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Ziel dieser Studie ist die Darstellung des kurz- und mittelfristigen Outcomes von Hochrisiko-Patienten mit symptomatischer hochgradiger Aortenstenose nach TAVI sowie im Speziellen die Untersuchung des Outcomes von Patienten mit Low-Gradient-Aortenstenose nach TAVI.
Methoden: 50 Patienten (TAVI-Gruppe) wurde eine Aortenklappe über einen transapikalen (49 Patienten)- beziehungsweise transfemoralen (1 Patient) Zugangsweg implantiert. Es wurden perioperative- sowie unmittelbar postoperative und mittelfristige Daten nach 6 Monaten ermittelt. Dabei führten wir eine konventionelle- und spezielle echokardiographische Untersuchung-, den Lebensqualitätsfragebogen SF-36- sowie einen 6-Minuten-Gehtest durch und befragten die Patienten nach ihrem subjektiven Empfinden und Symptomatik. Eine Kontroll-Gruppe, die ebenfalls Hochrisiko-Patienten mit symptomatischer hochgradiger Aortenstenose beinhaltete, wurde konservativ-medikamentös therapiert und diente als Vergleichsgruppe. Zur näheren Untersuchung der Patienten mit Low-Gradient-Aortenstenose unterteilten wir die TAVI-Gruppe in LG-AS und HG-AS und bestimmten deren Outcome nach 6 Monaten.
Ergebnisse: Bei allen Patienten konnte die Aortenklappe erfolgreich implantiert werden. Die 30-Tages-Mortalität lag bei 4,0%, die Mortalität nach 6 Monaten bei 12%. Die echokardiographischen Untersuchungen ergaben im Follow-up eine signifikante Verbesserung der hämodynamischen Funktion (AVA: 0,69±0,15cm2 vs. 2,27±2,15cm2, mittlerer aortaler Druckgradient: 54,4±15,3mmHg vs. 13,3±5,5mmHg, maximale aortale Geschwindigkeit: 4,5±0,6m/s vs. 2,3±0,5m/s). Die Patienten zeigten 6 Monate nach TAVI eine signifikante Verbesserung der Lebensqualität, der Gehstrecke (189,4m vs. 362,9m) sowie eine subjektive Verbesserung ihrer Beschwerden. Die Patienten mit LG-AS hatten eine höhere Mortalität als Patienten ohne LG-AS (21.4% vs. 8,3%), die überlebenden Patienten zeigten jedoch ebenfalls eine signifikante Verbesserung der hämodynamischen Funktion, der Lebensqualität und der Gehstrecke.
Zusammenfassung: Diese Daten belegen gute kurz- und mittelfristige Ergebnisse bei Hochrisiko-Patienten nach TAVI und stellen eine Alternative zur konventionellen Therapie dar. Die Mortalität nach 6 Monaten war in der TAVI-Gruppe signifikant geringer als in der Kontroll-Gruppe, die myokardiale Funktion verbesserte sich und ein symptomatischer Benefit konnte gezeigt werden.
Es wurde bei Patienten mit LG-AS eine höhere Mortalität erfasst, die überlebenden Patienten zeigten jedoch eine signifikante Verbesserung der myokardialen Funktion, der Ausdauerfähigkeit sowie eine signifikant verbesserte Lebensqualität.
Bacterial mastitis is caused by invasion of the udder, bacterial multiplication and induction of
inflammatory responses in the bovine mammary gland. Disease severity and the cause of disease are
influenced by environmental factors, the cow’s immune response as well as bacterial traits. Escherichia coli (E. coli) is one of the main causes of acute bovine mastitis, but although pathogenic E. coli strains can be classified into different pathotypes, E. coli causing mastitis cannot unambiguously be distinguished from commensal E. coli nor has a common set of virulence factors
been described for mastitis isolates. This project focussed on the characterization of virulence-
associated traits of E. coli mastitis isolates in comprehensive analyses under conditions either
mimicking initial pathogenesis or conditions that E. coli mastitis isolates should encounter while entering the udder. Virulence-associated traits as well as fitness traits of selected bovine mastitis or faecal E. coli strains were identified and analyzed in comparative phenotypic assays. Raw milk whey was introduced to
test bacterial fitness in native mammary secretion known to confer antimicrobial effects.
Accordingly, E. coli isolates from bovine faeces represented a heterogeneous group of which some
isolates showed reduced ability to survive in milk whey whereas others phenotypically resembled
mastitis isolates that represented a homogeneous group in that they showed similar survival and
growth characteristics in milk whey. In contrast, mastitis isolates did not exhibit such a uniform phenotype when challenged with iron shortage, lactose as sole carbon source and lingual
antimicrobial peptide (LAP) as a main defensin of milk. Reduced bacterial fitness could be related to LAP suggesting that bacterial adaptation to an intramammary lifestyle requires resistance to host
defensins present in mammary secretions, at least LAP.
