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The honeybee olfactory pathway comprises an intriguing pattern of convergence and divergence: ~60.000 olfactory sensory neurons (OSN) convey olfactory information on ~900 projection neurons (PN) in the antennal lobe (AL). To transmit this information reliably, PNs employ relatively high spiking frequencies with complex patterns. PNs project via a dual olfactory pathway to the mushroom bodies (MB). This pathway comprises the medial (m-ALT) and the lateral antennal lobe tract (l-ALT). PNs from both tracts transmit information from a wide range of similar odors, but with distinct differences in coding properties. In the MBs, PNs form synapses with many Kenyon cells (KC) that encode odors in a spatially and temporally sparse way. The transformation from complex information coding to sparse coding is a well-known phenomenon in insect olfactory coding. Intrinsic neuronal properties as well as GABAergic inhibition are thought to contribute to this change in odor representation. In the present study, we identified intrinsic neuronal properties promoting coding differences between PNs and KCs using in-situ patch-clamp recordings in the intact brain. We found very prominent K+ currents in KCs clearly differing from the PN currents. This suggests that odor coding differences between PNs and KCs may be caused by differences in their specific ion channel properties. Comparison of ionic currents of m- and l-ALT PNs did not reveal any differences at a qualitative level.
Background:
Despite the high persistence rate of attention-deficit/hyperactivity disorder (ADHD) throughout the lifespan, there is a considerable gap in knowledge regarding effective treatment strategies for adolescents with ADHD. This group in particular often shows substantial psychosocial impairment, low compliance and insufficient response to psychopharmacological interventions. Effective and feasible treatments should further consider the developmental shift in ADHD symptoms, comorbidity and psychosocial adversity as well as family dysfunction. Thus, individualised interventions for adolescent ADHD should comprise a multimodal treatment strategy. The randomised controlled ESCAadol study addresses the needs of this patient group and compares the outcome of short-term cognitive behavioural therapy with parent-based telephone-assisted self-help.
Methods/design:
In step 1, 160 adolescents aged 12 to 17 years with a diagnosis of ADHD will undergo a treatment as usual (TAU) observation phase of 1 month. In step 2, those still severely affected are randomised to the intervention group with an Individualised Modular Treatment Programme (IMTP) or a telephone-assisted self-help programme for parents (TASH) as an active control condition. The IMTP was specifically designed for the needs of adolescent ADHD. It comprises 10 sessions of individual cognitive behavioural therapy with the adolescents and/or the parents, for which participants choose three out of 10 available focus modules (e.g. organisational skills and planning, emotion regulation, problem solving and stress management, dysfunctional family communication). TASH combines a bibliotherapeutic component with 10 counselling sessions for the parents via telephone. Primary outcome is the change in ADHD symptoms in a clinician-rated diagnostic interview. Outcomes are assessed at inclusion into the study, after the TAU phase, after the intervention phase and after a further 12-week follow-up period. The primary statistical analysis will be by intention-to-treat, using linear regression models. Additionally, we will analyse psychometric and biological predictors and moderators of treatment response.
Discussion:
ESCAadol compares two short-term non-pharmacological interventions as cost-efficient and feasible treatment options for adolescent ADHD, addressing the specific needs and obstacles to treatment success in this group. We aim to contribute to personalised medicine for adolescent ADHD intended to be implemented in routine clinical care.
This thesis describes the studies of topological superconductivity, which is predicted to
emerge when pair correlations are induced into the surface states of 2D and 3D topolog-
ical insulators (TIs). In this regard, experiments have been designed to investigate the
theoretical ideas first pioneered by Fu and Kane that in such system Majorana bound
states occur at vortices or edges of the system [Phys. Rev. Lett. 100, 096407 (2008), Phys.
Rev. B 79, 161408 (2009)]. These states are of great interest as they constitute a new
quasiparticle which is its own antiparticle and can be used as building blocks for fault
tolerant topological quantum computing.
