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Background Data on Device-related Thrombus (DRT) after left atrial appendage closure (LAAC) remain scarce. This study aimed to investigate risk factors for DRT from centers reporting to the EUROC-DRT registry. Methods We included 537 patients (112 with DRT and 425 without DRT) who had undergone LAAC between 12/2008 and 04/2019. Baseline and implantation characteristics, anti-thrombotic treatment and clinical outcomes were compared between both groups in uni- and multivariate analyses. Additional propensity-score matching (PSM) was conducted to focus on the role of implantation characteristics. Results Patients with DRT showed higher rates of previous stroke/transient ischemic attack (TIA) (49.1% vs. 34.7%, p < 0.01), spontaneous echocardiographic contrast (SEC) (44.9% vs. 27.7%, p < 0.01) and lower left atrial appendage (LAA) peak emptying velocity (35.4 +/- 18.5 vs. 42.4 +/- 18.0 cm/s, p= 0.02). Occluders implanted in DRT patients were larger (25.5 +/- 3.8 vs. 24.6 +/- 3.5 mm, p =0.03) and implanted deeper in the LAA (mean depth: 7.6 +/- 4.7 vs. 5.7 +/- 4.7 mm, p

Background Germany is highly dependent on natural gas, the availability of which has become uncertain due to Russia's invasion of Ukraine. Biogas provision in Germany is realized by more than 9500 mainly farm-side biogas plants that have the potential to increase the security of gas supply. Main text To assess the potential contribution of biogas to a secure gas supply in Germany, we combine a literature-based analysis of the current status and potentials of the biogas supply chain with calculations of the marginal costs for producing biogas under the current market conditions. Biogas provided 50 TWh of final energy in Germany in 2021, primarily in the form of power and heat. The production of biomethane, which can in principle replace natural gas when fed into the gas grid, amounted to 10 TWh in terms of the lower heating value, which corresponds to a share of about 1% of the German gas market in 2021. However, at the end of 2021, biogas significantly contributed to the provided power (13 TWh or 22% of power supply from natural gas) combined with co-generated heat (13 TWh or 2% of heat supply from natural gas). Increasing flexible power provision from biogas is promising under the current power market conditions. In contrast, the current biogas substrate mix will lead to crucial limitations: 75% of the input into German biogas are energy crops, which are limited in availability under rising agricultural prices. Conclusions and recommendations In conclusion, biogas can only make up a small share of the current natural gas consumption. An immediate programme to mobilize the use of biogenic by-products, waste, and cultivated biomass without requiring additional land is recommended. We also propose measures to increase the flexibility of power production and heat use and more greenhouse gas-related incentives of biogas supply for the medium term. Finally, we see the need for additional efforts for non-food feedstock mobilization on a European scale by realizing the envisaged tenfold increase in the contribution of biomethane to a production goal of 35 billion cubic metres by 2030 in the REPower EU Plan of the European Commission.

Porous silica was synthesized from cornhusk using the sol–gel polymeric route and compared with ash obtained from the direct combustion process under laboratory conditions. The unmodified ash from the direct combustion process was dissolved in NaOH for 1 h to form sodium silicate, which was subsequently hydrolyzed with citric acid to yield a silica xerogel. The obtained xerogel was characterized using inductively coupled plasma–optical emission spectrometry (ICP-OES), Fourier transforms infrared (FTIR) spectroscopy, X-ray diffraction (XRD), simultaneous thermal analysis (STA), gas sorption techniques to determine their elemental constituents, functional groups, crystalline phases, thermal stability, and porosity, respectively. The results showed that the synthesized silica xerogel exhibited porous network structures with a high-specific surface area and mesopore volume of 384 m2/g and 0.35 cm3/g, respectively. The pore size distribution revealed a complete transformation of the pore network structures of the unmodified ash from a monomodal to a bimodal pore system, with micro- and mesopore peaks centered around 1.5 and 3.8 nm, respectively. The ICP-OES results showed that the silica content significantly increased from 52.93 to 91.96 wt.% db after the sol–gel treatment. XRD diffraction confirmed the amorphicity of the silica particles obtained from the sol–gel extraction method. In addition, the STA data showed that the silica xerogel has high thermal stability compared to the unmodified ash, as the latter exhibited poor thermal stability and low textural properties. The high surface area and narrow pore cavity size distribution of the porous silica xerogel make it an ideal substrate for catalysts and an excellent template for growing other nanoparticles within the pores.

