@article{HennesHuflageGrunzetal.2023, author = {Hennes, Jan-Lucca and Huflage, Henner and Grunz, Jan-Peter and Hartung, Viktor and Augustin, Anne Marie and Patzer, Theresa Sophie and Pannenbecker, Pauline and Petritsch, Bernhard and Bley, Thorsten Alexander and Gruschwitz, Philipp}, title = {An intra-individual comparison of low-keV photon-counting CT versus energy-integrating-detector CT angiography of the aorta}, series = {Diagnostics}, volume = {13}, journal = {Diagnostics}, number = {24}, issn = {2075-4418}, doi = {10.3390/diagnostics13243645}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-355568}, year = {2023}, abstract = {This retrospective study aims to provide an intra-individual comparison of aortic CT angiographies (CTAs) using first-generation photon-counting-detector CT (PCD-CT) and third-generation energy-integrating-detector CT (EID-CT). High-pitch CTAs were performed with both scanners and equal contrast-agent protocols. EID-CT employed automatic tube voltage selection (90/100 kVp) with reference tube current of 434/350 mAs, whereas multi-energy PCD-CT scans were generated with fixed tube voltage (120 kVp), image quality level of 64, and reconstructed as 55 keV monoenergetic images. For image quality assessment, contrast-to-noise ratios (CNRs) were calculated, and subjective evaluation (overall quality, luminal contrast, vessel sharpness, blooming, and beam hardening) was performed independently by three radiologists. Fifty-seven patients (12 women, 45 men) were included with a median interval between examinations of 12.7 months (interquartile range 11.1 months). Using manufacturer-recommended scan protocols resulted in a substantially lower radiation dose in PCD-CT (size-specific dose estimate: 4.88 ± 0.48 versus 6.28 ± 0.50 mGy, p < 0.001), while CNR was approximately 50\% higher (41.11 ± 8.68 versus 27.05 ± 6.73, p < 0.001). Overall image quality and luminal contrast were deemed superior in PCD-CT (p < 0.001). Notably, EID-CT allowed for comparable vessel sharpness (p = 0.439) and less pronounced blooming and beam hardening (p < 0.001). Inter-rater agreement was good to excellent (0.58-0.87). Concluding, aortic PCD-CTAs facilitate increased image quality with significantly lower radiation dose compared to EID-CTAs}, language = {en} } @article{HampfScherfClavelWeissetal.2023, author = {Hampf, Chantal and Scherf-Clavel, Maike and Weiß, Carolin and Kl{\"u}pfel, Catherina and Stonawski, Saskia and Hommers, Leif and Lichter, Katharina and Erhardt-Lehmann, Angelika and Unterecker, Stefan and Domschke, Katharina and Kittel-Schneider, Sarah and Menke, Andreas and Deckert, J{\"u}rgen and Weber, Heike}, title = {Effects of anxious depression on antidepressant treatment response}, series = {International Journal of Molecular Sciences}, volume = {24}, journal = {International Journal of Molecular Sciences}, number = {24}, issn = {1422-0067}, doi = {10.3390/ijms242417128}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-355801}, year = {2023}, abstract = {Anxious depression represents a subtype of major depressive disorder and is associated with increased suicidality, severity, chronicity and lower treatment response. Only a few studies have investigated the differences between anxious depressed (aMDD) and non-anxious depressed (naMDD) patients regarding treatment dosage, serum-concentration and drug-specific treatment response. In our naturalistic and prospective study, we investigated whether the effectiveness of therapy including antidepressants (SSRI, SNRI, NaSSA, tricyclics and combinations) in aMDD patients differs significantly from that in naMDD patients. In a sample of 346 patients, we calculated the anxiety somatization factor (ASF) and defined treatment response as a reduction (≥50\%) in the Hamilton Depression Rating Scale (HDRS)-21 score after 7 weeks of pharmacological treatment. We did not observe an association between therapy response and the baseline ASF-scores, or differences in therapy outcomes between aMDD and naMDD patients. However, non-responders had higher ASF-scores, and at week 7 aMDD patients displayed a worse therapy outcome than naMDD patients. In subgroup analyses for different antidepressant drugs, venlafaxine-treated aMDD patients showed a significantly worse outcome at week 7. Future prospective, randomized-controlled studies should address the question of a worse therapy outcome in aMDD patients for different psychopharmaceuticals individually.}, language = {en} } @article{SchuhmannLanghauserZimmermannetal.2023, author = {Schuhmann, Michael K. and Langhauser, Friederike and Zimmermann, Lena and Bellut, Maximilian and Kleinschnitz, Christoph and Fluri, Felix}, title = {Dimethyl fumarate attenuates lymphocyte infiltration and reduces infarct size in experimental stroke}, series = {International journal of molecular sciences}, volume = {24}, journal = {International journal of molecular sciences}, number = {21}, doi = {10.3390/ijms242115540}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357731}, year = {2023}, abstract = {Ischemic stroke is associated with exacerbated tissue damage caused by the activation of immune cells and the initiation of other inflammatory processes. Dimethyl fumarate (DMF) is known to modulate the immune response, activate antioxidative pathways, and improve the blood-brain barrier (BBB) after stroke. However, the specific impact of DMF on immune cells after cerebral ischemia remains unclear. In our study, male mice underwent transient middle cerebral artery occlusion (tMCAO) for 30 min and received oral DMF (15 mg/kg) or a vehicle immediately after tMCAO, followed by twice-daily administrations for 7 days. Infarct volume was assessed on T2-weighted magnetic resonance images on days 1 and 7 after tMCAO. Brain-infiltrating immune cells (lymphocytes, monocytes) and microglia were quantified using fluorescence-activated cell sorting. DMF treatment significantly reduced infarct volumes and brain edema. On day 1 after tMCAO, DMF-treated mice showed reduced lymphocyte infiltration compared to controls, which was not observed on day 7. Monocyte and microglial cell counts did not differ between groups on either day. In the acute phase of stroke, DMF administration attenuated lymphocyte infiltration, probably due to its stabilizing effect on the BBB. This highlights the potential of DMF as a therapeutic candidate for mitigating immune cell-driven damage in stroke.}, language = {en} } @article{EberlRebsHoppeetal.2024, author = {Eberl, Hanna and Rebs, Sabine and Hoppe, Stefanie and Sedaghat-Hamedani, Farbod and Kayvanpour, Elham and Meder, Benjamin and Streckfuss-B{\"o}meke, Katrin}, title = {Generation of an RBM20-mutation-associated left-ventricular non-compaction cardiomyopathy iPSC line (UMGi255-A) into a DCM genetic background to investigate monogenetic cardiomyopathies}, series = {Stem Cell Research}, volume = {74}, journal = {Stem Cell Research}, issn = {1873-5061}, doi = {10.1016/j.scr.2023.103290}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350565}, year = {2024}, abstract = {RBM20 mutations account for 3 \% of genetic cardiomypathies and manifest with high penetrance and arrhythmogenic effects. Numerous mutations in the conserved RS domain have been described as causing dilated cardiomyopathy (DCM), whereas a particular mutation (p.R634L) drives development of a different cardiac phenotype: left-ventricular non-compaction cardiomyopathy. We generated a mutation-induced pluripotent stem cell (iPSC) line in which the RBM20-LVNC mutation p.R634L was introduced into a DCM patient line with rescued RBM20-p.R634W mutation. These DCM-634L-iPSC can be differentiated into functional cardiomyocytes to test whether this RBM20 mutation induces development of the LVNC phenotype within the genetic context of a DCM patient.}, language = {en} } @article{PozziBolzoniBiellaetal.2023, author = {Pozzi, Nicol{\´o} Gabriele and Bolzoni, Francesco and Biella, Gabriele Eliseo Mario and Pezzoli, Gianni and Ip, Chi Wang and Volkmann, Jens and Cavallari, Paolo and Asan, Esther and Isaias, Ioannis Ugo}, title = {Brain noradrenergic innervation supports the development of Parkinson's tremor: a study in a reserpinized rat model}, series = {Cells}, volume = {12}, journal = {Cells}, number = {21}, issn = {2073-4409}, doi = {10.3390/cells12212529}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357721}, year = {2023}, abstract = {The pathophysiology of tremor in Parkinson's disease (PD) is evolving towards a complex alteration to monoaminergic innervation, and increasing evidence suggests a key role of the locus coeruleus noradrenergic system (LC-NA). However, the difficulties in imaging LC-NA in patients challenge its direct investigation. To this end, we studied the development of tremor in a reserpinized rat model of PD, with or without a selective lesioning of LC-NA innervation with the neurotoxin DSP-4. Eight male rats (Sprague Dawley) received DSP-4 (50 mg/kg) two weeks prior to reserpine injection (10 mg/kg) (DR-group), while seven male animals received only reserpine treatment (R-group). Tremor, rigidity, hypokinesia, postural flexion and postural immobility were scored before and after 20, 40, 60, 80, 120 and 180 min of reserpine injection. Tremor was assessed visually and with accelerometers. The injection of DSP-4 induced a severe reduction in LC-NA terminal axons (DR-group: 0.024 ± 0.01 vs. R-group: 0.27 ± 0.04 axons/um\(^2\), p < 0.001) and was associated with significantly less tremor, as compared to the R-group (peak tremor score, DR-group: 0.5 ± 0.8 vs. R-group: 1.6 ± 0.5; p < 0.01). Kinematic measurement confirmed the clinical data (tremor consistency (\% of tremor during 180 s recording), DR-group: 37.9 ± 35.8 vs. R-group: 69.3 ± 29.6; p < 0.05). Akinetic-rigid symptoms did not differ between the DR- and R-groups. Our results provide preliminary causal evidence for a critical role of LC-NA innervation in the development of PD tremor and foster the development of targeted therapies for PD patients.}, language = {en} } @phdthesis{Aggar2024, author = {Aggar, Sara}, title = {Plastizit{\"a}t regulatorischer T-Zellen in Abh{\"a}ngigkeit des umgebenden Zytokinmilieus}, doi = {10.25972/OPUS-35187}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-351870}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Eine Dysbalance zwischen regulatorischen und proinflammatorischen T-Helferzellen kann zu Autoimmunerkrankungen f{\"u}hren. In dieser methodischen Arbeit wurde die Polarisierbarkeit von peripheren T-Lymphozyten durch verschiedene Zytokin-Stimuli untersucht. Hauptziel war es, CD4+CD25-CD127- Lymphozyten durch Stimulation mit einem IL-2 und TGFβ-beinhaltenden Zytokin-Cocktail (Treg-Cocktail) zu iTregs zu polarisieren und deren Suppressionsfunktion auf autologe Effektor-Leukozyten zu untersuchen. Es erfolgte eine Ph{\"a}notypisierung der PBMCs gesunder Probanden, insbesondere im Hinblick auf die Verteilung der T-Lymphozyten-Subpopulationen, deren Zytokinproduktion und FoxP3-Expression. Zudem wurden aus den PBMCs der Probanden Tregs (CD4+CD25+CD127low/-) sowie CD4+CD25-CD127- Zellen isoliert und deren Funktionsf{\"a}higkeit durch die Untersuchung ihrer Suppressionsfunktion auf autologe Effektor-Lymphozyten analysiert. Die Zellen wurden mittels verschiedener Zytokin-Cocktails in Richtung Treg sowie in Richtung Th17-Zellen polarisiert; anschließend wurde die Funktionsf{\"a}higkeit der polarisierten Zellen in Suppression-Assays gemessen. Wir konnten zeigen, dass die CD4+CD25+CD127low/- Zellen Tregs mit der F{\"a}higkeit zur Suppression der Proliferation autologer Effektor-Lymphozyten waren. Bei den CD4+CD25-CD127-Zellen handelte es sich um T-Lymphozyten ohne Suppressionsfunktion. Nach Stimulation der CD4+CD25-CD127-Zellen mit dem Treg-Cocktail zeigten die Zellen eine mit den Tregs vergleichbare Suppressionsfunktion. Mit dieser Studie haben wir eine aktuelle methodische Quelle f{\"u}r die Untersuchung von Ph{\"a}notyp und Funktion regulatorischer T-Zellen sowie f{\"u}r die Stimulation peripherer T-Lymphozyten hin zu Tregs geschaffen, die als Basis f{\"u}r Folgeversuche dienen soll, in denen Zellen von Patienten mit Autoimmunkrankheiten untersucht werden sollen. Da sich die Inflammation bei Autoimmunerkrankungen insbesondere in den betroffenen Geweben abspielt, w{\"a}re eine Studie anzustreben, in der aus dem Blut isolierte T-Lymphozyten den Zellen aus den entz{\"u}ndeten Geweben gegen{\"u}bergestellt werden. Erg{\"a}nzend sollte eine Ph{\"a}notypisierung der Tregs und der CD4+CD25-CD127- Zellen nach der Zytokin-Stimulation erfolgen. Zusammenfassend konnte die Plastizit{\"a}t peripherer T-Lymphozyten in Richtung Treg gezeigt werden. Besonders hervorzuheben ist die bislang wenig untersuchte Zellpopulation der CD4+CD25-CD127- Zellen, die eine vielversprechende Zellpopulation f{\"u}r die in vitro Induktion von Tregs darstellt.}, subject = {Regulatorischer T-Lymphozyt}, language = {de} } @phdthesis{Zehner2024, author = {Zehner, Leonie Constanze}, title = {Evaluierung der Rezidivbestrahlung des Prostatakarzinoms}, doi = {10.25972/OPUS-35123}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-351230}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Es erfolgte eine Evaluierung von Bestrahlungsdaten aus der Strahlentherapie der Universit{\"a}tsklinik W{\"u}rzburg von 435 Patienten mit biochemischen oder klinischen Rezidiv des Prostatakarzinoms. Der prim{\"a}re Endpunkt war das biochemisch rezidivfreie {\"U}berleben. Sekund{\"a}re Endpunkte waren das Auftreten von Fernmetastasen und das Versterben der Patienten. Zudem wurde der Einfluss patienten-, tumor-, und behandlungsspezifischer Faktoren {\"u}berpr{\"u}ft.}, subject = {Prostata}, language = {de} } @phdthesis{WegmanngebWallo2024, author = {Wegmann [geb. Wallo], Monika Eva}, title = {Tumorkachexie diagnostizieren und behandeln - die Rolle der Bioimpedanzanalyse}, doi = {10.25972/OPUS-35150}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-351509}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Die tumorbedingte Mangelern{\"a}hrung und Kachexie ist ein Syndrom mit sowohl medizinischer als auch gesundheits{\"o}konomischer Relevanz. In den letzten Jahren wurde ein besseres Verst{\"a}ndnis f{\"u}r die komplexe Pathophysiologie, bestehend aus Stoffwechselst{\"o}rungen, verminderter Energiezufuhr und Entz{\"u}ndungsprozessen, die zum fortschreitenden Muskel- und Fettmassenverlust f{\"u}hren, erreicht. Dieses Verst{\"a}ndnis dient bis heute der Entwicklung m{\"o}glicher pr{\"a}ventiver und therapeutischer Ans{\"a}tze. Geeignete Screening-Tests tragen dazu bei, das Syndrom rechtzeitig zu erkennen und weitere Maßnahmen einzuleiten. Da der Muskel- und Fettmassenverlust nicht immer durch einen reinen Gewichtsverlust gekennzeichnet ist, ist die Erfassung der K{\"o}rperzusammensetzung ein wesentlicher Bestandteil in der Betreuung onkologisch Erkrankter. Die BIA ist ein hierf{\"u}r geeignetes Verfahren, welches leicht in den klinischen Alltag zu integrieren ist und besonders zur interindividuellen Verlaufskontrolle herangezogen werden k{\"o}nnte. Ern{\"a}hrungsmedizinische und bewegungstherapeutische Maßnahmen sind bereits fester Bestandteil internationaler Leitlinien. F{\"u}r pharmakologische Therapiekonzepte besteht noch weiterer Forschungsbedarf, um eine Arzneimittelzulassung zu erreichen. Eine alleinige Intervention ist in der Behandlung der onkologischen Mangelern{\"a}hrung und Kachexie wenig effektiv. Deshalb m{\"u}ssen die Bedeutung und der potentielle Nutzen einer Kombination der einzelnen Behandlungsbausteine n{\"a}her betrachtet werden, um eine bessere Evidenz zu erhalten. Der nachweisliche Mangel an Ern{\"a}hrungsstrukturen und ern{\"a}hrungsmedizinischer Fachkompetenz, Schwierigkeiten der Definitionsentwicklung und Gestaltung von Studien sowie finanzierungstechnische Fragen stellen ein zentrales Problem in der angemessenen Betreuung der Erkrankten dar. Jedoch bestehen klare Handlungsempfehlungen und Strategien, durch die entsprechende Herausforderungen reduziert oder beseitigt werden k{\"o}nnten. Dadurch profitieren sowohl Erkrankte als auch das Gesundheitssystem. Dies kann durch eine verbesserte Versorgung mittels Pr{\"a}vention, fr{\"u}hzeitiger Erfassung, Diagnose und Einleitung angebrachter Therapiemaßnahmen auf dem Gebiet der tumorbedingten Mangelern{\"a}hrung und Kachexie erreicht werden.