Syntheses of Azaborine Polymers and Optimisation of Precursor Syntheses

On the route to 1,2-azaborines, secondary allylamines were needed as starting materials. For the syntheses of these allylamines, the reduction of allylamides by lithium aluminium hydride is a common method. However, the application of reported procedures led to an unexpected attack of the unactivated nonpolar double bond and, consequently, to a separation problem of product and by-product. Therefore, an in-depth investigation of the mechanism and an optimisation of the reaction conditions were performed. Towards the synthesis of monomers for conjugated 1,2-azaborine polymers, the aromatisation (oxidative dehydrogenation) to 1,2-azaborines emerged to be the bottleneck reaction with only moderate conversion. Consequently, an optimisation of the reaction conditions was performed which led to an improvement, but also revealed inherent limitations due to a fast catalyst deactivation by the aryl bromide substituent. Since the aromatisation to the N-methylated azaborine led to nearly full conversion and a feasible isolation, N-methyl-B-vinylazaborine was successfully synthesised. A following free radical polymerisation resulted in a novel poly(vinylazaborine) – a new B-N analogue of polystyrene. Furthermore, a copolymerisation with the C-C analogue (2-methylstyrene) led to the first copolymer of its type. A thorough comparison of the polymers by NMR spectroscopy, thermogravimetry, differential scanning calorimetry, gel permeations chromatography, UV-Vis spectroscopy and infrared spectroscopy showed significant differences of their physical and chemical properties.Eine essentielle Komponente für die Synthese von 1,2-Azaborinen ist sekundäres Allylamin. Um dieses herzustellen, ist die Reduktion von Allylamiden mit Hilfe von Lithiumaluminiumhydrid eine gängige Methode. Die Anwendung von literaturbekannten Vorschriften führte allerdings zu einem Angriff auf die nicht aktivierte, unpolare Doppelbindung. Daraus resultierte ein Problem in der Separation von Produkt und Nebenprodukt. In Folge dessen wurden eine detaillierte Untersuchung des Mechanismus und eine Optimierung der Reaktionsbedingungen für die Synthese von Allylaminen durchgeführt. Bei der Synthese der Monomere für konjugierte 1,2-Azaborin-Polymere stellte sich die Aromatisierung (oxidative Dehydrogenierung) zu 1,2-Azaborinen als Nadelöhr-Reaktion mit mä-ßiger Umsetzung heraus. Eine Optimierung der Reaktionsbedingungen führte zwar zur Verbesserung der Umsetzung, aber durch die schnelle Desaktivierung durch den Arylbromid-Substitutent auch zur Limitierung von Palladium als Katalysator dieser Reaktion. Da allerdings die Aromatisierung zum N-methylierten Azaborin zu einer nahezu vollständigen Umsetzung führte und eine erfolgreiche Isolierung ermöglichte, konnte das N-Methyl-B-vinylazaborin synthetisiert werden. Eine anschließende freie radikalische Polymerisation ergab ein neuartiges Poly(vinylazaborin) – ein neues B-N-Analogon von Polystyrol. Darüber hinaus wurde das erste Copolymer seiner Art durch die Copolymerisation mit dem C-C-Analogon (2-Methylstyrol) erfolgreich hergestellt. Ein sorgfältiger Vergleich der Polymere mit Hilfe von NMR-Spektroskopie, Thermogravimetrie, dynamischer Differenzkalorimetrie, Gel-Permeations-Chromatographie, UV/Vis-Spektroskopie und IR-Spektroskopie zeigte signifikante Unterschiede der Eigenschaften

Untersuchungen zur Häufigkeit von Schlafstörungen und deren Einfluss auf das Rehabilitationsergebnis in der geriatrischen und neurologischen Rehabilitation : eine prospektive Studie

Sleep disorders, especially Insomnia, sleep apnea syndrome and sleep related movement disorders are relevant in the elderly and are often correlated to somatic and psychiatric disorders (Happe 2011). Aim of this prospective study was Primary to investigate the effect of restful/ restless sleep to the rehabilitation-outcome during a geriatric or neurological rehabilitation and secondary to identify other parameters having an effect on the rehabilitation-outcome. Overall 678 geriatric subjects and geriatric subjects with a neurological principal diagnosis participated successfully. Subjects were interviewed 1-3 days (visit 1) and 3 weeks (visit 2) after entering the rehabilitation clinic to sleep disorders, sleep quality as well as to physical and psychic conditions by using several questionnaires. Additionally objective parameters from the medical report were used. Results reveal that sleep quality (questionnaire: PSQI) does not have an effect on the rehabilitation-outcome of geriatric subjects directly. But this study featured other parameters like daytime sleepiness (EES) as well as mental and psychical parameters (age, sub items of the IADL and SF-36) do have an significant effect. Interpretation of these results could be that other parameters like age, daytime sleepiness as well as mental and physical conditions have more effect on the rehabilitation-outcome than sleep quality itself. But the fact that these parameters are linked to sleep quality can be a hint that sleep quality can have a more indirect effect on the rehabilitation-outcome

Necessity of Immediate MRI Imaging in the Acute Care of Severely Injured Patients

