[Ethical aspects in the context of extracorporeal life support systems (ECLS): consensus paper of the DGK, DGTHG and DGAI].

Extracorporeal life support systems (ECLS) are life-sustaining measures for severe cardiovascular diseases, serving as bridging treatment either until cardiovascular function is restored or alternative treatment, such as heart transplantation or the implantation of permanent ventricular assist devices is performed. Given the insufficient evidence and frequent urgency of implantation without initial patient consent, the ethical challenges and psychological burden for patients, relatives and the interprofessional intensive care team are significant. As with any treatment, an appropriate therapeutic goal for ECLS treatment based on the indications and patient informed consent is mandatory.

Unloading, ablation, bridging and transplant: different indications and treatments using the Impella 5.5 as longer-term circulatory support in one patient-an interdisciplinary case report.

Background: In patients with cardiogenic shock the clinical treatment often involves temporary mechanical circulatory support for initial haemodynamic stabilization to enable further assessment of therapeutic strategies. The surgically implanted Impella 5.5 can be used for several indications like ventricular unloading, haemodynamic support during high-risk interventions, and as a bridge-to-transplant strategy.

Frequency stabilization of a terahertz quantum-cascade laser to the Lamb dip of a molecular absorption line.

We demonstrate the frequency stabilization of a terahertz quantum-cascade laser (QCL) to the Lamb dip of the absorption line of a DO rotational transition at 3.3809309 THz. To assess the quality of the frequency stabilization, a Schottky diode harmonic mixer is used to generate a downconverted QCL signal by mixing the laser emission with a multiplied microwave reference signal.

On the relationship between occlusion times and in-car glance durations in simulated driving.

Drivers have spare visual capacity in driving, and often this capacity is used for engaging in secondary in-car tasks. Previous research has suggested that the spare visual capacity could be estimated with the occlusion method. However, the relationship between drivers' occlusion times and in-car glance duration preferences has not been sufficiently investigated for granting occlusion times the role of an estimate of spare visual capacity.

Impact of diastolic pulmonary gradient and pulmonary artery pulse index on outcomes in heart transplant patients-Results from the Eurotransplant database.

Background: Predicting complications associated with pulmonary hypertension (PH) after cardiac transplantation is an important factor when considering cardiac transplantation. The transpulmonary gradient (TPG) is recommended to quantify PH in transplant candidates. Nonetheless, PH remains a common driver of mortality.

Blunt traumatic right coronary artery dissection presenting with second-degree atrioventricular block and late-onset severe cardiogenic shock.

Background: Blunt chest injury may induce several cardiovascular traumata, requiring immediate care. Right coronary artery dissection (RCA) is an extremely rare sequela in this setting and is associated with high mortality, if it remains undiagnosed. Case presentation We present the case of an RCA dissection after blunt chest trauma in a 16-year-old patient, who initially presented with a second-degree atrioventricular block as solitary manifestation on admission.

Assessment of final-year medical students' entrustable professional activities after education on an interprofessional training ward: A case-control study.

Introduction: Interprofessional training wards (ITWs) are implemented to provide medical students with a holistic and authentic health care experience to improve their clinical competencies. Controlled outcome studies assessing students' competencies after ITW-training are uncommon. In this case-control study, we assessed final-year medical students who received ITW-training regarding entrustable professional activities (EPAs) and communicative as well as social competencies.

Symptom burden, psychosocial distress and palliative care needs in heart failure - A cross-sectional explorative pilot study.

Background: Beyond guideline-directed treatments aimed at improving cardiac function and prognosis in heart failure (HF), patient-reported outcomes have gained attention.

Purpose: Using a cross-sectional approach, we assessed symptom burden, psychosocial distress, and potential palliative care (PC) needs in patients with advanced stages of HF.

Methods: At a large tertiary care center, we enrolled HF patients in an exploratory pilot study.

Single-dose of adrecizumab versus placebo in acute cardiogenic shock (ACCOST-HH): an investigator-initiated, randomised, double-blinded, placebo-controlled, multicentre trial.

Background: Cardiogenic shock has a high mortality on optimal therapy. Adrenomedullin is released during cardiogenic shock and is involved in its pathophysiological processes. This study assessed treatment with the humanised, monoclonal, non-neutralising, adrenomedullin antibody adrecizumab, increasing circulating concentrations of adrenomedullin in cardiogenic shock.

Drastic Effect of Sequential Deposition Resulting from Flux Directionality on the Luminescence Efficiency of Nanowire Shells.

Core-shell nanowire heterostructures form the basis for many innovative devices. When compound nanowire shells are grown by directional deposition techniques, the azimuthal position of the sources for the different constituents in the growth reactor, substrate rotation, and nanowire self-shadowing inevitably lead to sequential deposition. Here, we uncover for InGaAs/GaAs shell quantum wells grown by molecular beam epitaxy a drastic impact of this sequentiality on the luminescence efficiency.

Gender differences in characteristics and outcomes in heart failure patients referred for end-stage treatment.

Aims: Despite signals from clinical trials and mechanistic studies implying different resilience to heart failure (HF) depending on gender, the impact of gender on presentation and outcomes in patients with HF remains unclear. This study assessed the impact of gender on clinical presentation and outcomes in patients with HF referred to a specialised tertiary HF service.