}, subject = {Kachexie}, language = {de} } @phdthesis{Boeser2024, author = {B{\"o}ser, Janis}, title = {Einfluss der PSMA-PET/CT auf das psychische Befinden von Patienten mit Prostatakarzinom}, doi = {10.25972/OPUS-35204}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-352046}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Das fr{\"u}hzeitige Erkennen psychoonkologischer Belastungen ist Bestandteil des optimalen therapeutischen Managements von Tumorpatienten. Nur wenige, widerspr{\"u}chliche Studien untersuchten bisher das psychische Befinden im Verlauf einer PET/CT. Bezogen auf das Prostatakarzinom gibt es bislang keine spezifische Studie, obwohl es die h{\"a}ufigste onkologische Erkrankung des Mannes darstellt. Aufgrund der insgesamt guten Prognose wird von einer geringeren psychischen Belastung ausgegangen. Mithilfe dieser Studie sollte durch Kombination etablierter Frageb{\"o}gen das psychische Befinden im Verlauf der PET/CT explorativ untersucht werden. Von Oktober 2018 bis Februar 2020 wurde 531 m{\"a}nnlichen Patienten der Nuklearmedizin des Universit{\"a}tsklinikums W{\"u}rzburg die Teilnahme angeboten. N = 85 Patienten (n = 38 Patienten mit Prostatakarzinom sowie n = 47 Patienten mit anderen malignen Erkrankungen) stimmten einer vollst{\"a}ndigen Teilnahme zu. Es wurden zwei Messzeitpunkte (T1 nach Durchf{\"u}hrung der PET/CT; T2 nach Ergebnismitteilung) festgelegt. Als Messinstrumente wurden der PA-F-KF, QUICC, DT, STAI-X1, PANAS und ein Selbsteinsch{\"a}tzungsbogen verwendet. 24 \% (T1) bzw. 35 \% (T2) der Patienten mit Prostatakarzinom gaben eine dysfunktionale Progredienzangst an, 55 \% (T1+T2) eine pathologische psychische Belastung. 53 \% (T1) bzw. 50 \% (T2) der Patienten zeigten eine relevant erh{\"o}hte Zustandsangst. Die Progredienzangst stieg nach Ergebnismitteilung an (p = 0,048; η² = 0,106), die Ungewissheit {\"u}ber den Stand der Erkrankung (p = 0,014; η² = 0,165) und Bew{\"a}ltigbarkeit des Alltags (p = 0,016; η² = 0,163) reduzierten sich. Allgemeine {\"A}ngste wie die Zustandsangst, der Distress und negative Affekte ver{\"a}nderten sich nicht. PSA-Werte ohne bildmorphologisches Korrelat l{\"o}sten eine gr{\"o}ßere Unsicherheit bez{\"u}glich des aktuellen Krankheitszustandes aus (p = 0,029; η² = 0,128). J{\"u}ngere Patienten zeigten vor (p = 0,005; η² = 0,207) und nach (p = 0,001; η² = 0,290) Ergebnismitteilung eine h{\"o}here Angst um ihre Berufst{\"a}tigkeit und gaben eine geringere Erleichterung nach Ergebnismitteilung (p = 0,016; η² = 0,165) an. Als Limitationen sind die geringe Fallzahl und Teilnahmequote, multiple Testung und fehlende Erfragung psychischer Erkrankungen zu beachten. Insgesamt zeigen sich eine hohe psychische Belastung und {\"A}ngste im Verlauf der PET/CT. Patienten mit Prostatakarzinom sind zu diesem Zeitpunkt nicht weniger belastet als Patienten mit anderen malignen Erkrankungen.}, subject = {Angst}, language = {de} } @article{SchanbacherHermannsLorenzetal.2023, author = {Schanbacher, Constanze and Hermanns, Heike M. and Lorenz, Kristina and Wajant, Harald and Lang, Isabell}, title = {Complement 1q/tumor necrosis factor-related proteins (CTRPs): structure, receptors and signaling}, series = {Biomedicines}, volume = {11}, journal = {Biomedicines}, number = {2}, issn = {2227-9059}, doi = {10.3390/biomedicines11020559}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304136}, year = {2023}, abstract = {Adiponectin and the other 15 members of the complement 1q (C1q)/tumor necrosis factor (TNF)-related protein (CTRP) family are secreted proteins composed of an N-terminal variable domain followed by a stalk region and a characteristic C-terminal trimerizing globular C1q (gC1q) domain originally identified in the subunits of the complement protein C1q. We performed a basic PubMed literature search for articles mentioning the various CTRPs or their receptors in the abstract or title. In this narrative review, we briefly summarize the biology of CTRPs and focus then on the structure, receptors and major signaling pathways of CTRPs. Analyses of CTRP knockout mice and CTRP transgenic mice gave overwhelming evidence for the relevance of the anti-inflammatory and insulin-sensitizing effects of CTRPs in autoimmune diseases, obesity, atherosclerosis and cardiac dysfunction. CTRPs form homo- and heterotypic trimers and oligomers which can have different activities. The receptors of some CTRPs are unknown and some receptors are redundantly targeted by several CTRPs. The way in which CTRPs activate their receptors to trigger downstream signaling pathways is largely unknown. CTRPs and their receptors are considered as promising therapeutic targets but their translational usage is still hampered by the limited knowledge of CTRP redundancy and CTRP signal transduction.}, language = {en} } @article{JanzWalzCirnuetal.2024, author = {Janz, Anna and Walz, Katharina and Cirnu, Alexandra and Surjanto, Jessica and Urlaub, Daniela and Leskien, Miriam and Kohlhaas, Michael and Nickel, Alexander and Brand, Theresa and Nose, Naoko and W{\"o}rsd{\"o}rfer, Philipp and Wagner, Nicole and Higuchi, Takahiro and Maack, Christoph and Dudek, Jan and Lorenz, Kristina and Klopocki, Eva and Erg{\"u}n, S{\"u}leyman and Duff, Henry J. and Gerull, Brenda}, title = {Mutations in DNAJC19 cause altered mitochondrial structure and increased mitochondrial respiration in human iPSC-derived cardiomyocytes}, series = {Molecular Metabolism}, volume = {79}, journal = {Molecular Metabolism}, issn = {2212-8778}, doi = {10.1016/j.molmet.2023.101859}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350393}, year = {2024}, abstract = {Highlights • Loss of DNAJC19's DnaJ domain disrupts cardiac mitochondrial structure, leading to abnormal cristae formation in iPSC-CMs. • Impaired mitochondrial structures lead to an increased mitochondrial respiration, ROS and an elevated membrane potential. • Mutant iPSC-CMs show sarcomere dysfunction and a trend to more arrhythmias, resembling DCMA-associated cardiomyopathy. Background Dilated cardiomyopathy with ataxia (DCMA) is an autosomal recessive disorder arising from truncating mutations in DNAJC19, which encodes an inner mitochondrial membrane protein. Clinical features include an early onset, often life-threatening, cardiomyopathy associated with other metabolic features. Here, we aim to understand the metabolic and pathophysiological mechanisms of mutant DNAJC19 for the development of cardiomyopathy. Methods We generated induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) of two affected siblings with DCMA and a gene-edited truncation variant (tv) of DNAJC19 which all lack the conserved DnaJ interaction domain. The mutant iPSC-CMs and their respective control cells were subjected to various analyses, including assessments of morphology, metabolic function, and physiological consequences such as Ca\(^{2+}\) kinetics, contractility, and arrhythmic potential. Validation of respiration analysis was done in a gene-edited HeLa cell line (DNAJC19tv\(_{HeLa}\)). Results Structural analyses revealed mitochondrial fragmentation and abnormal cristae formation associated with an overall reduced mitochondrial protein expression in mutant iPSC-CMs. Morphological alterations were associated with higher oxygen consumption rates (OCRs) in all three mutant iPSC-CMs, indicating higher electron transport chain activity to meet cellular ATP demands. Additionally, increased extracellular acidification rates suggested an increase in overall metabolic flux, while radioactive tracer uptake studies revealed decreased fatty acid uptake and utilization of glucose. Mutant iPSC-CMs also showed increased reactive oxygen species (ROS) and an elevated mitochondrial membrane potential. Increased mitochondrial respiration with pyruvate and malate as substrates was observed in mutant DNAJC19tv HeLa cells in addition to an upregulation of respiratory chain complexes, while cellular ATP-levels remain the same. Moreover, mitochondrial alterations were associated with increased beating frequencies, elevated diastolic Ca\(^{2+}\) concentrations, reduced sarcomere shortening and an increased beat-to-beat rate variability in mutant cell lines in response to β-adrenergic stimulation. Conclusions Loss of the DnaJ domain disturbs cardiac mitochondrial structure with abnormal cristae formation and leads to mitochondrial dysfunction, suggesting that DNAJC19 plays an essential role in mitochondrial morphogenesis and biogenesis. Moreover, increased mitochondrial respiration, altered substrate utilization, increased ROS production and abnormal Ca\(^{2+}\) kinetics provide insights into the pathogenesis of DCMA-related cardiomyopathy.}, language = {en} } @article{DelVecchioHanafiPozzietal.2023, author = {Del Vecchio, Jasmin and Hanafi, Ibrahem and Pozzi, Nicol{\´o} Gabriele and Capetian, Philipp and Isaias, Ioannis U. and Haufe, Stefan and Palmisano, Chiara}, title = {Pallidal recordings in chronically implanted dystonic patients: mitigation of tremor-related artifacts}, series = {Bioengineering}, volume = {10}, journal = {Bioengineering}, number = {4}, issn = {2306-5354}, doi = {10.3390/bioengineering10040476}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313498}, year = {2023}, abstract = {Low-frequency oscillatory patterns of pallidal local field potentials (LFPs) have been proposed as a physiomarker for dystonia and hold the promise for personalized adaptive deep brain stimulation. Head tremor, a low-frequency involuntary rhythmic movement typical of cervical dystonia, may cause movement artifacts in LFP signals, compromising the reliability of low-frequency oscillations as biomarkers for adaptive neurostimulation. We investigated chronic pallidal LFPs with the Percept\(^{TM}\) PC (Medtronic PLC) device in eight subjects with dystonia (five with head tremors). We applied a multiple regression approach to pallidal LFPs in patients with head tremors using kinematic information measured with an inertial measurement unit (IMU) and an electromyographic signal (EMG). With IMU regression, we found tremor contamination in all subjects, whereas EMG regression identified it in only three out of five. IMU regression was also superior to EMG regression in removing tremor-related artifacts and resulted in a significant power reduction, especially in the theta-alpha band. Pallido-muscular coherence was affected by a head tremor and disappeared after IMU regression. Our results show that the Percept PC can record low-frequency oscillations but also reveal spectral contamination due to movement artifacts. IMU regression can identify such artifact contamination and be a suitable tool for its removal.}, language = {en} } @article{NeubertSchlechtMengetal.2023, author = {Neubert, Sven and Schlecht, Sina and Meng, Karin and Rabe, Antonia and Jentschke, Elisabeth}, title = {Effects of a video sequence based intervention on anxiety, fatigue and depression in cancer patients: results of a randomized controlled trial}, series = {Integrative Cancer Therapies}, volume = {22}, journal = {Integrative Cancer Therapies}, issn = {1552-695X}, doi = {10.1177/15347354231153172}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304581}, year = {2023}, abstract = {Background: Cancer patients often suffer from psychological symptoms and need psychological support. Especially during the COVID-19 pandemic, eHealth interventions might be helpful to overcome the obstacles of the pandemic. This study evaluates the effectiveness of a video sequence-based eHealth intervention on anxiety, fatigue, and depression in cancer patients. Methods: Patients (N = 157) with different tumor entities were randomly assigned to the video intervention group (IG) and the waiting control group (CG). Patients in the IG received a video intervention comprising 8 video sequences over 4 weeks. The videos included psychoeducation on distress and psychological symptoms, Acceptance and Commitment Therapy elements, and Yoga and Qigong exercises. Patients' anxiety and fear of progression (primary outcomes) and secondary outcomes were assessed before randomization (T1) and after the end of the intervention for IG or the waiting period for CG (T2) using self-reported questionnaires (GAD-7, PA-F-KF, EORTC QLQ-FA12, PHQ-8). Results: Patients of the IG showed no significant improvement in anxiety (GAD-7; P = .75), fear of progression (FoP-Q-SF; P = .29), fatigue (EORTC QLQ-FA12; P = .72), and depression (PHQ-8; P = .95) compared to patients in the waiting CG. However, symptoms of anxiety, fatigue, and depression decreased in both groups. Exploratory subgroup analysis regarding sex, therapy status, therapy goal, and tumor entity showed no effects. Overall, the intervention had a high level of acceptance. Conclusions: The video intervention was ineffective in reducing the psychological burden compared to a waiting CG. The findings support prior observations of the value of therapeutic guidance and promoting self-management for improving patients' psychological burdens. Further studies are required to evaluate the effectiveness of psycho-oncological eHealth delivered through video sequences.}, language = {en} } @phdthesis{BougebStoermer2024, author = {Bou [geb. St{\"o}rmer], Tan{\´e}e Bel{\´e}n}, title = {Temporale Vokalisationseigenschaften von Neugeborenen mit intrauteriner Wachstumsretardierung}, doi = {10.25972/OPUS-34964}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349646}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Die Zielstellung der vorliegenden Arbeit bestand in der Reflektion m{\"o}glicher Einfl{\"u}sse intrauteriner Wachstumsretardierungen auf die temporalen Vokalisationseigenschaften von Neugeborenen in den ersten f{\"u}nf Lebenstagen. Unter der Annahme, dass das Gehirn des Neugeborenen das Schreiverhalten steuert, k{\"o}nnen die spezifischen Merkmale des Schreiens Aufschluss {\"u}ber die zugrunde liegende neuronale Integrit{\"a}t des S{\"a}uglings und eine eventuelle Pr{\"a}disposition f{\"u}r Sprachanomalien geben. Zus{\"a}tzlich wurden m{\"o}gliche Einfl{\"u}sse des Geburtsmodus, des Geschlechts und des Probanden- und Gestationsalters auf die temporalen Vokalisationseigenschaften untersucht. Dazu wurden spontane Laut{\"a}ußerungen von 55 reifgeborenen, gesunden, neurologisch unbeeintr{\"a}chtigten Neugeborenen mit einem Gestationsalter von 36-41 Wochen untersucht. Der Atemzyklus wurde gesamt und spezifisch f{\"u}r jedes Intervall betrachtet. 1605 Lautaufnahmen wurden vermessen und analysiert. Anhand standardisierter Wachstumskurven des Geburtsgewichtes erfolgte die somatische Klassifikation in SGA und AGA. Die Analysen ergaben signifikant verl{\"a}ngerte Zeitwerte der SGA-Neugeborenen f{\"u}r die Inspirationsl{\"a}nge, die Exspirationsl{\"a}nge und das Messintervall. Die hier berichteten Ergebnisse zeigen, dass signifikante Unterschiede bez{\"u}glich der Dauer einzelner zeitlicher Intervalle spontaner Vokalisationen zwischen SGA- und AGA-Neugeborenen bestehen. Das Verh{\"a}ltnis zwischen Inspirationsl{\"a}nge und Exspirationsl{\"a}nge hingegen erweist sich als robuste Gr{\"o}ße, die sich nicht signifikant unterschied. Ein signifikanter Einfluss des Geburtsmodus auf die zeitliche Organisation von spontanen Lauten konnte in den Analysen nicht festgestellt werden. Jedoch waren die Zeitwerte der Messgr{\"o}ßen bei per Sectionem entbundenen Neugeborenen im Vergleich zu Spontangeburten tendenziell erh{\"o}ht. Auch ein Einfluss des Geschlechts, des Probanden- oder Gestationsalters wurde f{\"u}r die temporalen Charakteristika nicht beobachtet.}, subject = {Sprachentwicklung}, language = {de} } @phdthesis{Goeser2024, author = {G{\"o}ser, Marlies}, title = {"Eignet sich die kritische Flimmerfrequenz zur Diagnose einer minimal hepatischen Enzephalopathie?"}, doi = {10.25972/OPUS-34936}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349363}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Korrelation und Kontingenzpr{\"u}fung von Kritischer Flimmerfrequenz als diagnostischem Mittel bei minimal hepatischer Enzephalopathie mit anderen etablierten diagnostischen Mitteln und beschreibenden Parametern. In den Ergebnissen lediglich Korrelation mit Alertness Testung in der Testbatterie. Minimal hepatische Enzephalopathie braucht zur Diagnostik mindestens 2 verschiedene erg{\"a}nzende diagnostische Verfahren (neuropsychologisch und -physiologisch), um sicher entdeckt werden zu k{\"o}nnen. Bei nur einem Testverfahren blieben zahlreiche Betroffene unentdeckt. M{\"o}glicherweise ist das verschiedenen pathophysiologischen Subgruppen geschuldet.