After an introduction in chapter 1, chapter 2 of the thesis lays the foundation for the
understanding of the field of topology in the context of condensed matter physics with a
focus on topological band insulators and topological superconductors. Starting from a
Chern insulator, the concepts of topological band theory and the bulk boundary corre-
spondence are explained. It is then shown that the low energy Hamiltonian of mercury
telluride (HgTe) quantum wells of an appropriate thickness can be written as two time
reversal symmetric copies of a Chern insulator. This leads to the quantum spin Hall effect.
In such a system, spin-polarized one dimensional conducting states form at the edges
of the material, while the bulk is insulating. This concept is extended to 3D topological
insulators with conducting 2D surface states. As a preliminary step to treating topological
superconductivity, a short review of the microscopic theory of superconductivity, i.e. the
theory of Bardeen, Cooper, and Shrieffer (BCS theory) is presented. The presence of
Majorana end modes in a one dimensional superconducting chain is explained using the
Kitaev model. Finally, topological band insulators and conventional superconductivity
are combined to effectively engineer p-wave superconductivity. One way to investigate
these states is by measuring the periodicity of the phase of the Josephson supercurrent
in a topological Josephson junction. The signature is a 4π-periodicity compared to the
2π-periodicity in conventional Josephson junctions. The proof of the presence of this
effect in HgTe based Josephson junction is the main goal of this thesis and is discussed in
chapters 3 to 6.
Chapter 3 describes in detail the transport of a 3D topological insulator based weak
link under radio-frequency radiation. The chapter starts with a review of the state of
research of (i) strained HgTe as 3D topological insulator and (ii) the progress of induc-
ing superconducting correlations into the topological surface states and the theoretical
predictions of 3D TI based Josephson junctions. Josephson junctions based on strained
HgTe are successfully fabricated. Before studying the ac driven Josephson junctions, the
dc transport of the devices is analysed. The critical current as a function of temperature
is measured and it is possible to determine the induced superconducting gap. Under
rf illumination Shapiro steps form in the current voltage characteristic. A missing first
step at low frequencies and low powers is found in our devices. This is a signature of
a 4π-periodic supercurrent. By studying the device in a wide parameter range - as a
147148 SUMMARY
function of frequency, power, device geometry and magnetic field - it is shown that the
results are in agreement with the presence of a single gapless Andreev doublet and several
conventional modes.
Chapter 4 gives results of the numerical modelling of the I −V dynamics in a Josephson
junction where both a 2π- and a 4π-periodic supercurrents are present. This is done in
the framework of an equivalent circuit representation, namely the resistively shunted
Josephson junction model (RSJ-model). The numerical modelling is in agreement with
the experimental results in chapter 3. First, the missing of odd Shapiro steps can be
understood by a small 4π-periodic supercurrent contribution and a large number of
modes which have a conventional 2π-periodicity. Second, the missing of odd Shapiro
steps occurs at low frequency and low rf power. Third, it is shown that stochastic processes
like Landau Zener tunnelling are most probably not responsible for the 4π contribution.
In a next step the periodicity of Josephson junctions based on quantum spin Hall
insulators using are investigated in chapter 5. A fabrication process of Josephson junctions
based on inverted HgTe quantum wells was successfully developed. In order to achieve a
good proximity effect the barrier material was removed and the superconductor deposited
without exposing the structure to air. In a next step a gate electrode was fabricated which
allows the chemical potential of the quantum well to be tuned. The measurement of the
diffraction pattern of the critical current Ic due to a magnetic field applied perpendicular
to the sample plane was conducted. In the vicinity to the expected quantum spin Hall
phase, the pattern resembles that of a superconducting quantum interference device
(SQUID). This shows that the current flows predominantly on the edges of the mesa.
