Differential diagnosis of hypoglycemia in the non-diabetic adult patient is complex and comprises various diseases, including endogenous hyperinsulinism caused by functional β-cell disorders. The ...latter is also designated as nesidioblastosis or non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS). Clinically, this rare disease presents with unspecific adrenergic and neuroglycopenic symptoms and is, therefore, often overlooked. A combination of careful clinical assessment, oral glucose tolerance testing, 72 h fasting, sectional and functional imaging, and invasive insulin measurements can lead to the correct diagnosis. Due to a lack of a pathophysiological understanding of the condition, conservative treatment options are limited and mostly ineffective. Therefore, nearly all patients currently undergo surgical resection of parts or the entire pancreas. Consequently, apart from faster diagnosis, more elaborate and less invasive treatment options are needed to relieve the patients from the dangerous and devastating symptoms. Based on a case of a 23-year-old man presenting with this disease in our department, we performed an extensive review of the medical literature dealing with this condition and herein presented a comprehensive discussion of this interesting disease, including all aspects from epidemiology to therapy.
Neurovegetative and autonomic symptoms are common presentations of various diseases, ranging from psychosomatic to severe organic disorders. A 23-year-old man presented with a history of recurrent ...presyncope, dizziness, and tachycardia. Repeated diagnostic work-up in various clinical settings could not identify any definite cause for approximately eight years. However, the incidental detection of postprandial and exercise-induced hypoglycemia was suggestive of an insulin-related disorder. A 72 h plasma glucose fasting test revealed endogenous hyperinsulinism. Upon imaging studies, no tumor mass potentially indicating insulinoma could be detected.
Ga-DOTA-Exendin-4 PET/CT showed diffuse tracer enrichment throughout the whole pancreas. A subtotal pancreatectomy was performed, and the diagnosis of diffuse, adult-onset nesidioblastosis was established histopathologically. This corresponds to the clinical findings of a functional β-cell disorder, also known as non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS). After nine months, the symptoms recurred, making complete pancreatectomy necessary. Postoperative laboratory evaluation exhibited no residual endogenous C-peptide production. This case illustrates the diagnostic challenges in patients presenting with unspecific, neurovegetative and autonomic symptoms with a severe and rare underlying cause.
► A mechanical model is established for the detailing and design of post-strengthening measures for in-plane-loaded masonry walls with FRP materials. ► The model consists of three steps and covers ...load transfer within the structure, anchoring and bond. ► Ninety-one bonding tests were carried out with seven types of bricks and blocks to examine failure modes and the bonding strength. ► 24 anchoring tests overall on two different types of masonry – clay brick and calcium-silicate – were carried out under different geometrical and loading conditions. ► The test results of all test series can be explained by a combination of fracture mechanics and strut-and-tie modeling.
In-plane loaded masonry structures can be post-strengthened effectively with fiber-reinforced polymers (FRP). This applies to shear walls under vertical and horizontal loading, as well as to walls with additional cut-outs or single loads. A mechanical model is required in all cases for the detailing and design of post-strengthening measures and to characterize load transfer within the wall and, from this, to calculate stresses of masonry and FRP materials. To establish a three-step model for local post-strengthened masonry walls, extensive testing on different scales has been carried out at the University of Kassel within the last few years. Firstly, the load transfer between single masonry units and FRP was addressed. Overall, 91 bonding tests were carried out with seven types of bricks and blocks to examine failure modes and the bonding strength for a broad variety of bricks and blocks. Two different types of adhesive were used in combination with four types of glass- and carbon–fibers. Based on the results of the bonding tests, 24 anchoring tests overall on two different types of masonry – clay brick and calcium–silicate – were carried out under different geometrical and loading conditions. The test results of all test series will be explained by a combination of fracture mechanics and strut-and-tie modeling. A mechanical model based on fracture energy provides the background for the theoretical explanation of the debonding phenomena. The model can be used to predict failure of bonding on single bricks as well as bonding geometries with more than one brick where the bonding area is separated by bed or head joints. Comparison of data from calculations and testing exhibited good correlation.