}, subject = {Encephalopathia hepatica}, language = {de} } @article{RamirezZavalaBetsovaSchwanfelderetal.2023, author = {Ram{\´i}rez-Zavala, Bernardo and Betsova, Darina and Schwanfelder, Sonja and Kr{\"u}ger, Ines and Mottola, Austin and Kr{\"u}ger, Thomas and Kniemeyer, Olaf and Brakhage, Axel A. and Morschh{\"a}user, Joachim}, title = {Multiple phosphorylation sites regulate the activity of the repressor Mig1 in \(Candida\) \(albicans\)}, series = {mSphere}, volume = {8}, journal = {mSphere}, number = {6}, doi = {10.1128/msphere.00546-23}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350060}, year = {2023}, abstract = {ABSTRACT The highly conserved heterotrimeric protein kinase SNF1 is important for metabolic adaptations in the pathogenic yeast Candida albicans. A key function of SNF1 is to inactivate the repressor protein Mig1 and thereby allow the expression of genes that are required for the utilization of alternative carbon sources when the preferred carbon source, glucose, is absent or becomes limiting. However, how SNF1 controls Mig1 activity in C. albicans has remained elusive. Using a phosphoproteomics approach, we found that Mig1 is phosphorylated at multiple serine residues. Replacement of these serine residues by nonphosphorylatable alanine residues strongly increased the repressor activity of Mig1 in cells lacking a functional SNF1 complex, indicating that additional protein kinases are involved in the regulation of Mig1. Unlike wild-type Mig1, whose levels strongly decreased when the cells were grown on sucrose or glycerol instead of glucose, the levels of a mutant Mig1 protein lacking nine phosphorylation sites remained high under these conditions. Despite the increased protein levels and the absence of multiple phosphorylation sites, cells with a functional SNF1 complex could still sufficiently inhibit the hyperactive Mig1 to enable wild-type growth on alternative carbon sources. In line with this, phosphorylated forms of the mutant Mig1 were still detected in the presence and absence of a functional SNF1, demonstrating that Mig1 contains additional, unidentified phosphorylation sites and that downstream protein kinases are involved in the control of Mig1 activity by SNF1. IMPORTANCE The SNF1 protein kinase signaling pathway, which is highly conserved in eukaryotic cells, is important for metabolic adaptations in the pathogenic yeast Candida albicans. However, so far, it has remained elusive how SNF1 controls the activity of one of its main effectors, the repressor protein Mig1 that inhibits the expression of genes required for the utilization of alternative carbon sources when glucose is available. In this study, we have identified multiple phosphorylation sites in Mig1 that contribute to its inactivation. Mutation of these sites strongly increased Mig1 repressor activity in the absence of SNF1, but SNF1 could still sufficiently inhibit the hyperactive Mig1 to enable growth on alternative carbon sources. These findings reveal features of Mig1 that are important for controlling its repressor activity. Furthermore, they demonstrate that both SNF1 and additional protein kinases regulate Mig1 in this pathogenic yeast.}, language = {en} } @article{AktasUpcinHenkeetal.2019, author = {Aktas, Bertal H. and Upcin, Berin and Henke, Erik and Padmasekar, Manju and Qin, Xuebin and Erg{\"u}n, S{\"u}leyman}, title = {The Best for the Most Important: Maintaining a Pristine Proteome in Stem and Progenitor Cells}, series = {Stem Cells International}, journal = {Stem Cells International}, doi = {10.1155/2019/1608787}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-227769}, pages = {1-20}, year = {2019}, abstract = {Pluripotent stem cells give rise to reproductively enabled offsprings by generating progressively lineage-restricted multipotent stem cells that would differentiate into lineage-committed stem and progenitor cells. These lineage-committed stem and progenitor cells give rise to all adult tissues and organs. Adult stem and progenitor cells are generated as part of the developmental program and play critical roles in tissue and organ maintenance and/or regeneration. The ability of pluripotent stem cells to self-renew, maintain pluripotency, and differentiate into a multicellular organism is highly dependent on sensing and integrating extracellular and extraorganismal cues. Proteins perform and integrate almost all cellular functions including signal transduction, regulation of gene expression, metabolism, and cell division and death. Therefore, maintenance of an appropriate mix of correctly folded proteins, a pristine proteome, is essential for proper stem cell function. The stem cells' proteome must be pristine because unfolded, misfolded, or otherwise damaged proteins would interfere with unlimited self-renewal, maintenance of pluripotency, differentiation into downstream lineages, and consequently with the development of properly functioning tissue and organs. Understanding how various stem cells generate and maintain a pristine proteome is therefore essential for exploiting their potential in regenerative medicine and possibly for the discovery of novel approaches for maintaining, propagating, and differentiating pluripotent, multipotent, and adult stem cells as well as induced pluripotent stem cells. In this review, we will summarize cellular networks used by various stem cells for generation and maintenance of a pristine proteome. We will also explore the coordination of these networks with one another and their integration with the gene regulatory and signaling networks.}, language = {en} } @article{OPUS4-22778, title = {Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials}, series = {Lancet Oncology}, volume = {19}, journal = {Lancet Oncology}, number = {1}, organization = {Early Breast Cancer Trialists' Collaborative Group (EBCTCG)}, doi = {10.1016/S1470-2045(17)30777-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-227782}, pages = {27-39}, year = {2018}, abstract = {Background Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. Methods We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). Findings Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81\%] of 4756 women). More than two thirds (1349 [69\%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65\%] of 2320 treated with NACT vs 1135 [49\%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21.4\% for NACT versus 15.9\% for adjuvant chemotherapy (5.5\% increase [95\% CI 2.4-8.6]; rate ratio 1.37 [95\% CI 1.17-1.61]; p = 0.0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38.2\% for NACT vs 38.0\% for adjuvant chemotherapy; rate ratio 1.02 [95\% CI 0.92-1.14]; p = 0.66), breast cancer mortality (34.4\% vs 33.7\%; 1.06 [0.95-1.18]; p = 0.31), or death from any cause (40.9\% vs 41.2\%; 1.04 [0.94-1.15]; p = 0.45). Interpretation Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered-eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy. Copyright (c) The Author(s). Published by Elsevier Ltd.}, language = {en} } @article{GieselKratochwilSchlittenhardtetal.2021, author = {Giesel, Frederik L. and Kratochwil, Clemens and Schlittenhardt, Joel and Dendl, Katharina and Eiber, Matthias and Staudinger, Fabian and Kessler, Lukas and Fendler, Wolfgang P. and Lindner, Thomas and Koerber, Stefan A. and Cardinale, Jens and Sennung, David and Roehrich, Manuel and Debus, Juergen and Sathekge, Mike and Haberkorn, Uwe and Calais, Jeremie and Serfling, Sebastian and Buck, Andreas L.}, title = {Head-to-head intra-individual comparison of biodistribution and tumor uptake of \(^{68}\)Ga-FAPI and \(^{18}\)F-FDG PET/CT in cancer patients}, series = {European Journal of Nuclear Medicine and Molecular Imaging}, volume = {48}, journal = {European Journal of Nuclear Medicine and Molecular Imaging}, number = {13}, issn = {1619-7070}, doi = {10.1007/s00259-021-05307-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-307252}, pages = {4377-4385}, year = {2021}, abstract = {Purpose FAPI ligands (fibroblast activation protein inhibitor), a novel class of radiotracers for PET/CT imaging, demonstrated in previous studies rapid and high tumor uptake. The purpose of this study is the head-to-head intra-individual comparison of \(^{68}\)Ga-FAPI versus standard-of-care \(^{18}\)F-FDG in PET/CT in organ biodistribution and tumor uptake in patients with various cancers. Material and Methods This international retrospective multicenter analysis included PET/CT data from 71 patients from 6 centers who underwent both \(^{68}\)Ga-FAPI and \(^{18}\)F-FDG PET/CT within a median time interval of 10 days (range 1-89 days). Volumes of interest (VOIs) were manually drawn in normal organs and tumor lesions to quantify tracer uptake by SUVmax and SUVmean. Furthermore, tumor-to-background ratios (TBR) were generated (SUVmax tumor/ SUVmax organ). Results A total of 71 patients were studied of, which 28 were female and 43 male (median age 60). In 41 of 71 patients, the primary tumor was present. Forty-three of 71 patients exhibited 162 metastatic lesions. \(^{68}\)Ga-FAPI uptake in primary tumors and metastases was comparable to 18F-FDG in most cases. The SUVmax was significantly lower for \(^{68}\)Ga-FAPI than \(^{18}\)F-FDG in background tissues such as the brain, oral mucosa, myocardium, blood pool, liver, pancreas, and colon. Thus, \(^{68}\)Ga-FAPI TBRs were significantly higher than 18F-FDG TBRs in some sites, including liver and bone metastases. Conclusion Quantitative tumor uptake is comparable between \(^{68}\)Ga-FAPI and \(^{18}\)F-FDG, but lower background uptake in most normal organs results in equal or higher TBRs for \(^{68}\)Ga-FAPI. Thus, \(^{68}\)Ga-FAPI PET/CT may yield improved diagnostic information in various cancers and especially in tumor locations with high physiological \(^{18}\)F-FDG uptake.}, language = {en} } @article{FeketeEgbertsPreissleretal.2021, author = {Fekete, Stefanie and Egberts, K. and Preissler, T. and Wewetzer, C. and Mehler-Wex, C. and Romanos, M. and Gerlach, M.}, title = {Estimation of a preliminary therapeutic reference range for children and adolescents with tic disorders treated with tiapride}, series = {European Journal of Clinical Pharmacology}, volume = {77}, journal = {European Journal of Clinical Pharmacology}, number = {2}, doi = {10.1007/s00228-020-03000-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-279893}, pages = {163-170}, year = {2021}, abstract = {Purpose Tiapride is commonly used in Europe for the treatment of tics. The aim of this study was to examine the relationship between dose and serum concentrations of tiapride and potential influential pharmacokinetic factors in children and adolescents. In addition, a preliminary therapeutic reference range for children and adolescents with tics treated with tiapride was calculated. Methods Children and adolescents treated with tiapride at three university hospitals and two departments of child and adolescents psychiatry in Germany and Austria were included in the study. Patient characteristics, doses, serum concentrations, and therapeutic outcome were assessed during clinical routine care using standardised measures. Results In the 49 paediatric patients (83.7\% male, mean age = 12.5 years), a positive correlation was found between tiapride dose (median 6.9 mg/kg, range 0.97-19.35) and serum concentration with marked inter-individual variability. The variation in dose explained 57\% of the inter-patient variability in tiapride serum concentrations; age, gender, and concomitant medication did not contribute to the variability. The symptoms improved in 83.3\% of the patients. 27.1\% of the patients had mild or moderate ADRs. No patient suffered from severe ADRs. Conclusions This study shows that tiapride treatment was effective and safe in most patients with tics. Compared with the therapeutic concentration range established for adults with Chorea Huntington, our data hinted at a lower lower limit (560 ng/ml) and similar upper limit (2000 ng/ml).}, language = {en} } @article{GuthHueserRothetal.2021, author = {Guth, Sabine and H{\"u}ser, Stephanie and Roth, Angelika and Degen, Gisela and Diel, Patrick and Edlund, Karolina and Eisenbrand, Gerhard and Engel, Karl-Heinz and Epe, Bernd and Grune, Tilman and Heinz, Volker and Henle, Thomas and Humpf, Hans-Ulrich and J{\"a}ger, Henry and Joost, Hans-Georg and Kulling, Sabine E. and Lampen, Alfonso and Mally, Angela and Marchan, Rosemarie and Marko, Doris and M{\"u}hle, Eva and Nitsche, Michael A. and R{\"o}hrdanz, Elke and Stadler, Richard and van Thriel, Christoph and Vieths, Stefan and Vogel, Rudi F. and Wascher, Edmund and Watzl, Carsten and N{\"o}thlings, Ute and Hengstler, Jan G.}, title = {Contribution to the ongoing discussion on fluoride toxicity}, series = {Archives of Toxicology}, volume = {95}, journal = {Archives of Toxicology}, number = {7}, issn = {0340-5761}, doi = {10.1007/s00204-021-03072-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-307161}, pages = {2571-2587}, year = {2021}, abstract = {Since the addition of fluoride to drinking water in the 1940s, there have been frequent and sometimes heated discussions regarding its benefits and risks. In a recently published review, we addressed the question if current exposure levels in Europe represent a risk to human health. This review was discussed in an editorial asking why we did not calculate benchmark doses (BMD) of fluoride neurotoxicity for humans. Here, we address the question, why it is problematic to calculate BMDs based on the currently available data. Briefly, the conclusions of the available studies are not homogeneous, reporting negative as well as positive results; moreover, the positive studies lack control of confounding factors such as the influence of well-known neurotoxicants. We also discuss the limitations of several further epidemiological studies that did not meet the inclusion criteria of our review. Finally, it is important to not only focus on epidemiological studies. Rather, risk analysis should consider all available data, including epidemiological, animal, as well as in vitro studies. Despite remaining uncertainties, the totality of evidence does not support the notion that fluoride should be considered a human developmental neurotoxicant at current exposure levels in European countries.}, language = {en} } @article{DietzschBraesigkSeideletal.2022, author = {Dietzsch, Stefan and Braesigk, Annett and Seidel, Clemens and Remmele, Julia and Kitzing, Ralf and Schlender, Tina and Mynarek, Martin and Geismar, Dirk and Jablonska, Karolina and Schwarz, Rudolf and Pazos, Montserrat and Weber, Damien C. and Frick, Silke and Gurtner, Kristin and Matuschek, Christiane and Harrabi, Semi Ben and Gl{\"u}ck, Albrecht and Lewitzki, Victor and Dieckmann, Karin and Benesch, Martin and Gerber, Nicolas U. and Obrecht, Denise and Rutkowski, Stefan and Timmermann, Beate and Kortmann, Rolf-Dieter}, title = {Types of deviation and review criteria in pretreatment central quality control of tumor bed boost in medulloblastoma—an analysis of the German Radiotherapy Quality Control Panel in the SIOP PNET5 MB trial}, series = {Strahlentherapie und Onkologie}, volume = {198}, journal = {Strahlentherapie und Onkologie}, number = {3}, issn = {0179-7158}, doi = {10.1007/s00066-021-01822-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-307812}, pages = {282-290}, year = {2022}, abstract = {Purpose In Germany, Austria, and Switzerland, pretreatment radiotherapy quality control (RT-QC) for tumor bed boost (TB) in non-metastatic medulloblastoma (MB) was not mandatory but was recommended for patients enrolled in the SIOP PNET5 MB trial between 2014 and 2018. This individual case review (ICR) analysis aimed to evaluate types of deviations in the initial plan proposals and develop uniform review criteria for TB boost. Patients and methods A total of 78 patients were registered in this trial, of whom a subgroup of 65 patients were available for evaluation of the TB treatment plans. Dose uniformity was evaluated according to the definitions of the protocol. Additional RT-QC criteria for standardized review of target contours were elaborated and data evaluated accordingly. Results Of 65 initial TB plan proposals, 27 (41.5\%) revealed deviations of target volume delineation. Deviations according to the dose uniformity criteria were present in 14 (21.5\%) TB plans. In 25 (38.5\%) cases a modification of the RT plan was recommended. Rejection of the TB plans was rather related to unacceptable target volume delineation than to insufficient dose uniformity. Conclusion In this analysis of pretreatment RT-QC, protocol deviations were present in a high proportion of initial TB plan proposals. These findings emphasize the importance of pretreatment RT-QC in clinical trials for MB. Based on these data, a proposal for RT-QC criteria for tumor bed boost in non-metastatic MB was developed.