This observation is taken as a proof of the presence of edge currents. By irradiating the
sample with rf, missing odd Shapiro steps up to step index n = 9 have been observed. This
evidences the presence of a 4π-periodic contribution to the supercurrent. The experiment
is repeated using a weak link based on a non-inverted HgTe quantum well. This material
is expected to be a normal band insulator without helical edge channels. In this device,
all the expected Shapiro steps are observed even at low frequencies and over the whole
gate voltage range. This shows that the observed phenomena are directly connected
to the topological band structure. Both features, namely the missing of odd Shapiro
steps and the SQUID like diffraction pattern, appear strongest towards the quantum spin
Hall regime, and thus provide evidence for induced topological superconductivity in the
helical edge states.
A more direct way to probe the periodicity of the Josephson supercurrent than using
Shapiro steps is the measurement of the emitted radiation of a weak link. This experiment
is presented in chapter 6. A conventional Josephson junction converts a dc bias V to
an ac current with a characteristic Josephson frequency fJ
= eV /h. In a topological
Josephson junction a frequency at half the Josephson frequency fJ /2 is expected. A
new measurement setup was developed in order to measure the emitted spectrum of a
single Josephson junction. With this setup the spectrum of a HgTe quantum well based
Josephson junction was measured and the emission at half the Josephson frequency fJ /2
was detected. In addition, fJ emission is also detected depending on the gate voltage and
detection frequency. The spectrum is again dominated by half the Josephson emission at
low voltages while the conventional emission is determines the spectrum at high voltages.
A non-inverted quantum well shows only conventional emission over the whole gateSUMMARY 149
voltage and frequency range. The linewidth of the detected frequencies gives a measure
on the lifetime of the bound states: From there, a coherence time of 0.3–4ns for the fJ /2
line has been deduced. This is generally shorter than for the fJ line (3–4ns).
The last part of the thesis, chapter 7, reports on the induced superconducting state
in a strained HgTe layer investigated by point-contact Andreev reflection spectroscopy.
For the experiment, a HgTe mesa was fabricated with a small constriction. The diameter
of the orifice was chosen to be smaller than the mean free path estimated from magne-
totransport measurements. Thus one gets a ballistic point-contact which allows energy
resolved spectroscopy. One part of the mesa is covered with a superconductor which
induces superconducting correlations into the surface states of the topological insulator.
This experiment therefore probes a single superconductor normal interface. In contrast to
the Josephson junctions studied previously, the geometry allows the acquisition of energy
resolved information of the induced superconducting state through the measurement
of the differential conductance dI/dV as a function of applied dc bias for various gate
voltages, temperatures and magnetic fields. An induced superconducting order parame-
ter of about 70µeV was extracted but also signatures of the niobium gap at the expected
value around Δ Nb
≈ 1.1meV have been found. Simulations using the theory developed by
Blonder, Tinkham and Klapwijk and an extended model taking the topological surface
states into account were used to fit the data. The simulations are in agreement with a
small barrier at the topological insulator-induced topological superconductor interface
and a high barrier at the Nb to topological insulator interface. To understand the full con-
ductance curve as a function of applied voltage, a non-equilibrium driven transformation
is suggested. The induced superconductivity is suppressed at a certain bias value due to
local electron population. In accordance with this suppression, the relevant scattering
regions change spatially as a function of applied bias.
To conclude, it is emphasized that the experiments conducted in this thesis found
clear signatures of induced topological superconductivity in HgTe based quantum well
and bulk devices and opens up the avenue to many experiments. It would be interesting
to apply the developed concepts to other topological matter-superconductor hybrid
systems. The direct spectroscopy and manipulation of the Andreev bound states using
circuit quantum electrodynamic techniques should be the next steps for HgTe based
samples. This was already achieved in superconducting atomic break junctions by the
group in Saclay [Science 2015, 349, 1199-1202 (2015)]. Another possible development
would be the on-chip detection of the emitted spectrum as a function of the phase φ
through the junction. In this connection, the topological junction needs to be shunted
by a parallel ancillary junction. Such a setup would allow the current phase relation
I(φ) directly and the lifetime of the bound states to be measured directly. By coupling
this system to a spectrometer, which can be another Josephson junction, the energy
dependence of the Andreev bound states E(φ) could be obtained. The experiments on
the Andreev reflection spectroscopy described in this thesis could easily be extended to
two dimensional topological insulators and to more complex geometries, like a phase
bias loop or a tunable barrier at the point-contact. This work might also be useful for
answering the question how and why Majorana bound states can be localized in quantum
spin Hall systems.