Nowadays, Tunisia faces challenging environmental and energy issues which relate mainly to the implementation of an appropriate solid waste management system capable of dealing with the high production of biowaste on the one hand, and the increased need for water and energy resources on the other. Therefore, the current study is intended to develop a closed cycle technical concept treating mainly food waste (FW) through combined biological processes. In this approach, FW anaerobic digestion (AD) was destined to provide a valuable input material for FW in vessel-composting by exploiting the produced digestates. To this end, the gathered AD-effluents of three systems (D1, D2, D3) were entirely analyzed to select, as a further step, the most suitable one to be subject of the suggested post-treatment. Hence, several physiochemical parameters were examined as key performance indicators. It mainly consisted of moisture content, pH, C:N ratio and heavy metals contents. The current findings depicted that the generated digestates were characterized by a high moisture content which inspired its utilization as an unconventional moisturizing agent (MA) aiming to reduce the fresh water consumption during the composting process. Thus, two experimental setups were carried out to evaluate the effect of the selected digestate on FW-in-vessel composting process performance, as a non-standard MA inserted to A2, comparing to the unamended one (A1) which was moistened by fresh water. In fact, basing on the above-mentioned criteria, the relatively high C:N ratio (of around 15), as well as the relatively significant rate of the required macro- and micro-nutrients promoted the exploitation of biochar-rich digestate (D3) as not only an efficient unconventional MA, but also as a composting process booster. Furthermore, the results revealed that the addition of D3 improved significantly the composting process performance in terms of steering parameters including the attained temperature, MC and pH. When it comes to the maturity and stability assessment, the decreased profiles of C:N ratio, the nitrification index (NI), as well as the respiration activity (AT4) ascertained the fulfilment of the required conditions for both A1 and A2 to produce stable and mature end-products. However, regarding the compost quality, the examined concentrations of heavy metals met the requirement set by German standards and attested that both A1 and A2 generated highly-qualified products, rated as class B and A, respectively. Furthermore, it is noteworthy to mention that even the AD-effluents which were classified as an “inappropriate substrate” to be inserted to the composters, met the required criteria to be applied directly to land as a highly-qualified liquid biofertilizer. This latter ascertained, additionally, the efficiency and feasibility of the suggested closed cycle for a sustainable FW management. Graphic Abstract

ZusammenfassungDer Veterans RAND 12-Item Health Survey (VR-12) wurde als Selbstbeurteilungsverfahren zur Erfassung gesundheitsbezogener Lebensqualität 2016 in den Deutschen Schmerzfragebogen (DSF) aufgenommen und ersetzt den bis dahin verwendeten lizenzpflichtigen SF-12. Beide Verfahren haben 12 Items und führen zu einer körperlichen und einer psychischen Summenskala. Auswertungen der deutschen Version mit größerer Stichprobe zu Kennwerten und zur teststatistischen Güte des VR-12 bei Patienten mit chronischem Schmerz fehlen bislang.Daten zum VR-12 und weiterer Verfahren des DSF wurden von 11.644 Patienten aus 31 an KEDOQ-Schmerz beteiligten Zentren ausgewertet. Die Patienten hatten den DSF vor Beginn einer angestrebten schmerztherapeutischen Behandlung ausgefüllt. Die Bestimmung der Änderungssensitivität erfolgte für 565 Patienten, für die der VR-12 aus einem Verlaufsfragebogen des DSF mehrere Monate nach der Ersterhebung vorlag.Die Reliabilität (Cronbachs Alpha) der körperlichen Summenskala war rtt = 0,78 und für die psychische Summenskala rtt = 0,84. Die psychische Summenskala wies deutliche Beziehungen zu den Depression-Angst-Stress-Skalen (DASS) auf (r = −0,51 bis r = −0,72), die körperliche Summenskala korrelierte höher mit Bereichen schmerzbedingter Beeinträchtigungen (r = −0,48 bis r = −0,52). Patienten mit höherer Schmerzchronifizierung, solche mit höherem Schmerz-Schweregrad und solche mit Hinweis auf hohe psychische Belastung beschrieben in beiden Summenskalen signifikant geringere gesundheitsbezogene Lebensqualität. Die Effektstärke (ES) der Veränderung im Sinne einer Verbesserung der gesundheitsbezogenen Lebensqualität war in der psychischen Summenskala ES = 0,33 und in der körperlichen Summenskala ES = 0,51.Die Ergebnisse sind in Übereinstimmung zu Befunden zum SF-36 bzw. SF-12 bei anderen Patientenkollektiven mit chronischem Schmerz. Sie zeigen zusammengefasst, dass mit dem VR-12 ein angemessener Ersatz zum SF-12 im Deutschen Schmerzfragebogen integriert wurde.