}, language = {en} } @article{PinkawaAebersoldBoehmeretal.2021, author = {Pinkawa, Michael and Aebersold, Daniel M. and B{\"o}hmer, Dirk and Flentje, Michael and Ghadjar, Pirus and Schmidt-Hegemann, Nina-Sophie and H{\"o}cht, Stefan and H{\"o}lscher, Tobias and M{\"u}ller, Arndt-Christian and Niehoff, Peter and Sedlmayer, Felix and Wolf, Frank and Zamboglou, Constantinos and Zips, Daniel and Wiegel, Thomas}, title = {Radiotherapy in nodal oligorecurrent prostate cancer}, series = {Strahlentherapie und Onkologie}, volume = {197}, journal = {Strahlentherapie und Onkologie}, number = {7}, issn = {0179-7158}, doi = {10.1007/s00066-021-01778-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-307763}, pages = {575-580}, year = {2021}, abstract = {Objective The current article encompasses a literature review and recommendations for radiotherapy in nodal oligorecurrent prostate cancer. Materials and methods A literature review focused on studies comparing metastasis-directed stereotactic ablative radiotherapy (SABR) vs. external elective nodal radiotherapy (ENRT) and studies analyzing recurrence patterns after local nodal treatment was performed. The DEGRO Prostate Cancer Expert Panel discussed the results and developed treatment recommendations. Results Metastasis-directed radiotherapy results in high local control (often > 90\% within a follow-up of 1-2 years) and can be used to improve progression-free survival or defer androgen deprivation therapy (ADT) according to prospective randomized phase II data. Distant progression after involved-node SABR only occurs within a few months in the majority of patients. ENRT improves metastases-free survival rates with increased toxicity in comparison to SABR according to retrospective comparative studies. The majority of nodal recurrences after initial local treatment of pelvic nodal metastasis are detected within the true pelvis and common iliac vessels. Conclusion ENRT with or without a boost should be preferred to SABR in pelvic nodal recurrences. In oligometastatic prostate cancer with distant (extrapelvic) nodal recurrences, SABR alone can be performed in selected cases. Application of additional systemic treatments should be based on current guidelines, with ADT as first-line treatment for hormone-sensitive prostate cancer. Only in carefully selected patients can radiotherapy be initially used without additional ADT outside of the current standard recommendations. Results of (randomized) prospective studies are needed for definitive recommendations.}, language = {en} } @article{BarileBerryBlaauboeretal.2021, author = {Barile, Frank A. and Berry, Colin and Blaauboer, Bas and Boobis, Alan and Bolt, Herrmann M. and Borgert, Christopher and Dekant, Wolfgang and Dietrich, Daniel and Domingo, Jose L. and Galli, Corrado L. and Gori, Gio Batta and Greim, Helmut and Hengstler, Jan G. and Heslop-Harrison, Pat and Kacew, Sam and Marquardt, Hans and Mally, Angela and Pelkonen, Olavi and Savolainen, Kai and Testai, Emanuela and Tsatsakis, Aristides and Vermeulen, Nico P.}, title = {The EU chemicals strategy for sustainability: in support of the BfR position}, series = {Archives of Toxicology}, volume = {95}, journal = {Archives of Toxicology}, number = {9}, issn = {0340-5761}, doi = {10.1007/s00204-021-03125-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-307154}, pages = {3133-3136}, year = {2021}, abstract = {The EU chemicals strategy for sustainability (CSS) asserts that both human health and the environment are presently threatened and that further regulation is necessary. In a recent Guest Editorial, members of the German competent authority for risk assessment, the BfR, raised concerns about the scientific justification for this strategy. The complexity and interdependence of the networks of regulation of chemical substances have ensured that public health and wellbeing in the EU have continuously improved. A continuous process of improvement in consumer protection is clearly desirable but any initiative directed towards this objective must be based on scientific knowledge. It must not confound risk with other factors in determining policy. This conclusion is fully supported in the present Commentary including the request to improve both, data collection and the time-consuming and bureaucratic procedures that delay the publication of regulations.}, language = {en} } @article{DornHerzberg2021, author = {Dorn, Franziska and Herzberg, Moriz}, title = {Response to Letter to the Editor "Keeping Late Thrombectomy Imaging Protocols Simple to Avoid Analysis Paralysis"}, series = {Clinical Neuroradiology}, volume = {31}, journal = {Clinical Neuroradiology}, number = {3}, issn = {1869-1439}, doi = {10.1007/s00062-021-01091-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-307023}, pages = {813-814}, year = {2021}, language = {en} } @article{LodhaMuchsinJuergesetal.2023, author = {Lodha, Manivel and Muchsin, Ihsan and J{\"u}rges, Christopher and Juranic Lisnic, Vanda and L'Hernault, Anne and Rutkowski, Andrzej J. and Prusty, Bhupesh K. and Grothey, Arnhild and Milic, Andrea and Hennig, Thomas and Jonjic, Stipan and Friedel, Caroline C. and Erhard, Florian and D{\"o}lken, Lars}, title = {Decoding murine cytomegalovirus}, series = {PLOS Pathogens}, volume = {19}, journal = {PLOS Pathogens}, number = {5}, issn = {1553-7374}, doi = {10.1371/journal.ppat.1010992}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350480}, year = {2023}, abstract = {The genomes of both human cytomegalovirus (HCMV) and murine cytomegalovirus (MCMV) were first sequenced over 20 years ago. Similar to HCMV, the MCMV genome had initially been proposed to harbor ≈170 open reading frames (ORFs). More recently, omics approaches revealed HCMV gene expression to be substantially more complex comprising several hundred viral ORFs. Here, we provide a state-of-the art reannotation of lytic MCMV gene expression based on integrative analysis of a large set of omics data. Our data reveal 365 viral transcription start sites (TiSS) that give rise to 380 and 454 viral transcripts and ORFs, respectively. The latter include 200 small ORFs, some of which represented the most highly expressed viral gene products. By combining TiSS profiling with metabolic RNA labelling and chemical nucleotide conversion sequencing (dSLAM-seq), we provide a detailed picture of the expression kinetics of viral transcription. This not only resulted in the identification of a novel MCMV immediate early transcript encoding the m166.5 ORF, which we termed ie4, but also revealed a group of well-expressed viral transcripts that are induced later than canonical true late genes and contain an initiator element (Inr) but no TATA- or TATT-box in their core promoters. We show that viral upstream ORFs (uORFs) tune gene expression of longer viral ORFs expressed in cis at translational level. Finally, we identify a truncated isoform of the viral NK-cell immune evasin m145 arising from a viral TiSS downstream of the canonical m145 mRNA. Despite being ≈5-fold more abundantly expressed than the canonical m145 protein it was not required for downregulating the NK cell ligand, MULT-I. In summary, our work will pave the way for future mechanistic studies on previously unknown cytomegalovirus gene products in an important virus animal model.}, language = {en} } @article{KerwagenRiemerWachteretal.2023, author = {Kerwagen, Fabian and Riemer, Uwe and Wachter, Rolf and von Haehling, Stephan and Abdin, Amr and B{\"o}hm, Michael and Schulz, Martin and St{\"o}rk, Stefan}, title = {Impact of the COVID-19 pandemic on implementation of novel guideline-directed medical therapies for heart failure in Germany: a nationwide retrospective analysis}, series = {The Lancet Regional Health - Europe}, volume = {35}, journal = {The Lancet Regional Health - Europe}, issn = {2666-7762}, doi = {10.1016/j.lanepe.2023.100778}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350510}, year = {2023}, abstract = {Background Guideline-directed medical therapy (GDMT) is the cornerstone in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) and novel substances such as sacubitril/valsartan (S/V) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated marked clinical benefits. We investigated their implementation into real-world HF care in Germany before, during, and after the COVID-19 pandemic period. Methods The IQVIA LRx data set is based on ∼80\% of 73 million people covered by the German statutory health insurance. Prescriptions of S/V were used as a proxy for HFrEF. Time trends were analysed between Q1/2016 and Q2/2023 for prescriptions for S/V alone and in combination therapy with SGLT2i. Findings The number of patients treated with S/V increased from 5260 in Q1/2016 to 351,262 in Q2/2023. The share of patients with combination therapy grew from 0.6\% (29 of 5260) to 14.2\% (31,128 of 219,762) in Q2/2021, and then showed a steep surge up to 54.8\% (192,429 of 351,262) in Q2/2023, coinciding with the release of the European Society of Cardiology (ESC) guidelines for HF in Q3/2021. Women and patients aged >80 years were treated less often with combined therapy than men and younger patients. With the start of the COVID-19 pandemic, the number of patients with new S/V prescriptions dropped by 17.5\% within one quarter, i.e., from 26,855 in Q1/2020 to 22,145 in Q2/2020, and returned to pre-pandemic levels only in Q1/2021. Interpretation The COVID-19 pandemic was associated with a 12-month deceleration of S/V uptake in Germany. Following the release of the ESC HF guidelines, the combined prescription of S/V and SGLT2i was readily adopted. Further efforts are needed to fully implement GDMT and strengthen the resilience of healthcare systems during public health crises.}, language = {en} } @article{HelmerRodemersHottenrottetal.2023, author = {Helmer, Philipp and Rodemers, Philipp and Hottenrott, Sebastian and Leppich, Robert and Helwich, Maja and Pryss, R{\"u}diger and Kranke, Peter and Meybohm, Patrick and Winkler, Bernd E. and Sammeth, Michael}, title = {Evaluating blood oxygen saturation measurements by popular fitness trackers in postoperative patients: a prospective clinical trial}, series = {iScience}, volume = {26}, journal = {iScience}, number = {11}, issn = {2589-0042}, doi = {10.1016/j.isci.2023.108155}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349913}, year = {2023}, abstract = {Summary Blood oxygen saturation is an important clinical parameter, especially in postoperative hospitalized patients, monitored in clinical practice by arterial blood gas (ABG) and/or pulse oximetry that both are not suitable for a long-term continuous monitoring of patients during the entire hospital stay, or beyond. Technological advances developed recently for consumer-grade fitness trackers could—at least in theory—help to fill in this gap, but benchmarks on the applicability and accuracy of these technologies in hospitalized patients are currently lacking. We therefore conducted at the postanaesthesia care unit under controlled settings a prospective clinical trial with 201 patients, comparing in total >1,000 oxygen blood saturation measurements by fitness trackers of three brands with the ABG gold standard and with pulse oximetry. Our results suggest that, despite of an overall still tolerable measuring accuracy, comparatively high dropout rates severely limit the possibilities of employing fitness trackers, particularly during the immediate postoperative period of hospitalized patients. Highlights •The accuracy of O2 measurements by fitness trackers is tolerable (RMSE ≲4\%) •Correlation with arterial blood gas measurements is fair to moderate (PCC = [0.46; 0.64]) •Dropout rates of fitness trackers during O2 monitoring are high (∼1/3 values missing) •Fitness trackers cannot be recommended for O2 measuring during critical monitoring}, language = {en} } @article{HalfmannCastioniWetzeletal.2024, author = {Halfmann, Marie and Castioni, Noah and Wetzel, Lea and Koopmann, Anne and K{\"o}nig, Sarah and Schmieder, Astrid}, title = {Effects of the COVID-19 pandemic on the mental health of medical students and young physicians in Germany: Gender-specific results of an online survey}, series = {Heliyon}, volume = {10}, journal = {Heliyon}, number = {1}, issn = {2405-8440}, doi = {10.1016/j.heliyon.2023.e23727}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350502}, year = {2024}, abstract = {Background Healthcare workers and medical students faced new challenges during the COVID-19 pandemic. Processes within many hospitals were completely disrupted. In addition, the face to face teaching of medical students was drastically reduced. Those at risk of developing mental health problems appear to be younger health care workers and women. Objective To investigate potential COVID-19 pandemic-related gender differences in psychological distress among medical students and physicians in their first years of practice. Design and setting An anonymous survey was carried out online between December 1, 2021, and March 31, 2022, at the Mannheim Medical Faculty and the W{\"u}rzburg Medical Faculty, Germany, after obtaining informed consent. Primary outcome measures were changes in anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS), and changes in participants' current quality of life using the WHO Quality of Life BREF. Results The results show wave-like courses for perceived anxiety and burden overlapping with the course of the COVID-19 incidence. In comparison to men, women showed a significant higher increase in HADS (p = 0.005) and a reduced life quality (p = 0.007) after COVID-19. Both sexes showed different frequencies of the factors influencing quality of life, with the presence of a previous mental illness and mean anxiety having a significant higher negative impact in women. Conclusion Future and young female physicians reported a disproportionate higher burden during COVID-19 compared to their male colleges. These observations suggest an increased need for support and prevention efforts especially in this vulnerable population.}, language = {en} } @article{PennigHoyerKrauskopfetal.2021, author = {Pennig, Lenhard and Hoyer, Ulrike Cornelia Isabel and Krauskopf, Alexandra and Shahzad, Rahil and J{\"u}nger, Stephanie T. and Thiele, Frank and Laukamp, Kai Roman and Grunz, Jan-Peter and Perkuhn, Michael and Schlamann, Marc and Kabbasch, Christoph and Borggrefe, Jan and Goertz, Lukas}, title = {Deep learning assistance increases the detection sensitivity of radiologists for secondary intracranial aneurysms in subarachnoid hemorrhage}, series = {Neuroradiology}, volume = {63}, journal = {Neuroradiology}, number = {12}, issn = {0028-3940}, doi = {10.1007/s00234-021-02697-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-308117}, pages = {1985-1994}, year = {2021}, abstract = {Purpose To evaluate whether a deep learning model (DLM) could increase the detection sensitivity of radiologists for intracranial aneurysms on CT angiography (CTA) in aneurysmal subarachnoid hemorrhage (aSAH). Methods Three different DLMs were trained on CTA datasets of 68 aSAH patients with 79 aneurysms with their outputs being combined applying ensemble learning (DLM-Ens). The DLM-Ens was evaluated on an independent test set of 104 aSAH patients with 126 aneuryms (mean volume 129.2 ± 185.4 mm3, 13.0\% at the posterior circulation), which were determined by two radiologists and one neurosurgeon in consensus using CTA and digital subtraction angiography scans. CTA scans of the test set were then presented to three blinded radiologists (reader 1: 13, reader 2: 4, and reader 3: 3 years of experience in diagnostic neuroradiology), who assessed them individually for aneurysms. Detection sensitivities for aneurysms of the readers with and without the assistance of the DLM were compared. Results In the test set, the detection sensitivity of the DLM-Ens (85.7\%) was comparable to the radiologists (reader 1: 91.2\%, reader 2: 86.5\%, and reader 3: 86.5\%; Fleiss κ of 0.502). DLM-assistance significantly increased the detection sensitivity (reader 1: 97.6\%, reader 2: 97.6\%,and reader 3: 96.0\%; overall P=.024; Fleiss κ of 0.878), especially for secondary aneurysms (88.2\% of the additional aneurysms provided by the DLM). Conclusion Deep learning significantly improved the detection sensitivity of radiologists for aneurysms in aSAH, especially for secondary aneurysms. It therefore represents a valuable adjunct for physicians to establish an accurate diagnosis in order to optimize patient treatment.