For mutagenicity testing, primary lymphocytes or mammalian cell lines are employed. However, the true target for carcinogenic action of mutagenic chemicals may be stem cells. Since hematopoietic cancers induced by chemical agents originate at the hematopoietic stem cell (HSC) stage and since one of the side effects of chemotherapeutic cancer treatment is the induction of secondary tumors, often leukemias, HSC may be a suitable cell system. We compared the sensitivity of HSC with the genotoxicity testing cell line TK6 for chromosomal mutations. HSC were less sensitive than TK6 cells for the genotoxic effects of the model genotoxins and chemotherapeutic agents doxorubicin, vinblastine, methyl methanesulfonate (MMS) and equally sensitive for mitomycin C (MMC). However, loss of viability after mitomycin C treatment was higher in HSC than in TK6 cells. Among the factors that may influence sensitivity for genomic damage, the generation or response to reactive oxygen species (ROS) and the effectiveness of DNA damage response can be discussed. Here we show that HSC can be used in a standard micronucleus test protocol for chromosomal mutations and that their sensitivity was not higher than that of a classical testing cell line.
In lymphocytes, immune receptor signals induce the rapid nuclear translocation of preformed cytosolic NFAT proteins. Along with co-stimulatory signals, persistent immune receptor signals lead to high levels of NFATc1/αA, a short NFATc1 isoform, in effector lymphocytes. Whereas NFATc1 is not expressed in plasma cells, in germinal centers numerous centrocytic B cells express nuclear NFATc1/αA. When overexpressed in chicken DT40 B cells or murine WEHI 231 B cells, NFATc1/αA suppressed their cell death induced by B cell receptor signals and affected the expression of genes controlling the germinal center reaction and plasma cell formation. Among those is the Prdm1 gene encoding Blimp-1, a key factor of plasma cell formation. By binding to a regulatory DNA element within exon 1 of the Prdm1 gene, NFATc1/αA suppresses Blimp-1 expression. Since expression of a constitutive active version of NFATc1/αA interfered with Prdm1 RNA expression, LPS-mediated differentiation of splenic B cells to plasmablasts in vitro and reduced immunoglobulin production in vivo, one may conclude that NFATc1/αA plays an important role in controlling plasmablast/plasma cell formation.
Influence of interleukin-6-type cytokine oncostatin M on murine aortic vascular smooth muscle cells
(2018)
Oncostatin M (OSM) is a cytokine of the interleukin-6 family and released in the early
phase of inflammation by neutrophils, activated macrophages, dendritic cells, and T
lymphocytes. Its roles in physiology and disease are not entirely understood yet. It
has been shown recently that substantial amounts of OSM are found in atherosclerotic
plaques.
The first part of this thesis addresses the effects of OSM on vascular smooth muscle
cells (VSMCs). This cell type is known to contribute to atherogenesis and expresses
the type I and type II OSM receptor complexes. This study revealed that OSM is a
strong inducer of an array of genes which have recently been shown to play important
roles in atherosclerosis. Investigation of VSMCs isolated from OSMRbeta-deficient
(Osmr-/-) mice proved that the regulation of these target genes is entirely dependent
on the activation of the type II OSMR complex. In addition to OSM, other cytokines
expressed by T lymphocytes were found to contribute to plaque development. According
to earlier publications, the influence of IL-4, IL-13, and IL-17 on the progression of
plaques were discussed controversially. Nevertheless, for the regulation of investigated
atherosclerotic target genes and receptor complexes in VSMCs, they seemed to play a
minor role compared to OSM. Only the expression of the decoy receptor IL-13Ralpha2 - a
negative feedback mechanism for IL-13-mediated signalling - was strongly induced after
treatment with all mentioned cytokines, especially when VSMCs were primed with OSM
before stimulation.
