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The liver‐derived, circulating transport protein transthyretin (TTR) is the cause of systemic hereditary (ATTRv) and wild‐type (ATTRwt) amyloidosis. TTR stabilization and knockdown are approved therapies to mitigate the otherwise lethal disease course. To date, the variety in phenotypic penetrance is not fully understood. This systematic review summarizes the current literature on TTR pathophysiology with its therapeutic implications. Tetramer dissociation is the rate‐limiting step of amyloidogenesis. Besides destabilizing TTR mutations, other genetic (RBP4, APCS, AR, ATX2, C1q, C3) and external (extracellular matrix, Schwann cell interaction) factors influence the type of onset and organ tropism. The approved small molecule tafamidis stabilizes the tetramer and significantly decelerates the clinical course. By sequence‐specific mRNA knockdown, the approved small interfering RNA (siRNA) patisiran and antisense oligonucleotide (ASO) inotersen both significantly reduce plasma TTR levels and improve neuropathy and quality of life compared to placebo. With enhanced hepatic targeting capabilities, GalNac‐conjugated siRNA and ASOs have recently entered phase III clinical trials. Bivalent TTR stabilizers occupy both binding groves in vitro, but have not been tested in trials so far. Tolcapone is another stabilizer with the potential to cross the blood–brain barrier, but its half‐life is short and liver failure a potential side effect. Amyloid‐directed antibodies and substances like doxycycline aim at reducing the amyloid load, however, none of the yet developed antibodies has successfully passed clinical trials. ATTR‐amyloidosis has become a model disease for pathophysiology‐based treatment. Further understanding of disease mechanisms will help to overcome the remaining limitations, including application burden, side effects, and blood–brain barrier permeability.
Background: With the availability of T-cell-directed therapy and next-generation compounds of established classes of drugs, the treatment of relapsed/refractory (r/r) myeloma is getting more complex. However, treatment options in practice are limited by availability, approval, and patient comorbidity. The aim of this article is to provide a practical approach toward the choice of treatment for r/r myeloma patients. Summary: Regarding market authorization and current guidelines, at least in Germany, most patients nowadays will have received a doublet or triplet combination as first-line therapy containing a proteasome inhibitor and an immunomodulatory drug, mostly lenalidomide. We focus on the treatment options for patients that are ineligible for (another) stem cell transplantation. We will review treatment options for relapse after first- or second-line therapy and beyond third-line. Key Messages: There is promising data supporting the efficacy and safety of triplet combinations containing anti-CD38-monoclonal antibodies (anti-CD38 mAbs) at first or second relapse in combination with next-generation compounds. For the treatment beyond third-line, comparative studies are scarce but some promising compounds are available via conditional authorization, and there is more to come in the future. We will present some early phase trials featuring promising results.
Background: Obesity is considered a risk factor for postoperative complications as it can limit exposure to the operation field, thereby significantly prolonging surgery time. Obesity-associated comorbidities, such as low-grade systemic inflammation, impaired functional status, and type 2 diabetes, are independent risk factors for impaired anastomotic wound healing and nonsurgical site infections. If obesity itself is an independent risk factor for surgical complications remains controversial, but the reason for this is largely unexplored. Summary: A MEDLINE literature search was performed using the terms: “obesity,” “excess body weight,” and “surgical complications.” Out of 65,493 articles 432 meta-analyses were screened, of which 25 meta-analyses were on the subject. The vast majority of complex oncologic procedures in the field of visceral surgery have shown higher complication rates in obese patients. Meta-analyses from the last 10 to 15 years with high numbers of patients enrolled consistently have shown longer operation times, higher blood loss, longer hospital stay for colorectal procedures, oncologic upper gastrointestinal (GI) procedures, and pancreatic surgery. Interestingly, these negative effects seem not to affect the overall survival in oncologic patients, especially in esophageal resections. A selection bias in oncologic upper GI patients may have influenced the results with higher BMI in upper GI cancer to be a predictor for better nutritional and performance status. Key Messages: Contrary to bariatric surgery, only limited evidence indicated that site and type of surgery, the approach to the abdominal cavity (laparoscopic vs. open), institutional factors, and the type of perioperative care such as ERAS protocols may play a role in determining postsurgical complications in obese patients. The initial question remains therefore partially unanswered. Large nationwide register-based studies are necessary to better understand which aspects of obesity and its related comorbidities define it as a risk factor for surgical complications.