}, language = {en} } @article{DuskeClausKroneetal.2024, author = {Duske, Helene and Claus, Heike and Krone, Manuel and L{\^a}m, Thi{\^e}n-Tr{\´i}}, title = {Prevalence of piperacillin/tazobactam resistance in invasive \(Haemophilus\) \(influenzae\) in Germany}, series = {JAC-Antimicrobial Resistance}, volume = {6}, journal = {JAC-Antimicrobial Resistance}, number = {1}, issn = {2632-1823}, doi = {10.1093/jacamr/dlad148}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350424}, year = {2024}, abstract = {Background Haemophilus influenzae (Hi) is a Gram-negative bacterium that may cause sepsis or meningitis, treatment of which mainly includes β-lactam antibiotics. Since 2019 EUCAST breakpoints for piperacillin/tazobactam have been available. Little is known about the prevalence and mechanisms of piperacillin/tazobactam resistance in Hi. Objectives To provide reliable prevalence data for piperacillin/tazobactam resistance in Hi in Germany, to evaluate different antibiotic susceptibility testing methods and to examine possible resistance mechanisms. Methods According to EUCAST breakpoints, the MIC for piperacillin/tazobactam resistance is >0.25 mg/L. All invasive Hi in Germany from 2019 were examined by gradient agar diffusion (GAD) for piperacillin/tazobactam susceptibility. Piperacillin/tazobactam broth microdilution (BMD), piperacillin GAD on tazobactam-containing agar [piperacillin GAD on Mueller-Hinton agar with horse blood (MH-F)/tazobactam) and piperacillin/tazobactam agar dilution (AD) were used for confirmation. Phenotypic testing was complemented by ftsI sequencing. Results Piperacillin/tazobactam GAD resulted in 2.9\% (21/726) resistant Hi. BMD did not confirm piperacillin/tazobactam resistance. Two strains were found resistant by AD, of which one was also resistant using piperacillin GAD on MH-F/tazobactam. Overall, we found two strains with a piperacillin/tazobactam MIC >0.25 mg/L in at least two different tests (0.3\%). Both were β-lactamase-producing amoxicillin/clavulanate-resistant with PBP3 mutations characterized as group III-like+. Relevant PBP3 mutations occurred in six strains without phenotypic piperacillin/tazobactam resistance. These mutations suggest a reduced efficacy of β-lactam antibiotics in these isolates. Conclusions Piperacillin/tazobactam resistance prevalence in invasive Hi is low in Germany. Reduced susceptibility was correlated with PBP3 mutations, in particular with group III mutations.}, language = {en} } @phdthesis{Stauf2024, author = {Stauf, Alisa}, title = {Scherfestigkeit an indirekten Kompositmaterialien und (Hybrid-) Keramiken vor und nach k{\"u}nstlicher Probenalterung - Ein Modellversuch zur Pr{\"u}fung eines intraoralen Reparaturprotokolls f{\"u}r indirekte Restaurationen}, doi = {10.25972/OPUS-35121}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-351212}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Gegenstand dieser Arbeit war die Ermittlung der Scherfestigkeit von Kompositreparaturen auf unterschiedlichen Materialien und der Einfluss k{\"u}nstlicher Probenalterung auf den Haftverbund. Ziel war es hier{\"u}ber ein m{\"o}glichst einfaches Reparaturprotokoll f{\"u}r die klinische Anwendung zu pr{\"u}fen. In der Versuchsreihe wurden neun verschiedene Materialien (SR Nexco®, Gradia® Plus, Estenia™ C\&B®, Grandio Blocs®, Tetric® CAD, Brilliant Crios®, VITA Enamic®, VITABLOCS® Mark II, IPS e.max® CAD) nach einem festgelegten Konditionierungsprotokoll (Sandstrahlen vs. Flusss{\"a}ure{\"a}tzung und Monobond® Plus-Applikation, anschließend 3M™ Scotchbond™ Universal Plus Adh{\"a}siv) mit Kompositzylindern (3M™ Filtek™ Supreme XTE Universal Komposit) verklebt. In einem Scherversuch wurden die Haftwerte des Klebeverbundes ermittelt sowie die vorkommenden Versagensmuster untersucht. Werden alle 216 untersuchten Pr{\"u}fk{\"o}rper betrachtet, so ist hervorzuheben, dass alle Pr{\"u}fzylinder Scherkr{\"a}ften von {\"u}ber 21 MPa standhielten. Dennoch zeigten sich Unterschiede unter den Materialgruppen. In den Kontrollgruppen zeigte Estenia™ C\&B® mit ±34,5 MPa die h{\"o}chste Scherfestigkeit. Die modellierbaren Verblend-komposite erreichten mit ±29,6 MPa h{\"o}here Haftwerte als die CAD/CAM Komposite (±24,1 MPa) und die keramischen Werkstoffe (±26,7 MPa). Eine k{\"u}nstliche Probenalterung wirkte sich signifikant auf die Verbundfestigkeit aus. Im gesamten Probenkorpus war zwischen den Kontrollgruppen und den Gruppen mit Temperaturwechselbehandlung vor und nach Verklebung eine Reduktion der Scherkraft um ±10,6 MPa zu beobachten. Insgesamt hatte eine Temperaturwechselbehandlung einzig vor Verklebung der Proben zumeist eine geringere Auswirkung auf den Haftverbund verglichen mit Alterung vor und nach Verklebung. Mit einer Inzidenz von 74,5 \% war ein koh{\"a}siver Bruch im Ausgangsmaterial das dominierende Versagensmuster. Daraus l{\"a}sst sich ableiten, dass ein ad{\"a}quates Konditionierungsprotokoll gew{\"a}hlt wurde. Auch auf das Versagensmuster hatte die Temperaturwechselbehandlung einen signifikanten Einfluss, wobei koh{\"a}sive Br{\"u}che zunahmen. Die vorliegende Arbeit konnte zeigen, dass Reparaturen in vitro auch zwischen unterschiedlichen Materialklassen suffiziente Haftverbunde erzielen k{\"o}nnen, obgleich der Verbund bei Kompositen verl{\"a}sslicher erscheint. Die ermittelten hohen Scherkr{\"a}fte verdeutlichen, dass die M{\"o}glichkeit einer Reparatur am Patienten in jedem Fall in Erw{\"a}gung gezogen werden sollte, bevor eine Restauration vollst{\"a}ndig ausgetauscht wird.}, subject = {Scherfestigkeit}, language = {de} } @article{VollmerNaglerHoerneretal.2023, author = {Vollmer, Andreas and Nagler, Simon and H{\"o}rner, Marius and Hartmann, Stefan and Brands, Roman C. and Breitenb{\"u}cher, Niko and Straub, Anton and K{\"u}bler, Alexander and Vollmer, Michael and Gubik, Sebastian and Lang, Gernot and Wollborn, Jakob and Saravi, Babak}, title = {Performance of artificial intelligence-based algorithms to predict prolonged length of stay after head and neck cancer surgery}, series = {Heliyon}, volume = {9}, journal = {Heliyon}, number = {11}, issn = {2405-8440}, doi = {10.1016/j.heliyon.2023.e20752}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350416}, year = {2023}, abstract = {Background Medical resource management can be improved by assessing the likelihood of prolonged length of stay (LOS) for head and neck cancer surgery patients. The objective of this study was to develop predictive models that could be used to determine whether a patient's LOS after cancer surgery falls within the normal range of the cohort. Methods We conducted a retrospective analysis of a dataset consisting of 300 consecutive patients who underwent head and neck cancer surgery between 2017 and 2022 at a single university medical center. Prolonged LOS was defined as LOS exceeding the 75th percentile of the cohort. Feature importance analysis was performed to evaluate the most important predictors for prolonged LOS. We then constructed 7 machine learning and deep learning algorithms for the prediction modeling of prolonged LOS. Results The algorithms reached accuracy values of 75.40 (radial basis function neural network) to 97.92 (Random Trees) for the training set and 64.90 (multilayer perceptron neural network) to 84.14 (Random Trees) for the testing set. The leading parameters predicting prolonged LOS were operation time, ischemia time, the graft used, the ASA score, the intensive care stay, and the pathological stages. The results revealed that patients who had a higher number of harvested lymph nodes (LN) had a lower probability of recurrence but also a greater LOS. However, patients with prolonged LOS were also at greater risk of recurrence, particularly when fewer (LN) were extracted. Further, LOS was more strongly correlated with the overall number of extracted lymph nodes than with the number of positive lymph nodes or the ratio of positive to overall extracted lymph nodes, indicating that particularly unnecessary lymph node extraction might be associated with prolonged LOS. Conclusions The results emphasize the need for a closer follow-up of patients who experience prolonged LOS. Prospective trials are warranted to validate the present results.}, language = {en} } @article{DrehmannMilanosSchaeferetal.2023, author = {Drehmann, Paul and Milanos, Sinem and Schaefer, Natascha and Kasaragod, Vikram Babu and Herterich, Sarah and Holzbach-Eberle, Ulrike and Harvey, Robert J. and Villmann, Carmen}, title = {Dual role of dysfunctional Asc-1 transporter in distinct human pathologies, human startle disease, and developmental delay}, series = {eNeuro}, volume = {10}, journal = {eNeuro}, number = {11}, doi = {10.1523/ENEURO.0263-23.2023}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349947}, year = {2023}, abstract = {Human startle disease is associated with mutations in distinct genes encoding glycine receptors, transporters or interacting proteins at glycinergic synapses in spinal cord and brainstem. However, a significant number of diagnosed patients does not carry a mutation in the common genes GLRA1, GLRB, and SLC6A5. Recently, studies on solute carrier 7 subfamily 10 (SLC7A10; Asc-1, alanine-serine-cysteine transporter) knock-out (KO) mice displaying a startle disease-like phenotype hypothesized that this transporter might represent a novel candidate for human startle disease. Here, we screened 51 patients from our patient cohort negative for the common genes and found three exonic (one missense, two synonymous), seven intronic, and single nucleotide changes in the 5′ and 3′ untranslated regions (UTRs) in Asc-1. The identified missense mutation Asc-1\(^{G307R}\) from a patient with startle disease and developmental delay was investigated in functional studies. At the molecular level, the mutation Asc-1\(^{G307R}\) did not interfere with cell-surface expression, but disrupted glycine uptake. Substitution of glycine at position 307 to other amino acids, e.g., to alanine or tryptophan did not affect trafficking or glycine transport. By contrast, G307K disrupted glycine transport similar to the G307R mutation found in the patient. Structurally, the disrupted function in variants carrying positively charged residues can be explained by local structural rearrangements because of the large positively charged side chain. Thus, our data suggest that SLC7A10 may represent a rare but novel gene associated with human startle disease and developmental delay.}, language = {en} } @article{WiesslerTalucciPiroetal.2024, author = {Wiessler, Anna-Lena and Talucci, Ivan and Piro, Inken and Seefried, Sabine and H{\"o}rlin, Verena and Baykan, Bet{\"u}l B. and T{\"u}z{\"u}n, Erdem and Schaefer, Natascha and Maric, Hans M. and Sommer, Claudia and Villmann, Carmen}, title = {Glycine receptor β-targeting autoantibodies contribute to the pathology of autoimmune diseases}, series = {Neurology: Neuroimmunology \& Neuroinflammation}, volume = {11}, journal = {Neurology: Neuroimmunology \& Neuroinflammation}, number = {2}, doi = {10.1212/NXI.0000000000200187}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349958}, year = {2024}, abstract = {Background and Objectives Stiff-person syndrome (SPS) and progressive encephalomyelitis with rigidity and myoclonus (PERM) are rare neurologic disorders of the CNS. Until now, exclusive GlyRα subunit-binding autoantibodies with subsequent changes in function and surface numbers were reported. GlyR autoantibodies have also been described in patients with focal epilepsy. Autoimmune reactivity against the GlyRβ subunits has not yet been shown. Autoantibodies against GlyRα1 target the large extracellular N-terminal domain. This domain shares a high degree of sequence homology with GlyRβ making it not unlikely that GlyRβ-specific autoantibody (aAb) exist and contribute to the disease pathology. Methods In this study, we investigated serum samples from 58 patients for aAb specifically detecting GlyRβ. Studies in microarray format, cell-based assays, and primary spinal cord neurons and spinal cord tissue immunohistochemistry were performed to determine specific GlyRβ binding and define aAb binding to distinct protein regions. Preadsorption approaches of aAbs using living cells and the purified extracellular receptor domain were further used. Finally, functional consequences for inhibitory neurotransmission upon GlyRβ aAb binding were resolved by whole-cell patch-clamp recordings. Results Among 58 samples investigated, cell-based assays, tissue analysis, and preadsorption approaches revealed 2 patients with high specificity for GlyRβ aAb. Quantitative protein cluster analysis demonstrated aAb binding to synaptic GlyRβ colocalized with the scaffold protein gephyrin independent of the presence of GlyRα1. At the functional level, binding of GlyRβ aAb from both patients to its target impair glycine efficacy. Discussion Our study establishes GlyRβ as novel target of aAb in patients with SPS/PERM. In contrast to exclusively GlyRα1-positive sera, which alter glycine potency, aAbs against GlyRβ impair receptor efficacy for the neurotransmitter glycine. Imaging and functional analyses showed that GlyRβ aAbs antagonize inhibitory neurotransmission by affecting receptor function rather than localization.}, language = {en} } @article{BreyerGruenerKleinetal.2024, author = {Breyer, Maximilian and Gr{\"u}ner, Julia and Klein, Alexandra and Finke, Laura and Klug, Katharina and Sauer, Markus and {\"U}{\c{c}}eyler, Nurcan}, title = {\(In\) \(vitro\) characterization of cells derived from a patient with the GLA variant c.376A>G (p.S126G) highlights a non-pathogenic role in Fabry disease}, series = {Molecular Genetics and Metabolism Reports}, volume = {38}, journal = {Molecular Genetics and Metabolism Reports}, issn = {22144269}, doi = {10.1016/j.ymgmr.2023.101029}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350295}, year = {2024}, abstract = {Highlights • The GLA variant S126G is not associated with Fabry symptoms in the presented case • S126G has no effect on α-GAL A activity or Gb3 levels in this patient • S126G sensory neurons show no electrophysiological abnormalities Abstract Fabry disease (FD) is a life-limiting disorder characterized by intracellular globotriaosylceramide (Gb3) accumulations. The underlying α-galactosidase A (α-GAL A) deficiency is caused by variants in the gene GLA. Variants of unknown significance (VUS) are frequently found in GLA and challenge clinical management. Here, we investigated a 49-year old man with cryptogenic lacunar cerebral stroke and the chance finding of the VUS S126G, who was sent to our center for diagnosis and initiation of a costly and life-long FD-specific treatment. We combined clinical examination with in vitro investigations of dermal fibroblasts (HDF), induced pluripotent stem cells (iPSC), and iPSC-derived sensory neurons. We analyzed α-GAL A activity in iPSC, Gb3 accumulation in all three cell types, and action potential firing in sensory neurons. Neurological examination and small nerve fiber assessment was normal except for reduced distal skin innervation. S126G iPSC showed normal α-GAL A activity compared to controls and no Gb3 deposits were found in all three cell types. Baseline electrophysiological characteristics of S126G neurons showed no difference compared to healthy controls as investigated by patch-clamp recordings. We pioneer multi-level cellular characterization of the VUS S126G using three cell types derived from a patient and provide further evidence for the benign nature of S126G in GLA, which is of great importance in the management of such cases in clinical practice.