The second part of this thesis focuses on the role of OSM during the progression of
atherosclerosis in vivo. Therefore, Ldlr-/-Osmr-/- mice were generated by crossing Ldlr-/-
mice - a typical mouse model for atherosclerosis - with Osmr-/- mice. These double-deficient
mice together with Ldlr-/-Osmr+/+ mice were set on cholesterol rich diet (Western
diet, WD) for 12 weeks before they were sacrificed. Determination of body and
organ weight, staining of aortas and aortic roots as well as gene expression profiling
strongly suggested that Ldlr-/-Osmr-/- mice are less susceptible for plaque development
and weight gain compared to Ldlr-/-Osmr+/+ mice. However, further experiments and
additional controls (C57Bl/6 and Osmr-/- mice) on WD are necessary to clarify the
underlying molecular mechanisms.
Taken together, the interleukin-6-type cytokine OSM is a strong inducer of an array of
target genes involved in de-differentiation and proliferation of VSMCs, a process known
to contribute substantially to atherogenesis. Further in vivo studies will help to clarify
the role of OSM in atherosclerosis.
The transcription factor Myc interacts with several co-factors to regulate growth and proliferationand thereby enables normal animal development. Deregulation of Myc is associated witha wide range of human tumors. Myc binds to DNA together with its dimerization partner Max, preferentially to canonical E-box motifs, but this sequence-specific interaction is probably not sufficient for Myc’s binding to target genes.
In this work, the PAF1 complex was characterized as a novel co-factor of Myc in Drosophila melanogaster. All components of the complex are required for Myc’s recruitment to chromatin, but the subunit Atu has the strongest effect on Myc's binding to target genes through ist direct physical interaction with Myc. Unexpectedly, the impact of Atu depletion on the Expression of Myc target genes was weak compared to its effect on Myc binding. However, the influence of Atu becomes more prominent in situations of elevated Myc levels in vivo . Mycrepressed as well as Myc-activated targets are affected, consistent with the notion that Myc
recruitment is impaired.
An independent set of analyses revealed that Myc retains substantial activity even in the complete absence of Max. The overexpression of Myc in Max0 mutants specifically blocks their pupariation without affecting their survival, which raised the possibility that Myc might
affect ecdysone biosynthesis. This connection was studied in the second part of this Thesis which showed that Myc inhibits the expression of ecdysteroidogenic genes and thereby the production of ecdysone. Myc most likely affects the signaling pathways (PTTH and insulin
signaling) upstream of the PG, the organ where ecdysone is produced. By combining existing ChIPseq, RNAseq and electronic annotation data, we identified five potential Maxindependent Myc targets and provided experimental data that they might be involved in Myc's effect on Max mutant animals. Together our data confirm that some Myc functions are Max-independent and they raise the possibility that this effect might play a role during replication.
Apoptosis is a physiological cell death process essential for development, tissue homeostasis, and for immune defense of multicellular animals. Inhibitors of apoptosis proteins (IAPs) regulate apoptosis in response to various cellular assaults. Using both genetic and pharmacological approaches we demonstrate here that the IAPs not only support opportunistic survival of intracellular human pathogens like Chlamydia pneumoniae but also control plasticity of iNOS+ M1 macrophage during the course of infection and render them refractory for immune stimulation. Treatment of Th1 primed macrophages with birinapant (IAP-specific antagonist) inhibited NO generation and relevant proteins involved in innate immune signaling. Accordingly, birinapant promoted hypoxia, angiogenesis, and tumor-induced M2 polarization of iNOS+ M1 macrophages. Interestingly, birinapant-driven changes in immune signaling were accompanied with changes in the expression of various proteins involved in the metabolism, and thus revealing the new role of IAPs in immune metabolic reprogramming in committed macrophages. Taken together, our study reveals the significance of IAP targeting approaches (Smac mimetic compounds) for the management of infectious and inflammatory diseases relying on macrophage plasticity.