Für die Erweiterung des Containerterminals in Beirut wurde eine fugenlose, ca. 500 m lange Kaimauer als Piled Deck entworfen. Seit 2010 werden Rammarbeiten sowie das Aufspülen der Terminalfläche ...durchgeführt. Die für den Entwurf maßgebenden Randbedingungen sowie deren Umsetzung werden erläutert. Einen Schwerpunkt bildet dabei die fugenlose Bauweise und deren Vorteile für die Kaimauerkonstruktion.
Jointless quay wall construction for the container terminal in Beirut
For the extension of the quay wall of the existing container terminal in Beirut a jointless piled deck construction with a length of 500 m was designed. In 2010, the driving of steel piles and reclamation works started. Determining boundary conditions and their implementation in the design are explained. Special attention is given to the jointless construction and resulting advantages for the quay wall system.
Objectives:
Approximately one in two patients with multiple sclerosis (MS) suffer from comorbid depression. The primary objective of this study was to evaluate the safety and tolerability of ...fingolimod and antidepressant combination in relapsing–remitting MS patients with mild-to-moderate depression. Efficacy outcome variables were quality of life (QoL), fatigue, disability and depression.
Methods:
Patients received open-label fingolimod 0.5 mg over 2 weeks, followed by fingolimod plus citalopram (40 mg), fluoxetine (40 mg) or venlafaxine (150 mg) over 16 weeks. The antidepressant was selected at the physician’s discretion.
Results:
In total, 54 patients were recruited at 25 centres across Germany. No new safety signals (including cardiac) emerged compared with previous clinical studies. Adverse events (mostly mild-to-moderate) were reported in 43 patients. A total of three patients had serious adverse events and 10 discontinued the study. QoL (mean 95% confidence interval) improved by 2.2 (−3.3, −1.2; Patient Reported Indices for MS questionnaire), fatigue by 8.2 (−13.1, −3.3; modified Fatigue Impact Scale) and depression by 6.3 (−8.4, −4.2; Hamilton Depression Scale) points. However, the results must be interpreted cautiously owing to limited patient numbers.
Conclusions:
Combination of fingolimod with antidepressant medication showed no unexpected safety signals. Patient-reported outcomes (QoL, disability, fatigue and depression) remained stable or improved.
Gemauerte Konstruktionen lassen sich sehr effektiv mit Faserverbundwerkstoffen nachträglich verstärken. Dabei ist es sinnvoll, den Faserverbundwerkstoff direkt auf der Mauerwerksoberfläche durch das ...Einlegen von Fasergelegen in eine Klebstoffmatrix herzustellen. Anwendungsgebiete dieses Verfahrens sind die Umschnürung gemauerter Pfeiler, die Verstärkung von Wänden unter Scheibenbeanspruchung und die zugfeste Bewehrung biegebeanspruchter Bauteile. Die wichtigsten Ergebnisse umfangreicher experimenteller Untersuchungen, die an der Universität Kassel in den vergangenen Jahren durchgeführt wurden, werden vorgestellt und erläutert.
Post‐strengthening of masonry structures with fibre reinforced polymers. Fiber reinforced polymeres can be used effectively for post‐strengthening of masonry structures. In this context it is reasonable to manufacture the FRP material by wet‐lay‐up directly on the surface of the masonry structure. Possible applications of the method are the confinement of columns as well as post‐strengthening of in‐plane and out‐of‐plane loaded structures. The main results of experimental research carried out at the University of Kassel during the last years will be presented.
The authors summarized that the two-dimensional (2D) model is sufficient in cases where the slabs are strengthened with fiber reinforced polymer (FRP) that is uniformly distributed along the width of ...the slab and which has a relatively high stiffness and strength compared to the other materials of the structure. Otherwise, a three-dimensional (3D) model should be used in order to capture the complex stress state. They stated that their material model based on a relatively simple softening plasticity model yielded amazingly good results in the simulation of the rather complex structures.
Celotno besedilo
Dostopno za:
DOBA, FGGLJ, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