Methods And Results: Consecutive patients with HF referred to a specialised tertiary HF service offering advanced therapy options including left ventricular assist devices (LVAD) and heart transplantation were prospectively enrolled from August 2015 until March 2018.

qSOFA Score Is Useful to Assess Disease Severity in Patients With Heart Failure in the Setting of a Heart Failure Unit (HFU).

There is no gold standard to predict outcome in acute decompensated heart failure (ADHF). Several scores for mortality prediction of patients with ADHF have been developed and mostly consist of complex regression models. None of these models has been widely adopted by clinicians.

Left Ventricular Assist Device Implantation and Concomitant Dor Procedure: a Single Center Experience.

Objective: Left ventricular assist device (LVAD) implantation with concomitant Dor plasty is only reported anecdotally. We herein aimed to describe our experience with LVAD and concomitant Dor procedures and describe long-term outcomes of this special subset of heart failure patients.

Methods: Between January/2010 and December/2018, 144 patients received LVAD therapy at our institution.

Expert Drivers' Prospective Thinking-Aloud to Enhance Automated Driving Technologies - Investigating Uncertainty and Anticipation in Traffic.

Current automated driving technology cannot cope in numerous conditions that are basic daily driving situations for human drivers. Previous studies show that profound understanding of human drivers' capability to interpret and anticipate traffic situations is required in order to provide similar capacities for automated driving technologies. There is currently not enough a priori understanding of these anticipatory capacities for safe driving applicable to any given driving situation.

Right heart failure before LVAD implantation predicts right heart failure after LVAD implantation - is it that easy?

Background: Right heart failure (RHF) after left ventricular assist device (LVAD) implantation is common and associated with worse outcome. Prediction of RHF remains challenging. Our study aims to assess predictors of RHF focusing on clinical manifestations.

Switching to Impella 5.0 decreases need for transfusion in patients undergoing temporary mechanical circulatory support.

Purpose: Various options of temporary mechanical circulatory support (tMCS) exist for the treatment of cardiogenic shock, however, all forms of tMCS carry a risk of complications. The aim of this study was to compare bleeding complications and thromboembolic events under extracorporeal life support + Impella 2.5/CP (ECMELLA) and isolated Impella 5.

Academic emotions during an interprofessional learning episode in a clinical context: assessing within- and between-variation.

Emotional experiences in the context of learning play an important role in the handling of learning processes. The aim of this study was to track participants' self-reported academic emotions using a momentary assessment design with 14 measurement points to identify patterns and emotional states. In a 2-week course, 35 medical and nursing students were assigned to work together in small groups and assess real cardiac patients' histories, treatment, and care.

Bridging INTERMACS 1 patients from VA-ECMO to LVAD via Impella 5.0: De-escalate and ambulate.

Purpose: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) stabilizes patients in refractory cardiogenic shock. However, ECMO-related complications strongly affect the outcome, especially if a long-term LVAD is needed.

Methods And Materials: We describe a new strategy in management of INTERMACS 1 patients consisting in early weaning from VA-ECMO with axillary Impella 5.

Application of the SCAI classification in a cohort of patients with cardiogenic shock.

Background: The Society of Cardiovascular Angiography and Interventions (SCAI) have recently proposed a new classification of cardiogenic shock (CS) dividing patients into five subgroups.

Objective: Aim of this study was to apply the SCAI classification to a cohort of patients presenting with CS and to evaluate its ability to predict 30-day survival.

Methods: SCAI CS subgroups were interpreted based on the recent consensus statement and then applied to N = 1,007 consecutive patients presenting with CS or large myocardial infarction (MI) between October 2009 and October 2017.

Frequency and power stabilization of a terahertz quantum-cascade laser using near-infrared optical excitation.

We demonstrate a technique to simultaneously stabilize the frequency and output power of a terahertz quantum-cascade laser (QCL). This technique exploits frequency and power variations upon near-infrared illumination of the QCL with a diode laser. It does not require an external terahertz optical modulator.

Absence of Quantum-Confined Stark Effect in GaN Quantum Disks Embedded in (Al,Ga)N Nanowires Grown by Molecular Beam Epitaxy.

Several of the key issues of planar (Al,Ga)N-based deep-ultraviolet light-emitting diodes could potentially be overcome by utilizing nanowire heterostructures, exhibiting high structural perfection, and improved light extraction. Here, we study the spontaneous emission of GaN/(Al,Ga)N nanowire ensembles grown on Si(111) by plasma-assisted molecular beam epitaxy. The nanowires contain single GaN quantum disks embedded in long (Al,Ga)N nanowire segments essential for efficient light extraction.

Impella 5.0 therapy as a bridge-to-decision option for patients on extracorporeal life support with unclear neurological outcomes.

Objectives: Peripheral venoarterial extracorporeal life support (ECLS) for the treatment of cardiogenic shock has shown to improve survival but is associated with complications. However, if the patient cannot be weaned from ECLS, their therapy options are limited. Although durable left ventricular assist device implantation might be an option in such cases, an unclear neurological outcome is often a contraindication.

Wideband, high-resolution terahertz spectroscopy by light-induced frequency tuning of quantum-cascade lasers.

Near-infrared optical excitation enables wideband frequency tuning of terahertz quantum-cascade lasers. In this work, we demonstrate the feasibility of the approach for molecular laser absorption spectroscopy. We present a physical model which explains the observed frequency tuning characteristics by the optical excitation of an electron-hole plasma.