Fragestellung: In Bayern leben etwa 10 % aller jungen Menschen mit Intelligenzminderung in Heimeinrichtungen. 2016 wurde in Presseberichten der Vorwurf unzulässiger freiheitsentziehender Maßnahmen formuliert. Im Rahmen des Projekts REDUGIA wurde in bayerischen Heimeinrichtungen eine repräsentative Erhebung zu freiheitsentziehenden Maßnahmen (FeM), herausforderndem Verhalten (hfV) und der Mitarbeiterbelastung (MaB) durchgeführt. Methodik: 65 Einrichtungen für junge Menschen mit Intelligenzminderung in Bayern wurde ein Fragebogen zu strukturellen Gegebenheiten sowie MaB, hfV und FeM zugesendet. Neben deskriptiven Auswertungen wurden korrelative Analysen bzw. Regressionsanalysen zum Zusammenhang zwischen hfV, FeM und MaB durchgeführt. Ergebnisse: Es wurden Daten zu 1839 Personen in 61 Einrichtungen erhoben. 84.3 % der Einrichtungen berichteten geringe Raten an hfV und FeM, während 15.7 % ein gehäuftes Vorkommen von hfV und FeM angaben. Auf n = 1809 Vollzeitäquivalente kam es innerhalb von 14 Tagen zu 639 körperlichen Angriffen durch Bewohner_innen. In 12 Monaten wurden problemverhaltensassoziiert 85 Krankmeldungen sowie 33 Versetzungsanträge/Kündigungen berichtet. Es zeigte sich ein signifikant positiver Zusammenhang zwischen hfV und FeM (R² = .307, F = 21.719, p < .001). Die Mitarbeiterbelastung korrelierte positiv mit hfV (r = .507, p < .001). Schlussfolgerungen: Die Studienbefunde weisen darauf hin, dass hfV sowie FeM bei jungen Menschen mit Intelligenzminderung kein flächendeckendes Phänomen darstellen, sondern sich auf wenige spezialisierte Einrichtungen fokussieren. Mögliche Maßnahmen zur Prävention von Problemverhalten und Freiheitsentzug werden diskutiert.
Studieren stellt hohe Anforderungen an selbstregulatorische Fähigkeiten und eigenverantwortlichen Umgang mit schwierigen Situationen. Aus den zusätzlichen sprachlichen Barrieren für ausländische Studierende erwachsen spezifische selbstregulatorische Aufgaben, wie der Umgang mit Verständnisproblemen in Vorlesungen. Da hierfür bisher kaum geeignete Erhebungsinstrumente existieren, versucht ScenEx diese Lücke zu schließen. Der Test erfasst das metakognitive Strategiewissen in sprachlich herausfordernden Situationen im Studienalltag. Anhand einer Stichprobe von 290 ausländischen Studierenden im ersten Fachsemester wird die psychometrische Qualität und interne Struktur des Instruments überprüft. ScenEx zeigt eine zufriedenstellende interne Konsistenz und gute Itemfit-Kennwerte, erwartungskonform liegen lokale stochastische Abhängigkeiten der Aufgaben innerhalb der Szenarien vor. Eine konfirmatorische Faktorenanalyse bestätigt die Grobstruktur der Szenarien und des Gesamtscores des Tests. Das Verfahren ist für die weitere Entwicklung der Sprachkompetenz über die anfängliche Sprachfähigkeit hinaus prädiktiv. ScenEx erweist sich insgesamt als ein reliables und valides Instrument zur Erfassung des Strategiewissens in schwierigen Situationen im Studium.
Stranger, Lover, Friend?
(2021)
Social exclusion, even from minimal game-based interactions, induces negative consequences. We investigated whether the nature of the relationship with the excluder modulates the effects of ostracism. Participants played a virtual ball-tossing game with a stranger and a friend (friend condition) or a stranger and their romantic partner (partner condition) while being fully included, fully excluded, excluded only by the stranger, or excluded only by their close other. Replicating previous findings, full exclusion impaired participants’ basic-need satisfaction and relationship evaluation most severely. While the degree of exclusion mattered, the relationship to the excluder did not: Classic null hypothesis testing and Bayesian statistics showed no modulation of ostracism effects depending on whether participants were excluded by a stranger, a friend, or their partner.
Background: The distinctness of grief from depression has been the subject of a long scholarly debate, even influencing definitions of diagnostic criteria. Aims: This study aims at clarifying the issue by a multifaceted analysis of data from a large German sample. Method: A community sample of 406 bereaved persons answered the Wuerzburg Grief Inventory (WGI), a multidimensional grief questionnaire designed to measure normal grief in the German language, and the General Depression Scale – Short Version (GDS-S), a self-report depression scale. Data were analyzed by factor analysis to identify structural (dis-)similarities of the constructs, and analysis of variance (ANOVA) to identify the influence of the factors relationship to the deceased, type of death, and time since loss on grief measures and depression scores. Results: Factor analysis clustered items referring to grief-related impairments and depression into one factor, items referring to other dimensions of grief on separate factors, however. Relationship to the deceased influenced the grief measures impairments and nearness to the deceased, but not depression scores if controlled for impairments. Type of death showed specific effects on grief scores, but not on depression scores. Time since loss influenced grief scores, but not depression scores. Limitations: The analysis is based on a self-selected community sample of grieving persons, self-report measures, and in part, on cross-sectional data. Conclusion: Factor analysis and objective data show a clear distinction of dimensions of grief and depression. The human experience of grief contains a sense of nearness to the lost person, feelings of guilt, and positive aspects of the loss experience in addition to components resembling depression.
Organic light emitting diodes (OLEDs) based on thermally activated delayed fluorescence (TADF) utilize molecular systems with a small energy splitting between singlet and triplet states. This can either be realized in intramolecular charge transfer states of molecules with near‐orthogonal donor and acceptor moieties or in intermolecular exciplex states formed between a suitable combination of individual donor and acceptor materials. Here, 4,4′‐(9H,9′H‐[3,3′‐bicarbazole]‐9,9′‐diyl)bis(3‐(trifluoromethyl) benzonitrile) (pCNBCzoCF\(_{3}\)) is investigated, which shows intramolecular TADF but can also form exciplex states in combination with 4,4′,4′′‐tris[phenyl(m‐tolyl)amino]triphenylamine (m‐MTDATA). Orange emitting exciplex‐based OLEDs additionally generate a sky‐blue emission from the intramolecular emitter with an intensity that can be voltage‐controlled. Electroluminescence detected magnetic resonance (ELDMR) is applied to study the thermally activated spin‐dependent triplet to singlet up‐conversion in operating devices. Thereby, intermediate excited states involved in OLED operation can be investigated and the corresponding activation energy for both, intra‐ and intermolecular based TADF can be derived. Furthermore, a lower estimate is given for the extent of the triplet wavefunction to be ≥ 1.2 nm. Photoluminescence detected magnetic resonance (PLDMR) reveals the population of molecular triplets in optically excited thin films. Overall, the findings allow to draw a comprehensive picture of the spin‐dependent emission from intra‐ and intermolecular TADF OLEDs.
