for normal AST, p = 0.010). Elevated ferritin levels pointed to a higher incidence of steatosis (48 vs. 10% for normal ferritin, p < 0.001) and inflammation (87 vs. 62% for normal ferritin, p = 0.004). Conclusions: Our results indicate that elevated AST and GLDH were associated with a greater likelihood of recommending liver biopsy. Elevated AST and ferritin levels were associated with steatosis, inflammation and fibrosis on liver biopsies. Thus, AST and ferritin may be useful non-invasive predictors of liver pathology in patients with unclear hepatopathy

Reformation als Kommunikationsprozess

Beim Hussitismus bzw. Utraquismus in Böhmen und der reformatorische Bewegung ab 1517 in Sachsen handelt es sich um zwei unterschiedliche Reformationen, jedoch mit einer Fülle von sachlichen und personalen Verbindungslinien. Diese rücken im vorliegenden Band erstmalig in einen gemeinsamen Fokus.»Wir sind alle Hussiten«, bekannte Martin Luther 1520 nach der Lektüre von Schriften des tschechischen Reformators Jan Hus, der gut einhundert Jahre zuvor als Ketzer verbrannt worden war. Die beiden Reformatoren verbinden, ebenso wie die von ihnen ausgehenden Erweckungs- und Erneuerungsbewegungen, viele Ähnlichkeiten, Übereinstimmungen und parallele Entwicklungsverläufe. Dennoch werden sie meist getrennt betrachtet. Der Sammelband analysiert Aspekte der Reformation in Böhmen und Sachsen und rückt so die beiden religiösen Brennpunkte in einen gemeinsamen Fokus. Methodisch wählen die Beiträgerinnen und Beiträger dabei einen kommunikationsgeschichtlichen Zugang

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI