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Das duktale Carcinoma in situ (DCIS) der Mamma stellt eine Neoplasie mit sowohl heterogener Morphologie als auch variierendem biologischen Verhaltens dar. Dies führte in der Vergangenheit zur Etablierung zahlreicher pathohistologischer Klassifikationssysteme mit dem Ziel, das Risiko einer malignen Transformation in ein invasives Carcinom und die Wahrscheinlichkeit eines Lokalrezidivs nach Tumorektomie anhand histologischer Kriterien abzuschätzen. Zur Untersuchung solcher Klassifikationsparameter auf ihre Wichtigkeit sollte der genetische Hintergrund am Beispiel der chromosomalen Trisomie untersucht werden und mit diesen korreliert werden. Die Ergebnisse einer DNA-in situ-Hybridisierung an Paraffin-Material mit spezifischen Proben für die Chromosomen 1, 7, 8 und 18 zeigen, daß Trisomien in dieser Neoplasie ein häufiges Ereignis darstellen (56 Prozent aller Fälle) und daß diese mit den histologischen Parametern der Nekrose und einem hohen Kernatypiegrad korrelieren. Dieser Befund wird durch die Tatsache untermauert, daß solche Beziehungen sogar im gleichen Tumor gefunden werden, wenn dieser eine heterogene Morphologie aufwies. So läßt sich die große Bedeutung der Klassifikationsparameter Nekrose und Kern-Atypie auch durch die Ergebnisse der vorliegenden Arbeit unterstreichen. Eine Trisomie des Chromosoms 18 konnte nur in Fällen von einer Koinzidenz mit mikroinvasiven Herden detektiert werden. Dies deckt sich mit sämtlichen Angaben der Literatur, bei denen eine Trisomie 18 nie bei streng intraduktalem DCIS, sondern nur bei mikroinvasiven oder invasiven Mamma-Karzinomen gefunden wurde. Folglich wäre es wichtig, mit weiteren Untersuchungen die Bedeutung dieser Aberration im Invasionsgeschehen und in der Diagnosestellung einer Mikroinvasion des DCIS zu analysieren.
Knöcherne Verletzungen am Ellenbogen stehen bei Kindern und Jugendlichen nach Unterarm-, Unterschenkel- und Schlüsselbeinbrüchen an vierter Stelle. Von diesen ist die suprakondyläre Humerusfraktur mit ca. 60 Prozent (50 Prozent - 70 Prozent) die häufigste Fraktur. Bedeutend ist sie, weil es sich um eine gelenknahe Fraktur handelt, deren exakte Reposition und Fixation schwierig ist und Wachstumsfugen nicht tangiert werden dürfen. Es treten auch relativ häufig Nerven- und Gefäßläsionen, Gelenkfehlstellungen und Bewegungseinschränkungen sowie der Cubitus varus auf, die immer wieder erneut Anlaß zu Diskussionen über neue, verbesserte Therapiemaßnahmen geben. Das Bestreben, Komplikationen zu vermindern, hat in der Vergangenheit zu einer Vielzahl von Therapiemaßnahmen geführt. Erst 1998 einigte sich die Arbeitsgemeinschaft Kindertraumatologie der Deutschen Gesellschaft für Unfallchirurgie auf eine einheitliche Klassifikation der Frakturen, die im Vergleich zu den früher gebräuchlichen Klassifikationen, die Rotationsstellung, den wichtigsten Grund für die Entstehung für Fehlstellungen, mit berücksichtigt. Es wurden auch, nach der Auswertung einer retrospektiven deutschlandweiten Sammelstudie, Therapieempfehlungen nach Dislokations- und Rotationsgrad der neuen Klassifikation herausgegeben. Leider konnte man sich immer noch nicht auf einheitliche Bewertungskriterien einigen. In der Universitätsklinik Würzburg wurde bereits in den Jahren 1986 bis 1996 im weitesten Sinne nach diesen Richtlinien therapiert, da man frühzeitig die Bedeutung des Rotationsfehlers erkannt hatte. Im Allgemeinen Teil wird auf die speziellen Grundlagen eingegangen, die Besonderheiten der Ellenbogenregion und des wachsenden Skeletts erläutert, um das Entstehen der verschiedenen Komplikationen zu verdeutlichen. Der Spezielle Teil stellt die Auswertung der nachuntersuchten 80 von 136 Patienten, die von 1986 bis 1996 in der kinderchirurgischen Abteilung der Universität Würzburg behandelt wurden, von den allgemeinen Daten über die Klassifikationen, Therapiemethoden und Komplikationen detailliert dar. An Behandlungsmethoden kamen zwei konservative (Blount und Gips), die perkutane gekreuzte Kirschner-Draht-Osteosynsthese und die offene Reposition als Therapiemethoden zum Einsatz. Die perkutane Kirschner-Draht-Osteosynthese erzielte mit 94 Prozent Ideale und Gute Ergebnisse in der Bewertung nach Morger. Bei den konservativen Therapien wurden 80 Prozent mit ideal und gut bewertet. Das Ergebnis der offenen Repositionen lag mit 83 Prozent auch noch weit über dem deutschlandweiten Durchschnitt von 56 Prozent der Idealen Ergebnissen. Die größere Anzahl an schwierigen Fällen führten auch zu dem Auftreten einer relativ hohen Anzahl primärer Komplikationen wie Nerven- (22,5 Prozent) und Gefäßläsionen (5 Prozent), die jedoch fast alle innerhalb kurzer Zeit folgenlos ausheilten. In unserem Patientengut hatten fünf Patienten (6,25 Prozent) einen Cubitus varus. Schwerwiegende Komplikationen wie die Volkmann´sche Kontraktur traten nicht auf. In der Diskussion werden die eigenen Ergebnisse in Bezug zur deutschland-weiten Sammelstudie, zu Vorgängerarbeiten (Fälle von 1975 – 1985 und 1964 – 1974) und weiteren aktuellen Veröffentlichungen gebracht.