Solid waste management and disposal is one of the most significant challenges facing urban communities around the world. There is a wide range of alternative waste management options and strategies available for dealing with the notable increase in the waste stream. Composting is one of the most viable and efficient waste treatment options in terms of the reduction in the negative effects from the application of organic waste to soil. The experimental research aimed to examine the potential of producing compost from different organic waste streams in Tunisia. Two experimental windrow piles made from cooked and uncooked food and garden wastes were initiated and temporally monitored. The composting process was controlled in terms of temperature and moisture. Sampling was carried out over the period of the composting process. All of the collected samples were analyzed in terms of their physical, chemical, and biological properties; pH, C:N ratio, nitrification index (NI), microbiological tests, respiration activity (AT4), and heavy metal content. The quality of the final product was determined and compared with Tunisian and German standards. The findings demonstrated a significant reduction in the initial C:N ratio to about 15 by the end of the process. Additionally, the results showed that the compost produced appeared to be stable and was deemed to be class V finished compost; the NI was found to be around 1, while the AT4 was estimated to be lower than 6 mg O2/g TS. Regarding the heavy metal content, the final products were characterized as having a lower concentration than those values set by Tunisian and German standards.

In the short- and mid-term perspective, drastic measures for the reduction of anthropogenic emissions including extensive decarbonization of the residential and industrial heating sector have to be implemented. To replace fossil fuels, solid biogenic residues and wastes will have to be increasingly utilized. Compared to clean woody biomass, these biomass assortments are commonly characterized by higher Si and alkaline metal contents recognized as major driver for low ash melting temperatures resulting in elevated risk of bottom ash slagging. To facilitate the prediction of bottom ash slagging during combustion, several fuel indices have been proposed. Based on empirical correlations with parameters relevant for slagging behavior, e.g., ash melting temperatures or slag fraction of the bottom ash, these fuel indices were subsequently enhanced and adapted for an increasing range of biomass fuel characteristics. In this study, analysis data of 26 woody and non-woody fuels and experimental data derived from two combustion test campaigns with an automatically stoked small-scale boiler were investigated through principal component analysis. Thus, the complex interdependencies between the fuel composition and the resulting bottom ash characteristics and the applicability of existing fuel indices were evaluated. The chemometric analysis highlighted that Si, Ca, K, Mg, and also the remaining Al and S in the bottom ash are crucial fuel components in the context of bottom ash melting. On this basis, the molar ratio (Si + P + K)/(Ca + Mg) was adapted and correlated with the susceptibility to slag formation which is a new parameter derived from ash content, slag fraction > 16 mm in the bottom ash, and slag category. Thus, the applicability of a newly developed fuel index was evaluated with respect to the bottom ash slagging risk during real-scale combustion. Three ranges were distinguished for the fuel index corresponding to a specific susceptibility to slag formation (i.e., low 75 mol/g for straw-like fuels and blends with wood). The linear regression of the fuel index with susceptibility to slag formation exhibits a high coefficient of determination (i.e., 0.99 for woody biomass and 0.84 for straw-like fuels and their blends with wood).