Background and Objectives: The standard diagnostic procedure for a patient with a suspected polytrauma injury is computed tomography (CT). In individual cases, however, extended acute imaging using magnetic resonance imaging (MRI) can provide valuable and therapy-relevant information. The aim of our cohort study was to find such cases and to describe their characteristics in order to be able to give possible recommendations for MRI application in acute trauma situations. Materials and Methods: In the study period from 2015–2019, an evaluation of the imaging performed on polytrauma patients was carried out. The specific diagnostic and therapeutic criteria of the MRI group were further defined. Results: In total, 580 patients with an ISS ≥16 (injury severity score) were included in the study. Of these 580 patients, 568 patients received a CT scan and 12 patients an MRI scan as part of the initial diagnostic. Altogether, 66.67% of the MRIs took place outside of regular service hours. The main findings for MRI indications were neurological abnormalities with a focus on myelon injuries. Further MRI examinations were performed to rule out vascular injuries. All in all, 58.3% of the MRIs performed resulted in modified therapeutic strategies afterward. Conclusions: MRI in the context of acute diagnostic of a severely injured patient will likely remain reserved for special indications in the future. However, maximum care hospitals with a high flow of severely injured patients should provide 24/7 MR imaging to ensure the best possible care, especially in neurological and blunt vascular injuries

Diaphragmatic Injuries among Severely Injured Patients (ISS ≥ 16)—An Indicator of Injury Pattern and Severity of Abdominal Trauma

Background and Objectives: Abdominal trauma among severely injured patients with an injury severity score (ISS) of 16 and above can lead to potentially life-threatening injuries that might need immediate surgical intervention. Traumatic injuries to the diaphragm (TID) are a challenging condition often accompanied by other injuries in the thoracoabdominal region. Materials and Methods: We retrospectively analyzed the occurrence and clinical course of TID among severely injured patients treated at our center between 2008 and 2019 and compared them to other groups of severely injured patients without TID. Results: Thirty-five patients with TID and a median ISS of 41 were treated in the period mentioned above. They were predominantly middle-aged men and mostly victims of blunt trauma as a consequence of motor vehicle accidents. A total of 70.6% had left-sided TID, and in 69.6%, the size of defect was larger than 10 cm. The diagnosis was made with computed tomography (CT) in 68.6% of the cases, while in 25.8%, it was made intraoperatively or delayed by a false-negative initial CT scan, and in 5.7%, an intraoperative diagnosis was made without preoperative CT imaging. Surgical repair was mostly conducted via laparotomy, performing a direct closure with continuous suture. A comparison to 191 patients that required laparotomy for abdominal injuries other than TID revealed significantly higher rates of concomitant injuries to several abdominal organs among patients suffering from TID. Compared to all other severely injured patients treated in the same period (n = 1377), patients suffering from TID had a significantly higher median ISS and a longer mean duration of hospital stay. Conclusions: Our findings show that TID can be seen as an indicator of particularly severe thoracoabdominal trauma that requires increased attention from the treatment team so as not to miss relevant concomitant injuries that require immediate intervention

The implications of autonomy: Viewed in the light of efforts to uphold patients dignity and integrity

This article focuses on Danish patients’ experience of autonomy and its interplay with dignity and integrity in their meeting with health professionals. The aim is to chart the meanings and implications of autonomy for persons whose illness places them in a vulnerable life situation. The interplay between autonomy and personal dignity in the meeting with health care staff are central concepts in the framework. Data collection and findings are based on eight qualitative semi-structured interviews with patients. Patients with acute, chronic, and life threatening diseases were represented including surgical as well as medical patients. The values associated with autonomy are in many ways vitalising, but may become so dominant, autonomy seeking, and pervasive that the patient's dignity is affected. Three types of patient behaviour were identified. (1) The proactive patient: Patients feel that they assume responsibility for their own situation, but it may be a responsibility that they find hard to bear. (2) The rejected patient: proactive patients take responsibility on many occasions but very active patients are at risk of being rejected with consequences for their dignity. (3) The knowledgeable patient: when patients are health care professionals, the patient's right of self-determination was managed in a variety of ways, sometimes the patient's right of autonomy was treated in a dignified way but the opposite was also evident. In one way, patients are active and willing to take responsibility for themselves, and at the same time they are “forced” to do so by health care staff. Patients would like health professionals to be more attentive and proactive

Investigation to the prevalence of sleep disorders and its effect on the rehabilitation-outcome during a neurological and geriatric rehabiliation : a prospective study

Sleep disorders, especially Insomnia, sleep apnea syndrome and sleep related movement disorders are relevant in the elderly and are often correlated to somatic and psychiatric disorders (Happe 2011). Aim of this prospective study was Primary to investigate the effect of restful/ restless sleep to the rehabilitation-outcome during a geriatric or neurological rehabilitation and secondary to identify other parameters having an effect on the rehabilitation-outcome. Overall 678 geriatric subjects and geriatric subjects with a neurological principal diagnosis participated successfully. Subjects were interviewed 1-3 days (visit 1) and 3 weeks (visit 2) after entering the rehabilitation clinic to sleep disorders, sleep quality as well as to physical and psychic conditions by using several questionnaires. Additionally objective parameters from the medical report were used. Results reveal that sleep quality (questionnaire: PSQI) does not have an effect on the rehabilitation-outcome of geriatric subjects directly. But this study featured other parameters like daytime sleepiness (EES) as well as mental and psychical parameters (age, sub items of the IADL and SF-36) do have an significant effect. Interpretation of these results could be that other parameters like age, daytime sleepiness as well as mental and physical conditions have more effect on the rehabilitation-outcome than sleep quality itself. But the fact that these parameters are linked to sleep quality can be a hint that sleep quality can have a more indirect effect on the rehabilitation-outcome