The present work aims towards the investigation of polymer degradation under biologically relevant conditions. In order to assess a potential degradation of polymers of interest for biomedical applications in vivo and associated effects on living tissue, representatives of poly(2-oxazoline)s and polypeptoids as well as poly(ethylene glycol) and poly(N-vinylpyrrolidone) for reference purposes are examined regarding their stability under oxidative and hydrolytic conditions as well as towards enzymatic degradation.
The polymers investigated in the framework of this thesis are generally considered to be non-biodegradable. Both poly(ethylene glycol) and poly(N-vinylpyrrolidone) are or were applied intensively in vivo provoking seriously harmful side effects like fatal blood poisoning from the oxidation of poly(ethylene glycol) chain ends or poly(N-vinylpyrrolidone) storage disease. Poly(2-alkyl-2-oxazoline)s and polypeptoids, both promising polymeric biomaterials for a wide variety of in vivo applications, are not clinically applied yet but undergo thorough investigations. However, comprising amide bonds within the backbone or the appending side chain, poly(2-alkyl-2-oxazoline)s and polypeptoids potentially offer a higher susceptibility towards (bio-)degradation. Representing the three most impactful initiators of degradation in vivo, the present study is focused on polymer deterioration by oxidative species, hydrolytic conditions and enzymes.
Oxidative species are generated in a variety of processes in vivo, both on purpose and as an unintentional by-product. Previous investigations revealed the susceptibility of poly(ethylene glycol), poly(N-vinylpyrrolidone), poly(2-alkyl-2-oxazoline)s and polypeptoids to deterioration by hydroxyl radicals deriving from hydrogen peroxide and copper ions. The obtained data confirm previous results of an apparent degradation rate increasing with increasing chain length due to self-inhibitory end group effects for all investigated polymer species. Although the exact concentrations of oxidative species in vivo are very controversial, with respect to their great variety and wide distribution the investigated polymers are likely prone to oxidative deterioration to some extent, with rates, mechanisms and degradation products strongly depending on the respective reactive species, polymer structure and chain length.
Like blood, most tissues of the human body benefit from a slightly alkaline pH value. Nevertheless, specific areas like the human stomach or tumor tissues possess acidic conditions potentially capable to cleave amide bonds comprised by poly(2-alkyl-2-oxazoline)s and polypeptoids. Unlike the hydrolysis of poly(2-alkyl-2-oxazoline)s resulting in side chain cleavage, the hydrolysis of polypeptoids induces backbone scission decreasing the polymer chain length tremendously and releasing, if performed exhaustively, the respective amino acids. Hydrolysis of polysarcosine is monitored by quantification of the released sarcosine via 1H-NMR spectroscopy and determination of the residual Mw via GPC. Its cyclic dimer sarcosine anhydride is formed as an intermediate product in this process via cyclization of unstable linear dimers of sarcosine.
Modification and degradation of bio(macro)molecules is an essential part of human metabolism. Polymers bearing amide bonds and showing a great similarity to natural occurring and widely distributed polypeptides, like poly(2-alkyl-2-oxazoline)s and polypeptoids, bear the potential of an enzymatic biodegradability by (more or less specific) peptidases. Just like the acidic hydrolysis described previously, peptidase activity would result in the cleavage of polymer amide bonds. The aim of the present thesis was to evaluate the stability of poly(2-alkyl-2-oxazoline)s and polypeptoids as well as poly(ethylene glycol) for the sake of reference under circumstances resembling in vivo conditions as closely as possible. Initial experiments focused on the degradation of dye-labeled upon incubation with homogenates of freshly harvested rat liver and kidney. However, although the obtained results are promising for the most part, they are considered rather unreliable and non-reproducible for various reasons. More conclusive data are attained from the incubation of non-labeled polymers in freshly laid chicken eggs. While no evidence for an enzymatic digestion of poly(ethylene glycol) in chicken egg white is found and deterioration of poly(2-methyl-2-oxazoline) upon incubation apparently derives from non-enzymatic hydrolysis, incubated polysarcosine samples reveal distinct elugram patterns depending on the respective C- and N-terminal end groups indicating both exopeptidase and endopeptidase activity. It has to be kept in mind though, that an enzymatic digestibility of polysarcosine does not necessarily imply the digestion of polypeptoids bearing longer side chains by peptidases as well, which should be investigated in further studies.
Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers
(2018)
Background:
Evaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated.
Methods:
Ninety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed.
Results:
The sensitivity and specificity of synovial fluid culture was 4.6 and 94.3%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671).
Conclusions:
Synovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip.
Athletes schedule their training and recovery in periods, often utilizing a pre-defined strategy. To avoid underperformance and/or compromised health, the external load during training should take into account the individual’s physiological and perceptual responses. No single variable provides an adequate basis for planning, but continuous monitoring of a combination of several indicators of internal and external load during training, recovery and off-training as well may allow individual responsive adjustments of a training program in an effective manner. From a practical perspective, including that of coaches, monitoring of potential changes in health and performance should ideally be valid, reliable and sensitive, as well as time-efficient, easily applicable, non-fatiguing and as non-invasive as possible. Accordingly, smartphone applications, wearable sensors and point-of-care testing appear to offer a suitable monitoring framework allowing responsive adjustments to exercise prescription. Here, we outline 24-h monitoring of selected parameters by these technologies that (i) allows responsive adjustments of exercise programs, (ii) enhances performance and/or (iii) reduces the risk for overuse, injury and/or illness.
Inter-comparison of quantitative imaging of lutetium-177 (\(^{177}\)Lu) in European hospitals
(2018)
Background
This inter-comparison exercise was performed to demonstrate the variability of quantitative SPECT/CT imaging for lutetium-177 (\(^{177}\)Lu) in current clinical practice. Our aim was to assess the feasibility of using international inter-comparison exercises as a means to ensure consistency between clinical sites whilst enabling the sites to use their own choice of quantitative imaging protocols, specific to their systems.
Dual-compartment concentric spherical sources of accurately known activity concentrations were prepared and sent to seven European clinical sites. The site staff were not aware of the true volumes or activity within the sources—they performed SPECT/CT imaging of the source, positioned within a water-filled phantom, using their own choice of parameters and reported their estimate of the activities within the source.
Results
The volumes reported by the participants for the inner section of the source were all within 29% of the true value and within 60% of the true value for the outer section. The activities reported by the participants for the inner section of the source were all within 20% of the true value, whilst those reported for the outer section were up to 83% different to the true value.
Conclusions
A variety of calibration and segmentation methods were used by the participants for this exercise which demonstrated the variability of quantitative imaging across clinical sites. This paper presents a method to assess consistency between sites using different calibration and segmentation methods.
Background: The combination of intermediate-dose cytarabine plus mitoxantrone (IMA) can induce high complete remission rates with acceptable toxicity in elderly patients with acute myeloid leukemia (AML). We present the final results of a randomized-controlled trial comparing IMA with the standard 7+3 induction regimen consisting of continuous infusion cytarabine plus daunorubicin (DA).
Patients and methods: Patients with newly diagnosed AML>60 years were randomized to receive either intermediate-dose cytarabine (1000 mg/m(2) twice daily on days 1, 3, 5, 7) plus mitoxantrone (10 mg/m(2) days 1-3) (IMA) or standard induction therapy with cytarabine (100 mg/m(2) continuously days 1-7) plus daunorubicin (45 mg/m(2) days 3-5) (DA). Patients in complete remission after DA received intermediate-dose cytarabine plus amsacrine as consolidation treatment, whereas patients after IMA were consolidated with standard-dose cytarabine plus mitoxantrone.