Tunisia is one of the developing countries which faces crucial challenges, the most prominent of which are the production of organic waste, the need for an appropriate waste treatment, and the demand for water and energy conservation. To this end, the present research was designed to develop a technical concept on closed cycle “biowaste to bioenergy” treating food waste (FW) through combined biological processes. In this approach, semi-continuous anaerobic co-digestion (ACoD) of FW, wheat straw (WS), and cattle manure (CM) was tested to investigate the relationship between the effect of the feedstock mixtures and C:N ratio on biogas and digestate generation at different organic loading rates (OLRs) ranging from 2 to 3.6 kg VS/m3.d. Results showed that the mono-digested FW was optimal and reached 565.5 LN/kg VSin at an OLR of 2.4 kg VS/m3.d, and then a drop of biogas production was recorded. However, for co-digested substrates, the optimum mixture ratio was FW:CM 75:25, where 62%, 39.89%, 91.26%, 130.9%, and 119.97% of the biogas yield improved for OLRs ranging from 2 to 3.6 kg VS/m3.d, respectively. Admittedly, the target of this work was to enhance the ACoD process, but it also examined the exploitation of different AD effluents. Therefore, special attention was paid to the generated digestates to decide how it can be efficiently upcycled later. Thus, the closed cycle “biowaste to bioenergy” treatment met two of the major Tunisian concerns: efficient organic waste management and sustainable bioenergy production.

In Tunisia, there are crucial challenges facing both urban and rural areas, the most prominent of which are the production of organic waste, the need for waste treatment, the demand for water and energy and the need for a circular economy. To this end, the study was designed to develop a technical concept on closed cycle ‘biowaste to bioenergy’ treating, basically food waste (FW) through combined biological processes. In this approach, the generated digestate from FW anaerobic reactors was used successfully as a moisturizing agent for FW in-vessel composting. Four types of digestate were examined to be used as moisturizing agent (MA). The selection of the appropriate MA was achieved based on technical criteria; moisture content (MC), C:N ratio and heavy metals concentrations. The findings showed that the digestate obtained from anaerobic co-digestion of food waste and wheat straw (D1) was the most efficient AD-effluent to be added. In terms of composting process performance, the thermophilic phase of the amended reactor (A1) lasted 16 days and reached higher temperatures of about 72 °C, while the unamended one (A1) was characterized by a thermophilic temperature of around 66 °C indicating that the end products were of a pathogen-free compost. When it comes to the physico-chemical factors examined demonstrating that the biological conditions were sufficiently developed. The findings showed overall decreasing profiles during the composting period for moisture, C:N ratio as well as nitrification index (NI). From the quality-point of view, it was found that heavy metal concentrations had lower limits than those values set by German standards. Moreover, all the compost samples appeared to be stable and classified as class IV and V end product.

Wood chip quality is essential for failure-free and low-emission combustion in automatically stoked small-scale biomass boilers (

Adoptive cell therapy using autologous tumor-infiltrating lymphocytes (TIL) has shown significant clinical benefit, but is limited by toxicities due to a requirement for post-infusion interleukin-2 (IL-2), for which high dose is standard. To assess a modified TIL protocol using lower dose IL-2, we performed a single institution phase II protocol in unresectable, metastatic melanoma. The primary endpoint was response rate. Secondary endpoints were safety and assessment of immune correlates following TIL infusion. Twelve metastatic melanoma patients were treated with non-myeloablative lymphodepleting chemotherapy, TIL, and low-dose subcutaneous IL-2 (125,000 IU/kg/day, maximum 9-10 doses over 2 weeks). All but one patient had previously progressed after treatment with immune checkpoint inhibitors. No unexpected adverse events were observed, and patients received an average of 6.8 doses of IL-2. By RECIST v1.1, two patients experienced a partial response, one patient had an unconfirmed partial response, and six had stable disease. Biomarker assessment confirmed an increase in IL-15 levels following lymphodepleting chemotherapy as expected and a lack of peripheral regulatory T-cell expansion following protocol treatment. Interrogation of the TIL infusion product and monitoring of the peripheral blood following infusion suggested engraftment of TIL. In one responding patient, a population of T cells expressing a T-cell receptor Vβ chain that was dominant in the infusion product was present at a high percentage in peripheral blood more than 2 years after TIL infusion. This study shows that this protocol of low-dose IL-2 following adoptive cell transfer of TIL is feasible and clinically active. (ClinicalTrials.gov identifier NCT01883323.).