}, language = {en} } @article{JaenschEvdokimovEgenolfetal.2024, author = {J{\"a}nsch, Sarah and Evdokimov, Dimitar and Egenolf, Nadine and Meyer zu Altenschildesche, Caren and Kreß, Luisa and {\"U}{\c{c}}eyler, Nurcan}, title = {Distinguishing fibromyalgia syndrome from small fiber neuropathy: a clinical guide}, series = {Pain Reports}, volume = {9}, journal = {Pain Reports}, number = {1}, doi = {10.1097/PR9.0000000000001136}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350306}, year = {2024}, abstract = {Introduction: Fibromyalgia syndrome (FMS) and small fiber neuropathy (SFN) are distinct pain conditions that share commonalities and may be challenging as for differential diagnosis. Objective: To comprehensively investigate clinical characteristics of women with FMS and SFN to determine clinically applicable parameters for differentiation. Methods: We retrospectively analyzed medical records of 158 women with FMS and 53 with SFN focusing on pain-specific medical and family history, accompanying symptoms, additional diseases, and treatment. We investigated data obtained using standardized pain, depression, and anxiety questionnaires. We further analyzed test results and findings obtained in standardized small fiber tests. Results: FMS patients were on average ten years younger at symptom onset, described higher pain intensities requiring frequent change of pharmaceutics, and reported generalized pain compared to SFN. Pain in FMS was accompanied by irritable bowel or sleep disturbances, and in SFN by paresthesias, numbness, and impaired glucose metabolism (P < 0.01 each). Family history was informative for chronic pain and affective disorders in FMS (P < 0.001) and for neurological disorders in SFN patients (P < 0.001). Small fiber pathology in terms of skin denervation and/or thermal sensory threshold elevation was present in 110/158 (69.7 \%) FMS patients and 39/53 (73.6 \%) SFN patients. FMS patients mainly showed proximally reduced skin innervation and higher corneal nerve branch densities (p<0.001) whereas SFN patients were characterized by reduced cold detection and prolonged electrical A-delta conduction latencies (P < 0.05). Conclusions: Our data show that FMS and SFN differ substantially. Detailed pain, drug and family history, investigating blood glucose metabolism, and applying differential small fiber tests may help to improve diagnostic differentiation and targeted therapy.}, language = {en} } @article{BinderLangePozzietal.2023, author = {Binder, Tobias and Lange, Florian and Pozzi, Nicol{\`o} and Musacchio, Thomas and Daniels, Christine and Odorfer, Thorsten and Fricke, Patrick and Matthies, Cordula and Volkmann, Jens and Capetian, Philipp}, title = {Feasibility of local field potential-guided programming for deep brain stimulation in Parkinson's disease: a comparison with clinical and neuro-imaging guided approaches in a randomized, controlled pilot trial}, series = {Brain Stimulation}, volume = {16}, journal = {Brain Stimulation}, number = {5}, doi = {10.1016/j.brs.2023.08.017}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350280}, pages = {1243-1251}, year = {2023}, abstract = {Highlights • Beta-Guided programming is an innovative approach that may streamline the programming process for PD patients with STN DBS. • While preliminary findings from our study suggest that Beta Titration may potentially mitigate STN overstimulation and enhance symptom control, • Our results demonstrate that beta-guided programming significantly reduces programming time, suggesting it could be efficiently integrated into routine clinical practice using a commercially available patient programmer. Background Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson's disease (PD). Clinical outcomes after DBS can be limited by poor programming, which remains a clinically driven, lengthy and iterative process. Electrophysiological recordings in PD patients undergoing STN-DBS have shown an association between STN spectral power in the beta frequency band (beta power) and the severity of clinical symptoms. New commercially-available DBS devices now enable the recording of STN beta oscillations in chronically-implanted PD patients, thereby allowing investigation into the use of beta power as a biomarker for DBS programming. Objective To determine the potential advantages of beta-guided DBS programming over clinically and image-guided programming in terms of clinical efficacy and programming time. Methods We conducted a randomized, blinded, three-arm, crossover clinical trial in eight Parkinson's patients with STN-DBS who were evaluated three months after DBS surgery. We compared clinical efficacy and time required for each DBS programming paradigm, as well as DBS parameters and total energy delivered between the three strategies (beta-, clinically- and image-guided). Results All three programming methods showed similar clinical efficacy, but the time needed for programming was significantly shorter for beta- and image-guided programming compared to clinically-guided programming (p < 0.001). Conclusion Beta-guided programming may be a useful and more efficient approach to DBS programming in Parkinson's patients with STN-DBS. It takes significantly less time to program than traditional clinically-based programming, while providing similar symptom control. In addition, it is readily available within the clinical DBS programmer, making it a valuable tool for improving current clinical practice.}, language = {en} } @phdthesis{Pitsch2024, author = {Pitsch, Maximilian Jonathan}, title = {Zyklisches Adenosinmonophosphat (cAMP) als {\"A}quivalent akkumulierter neuronaler Evidenz}, doi = {10.25972/OPUS-35129}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-351292}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Die vier Crz-Neurone des ventralen Nervensystems von Drosophila melanogaster sammeln Evidenz, wann im Rahmen eines Paarungsakts zirka 6 Minuten vergangen sind. Diese Entscheidung ist f{\"u}r die m{\"a}nnliche Fliege von Bedeutung, da das M{\"a}nnchen vor Ablauf dieser ~6 Minuten, welche den Zeitpunkt der Ejakulation darstellen, eher das eigene Leben opfern w{\"u}rde, als dass es die Paarung beenden w{\"u}rde. Nach Ablauf der ~6 Minuten f{\"a}llt die Motivation des M{\"a}nnchens dagegen dramatisch ab. Im Rahmen der vorliegenden Arbeit wurde zun{\"a}chst mittels optogenetischer neuronaler Inhibitionsprotokolle sowie Verhaltensanalysen das Ph{\"a}nomen der Evidenz-akkumulation in den Crz-Neuronen genauer charakterisiert. Dabei zeigte sich, dass die akkumulierte Evidenz auch w{\"a}hrend einer elektrischen Inhibition der Crz-Neurone persistierte. Dieses Ergebnis warf die Hypothese auf, dass das {\"A}quivalent der akkumulierten Evidenz in den Crz-Neuronen biochemischer Natur sein k{\"o}nnte. Es wurde daraufhin ein Hochdurchsatzscreening-Verfahren entwickelt, mittels dessen 1388 genetische Manipulationen der Crz-Neurone durchgef{\"u}hrt und auf eine {\"A}nderung der Evidenzakkumulation getestet wurden. Nur ~30 genetische Manipulationen zeigten eine ver{\"a}nderte Evidenzakkumulation, wobei die meisten dieser Manipulationen den cAMP-Signalweg betrafen. Mittels der optogenetischen Photoadenylatzyklase bPAC, einer Reihe weiterer genetischer Manipulationen des cAMP-Signalwegs sowie der ex vivo Kalzium-Bildgebung und Fluoreszenzlebensdauer-Mikroskopie konnte best{\"a}tigt werden, dass cAMP das {\"A}quivalent der in den Crz-Neuronen spannungsabh{\"a}ngig akkumulierten Evidenz darstellt, wobei die Kombination dieser Methoden nahelegte, dass der Schwellenwert der Evidenzakkumulation durch die cAMP-Bindungsaffinit{\"a}t der regulatorischen PKA-Untereinheiten festgelegt sein k{\"o}nnte. Mittels genetischer Mosaikexperimente sowie bildgebenden Verfahren konnte dar{\"u}ber hinaus gezeigt werden, dass innerhalb des Crz-Netzwerks eine positive R{\"u}ckkopplungsschleife aus rekurrenter Aktivit{\"a}t sowie der cAMP-Akkumulation besteht, welche, sobald die cAMP-Spiegel den Schwellenwert erreichen, zu einem netzwerkweit synchronisierten massiven Kalziumeinstrom f{\"u}hrt, was die Abgabe des Crz-Signals an nachgeschaltete Netzwerke triggert. Dieses Ph{\"a}nomen k{\"o}nnte ein Analogon des Aktionspotenzials auf Netzwerkebene sowie auf Intervallzeitskalen darstellen und wurde als „Eruption" bezeichnet. Genetische, optogenetische sowie Bildgebungsexperimente konnten zeigen, dass die CaMKII derartige Eruptionen durch Niedrighalten der cAMP-Spiegel unterdr{\"u}ckt, was den Zeitmessmechanismus des ersten beschriebenen Intervallzeitmessers CaMKII offenlegt.}, subject = {Evidenz}, language = {de} } @phdthesis{WidmaiergebWirth2024, author = {Widmaier [geb. Wirth], Lisa Marie}, title = {K{\"u}nstliche Intelligenz zur vollst{\"a}ndig automatisierten FRS-Auswertung: Bewertung der Auswertequalit{\"a}t verschiedener kommerzieller Anbieter im Vergleich zu einem menschlichen Goldstandard}, doi = {10.25972/OPUS-35180}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-351803}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Ziel der vorliegenden Studie war es, verschiedene kommerzielle Anbieter f{\"u}r KI-gest{\"u}tzte FRS-Analysen hinsichtlich ihrer Genauigkeit mit einem menschlichen Goldstandard zu vergleichen. Auf 50 FRS wurden durch zw{\"o}lf erfahrene Untersucher 15 Landmarken identifiziert, auf deren Basis neun relevante Parameter vermessen wurden. Der Medianwert dieser zw{\"o}lf Auswertungen wurde f{\"u}r jeden Parameter auf jedem FRS als Goldstandard definiert und als Referenz f{\"u}r die Vergleiche mit vier verschiedenen kommerziellen KI-Anbietern (DentaliQ.ortho, WebCeph, AudaxCeph, CephX) festgelegt. Die statistische Auswertung erfolgte mittels ANOVA mit Messwiederholung, paarweiser Vergleiche mittels Post-hoc-Test und Bland-Altman-Plots. DentaliQ.ortho zeigte f{\"u}r alle neun untersuchten Parameter keinen statistisch signifikanten Unterschied zum menschlichen Goldstandard und es konnte insgesamt von einer hohen Genauigkeit der Auswertungen ausgegangen werden. Auch f{\"u}r WebCeph war kein statistisch signifikanter Unterschied zum menschlichen Goldstandard zu verzeichnen. Allerdings war die Pr{\"a}zision im Vergleich zu den anderen Anbietern f{\"u}r alle Parameter am geringsten und der proportionale Fehler bei nahezu allen Parametern am h{\"o}chsten. AudaxCeph wies f{\"u}r sieben Parameter statistisch signifikante Unterschiede zum menschlichen Goldstandard auf. F{\"u}r CephX wurden f{\"u}r f{\"u}nf Parameter statistisch signifikante Unterschiede zum menschlichen Goldstandard ermittelt. Insbesondere f{\"u}r die dentale Analyse war f{\"u}r alle untersuchten kommerziellen KI-Anbieter eine vergleichsweise niedrigere Genauigkeit zu verzeichnen. Die Ergebnisse zeigen, dass noch deutliche Qualit{\"a}tsunterschiede zwischen den kommerziellen KI-Anbietern f{\"u}r die vollst{\"a}ndig automatisierte FRS-Analyse bestehen. Vor dem Hintergrund der Zeitersparnis und Qualit{\"a}tssicherung sind KI zwar vielversprechend, sollten aber zum aktuellen Zeitpunkt nur unter Aufsicht durch menschliche Experten zum Einsatz kommen.}, subject = {Kieferorthop{\"a}die}, language = {de} } @phdthesis{Schindler2024, author = {Schindler, Paul}, title = {Stellenwert der Strahlentherapie beim fortgeschrittenen adrenokortikalen Karzinom}, doi = {10.25972/OPUS-34930}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349304}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Das adrenokortikale Karzinom (ACC) ist eine seltene Tumorerkrankung der Nebennierenrinde. Die Prognose ist im Allgemeinen ung{\"u}nstig und vom Tumorstadium sowie von weiteren tumor- und patientenspezifischen Faktoren abh{\"a}ngig. Die chirurgische Komplettresektion stellt das bisher einzige kurative Behandlungsverfahren dar. Dabei gibt es bisher f{\"u}r sonstige Lokaltherapien beim fortgeschrittenen bzw. rezidivierten ACC kaum umfangreiche Daten, welche die entsprechende lokale Wirksamkeit belegen. Neben der Operation stellt die Strahlentherapie eine bisher effektive Therapieoption bei verschiedenen anderen Tumorerkrankungen hinsichtlich Tumorkontrolle, Vertr{\"a}glichkeit und Zug{\"a}nglichkeit dar. Allerdings ist diese Option in der Behandlung des fortgeschrittenen ACC als Lokaltherapie bislang nicht mit zufriedenstellenden Datens{\"a}tzen umf{\"a}nglich untersucht. Ziel dieser Studie war es, anhand einer retrospektiven Datenanalyse aus dem European Network for the Study of Adrenal Tumours (ENSAT) den Stellenwert der Strahlentherapie als Lokaltherapie beim fortgeschrittenen bzw. rezidivierten ACC zu untersuchen. Es wurden insgesamt 132 F{\"a}lle hinsichtlich strahlentherapeutischer Dosis, Lokalkontrolle, progressionsfreiem {\"U}berleben, Gesamt{\"u}berleben, objektivem Ansprechen, Vertr{\"a}glichkeit und Risikofaktoren untersucht. Hierbei konnte gezeigt werden, dass die Anwendung einer hohen biologischen Effektivdosis mit einer verbesserten lokalen Tumorkontrolle einhergeht. Insgesamt zeigte sich eine gute Vertr{\"a}glichkeit der strahlentherapeutischen Behandlung. Die Ergebnisse dieser Arbeit legen nahe, dass wahrscheinlich weitere Risikofaktoren mit Rezidiven dieser Tumorart einhergehen, allerdings weitere Untersuchungen (z.B. randomisierte prospektive Studien) erfordern. Letztendlich stellt diese Arbeit auch die angewandten Dosis- und Fraktionierungskonzepte der vergangenen Jahrzente bei der Behandlung des ACC dar.}, subject = {Nebennierenrindenkrebs}, language = {de} } @phdthesis{Bauer2024, author = {Bauer, Maria Franziska}, title = {Perioperative {\"A}nderung der Ventilationsverteilung und der Lungenfunktion bei Patienten nach intraabdominellen Operationen - Untersuchung mit Hilfe der Elektroimpedanztomographie}, doi = {10.25972/OPUS-34567}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-345676}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Postoperative pulmonale Komplikationen (PPC) stellen den Hauptgrund f{\"u}r erh{\"o}hte Morbidit{\"a}t und Mortalit{\"a}t sowie eine l{\"a}ngere station{\"a}re Liegedauer nach chirurgischen Eingriffen dar. Die Elektrische Impedanztomographie (EIT) erm{\"o}glicht als strahlungsfreie Methode die bettseitige Visualisierung der regionalen pulmonalen Ventilation in einem thorakalen Querschnittsbereich {\"u}ber den zeitlichen Verlauf. Die Hauptfragestellung dieser Studie war die perioperativen Ver{\"a}nderungen der regionalen pulmonalen Ventilation bei spontanatmenden Patienten nach abdominalchirurgischen Eingriffen in Allgemeinnarkose bis in die sp{\"a}te postoperative Phase zu untersuchen. Zus{\"a}tzlich untersuchten wir die Lungenfunktion mittels Spirometrie. Wir nahmen eine Verschiebung der pulmonalen Ventilation in dorso-ventraler Richtung an, sowie eine postoperativ reduzierte Vitalkapazit{\"a}t, z.B. durch Atelektasen oder Pleuraerg{\"u}sse. In die prospektive Observationsstudie wurden 36 erwachsene Patienten eingeschlossen, die sich einem elektiven abdominalchirurgischen Eingriff unter Allgemeinan{\"a}sthesie unterzogen und ein mittleres Risiko gem{\"a}ß ARISCAT Score f{\"u}r die Entwicklung von PPC aufwiesen. Pr{\"a}operativ, sowie am 1. und 3. postoperativen Tag erfolgte die Untersuchung der pulmonalen Ventilation mittels EIT in Spontanatmung, Errechnung des Center of Ventilation (COV), sowie eine Lungenfunktionspr{\"u}fung mittels Spirometrie. Nach abdominalchirurgischen Operationen kam es zu einer statistisch signifikanten und bis zum 3. postoperativen Tag anhaltenden Verschiebung der pulmonalen Ventilation nach ventral (COVy pr{\"a}op. 16,5; 1. Tag postop. 17,8; 3. Tag postop. 17,4). Zudem zeigte sich eine anhaltend reduzierte Forcierten Vitalkapazit{\"a}t in \% vom Sollwert (FVC\%Soll): pr{\"a}op. 93\%; 1. Tag postop. 58\%; 3. Tag postop. 64\%. Am 3. postoperativen Tag bestand unter forcierter Atmung eine negative Assoziation zwischen der {\"A}nderung des COVy und der {\"A}nderung der FVC\%Soll. PPC traten bei 10 Patienten in Form von respiratorischer Insuffizienz, Atelektase und Pleuraerguss auf. Bei diesen Patienten zeigte die EIT keine komplikationsspezifischen Bilder. Abdominalchirurgische Operationen hatten hat einen relevanten Einfluss auf die postoperative regionale Lungenventilation und somit auf die Entstehung von PPC. Die EIT hilft die Entstehung von PPC besser zu verstehen und Strategien zur Vermeidung solcher im klinischen Alltag zu implementieren.