Iconography of the Genus Hieracium in central Europe - Part 1: General Description and Morphotypes
(2005)
The genus Hieracium comprises more than one thousand sexual and apomictic species in Europe, with numerous intermediates and microspecies. Only a small fraction of the members of the genus Hieracium has been illustrated or photo-documented in the literature. Since many of these publications are difficult to obtain, only a few specialists are familiar with most of the species and subspecies described in the literature. In order to overcome this problem and encourage geobotanical research on the genus Hieracium, we decided to edit an iconography of central and southern European Hieracia in an electronical journal (Forum geobotanicum) with free international access through the internet. Part I of this endeavour contains descriptions and photographs of the morphological spectrum of the genus Hieracium. Here, we categorize the genus into 15 basic morphotypes. These types conform partly to the sections and subsections of the genus Hieracium, but are in some cases informal and may even include members of different sections. Classification of morphotypes is considered helpful to obtain a first rough picture of an unknown species that then can be traced to the species and subspecies level by using keys or, after completion of this iconography, simply by screening the relevant images. One particularly novel aspect of the present endeavour will be the regular inclusion of magnified images and scanning electron micrographs.
In this thesis, the development of a phylogenetic DNA microarray, the analysis of several gene expression microarray datasets and new approaches for improved data analysis and interpretation are described. In the first publication, the development and analysis of a phylogenetic microarray is presented. I could show that species detection with phylogenetic DNA microarrays can be significantly improved when the microarray data is analyzed with a linear regression modeling approach. Standard methods have so far relied on pure signal intensities of the array spots and a simple cutoff criterion was applied to call a species present or absent. This procedure is not applicable to very closely related species with high sequence similarity because cross-hybridization of non-target DNA renders species detection impossible based on signal intensities alone. By modeling hybridization and cross-hybridization with linear regression, as I have presented in this thesis, even species with a sequence similarity of 97% in the marker gene can be detected and distinguished from related species. Another advantage of the modeling approach over existing methods is that the model also performs well on mixtures of different species. In principle, also quantitative predictions can be made. To make better use of the large amounts of microarray data stored in public databases, meta-analysis approaches need to be developed. In the second publication, an explorative meta-analysis exemplified on Arabidopsis thaliana gene expression datasets is presented. Integrating datasets studying effects such as the influence of plant hormones, pathogens and different mutations on gene expression levels, clusters of similarly treated datasets could be found. From the clusters of pathogen-treated and indole-3-acetic acid (IAA) treated datasets, representative genes were selected which pointed to functions which had been associated with pathogen attack or IAA effects previously. Additionally, hypotheses about the functions of so far uncharacterized genes could be set up. Thus, this kind of meta-analysis could be used to propose gene functions and their regulation under different conditions. In this work, also primary data analysis of Arabidopsis thaliana datasets is presented. In the third publication, an experiment which was conducted to find out if microwave irradiation has an effect on the gene expression of a plant cell culture is described. During the first steps, the data analysis was carried out blinded and exploratory analysis methods were applied to find out if the irradiation had an effect on gene expression of plant cells. Small but statistically significant changes in a few genes were found and could be experimentally confirmed. From the functions of the regulated genes and a meta-analysis with publicly available microarray data, it could be suspected that the plant cell culture somehow perceived the irradiation as energy, similar to perceiving light rays. The fourth publication describes the functional analysis of another Arabidopsis thaliana gene expression dataset. The gene expression data of the plant tumor dataset pointed to a switch from a mainly aerobic, auxotrophic to an anaerobic and heterotrophic metabolism in the plant tumor. Genes involved in photosynthesis were found to be repressed in tumors; genes of amino acid and lipid metabolism, cell wall and solute transporters were regulated in a way that sustains tumor growth and development. Furthermore, in the fifth publication, GEPAT (Genome Expression Pathway Analysis Tool), a tool for the analysis and integration of microarray data with other data types, is described. It consists of a web application and database which allows comfortable data upload and data analysis. In later chapters of this thesis (publication 6 and publication 7), GEPAT is used to analyze human microarray datasets and to integrate results from gene expression analysis with other datatypes. Gene expression and comparative genomic hybridization data from 71 Mantle Cell Lymphoma (MCL) patients was analyzed and allowed proposing a seven gene predictor which facilitates survival predictions for patients compared to existing predictors. In this study, it was shown that CGH data can be used for survival predictions. For the dataset of Diffuse Large B-cell lymphoma (DLBCL) patients, an improved survival predictor could be found based on the gene expression data. From the genes differentially expressed between long and short surviving MCL patients as well as for regulated genes of DLBCL patients, interaction networks could be set up. They point to differences in regulation for cell cycle and proliferation genes between patients with good and bad prognosis.
Primary involvement of skeletal muscle is a very rare event in ALK-1 positive anaplastic large cell lymphoma (ALCL). We describe a case of a 10-year old boy presenting with a three week history of pain and a palpable firm swelling at the dorsal aspect of the left thigh. Histological examination of the lesion revealed a tumoral and diffuse polymorphic infiltration of the muscle by large lymphoid cells. Tumor cells displayed eccentric, lobulated "horse shoe" or "kidney-shape" nuclei. The cells showed immunohistochemical positivity for CD30, ALK-1, CD2, CD3, CD7, CD8, and Perforin. Fluorescence in situ hybridization analysis revealed a characteristic rearrangement of the ALK-1 gene in 2p23 leading to the diagnosis of ALK-1 positive ALCL. Chemotherapy according to the ALCL-99-NHL-BFM protocol was initiated and resulted in a complete remission after two cycles. This case illustrates the unusual presentation of a pediatric ALCL in soft tissue with a good response to chemotherapy.
Recently, several classifiers that combine primary tumor data, like gene expression data, and secondary data sources, such as protein-protein interaction networks, have been proposed for predicting outcome in breast cancer. In these approaches, new composite features are typically constructed by aggregating the expression levels of several genes. The secondary data sources are employed to guide this aggregation. Although many studies claim that these approaches improve classification performance over single genes classifiers, the gain in performance is difficult to assess. This stems mainly from the fact that different breast cancer data sets and validation procedures are employed to assess the performance. Here we address these issues by employing a large cohort of six breast cancer data sets as benchmark set and by performing an unbiased evaluation of the classification accuracies of the different approaches. Contrary to previous claims, we find that composite feature classifiers do not outperform simple single genes classifiers. We investigate the effect of (1) the number of selected features; (2) the specific gene set from which features are selected; (3) the size of the training set and (4) the heterogeneity of the data set on the performance of composite feature and single genes classifiers. Strikingly, we find that randomization of secondary data sources, which destroys all biological information in these sources, does not result in a deterioration in performance of composite feature classifiers. Finally, we show that when a proper correction for gene set size is performed, the stability of single genes sets is similar to the stability of composite feature sets. Based on these results there is currently no reason to prefer prognostic classifiers based on composite features over single genes classifiers for predicting outcome in breast cancer.
Background and Objectives: Cycloid psychoses are characterized by polymorphic symptomatology with intraphasic bipolarity, a remitting and recurrent course and favourable prognosis. Perris and Brocicington (P&B) described the first set of operational criteria that were partly incorporated in ICD-10. The present study investigates psychopathological profiles according to the P&B criteria and the original descriptions by Leonhard, both against the background of the criteria from the prevailing international classification systems.
Methods: Eighty patients with psychotic disorders were recruited and assessed with various psychometric instruments at baseline and after six weeks of antipsychotic treatment in order to investigate the presence of cycloid psychoses according to Leonhard (LCP) and the effect of treatment with antipsychotics. The overlap between LCP and DSM-IV Brief Psychotic Disorder (BPD), ICD Acute Polymorphic Psychotic Disorder (APP) and P&B criteria was calculated.