E. coli strain 1303 and ECC-1470 lack particular virulence genes associated to mastitis isolates. To find out whether differences in gene expression may contribute to the ability of E. coli variants to cause mastitis, the transcriptome of E. coli model mastitis isolates 1303 and ECC-1470 were analyzed to
identify candidate genes involved in bacterium-host interaction, fitness or even pathogenicity during bovine mastitis.
DNA microarray analysis was employed to assess the transcriptional response of E. coli 1303 and
ECC-1470 upon cocultivation with MAC-T immortalized bovine mammary gland epithelial cells to
identify candidate genes involved in bacterium-host interaction. Additionally, the cell adhesion and invasion ability of E. coli strain 1303 and ECC-1470 was investigated. The transcriptonal response to the presence of host cells rather suggested competition for nutrients and oxygen between E. coli and MAC-T cells than marked signs of adhesion and invasion. Accordingly, mostly fitness traits that may also contribute to efficient colonization of the E. coli primary habitat, the gut, have been utilized by the mastitis isolates under these conditions. In this study, RNA-Seq was employed to assess the bacterial transcriptional response to milk whey.
According to our transcriptome data, the lack of positively deregulated and also of true virulence-associated determinants in both of the mastitis isolates indicated that E. coli might have adapted by other means to the udder (or at least mammary secretion) as an inflammatory site. We identified traits that promote bacterial growth and survival in milk whey. The ability to utilize citrate promotes fitness and survival of E. coli that are thriving in mammary secretions. According to our results, lactoferrin has only weak impact on E. coli in mammary secretions. At the same time bacterial determinants involved in iron assimilation were negatively regulated, suggesting that, at least during the first hours, iron assimilation is not a challenge to E. coli colonizing the mammary gland. It has been hypothesized that cellular iron stores cause temporary independency to extracellular accessible iron. According to our transcriptome data, this hypothesis was supported and places iron uptake
systems beyond the speculative importance that has been suggested before, at least during early
phases of infection. It has also been shown that the ability to resist extracytoplasmic stress, by oxidative conditions as well as host defensins, is of substantial importance for bacterial survival in mammary secretions.
In summary, the presented thesis addresses important aspects of host-pathogen interaction and
bacterial conversion to hostile conditions during colonization of the mastitis inflammatory site, the mammary gland.
Organic solar cells have great potential to become a low-cost and clean alternative to conventional photovoltaic technologies based on the inorganic bulk material silicon. As a highly promising concept in the field of organic photovoltaics, bulk heterojunction (BHJ) solar cells consist of a mixture of an electron donating and an electron withdrawing component. Their degree of intermixing crucially affects the generation of photocurrent. In this work, the effect of an altered blend morphology on polaron pair dissociation, charge carrier transport, and nongeminate recombination is analyzed by the charge extraction techniques time delayed collection field (TDCF) and open circuit corrected transient charge extraction (OTRACE). Different comparative studies cover a broad range of material systems, including polymer and small-molecule donors in combination with different fullerene acceptors. The field dependence of polaron pair dissociation is analyzed in blends based on the polymer pBTTT-C16, allowing a systematic tuning of the blend morphology by varying the acceptor type and fraction. The effect of both excess photon energy and intercalated phases are minor compared to the influence of excess fullerene, which reduces the field dependence of photogeneration. The study demonstrates that the presence of neat fullerene domains is the major driving force for efficient polaron pair dissociation that is linked to the delocalization of charge carriers. Furthermore, the influence of the processing additive diiodooctane (DIO) is analyzed using the photovoltaic blends PBDTTT-C:PC71BM and PTB7:PC71BM. The study reveals amulti-tiered alteration of the blend morphology of PBDTTT-C based blends upon a systematic increase of the amount of DIO. Domains on the hundred nanometers length scale in the DIO-free blend are identified as neat fullerene agglomerates embedded in an intermixed matrix. With the addition of the additive, 0.6% and 1% DIO already substantially reduces the size of these domains until reaching the optimum 3% DIO mixture, where a 7.1% power conversion efficiency is obtained. It is brought into connection with the formation of interpenetrating polymer and fullerene phases. Similar to PBDTTT-C, the morphology of DIO-free PTB7:PC71BM blends is characterized by large fullerene domains being decreased in size upon the addition of 3% DIO. OTRACE measurements reveal a reduced Langevin-type, super-second order recombination in both blends. It is demonstrated that the deviation from bimolecular recombination kinetics cannot be fully attributed to the carrier density dependence of the mobility but is rather related to trapping in segregated PC71BM domains. Finally, with regard to small-molecule donors, a higher yield of photogeneration and balanced transport properties are identified as the dominant factors enhancing the efficiency of vacuum deposited MD376:C60 relative to its solution processed counterpart MD376:PC61BM. The finding is explained by a higher degree of dimerization of the merocyanine dye MD376 and a stronger donor-acceptor interaction at the interface in the case of the vacuum deposited blend.