von Jürgen Beck ; Christian Fung ; Daniel Strbian ; Lukas Bütikofer ; Werner J. Z'Graggen ; Matthias F. Lang ; Seraina Beyeler ; Jan Gralla ; Florian Ringel ; Karl Schaller ; Nikolaus Plesnila ; Marcel Arnold ; Werner Hacke ; Peter Jüni ; Alexander David Mendelow ; Christian Stapf ; Rustam Al-Shahi Salman ; Jenny Bressan ; Stefanie Lerch ; Arsany Hakim ; Nicolas Martinez-Majander ; Anna Piippo-Karjalainen ; Peter Vajkoczy ; Stefan Wolf ; Gerrit A. Schubert ; Anke Höllig ; Michael Veldeman ; Roland Rölz ; Andreas Gruber ; Philip Rauch ; Dorothee Wachter ; Veit Rohde ; Thomas Kerz ; Eberhard Uhl ; Enea Thanasi ; Hagen B. Huttner ; Bernd Kallmünzer ; L. Jaap Kappelle ; Wolfgang Deinsberger ; Christian Roth ; Robin Lemmens ; Jan Leppert ; Jose L. Sanmillan ; Jonathan M. Coutinho ; Katharina Hackenberg ; Gernot Reimann ; Mikael Mazighi ; Claudio L. A. Bassetti ; Heinrich P. Mattle ; Andreas Raabe ; Urs Fischer
BACKGROUND: It is unknown whether decompressive craniectomy improves clinical outcome for people with spontaneous severe deep intracerebral haemorrhage. The SWITCH trial aimed to assess whether decompressive craniectomy plus best medical treatment in these patients improves outcome at 6 months compared to best medical treatment alone. METHODS: In this multicentre, randomised, open-label, assessor-blinded trial conducted in 42 stroke centres in Austria, Belgium, Finland, France, Germany, the Netherlands, Spain, Sweden, and Switzerland, adults (18-75 years) with a severe intracerebral haemorrhage involving the basal ganglia or thalamus were randomly assigned to receive either decompressive craniectomy plus best medical treatment or best medical treatment alone. The primary outcome was a score of 5-6 on the modified Rankin Scale (mRS) at 180 days, analysed in the intention-to-treat population. This trial is registered with ClincalTrials.gov, NCT02258919, and is completed. FINDINGS: SWITCH had to be stopped early due to lack of funding. Between Oct 6, 2014, and April 4, 2023, 201 individuals were randomly assigned and 197 gave delayed informed consent (96 decompressive craniectomy plus best medical treatment, 101 best medical treatment). 63 (32%) were women and 134 (68%) men, the median age was 61 years (IQR 51-68), and the median haematoma volume 57 mL (IQR 44-74). 42 (44%) of 95 participants assigned to decompressive craniectomy plus best medical treatment and 55 (58%) assigned to best medical treatment alone had an mRS of 5-6 at 180 days (adjusted risk ratio [aRR] 0·77, 95% CI 0·59 to 1·01, adjusted risk difference [aRD] -13%, 95% CI -26 to 0, p=0·057). In the per-protocol analysis, 36 (47%) of 77 participants in the decompressive craniectomy plus best medical treatment group and 44 (60%) of 73 in the best medical treatment alone group had an mRS of 5-6 (aRR 0·76, 95% CI 0·58 to 1·00, aRD -15%, 95% CI -28 to 0). Severe adverse events occurred in 42 (41%) of 103 participants receiving decompressive craniectomy plus best medical treatment and 41 (44%) of 94 receiving best medical treatment. INTERPRETATION: SWITCH provides weak evidence that decompressive craniectomy plus best medical treatment might be superior to best medical treatment alone in people with severe deep intracerebral haemorrhage. The results do not apply to intracerebral haemorrhage in other locations, and survival is associated with severe disability in both groups. FUNDING: Swiss National Science Foundation, Swiss Heart Foundation, Inselspital Stiftung, and Boehringer Ingelheim.
The lancet London [u.a.] : Elsevier, 1823 403(2024), 10442 vom: Juni, Seite 2395-2404 Online-Ressource
von Davide Farnocchia ; Vishnu Reddy ; James M. Bauer ; Elizabeth M. Warner ; Marco Micheli ; Matthew J. Payne ; Tony Farnham ; Michael S. Kelley ; Miguel R. Alarcon ; Paolo Bacci ; Roberto Bacci ; Mauro Bachini ; Kevin Baillié ; Giorgio Baj ; Daniel Bamberger ; Anatoly P. Barkov ; Stefan Beck ; Guido Betti ; Enrico Biancalani ; Bryce T. Bolin ; David Briggs ; Luca Buzzi ; Haowen Cheng ; Eric Christensen ; Alessandro Coffano ; Luca Conversi ; Christophe Demeautis ; Larry Denneau ; Josselin Desmars ; Anlaug A. Djupvik ; Leonid Elenin ; Paolo Fini ; Tobias Felber ; Randy Flynn ; Gianni Galli ; Mikael Granvik ; Bill Gray ; Zuri Gray ; Luca Grazzini ; Werner Hasubick ; Tobias Hoffmann
Ensemble perturbation smoother for optimizing tidal boundary conditions by assimilation of High-Frequency radar surface currents : application to the German Bight
von Alexander Barth ; Aida Alvera-Azcárate ; Klaus-Werner Gurgel
An der Universität Oldenburg ist in etlichen Arbeiten im Labormaßstab an der Entwicklung eines Verfahrens zur Verwertung kommunaler Klärschlämme gearbeitet worden. Die angewandte thermische Behandlung umfaßte einen Pyrolyeschritt bei 600ʿC mit dem Ziel der Gewinnung von Ölen, die eine Basis für die Gewinnung von Chemierohstoffen bieten. Die festen Rückstände wurden einer anschließenden Wasserdampfvergasung bei 900ʿC unterzogen. Die Übertragbarkeit auf andere Stoffe wurde für Abfallholz sowie Linoleumabfall bei einer Pyrolysetemperatur von 500ʿC getestet. Zur Stabilisierung der zuvor genannten Öle wurden die Pyrolysegase im heißen Zustand - nach Filtration - durch einen Katalysator bei 450ʿC gecrackt. Die Wirbelschichttechnik wurde für die Pyrolyse und die Vergasung eingesetzt. Die heißen Prozeßgase wurden einer Heißgasfiltration unterzogen. Die energiedispersive Röntgenfluoreszenzanalyse liefert für die festen Rückstände aus Pyrolyse und Vergasung die elementare Zusammensetzung. Die Effektivität der Filtration wird durch die quantitative Zurückhaltung vieler Elemente in den festen Rückständen belegt. <dt.>
At the Carl-von-Ossietzky University of Oldenburg a thermal process has been developed to reuse communal sewage sludge. The thermal process applied consists of a pyrolytic step working at temperatures of 600ʿC which yields oils. These oils may be used as chemical feed stock. Solid residues are gasified in a steam gasification working at temperatures around 900ʿC. To find out if this process can be applied to other waste material, waste wood and used linoleum have been processed in the same way but at a pyrolysis temperature of 500ʿC. To stabilise the resulting oils from pyrolysis a catalyst has been used to crack the hot pyrolysis vapours at temperatures of 450ʿC. The feed and resulting solid products were investigated with energy dispersive X-ray fluorescence. Fluidized bed technique was applied for the pyrolysis and the gasification. The hot gases were filtered with a sintered metal disc. The efficiency of the hot gas filtration could be verified by the fact that many elements were quantitatively retained in solid residues. <engl.>