}, subject = {Ventilation}, language = {de} } @article{SchmiemannGreserMaunetal.2023, author = {Schmiemann, Guido and Greser, Alexandra and Maun, Andy and Bleidorn, Jutta and Schuster, Angela and Miljukov, Olga and R{\"u}cker, Viktoria and Klingeberg, Anja and Mentzel, Anja and Minin, Vitalii and Eckmanns, Tim and Heintze, Christoph and Heuschmann, Peter and G{\´a}gyor, Ildik{\´o}}, title = {Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial}, series = {BMJ}, volume = {383}, journal = {BMJ}, issn = {1756-1833}, doi = {10.1136/bmj-2023-076305}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349395}, year = {2023}, abstract = {Objectives To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women. Design Parallel, cluster randomised, controlled trial. Setting General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022. Participants General practitioners from 128 randomly assigned practices. Interventions Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention. Main outcome measures Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes. Results 110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was -0.13 (95\% confidence interval -0.21 to -0.06, P\<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of -0.08 (95\% confidence interval -0.15 to -0.02, P\<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups. Conclusions The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women. Trial registration German Clinical Trials Register (DRKS), DRKS00020389}, language = {en} } @article{GschmackMonoranuMaroufetal.2022, author = {Gschmack, Eva and Monoranu, Camelia-Maria and Marouf, Hecham and Meyer, Sarah and Lessel, Lena and Idris, Raja and Berg, Daniela and Maetzler, Walter and Steigerwald, Frank and Volkmann, Jens and Gerlach, Manfred and Riederer, Peter and Koutsilieri, Eleni and Scheller, Carsten}, title = {Plasma autoantibodies to glial fibrillary acidic protein (GFAP) react with brain areas according to Braak staging of Parkinson's disease}, series = {Journal of Neural Transmission}, volume = {129}, journal = {Journal of Neural Transmission}, number = {5-6}, doi = {10.1007/s00702-022-02495-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-325161}, pages = {545-555}, year = {2022}, abstract = {Idiopathic Parkinson's disease (PD) is characterized by a progredient degeneration of the brain, starting at deep subcortical areas such as the dorsal motor nucleus of the glossopharyngeal and vagal nerves (DM) (stage 1), followed by the coeruleus-subcoeruleus complex; (stage 2), the substantia nigra (SN) (stage 3), the anteromedial temporal mesocortex (MC) (stage 4), high-order sensory association areas and prefrontal fields (HC) (stage 5) and finally first-order sensory association areas, premotor areas, as well as primary sensory and motor field (FC) (stage 6). Autoimmunity might play a role in PD pathogenesis. Here we analyzed whether anti-brain autoantibodies differentially recognize different human brain areas and identified autoantigens that correlate with the above-described dissemination of PD pathology in the brain. Brain tissue was obtained from deceased individuals with no history of neurological or psychiatric disease and no neuropathological abnormalities. Tissue homogenates from different brain regions (DM, SN, MC, HC, FC) were subjected to SDS-PAGE and Western blot. Blots were incubated with plasma samples from 30 PD patients and 30 control subjects and stained with anti-IgG antibodies to detect anti-brain autoantibodies. Signals were quantified. Prominent autoantigens were identified by 2D-gel-coupled mass spectrometry sequencing. Anti-brain autoantibodies are frequent and occur both in healthy controls and individuals with PD. Glial fibrillary acidic protein (GFAP) was identified as a prominent autoantigen recognized in all plasma samples. GFAP immunoreactivity was highest in DM areas and lowest in FC areas with no significant differences in anti-GFAP autoantibody titers between healthy controls and individuals with PD. The anti-GFAP autoimmunoreactivity of different brain areas correlates with the dissemination of histopathological neurodegeneration in PD. We hypothesize that GFAP autoantibodies are physiological but might be involved as a cofactor in PD pathogenesis secondary to a leakage of the blood-brain barrier.}, language = {en} } @article{HartrampfWeinzierlBucketal.2022, author = {Hartrampf, Philipp E. and Weinzierl, Franz-Xaver and Buck, Andreas K. and Rowe, Steven P. and Higuchi, Takahiro and Seitz, Anna Katharina and K{\"u}bler, Hubert and Schirbel, Andreas and Essler, Markus and Bundschuh, Ralph A. and Werner, Rudolf A.}, title = {Matched-pair analysis of [\(^{177}\)Lu]Lu-PSMA I\&T and [\(^{177}\)Lu]Lu-PSMA-617 in patients with metastatic castration-resistant prostate cancer}, series = {European Journal of Nuclear Medicine and Molecular Imaging}, volume = {49}, journal = {European Journal of Nuclear Medicine and Molecular Imaging}, number = {9}, doi = {10.1007/s00259-022-05744-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324581}, pages = {3269-3276}, year = {2022}, abstract = {Background Labelled with lutetium-177, the urea-based small molecules PSMA I\&T and PSMA-617 are the two agents most frequently used for radioligand therapy (RLT) in patients with advanced metastatic castration-resistant and prostate-specific membrane antigen (PSMA) expressing prostate cancer (mCRPC). In this matched-pair analysis, we aimed to compare the toxicity and efficacy of both agents for PSMA-directed RLT. Materials and methods A total of 110 mCRPC patients from two centres were accrued, 55 individuals treated with [\(^{177}\)Lu]Lu-PSMA I\&T, and a matched cohort of 55 patients treated with [\(^{177}\)Lu]Lu-PSMA-617. Matching criteria included age at the first cycle, Gleason score, prostate-specific antigen (PSA) values, and previous taxane-based chemotherapy. Using common terminology criteria for adverse events (CTCAE v. 5.0), toxicity profiles were investigated (including bone marrow and renal toxicity). Overall survival (OS) between both groups was compared. Results Toxicity assessment revealed grade III anaemia in a single patient (1.8\%) for [\(^{177}\)Lu]Lu-PSMA I\&T and five (9.1\%) for [\(^{177}\)Lu]Lu-PSMA-617. In addition, one (1.9\%) grade III thrombopenia for [\(^{177}\)Lu]Lu-PSMA-617 was recorded. Apart from that, no other grade III/IV toxicities were present. A median OS of 12 months for patients treated with [\(^{177}\)Lu]Lu-PSMA I\&T did not differ significantly when compared to patients treated with [\(^{177}\)Lu]Lu-PSMA-617 (median OS, 13 months; P = 0.89). Conclusion In this matched-pair analysis of patients receiving one of the two agents most frequently applied for PSMA RLT, the rate of clinically relevant toxicities was low for both compounds. In addition, no relevant differences for OS were observed.}, language = {en} } @phdthesis{Englert2024, author = {Englert, Nils}, title = {Die Rolle der NO-sensitiven Guanylyl-Cyclase in der Lungenfibrose der Maus}, doi = {10.25972/OPUS-34805}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-348054}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Die idiopathische Lungenfibrose (IPF) stellt eine chronische Krankheit mit einer schlechten Prognose dar. Die Erkrankung zeichnet sich durch ein dysfunktionales Alveolarepithel, die Formation von α-smooth muscle actin (α-SMA)-positiven Myofibroblasten, eine starke Kollagendeposition sowie eine fehlgeleitete Inflammation aus. In der Vermittlung dieser pro-fibrotischen Effekte spielt das Zytokin transforming growth factor β (TGF-β) eine Schl{\"u}sselrolle. Aufgrund des t{\"o}dlichen Verlaufs der IPF und der limitierten Therapieoptionen ist die Entdeckung neuer Behandlungsans{\"a}tze erforderlich. Der NO/cGMP-Signalweg ist in der Modulation grundlegender physiologischer Vorg{\"a}nge wie der Blutdruckregulation und der Peristaltik involviert. Hierbei spielt die NO-sensitive Guanylyl-Cyclase (NO-GC) als NO-Rezeptor eine fundamentale Rolle. In der Lunge wird die NO-GC in glatten Muskelzellen und Perizyten exprimiert. W{\"a}hrend das Enzym in glatten Muskelzellen die Relaxation der glatten Muskulatur vermittelt, reguliert die NO-GC in Perizyten die Angiogenese, die Kapillardurchl{\"a}ssigkeit und den Blutfluss. Neben den physiologischen Aufgaben wurden anti-fibrotische sowie anti-inflammatorische Effekte der NO-GC in Herz, Leber, Niere und Haut beschrieben. Daher wurde im Rahmen dieser Arbeit die NO-GC auf eine anti-fibrotische und anti-inflammatorische Bedeutung in der Lungenfibrose der Maus {\"u}berpr{\"u}ft. Hierzu wurden Wildtyp- (WT) und globale NO-GC-Knockout-M{\"a}use (GCKO) untersucht. Die Fibrose wurde durch einmalige, orotracheale Bleomycin-Gabe induziert und zu unterschiedlichen Zeitpunkten (Tag 7 und 21) untersucht. Unbehandelte (Tag 0) Tiere dienten als Kontrolle. Im ersten Teil dieser Arbeit wurde die NO-GC auf eine anti-fibrotische Wirkung untersucht. Mittels Immunfluoreszenz wurde das Verhalten der α-SMA-positiven Myofibroblasten in den platelet-derived growth factor receptor β (PDGFRβ)-positiven fibrotischen Regionen untersucht. Der Kollagengehalt wurde mithilfe eines Hydroxyprolin-Kollagenassays ermittelt. Die untersuchten Fibrose-Kriterien waren in beiden Genotypen an Tag 21 st{\"a}rker ausgepr{\"a}gt als an Tag 7. An Tag 21 konnten im GCKO mehr α-SMA-positive Myofibroblasten, ausgepr{\"a}gtere PDGFRβ-positive fibrotische Areale und ein h{\"o}herer Kollagengehalt als im WT festgestellt werden. Zudem zeigten die GCKO-Tiere ein schlechteres {\"U}berleben als WT-M{\"a}use. Diese Ergebnisse wiesen auf eine {\"u}berschießende fibrotische Antwort im GCKO und somit auf eine anti-fibrotische Wirkung der NO-GC in der Bleomycin-induzierten Lungenfibrose hin. Dass an Tag 21 die Fibrose im GCKO st{\"a}rker ausfiel als im WT, konnte mit dem signifikant h{\"o}heren TGF-β-Gehalt in der bronchoalveol{\"a}ren Lavagefl{\"u}ssigkeit (BALF) im GCKO erkl{\"a}rt werden. Das Fehlen der NO-GC im GCKO k{\"o}nnte zu einem Wegfall der Inhibierung der TGF-β-vermittelten, pro-fibrotischen Effekte durch die NO-GC f{\"u}hren. Weitere Studien sind erforderlich, um die Hypothese zu belegen und zugrundeliegende Mechanismen aufzukl{\"a}ren. Die de novo Entstehung von Myofibroblasten, die maßgeblich an der Kollagensynthese beteiligt sind, stellt ein entscheidendes Fibrose-Merkmal dar. Umso bedeutender ist die Identifikation zweier Myofibroblasten-Subtypen, die sich in Lokalisation, NO-GC-Expression und Herkunft unterscheiden: (1) interstitielle, NO-GC-positive Myofibroblasten, die von Perizyten abstammen und Kollagen Typ I produzieren, und (2) intra-alveol{\"a}re, NO-GC-negative Myofibroblasten, deren Ursprung noch nicht abschließend gekl{\"a}rt ist. Die Anwesenheit beider Myofibroblasten-Typen konnte zu beiden untersuchten Zeitpunkten nach Bleomycin-Gabe best{\"a}tigt werden. Die NO-GC-Expression der Alveolarwand-st{\"a}ndigen Myofibroblasten, deren Abstammung von NO-GC-positiven Perizyten sowie deren dauerhafte Pr{\"a}senz sprechen f{\"u}r eine relevante Rolle der NO-GC in der murinen Lungenfibrose. In weiteren Untersuchungen m{\"u}ssen die exakten Funktionen und spezifische Marker der Myofibroblasten-Subtypen identifiziert werden. Im zweiten Teil dieser Arbeit wurde die NO-GC auf anti-inflammatorische Effekte in der Bleomycin-induzierten Lungenfibrose untersucht. Mittels HE-F{\"a}rbung und Immunfluoreszenz wurden lymphozyt{\"a}re Infiltrate an Tag 21 im GCKO festgestellt, was auf einen modulatorischen Einfluss der NO-GC auf das Immunsystem hindeutete. An Tag 21 wurden in der BALF von GCKO-Tieren signifikant mehr Gesamtimmunzellen, Lymphozyten und neutrophile Granulozyten als im WT gez{\"a}hlt, was auf eine starke Einwanderung von Immunzellen und somit auf eine ausgepr{\"a}gte Entz{\"u}ndung in GCKO-Lungen hinwies. Folglich k{\"o}nnte die NO-GC eine anti-inflammatorische Rolle {\"u}ber die Regulation der Immigration von Immunzellen in der Bleomycin-induzierten Lungenfibrose spielen. In der Literatur werden pro- und anti-fibrotische Effekte der Immunzellen in der murinen Lungenfibrose diskutiert. Durch Korrelationsanalysen wurde ein positiver Zusammenhang zwischen der Gesamtimmunzellzahl und der TGF-β-Konzentration an Tag 21 festgestellt. In verschiedenen Studien wurde ein pro-fibrotischer Einfluss der Immunzellen {\"u}ber die Aktivierung/Sekretion von TGF-β beschrieben. Die Abwesenheit der NO-GC im GCKO k{\"o}nnte also {\"u}ber die verst{\"a}rkte Immigration von Immunzellen in einem erh{\"o}hten TGF-β-Gehalt resultieren und so zu einer {\"u}berschießenden fibrotischen Reaktion an Tag 21 f{\"u}hren. Auf welche Weise die NO-GC die Einwanderung der Immunzellen in der Bleomycin-induzierten Lungenfibrose beeinflusst, muss in weiteren Studien untersucht werden. Zusammenfassend deuten die Daten dieser Arbeit auf eine anti-inflammatorische und anti-fibrotische Rolle der NO-GC in der Lungenfibrose der Maus hin.}, subject = {Lunge}, language = {de} } @phdthesis{Andelovic2024, author = {Andelovic, Kristina}, title = {Characterization of arterial hemodynamics using mouse models of atherosclerosis and tissue-engineered artery models}, doi = {10.25972/OPUS-30360}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-303601}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Within this thesis, three main approaches for the assessment and investigation of altered hemodynamics like wall shear stress, oscillatory shear index and the arterial pulse wave velocity in atherosclerosis development and progression were conducted: 1. The establishment of a fast method for the simultaneous assessment of 3D WSS and PWV in the complete murine aortic arch via high-resolution 4D-flow MRI 2. The utilization of serial in vivo measurements in atherosclerotic mouse models using high-resolution 4D-flow MRI, which were divided into studies describing altered hemodynamics in late and early atherosclerosis 3. The development of tissue-engineered artery models for the controllable application and variation of hemodynamic and biologic parameters, divided in native artery models and biofabricated artery models, aiming for the investigation of the relationship between atherogenesis and hemodynamics Chapter 2 describes the establishment of a method for the simultaneous measurement of 3D WSS and PWV in the murine aortic arch at, using ultra high-field MRI at 17.6T [16], based on the previously published method for fast, self-navigated wall shear stress measurements in the murine aortic arch using radial 4D-phase contrast MRI at 17.6 T [4]. This work is based on the collective work of Dr. Patrick Winter, who developed the method and the author of this thesis, Kristina Andelovic, who performed the experiments and statistical analyses. As the method described in this chapter is basis for the following in vivo studies and undividable into the sub-parts of the contributors without losing important information, this chapter was not split into the single parts to provide fundamental information about the measurement and analysis methods and therefore better understandability for the following studies. The main challenge in this chapter was to overcome the issue of the need for a high spatial resolution to determine the velocity gradients at the vascular wall for the WSS quantification and a high temporal resolution for the assessment of the PWV without prolonging the acquisition time due to the need for two separate measurements. Moreover, for a full coverage of the hemodynamics in the murine aortic arch, a 3D measurement is needed, which was achieved by utilization of retrospective navigation and radial trajectories, enabling a highly flexible reconstruction framework to either reconstruct images at lower spatial resolution and higher frame rates for the acquisition of the PWV or higher spatial resolution and lower frame rates for the acquisition of the 3D WSS in a reasonable measurement time of only 35 minutes. This enabled the in vivo assessment of all relevant hemodynamic parameters related to atherosclerosis development and progression in one experimental session. This method was validated in healthy wild type and atherosclerotic Apoe-/- mice, indicating no differences in robustness between pathological and healthy mice. The heterogeneous distribution of plaque development and arterial stiffening in atherosclerosis [10, 12], however, points out the importance of local PWV measurements. Therefore, future studies should focus on the 3D acquisition of the local PWV in the murine aortic arch based on the presented method, in order to enable spatially resolved correlations of local arterial stiffness with other hemodynamic parameters and plaque composition. In Chapter 3, the previously established methods