Within six case studies, different drying and sieving process steps were employed for the removal of adhering soil and other extraneous impurities from wood chips. Consequently, it was systematically investigated to which extent this strategy can be used to jointly mitigate the risk of bottom ash slagging and high pollutant emission levels during combustion in an automatically stoked small-scale boiler. Throughout all combustion tests, slag and emission formation were recorded. Formation of agglomerates in the bottom ash was not observed in the fuel bed. However, fuel processing resulted in an increase of the ash shrinking–softening range up to 230 K indicating a lower slagging risk in the bottom ash. An asymptotic trend for the ash melting temperatures was observed as a function of the molar (Si + P + K)/(Ca + Mg) ratio. It was also found that potassium is less efficiently retained in the bottom ash with lower Si content in the fuel. Lower moisture contents in the wood chips typically resulted in lower CO emissions and higher boiler efficiencies for the investigated range of moisture content. The sieving of the unprocessed wood chips reduced NOx emission levels up to 28%. However, fuel processing did not necessarily reduce the level of particulate matter emissions.

The aim of this study was to establish in vitro bench-tests of left atrial appendage occlusion (LAAo) devices regarding tug force, radial force and sealing capacity. Two LAAo devices, namely the WATCHMAN™ and the Occlutech®, of three different sizes underwent testing in novel dedicated in vitro setups. Radial force was assessed in a commercial radial force tester. At baseline, tug force of the WATCHMAN™ was significantly higher when compared to Occlutech® for all devices. Repeated resheathing resulted in a reduction of device-diameter in the WATCHMAN™ devices of max. 7.9%, whereas diameters of Occlutech® occluders remained unchanged. Tug force was not significantly impacted by resheathing in both devices. At baseline, sealing capacity in a bench-test using silicone LAA-models did not differ between the devices. Resheathing lead to an in vitro loss of sealing capacity of the WATCHMAN™ devices, increasing with resheathing and resulting in a max. peridevice leak of 91.1 ± 7.9%. Radial force was higher for the Occlutech® devices and decreased for WATCHMAN™ occluders after resheathing. The WATCHMAN™ occluder series showed progressive deformation, increased peridevice leakage and decreased radial force after resheathing, presumably as a result of diameter reduction. Tug force of the WATCHMAN™ was not impaired by resheathing and was significantly higher than that of the Occlutech® device.

To describe percutaneous left atrial appendage closure (LAAc) in a patient with recurrent gastric ulcer bleeding with the help of the TrueFusion™ fusion-imaging system. In a patient with paroxysmal atrial fibrillation, the need for an effective oral anticoagulation and recurrent gastrointestinal bleeding, left atrial appendage closure (LAAc) was performed under guidance of the TrueFusion™ fusion-imaging technology (Siemens Healthineers, Erlangen, Germany) to enhance procedural precision, save radiation time and contrast dye. Left atrial appendage closure was performed with the use of a 20 mm Amplatzer Amulet™ (Abbott Laboratories, Chicago, IL, USA) using the TrueFusion™ system under mild sedation with minimal use of contrast. Intraprocedural transesophageal echocardiography revealed complete LAA occlusion without residual flow. The patient was uneventfully discharged on the second postoperative day. LAAc using an integrated approach combining ultrasound and live fluoroscopy, as provided by the TrueFusion™, is safe and feasible. Target-oriented device navigation and synchronized image orientation as provided by fusion imaging may potentially be beneficial regarding radiation time, contrast dye and periprocedural risk of suboptimal device positioning.