Hydrophilic (AB)\(_{n}\) Segmented Copolymers for Melt Extrusion‐Based Additive Manufacturing
(2021)
Several manufacturing technologies beneficially involve processing from the melt, including extrusion‐based printing, electrospinning, and electrohydrodynamic jetting. In this study, (AB)\(_{n}\) segmented copolymers are tailored for melt‐processing to form physically crosslinked hydrogels after swelling. The copolymers are composed of hydrophilic poly(ethylene glycol)‐based segments and hydrophobic bisurea segments, which form physical crosslinks via hydrogen bonds. The degree of polymerization was adjusted to match the melt viscosity to the different melt‐processing techniques. Using extrusion‐based printing, a width of approximately 260 µm is printed into 3D constructs, with excellent interlayer bonding at fiber junctions, due to hydrogen bonding between the layers. For melt electrospinning, much thinner fibers in the range of about 1–15 µm are obtained and produced in a typical nonwoven morphology. With melt electrowriting, fibers are deposited in a controlled way to well‐defined 3D constructs. In this case, multiple fiber layers fuse together enabling constructs with line width in the range of 70 to 160 µm. If exposed to water the printed constructs swell and form physically crosslinked hydrogels that slowly disintegrate, which is a feature for soluble inks within biofabrication strategies. In this context, cytotoxicity tests confirm the viability of cells and thus demonstrating biocompatibility of this class of copolymers.
Investigations concerning the reactivity of the N‐heterocyclic silylene Dipp\(_{2}\)NHSi (1, 1,3‐bis(2,6‐diisopropylphenyl)‐1,3‐diaza‐2‐silacyclopent‐4‐en‐2‐ylidene) towards selected alanes and boranes, elemental halides X\(_{2}\) (X=Br, I), selected halide containing substrates such as tin chlorides and halocarbons, as well as organoazides are presented. The NHSi adducts Dipp\(_{2}\)NHSi⋅AlI\(_{3}\) (2), Dipp\(_{2}\)NHSi⋅Al(C\(_{6}\)F\(_{5}\))\(_{3}\) (3), and Dipp\(_{2}\)NHSi⋅B(C\(_{6}\)F\(_{5}\))\(_{3}\) (4) were formed by the reaction of Dipp\(_{2}\)NHSi with the corresponding Lewis acids AlI\(_{3}\), Al(C\(_{6}\)F\(_{6}\))\(_{3}\) and B(C\(_{6}\)F\(_{5}\))\(_{3}\). Adducts 3 and 4 were tested with respect to their ability to activate small organic molecules, but no frustrated Lewis pair reactivity was observed. Reactions of Dipp\(_{2}\)NHSi with Br\(_{2}\), I\(_{2}\), Ph\(_{2}\)SnCl\(_{2}\) and Me\(_{3}\)SnCl led to formation of Dipp\(_{2}\)NHSiBr\(_{2}\) (5), Dipp\(_{2}\)NHSiI\(_{2}\) (6), Dipp\(_{2}\)NHSiCl\(_{2}\) (7) and {(Me\(_{3}\)Sn)N(Dipp)CH}\(_{2}\) (8), respectively. The reaction with the halocarbons methyl iodide, benzyl chloride, and benzyl bromide afforded the insertion products Dipp\(_{2}\)NHSi(I)(CH\(_{3}\)) (9), Dipp\(_{2}\)NHSi(Cl)(CH\(_{2}\)Ph) (10) and Dipp\(_{2}\)NHSi(Br)(CH\(_{2}\)Ph) (11). Reaction of Dipp\(_{2}\)NHSi with the organoazides Ad‐N\(_{3}\) (Ad=adamantyl) and TMS‐N\(_{3}\) (TMS=trimethylsilyl) led to the formation of 1‐Dipp\(_{2}\)NHSi‐2,5‐bis(adamantyl)‐tetrazoline (12) and bis(trimethylsilyl)amido azido silane (13), respectively. For 2,6‐(diphenyl)phenyl‐N\(_{3}\) C−H activation occurs and a cyclosilamine 14 was isolated.