were used for the investigation of changing aortic hemodynamics during ageing and atherosclerosis in healthy wild type and atherosclerotic Apoe-/- mice using the previously established methods [4, 16] based on high-resolution 4D-flow MRI. In this work, serial measurements of healthy and atherosclerotic mice were conducted to track all changes in hemodynamics in the complete aortic arch over time. Moreover, spatially resolved 2D projection maps of WSS and OSI of the complete aortic arch were generated. This important feature allowed for the pixel-wise statistical analysis of inter- and intragroup hemodynamic changes over time and most importantly - at a glance. The study revealed converse differences of local hemodynamic profiles in healthy WT and atherosclerotic Apoe-/- mice, with decreasing longWSS and increasing OSI, while showing constant PWV in healthy mice and increasing longWSS and decreasing OSI, while showing increased PWV in diseased mice. Moreover, spatially resolved correlations between WSS, PWV, plaque and vessel wall characteristics were enabled, giving detailed insights into coherences between hemodynamics and plaque composition. Here, the circWSS was identified as a potential marker of plaque size and composition in advanced atherosclerosis. Moreover, correlations with PWV values identified the maximum radStrain could serve as a potential marker for vascular elasticity. This study demonstrated the feasibility and utility of high-resolution 4D flow MRI to spatially resolve, visualize and analyze statistical differences in all relevant hemodynamic parameters over time and between healthy and diseased mice, which could significantly improve our understanding of plaque progression towards vulnerability. In future studies the relation of vascular elasticity and radial strain should be further investigated and validated with local PWV measurements and CFD. Moreover, the 2D histological datasets were not reflecting the 3D properties and regional characteristics of the atherosclerotic plaques. Therefore, future studies will include 3D plaque volume and composition analysis like morphological measurements with MRI or light-sheet microscopy to further improve the analysis of the relationship between hemodynamics and atherosclerosis. Chapter 4 aimed at the description and investigation of hemodynamics in early stages of atherosclerosis. Moreover, this study included measurements of hemodynamics at baseline levels in healthy WT and atherosclerotic mouse models. Due to the lack of hemodynamic-related studies in Ldlr-/- mice, which are the most used mouse models in atherosclerosis research together with the Apoe-/- mouse model, this model was included in this study to describe changing hemodynamics in the aortic arch at baseline levels and during early atherosclerosis development and progression for the first time. In this study, distinct differences in aortic geometries of these mouse models at baseline levels were described for the first time, which result in significantly different flow- and WSS profiles in the Ldlr-/- mouse model. Further basal characterization of different parameters revealed only characteristic differences in lipid profiles, proving that the geometry is highly influencing the local WSS in these models. Most interestingly, calculation of the atherogenic index of plasma revealed a significantly higher risk in Ldlr-/- mice with ongoing atherosclerosis development, but significantly greater plaque areas in the aortic arch of Apoe-/- mice. Due to the given basal WSS and OSI profile in these two mouse models - two parameters highly influencing plaque development and progression - there is evidence that the regional plaque development differs between these mouse models during very early atherogenesis. Therefore, future studies should focus on the spatiotemporal evaluation of plaque development and composition in the three defined aortic regions using morphological measurements with MRI or 3D histological analyses like LSFM. Moreover, this study offers an excellent basis for future studies incorporating CFD simulations, analyzing the different measured parameter combinations (e.g., aortic geometry of the Ldlr-/- mouse with the lipid profile of the Apoe-/- mouse), simulating the resulting plaque development and composition. This could help to understand the complex interplay between altered hemodynamics, serum lipids and atherosclerosis and significantly improve our basic understanding of key factors initiating atherosclerosis development. Chapter 5 describes the establishment of a tissue-engineered artery model, which is based on native, decellularized porcine carotid artery scaffolds, cultured in a MRI-suitable bioreactor-system [23] for the investigation of hemodynamic-related atherosclerosis development in a controllable manner, using the previously established methods for WSS and PWV assessment [4, 16]. This in vitro artery model aimed for the reduction of animal experiments, while simultaneously offering a simplified, but completely controllable physical and biological environment. For this, a very fast and gentle decellularization protocol was established in a first step, which resulted in porcine carotid artery scaffolds showing complete acellularity while maintaining the extracellular matrix composition, overall ultrastructure and mechanical strength of native arteries. Moreover, a good cellular adhesion and proliferation was achieved, which was evaluated with isolated human blood outgrowth endothelial cells. Most importantly, an MRI-suitable artery chamber was designed for the simultaneous cultivation and assessment of high-resolution 4D hemodynamics in the described artery models. Using high-resolution 4D-flow MRI, the bioreactor system was proven to be suitable to quantify the volume flow, the two components of the WSS and the radStrain as well as the PWV in artery models, with obtained values being comparable to values found in literature for in vivo measurements. Moreover, the identification of first atherosclerotic processes like intimal thickening is achievable by three-dimensional assessment of the vessel wall morphology in the in vitro models. However, one limitation is the lack of a medial smooth muscle cell layer due to the dense ECM. Here, the utilization of the laser-cutting technology for the generation of holes and / or pits on a microscale, eventually enabling seeding of the media with SMCs showed promising results in a first try and should be further investigated in future studies. Therefore, the proposed artery model possesses all relevant components for the extension to an atherosclerosis model which may pave the way towards a significant improvement of our understanding of the key mechanisms in atherogenesis. Chapter 6 describes the development of an easy-to-prepare, low cost and fully customizable artery model based on biomaterials. Here, thermoresponsive sacrificial scaffolds, processed with the technique of MEW were used for the creation of variable, biomimetic shapes to mimic the geometric properties of the aortic arch, consisting of both, bifurcations and curvatures. After embedding the sacrificial scaffold into a gelatin-hydrogel containing SMCs, it was crosslinked with bacterial transglutaminase before dissolution and flushing of the sacrificial scaffold. The hereby generated channel was subsequently seeded with ECs, resulting in an easy-to-prepare, fast and low-cost artery model. In contrast to the native artery model, this model is therefore more variable in size and shape and offers the possibility to include smooth muscle cells from the beginning. Moreover, a custom-built and highly adaptable perfusion chamber was designed specifically for the scaffold structure, which enabled a one-step creation and simultaneously offering the possibility for dynamic cultivation of the artery models, making it an excellent basis for the development of in vitro disease test systems for e.g., flow-related atherosclerosis research. Due to time constraints, the extension to an atherosclerosis model could not be achieved within the scope of this thesis. Therefore, future studies will focus on the development and validation of an in vitro atherosclerosis model based on the proposed bi- and three-layered artery models. In conclusion, this thesis paved the way for a fast acquisition and detailed analyses of changing hemodynamics during atherosclerosis development and progression, including spatially resolved analyses of all relevant hemodynamic parameters over time and in between different groups. Moreover, to reduce animal experiments, while gaining control over various parameters influencing atherosclerosis development, promising artery models were established, which have the potential to serve as a new platform for basic atherosclerosis research.}, subject = {H{\"a}modynamik}, language = {en} } @article{SiverinoFahmyGarciaNiklausetal.2023, author = {Siverino, Claudia and Fahmy-Garcia, Shorouk and Niklaus, Viktoria and Kops, Nicole and Dolcini, Laura and Misciagna, Massimiliano Maraglino and Ridwan, Yanto and Farrell, Eric and van Osch, Gerjo J. V. M. and Nickel, Joachim}, title = {Addition of heparin binding sites strongly increases the bone forming capabilities of BMP9 in vivo}, series = {Bioactive Materials}, volume = {29}, journal = {Bioactive Materials}, doi = {10.1016/j.bioactmat.2023.07.010}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350470}, pages = {241-250}, year = {2023}, abstract = {Highlights • Despite not being crucial for bone development BMP9 can induce bone growth in vivo. • BMP9 induced bone formation is strongly enhanced by introduced heparin binding sites. • BMP9s bone forming capabilities are triggered by extracellular matrix binding. • Heparin binding BMP9 (BMP9 HB) can improve the current therapies in treating bone fractures. Abstract Bone Morphogenetic proteins (BMPs) like BMP2 and BMP7 have shown great potential in the treatment of severe bone defects. In recent in vitro studies, BMP9 revealed the highest osteogenic potential compared to other BMPs, possibly due to its unique signaling pathways that differs from other osteogenic BMPs. However, in vivo the bone forming capacity of BMP9-adsorbed scaffolds is not superior to BMP2 or BMP7. In silico analysis of the BMP9 protein sequence revealed that BMP9, in contrast to other osteogenic BMPs such as BMP2, completely lacks so-called heparin binding motifs that enable extracellular matrix (ECM) interactions which in general might be essential for the BMPs' osteogenic function. Therefore, we genetically engineered a new BMP9 variant by adding BMP2-derived heparin binding motifs to the N-terminal segment of BMP9′s mature part. The resulting protein (BMP9 HB) showed higher heparin binding affinity than BMP2, similar osteogenic activity in vitro and comparable binding affinities to BMPR-II and ALK1 compared to BMP9. However, remarkable differences were observed when BMP9 HB was adsorbed to collagen scaffolds and implanted subcutaneously in the dorsum of rats, showing a consistent and significant increase in bone volume and density compared to BMP2 and BMP9. Even at 10-fold lower BMP9 HB doses bone tissue formation was observed. This innovative approach of significantly enhancing the osteogenic properties of BMP9 simply by addition of ECM binding motifs, could constitute a valuable replacement to the commonly used BMPs. The possibility to use lower protein doses demonstrates BMP9 HB's high translational potential.}, language = {en} } @phdthesis{Albrecht2024, author = {Albrecht, Christina}, title = {Kardiorestriktiver Knockout desmosomaler Proteine f{\"u}hrt zu einer Beeintr{\"a}chtigung der elektromechanischen Kopplung ohne mitochondriale Dysfunktion bei arrhythmogener Kardiomyopathie}, doi = {10.25972/OPUS-34847}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-348472}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Arrhythmogene Kardiomyopathie (ACM) ist eine genetische Herzerkrankung, die durch Herzinsuffizienz, ventrikul{\"a}re Arrhythmien und pl{\"o}tzlichen Herztod gekennzeichnet ist. Mutationen in desmosomalen Proteinen der Zelladh{\"a}sion, wie Plakophilin 2 (PKP2) und Plakoglobin (PG), sind die h{\"a}ufigste Ursache der famili{\"a}ren ACM. Wie gest{\"o}rte Zelladh{\"a}sion zum ACM-Ph{\"a}notyp f{\"u}hrt, ist jedoch nur teilweise gekl{\"a}rt. Potentielle Mechanismen sind eine gest{\"o}rte Kalzium-(Ca2+)-Hom{\"o}ostase, mitochondrialer oxidativer Stress und metabolische St{\"o}rungen. Ziel dieser Studie ist es, die mitochondriale Energetik und die Ca2+ -Hom{\"o}ostase in kardio-restriktiven PKP2-Knockout-M{\"a}usen (KO) im Alter von 4, 8 und 12 Wochen sowie in PG-Knockout- M{\"a}usen im Alter von 6 Wochen zu untersuchen. Vier Wochen alte PKP2-KO-M{\"a}use zeigten fr{\"u}he Anzeichen von ACM, w{\"a}hrend alle anderen Altersgruppen typische Kennzeichen von ACM rekapitulierten. Kontraktilit{\"a}t, die damit verbundenen Ca2+ - Transienten, der Redoxstatus und das mitochondriale Membranpotenzial (ΔΨm) isolierter Kardiomyozyten wurden mit einem IonOptix-System bei elektrischer und β- adrenerger Stimulation untersucht. Alle desmosomalen KO-Kardiomyozyten zeigten eine verringerte diastolische Sarkomerl{\"a}nge, was auf eine diastolische Dysfunktion hinwies. In allen PKP2 KO Kardiomyozyten lag außerdem ein erh{\"o}hter intrazellul{\"a}rer Ca2+ -Spiegel vor, w{\"a}hrend in den PG KO-Kardiomyozyten das intrazellul{\"a}rer Ca2+ unver{\"a}ndert war. PKP2 KO- und PG KO-Kardiomyozyten wiesen keine Ca2+ - Sensibilisierung der Myofilamente auf. Zur weiteren Bewertung der mitochondrialen Funktion wurde eine hochaufl{\"o}sende Respirometrie in isolierten Herzmitochondrien bei gleichzeitiger {\"U}berwachung von ΔΨm in PKP2 KO und PG KO M{\"a}usen durchgef{\"u}hrt, welche in allen Versuchs- und Kontrollgruppen vergleichbar war. Im Verlauf der Versuche blieb der Redoxstatus stabil und es konnte kein Exzess reaktiver Sauerstoffspezies (ROS) festgestellt werden. Daraus konnte gefolgert werden, dass weder PKP2 KO noch PG KO-M{\"a}use eine beeintr{\"a}chtigte mitochondriale Atmung aufwiesen. Diese Studie zeigt, dass isolierte PKP2 KO- oder PG KO-Kardiomyozyten EC-Kopplungsdefekte ohne mitochondriale Dysfunktion aufwiesen. Eine mitochondriale Dysfunktion konnte als treibender Faktor f{\"u}r die Progression des ACM- Ph{\"a}notyps in den vorgestellten Mausmodellen ausgeschlossen werden. Weitere Studien sind erforderlich, um die mitochondriale Funktion im Zusammenhang mit ACM zu entschl{\"u}sseln.}, subject = {Herzmuskelkrankheit}, language = {de} } @article{GiansantiTheinertBoeingetal.2023, author = {Giansanti, Manuela and Theinert, Tobias and Boeing, Sarah Katharina and Haas, Dorothee and Schlegel, Paul-Gerhardt and Vacca, Paola and Nazio, Francesca and Caruana, Ignazio}, title = {Exploiting autophagy balance in T and NK cells as a new strategy to implement adoptive cell therapies}, series = {Molecular Cancer}, volume = {22}, journal = {Molecular Cancer}, doi = {10.1186/s12943-023-01893-w}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357515}, year = {2023}, abstract = {Autophagy is an essential cellular homeostasis pathway initiated by multiple stimuli ranging from nutrient deprivation to viral infection, playing a key role in human health and disease. At present, a growing number of evidence suggests a role of autophagy as a primitive innate immune form of defense for eukaryotic cells, interacting with components of innate immune signaling pathways and regulating thymic selection, antigen presentation, cytokine production and T/NK cell homeostasis. In cancer, autophagy is intimately involved in the immunological control of tumor progression and response to therapy. However, very little is known about the role and impact of autophagy in T and NK cells, the main players in the active fight against infections and tumors. Important questions are emerging: what role does autophagy play on T/NK cells? Could its modulation lead to any advantages? Could specific targeting of autophagy on tumor cells (blocking) and T/NK cells (activation) be a new intervention strategy? In this review, we debate preclinical studies that have identified autophagy as a key regulator of immune responses by modulating the functions of different immune cells and discuss the redundancy or diversity among the subpopulations of both T and NK cells in physiologic context and in cancer.}, language = {en} }