Results: Using P&B criteria and a symptom checklist adapted from the original descriptions by Leonhard, 14 and 12 cases of cycloid psychosis were identified respectively reflecting a prevalence of 15-18%. Small though significant concordance rates were found between LCP and both DSM-BPD and ICD-APP. Concordance between LCP and P&B criteria was also significant, but modest.
Conclusions: This study demonstrates that LCP can be identified in a substantial number of patients with psychotic disorders. Cycloid psychoses are not adequately covered in current classification systems and criteria. Since they are demonstrated to have a specific psychopathological profile, relapsing course and favourable prognosis, it is advocated to include these psychoses in daily differential diagnostic procedures.
Human growth has an estimated heritability of about 80%-90%. Nevertheless, the underlying cause of shortness of stature remains unknown in the majority of individuals. Genome-wide association studies (GWAS) showed that both common single nucleotide polymorphisms and copy number variants (CNVs) contribute to height variation under a polygenic model, although explaining only a small fraction of overall genetic variability in the general population. Under the hypothesis that severe forms of growth retardation might also be caused by major gene effects, we searched for rare CNVs in 200 families, 92 sporadic and 108 familial, with idiopathic short stature compared to 820 control individuals. Although similar in number, patients had overall significantly larger CNVs \((p-value <1 x 10^{-7})\). In a gene-based analysis of all non-polymorphic CNVs >50 kb for gene function, tissue expression, and murine knock-out phenotypes, we identified 10 duplications and 10 deletions ranging in size from 109 kb to 14 Mb, of which 7 were de novo (p < 0.03) and 13 inherited from the likewise affected parent but absent in controls. Patients with these likely disease causing 20 CNVs were smaller than the remaining group (p < 0.01). Eleven (55%) of these CNVs either overlapped with known microaberration syndromes associated with short stature or contained GWAS loci for height. Haploinsufficiency (HI) score and further expression profiling suggested dosage sensitivity of major growth-related genes at these loci. Overall 10% of patients carried a disease-causing CNV indicating that, like in neurodevelopmental disorders, rare CNVs are a frequent cause of severe growth retardation.
In this work the potential of polarimetric Synthetic Aperture Radar (PolSAR) data of dual-polarized TerraSAR-X (HH/VV) and quad-polarized Radarsat-2 was examined in combination with multispectral Landsat 8 data for unsupervised and supervised classification of tundra land cover types of Richards Island, Canada. The classification accuracies as well as the backscatter and reflectance characteristics were analyzed using reference data collected during three field work campaigns and include in situ data and high resolution airborne photography. The optical data offered an acceptable initial accuracy for the land cover classification. The overall accuracy was increased by the combination of PolSAR and optical data and was up to 71% for unsupervised (Landsat 8 and TerraSAR-X) and up to 87% for supervised classification (Landsat 8 and Radarsat-2) for five tundra land cover types. The decomposition features of the dual and quad-polarized data showed a high sensitivity for the non-vegetated substrate (dominant surface scattering) and wetland vegetation (dominant double bounce and volume scattering). These classes had high potential to be automatically detected with unsupervised classification techniques.
A new series of pyrazolo[4,3-e][1,2,4]triazolo[1,5-c]pyrimidine (PTP) derivatives has been developed in order to explore their affinity and selectivity profile at the four adenosine receptor subtypes. In particular, the PTP scaffold was conjugated at the C2 position with the 1-(3-trifluoromethyl-benzyl)-1H-pyrazole, a group believed to confer potency and selectivity toward the human (h) A\(_{2B}\) adenosine receptor (AR) to the xanthine ligand 8-(1-(3-(trifluoromethyl) benzyl)-1H-pyrazol-4-yl)-1,3-dimethyl-1H-purine-2,6(3H, 7H)-dione (CVT 6975). Interestingly, the synthesized compounds turned out to be inactive at the hA\(_{2B}\) AR but they displayed affinity at the hA\(_3\) AR in the nanomolar range. The best compound of the series (6) shows both high affinity (hA\(_3\) AR K\(_i\) = 11 nM) and selectivity (A\(_1\)/A\(_3\) and A\(_{2A}\)/A\(_3\) > 9090; A\(_{2B}\)/A\(_3\) > 909) at the hA\(_3\) AR. To better rationalize these results, a molecular docking study on the four AR subtypes was performed for all the synthesized compounds. In addition, CTV 6975 and two close analogues have been subjected to the same molecular docking protocol to investigate the role of the 1-(3-trifluoromethyl-benzyl)-1H-pyrazole on the binding at the four ARs.