Results: Between February 2005 and October 2009, 485 patients were randomized; 241 for treatment arm DA and 244 for IMA; 76% of patients were >65 years. The complete response rate after DA was 39% [95% confidence interval (95% CI): 33-45] versus 55% (95% CI: 49-61) after IMA (odds ratio 1.89, P = 0.001). The 6-week early-death rate was 14% in both arms. Relapse-free survival curves were superimposable in the first year, but separated afterwards, resulting in 3-year relapse-free survival rates of 29% versus 14% in the DA versus IMA arms, respectively (P = 0.042). The median overall survival was 10 months in both arms (P = 0.513).
Conclusion: The dose escalation of cytarabine in induction therapy lead to improved remission rates in the elderly AML patients. This did not translate into a survival advantage, most likely due to differences in consolidation treatment. Thus, effective consolidation strategies need to be further explored. In combination with an effective consolidation strategy, the use of intermediate-dose cytarabine in induction may improve curative treatment for elderly AML patients.
Objectives: Recently, the standardized reporting and data system for prostate-specific membrane antigen (PSMA)-targeted positron emission tomography (PET) imaging studies, termed PSMA-RADS version 1.0, was introduced. We aimed to determine the interobserver agreement for applying PSMA-RADS to imaging interpretation of 18F-DCFPyL PET examinations in a prospective setting mimicking the typical clinical work-flow at a prostate cancer referral center.
Methods: Four readers (two experienced readers (ER, > 3 years of PSMA-targeted PET interpretation experience) and two inexperienced readers (IR, < 1 year of experience)), who had all read the initial publication on PSMA-RADS 1.0, assessed 50 18F-DCFPyL PET/computed tomography (CT) studies independently. Per scan, a maximum of 5 target lesions were selected by the observers and a PSMA-RADS score for every target lesion was recorded. No specific pre-existing conditions were placed on the selection of the target lesions, although PSMA-RADS 1.0 suggests that readers focus on the most highly avid or largest lesions. An overall scan impression based on PSMA-RADS was indicated and interobserver agreement rates on a target lesion-based, on an organ-based, and on an overall PSMA-RADS score-based level were computed.
Results: The number of target lesions identified by each observer were as follows: ER 1, 123; ER 2, 134; IR 1, 123; and IR 2, 120. Among those selected target lesions, 125 were chosen by at least two individual observers (all four readers selected the same target lesion in 58/125 (46.4%) instances, three readers in 40/125 (32%) and two observers in 27/125 (21.6%) instances). The interobserver agreement for PSMA-RADS scoring among identical target lesions was good (intraclass correlation coefficient (ICC) for four, three and two identical target lesions, ≥0.60, respectively). For lymph nodes, an excellent interobserver agreement was derived (ICC=0.79). The interobserver agreement for an overall scan impression based on PSMA-RADS was also excellent (ICC=0.84), with a significant difference for ER (ICC=0.97) vs. IR (ICC=0.74, P=0.005).
Conclusions: PSMA-RADS demonstrates a high concordance rate in this study, even among readers with different levels of experience. This suggests that PSMA-RADS can be effectively used for communication with clinicians and can be implemented in the collection of data for large prospective trials.
The pancreas and the small intestine are pivotal organs acting in close synergism to regulate glucose metabolism. After absorption and processing of dietary glucose within the small intestine, insulin and glucagon are released from pancreatic islet cells to maintain blood glucose homeostasis. Malfunctions affecting either individual, organ-specific functions or the sophisticated interplay of both organs can result in massive complications and pathologic conditions. One of the most serious metabolic diseases of our society is diabetes mellitus (DM) that is hallmarked by a disturbance of blood glucose homeostasis. Type 1 (T1DM) and type 2 (T2DM) are the main forms of the disease and both are characterized by chronic hyperglycemia, a condition that evokes severe comorbidities in the long-term. In the past, several standard treatment options allowed a more or less adequate therapy for diabetic patients. Albeit there is much effort to develop new therapeutic interventions to treat diabetic patients in a more efficient way, no cure is available so far. In view of the urgent need for alternative treatment options, a more systemic look on whole organ systems, their biological relation and complex interplay is needed when developing new therapeutic strategies for DM.
T1DM is hallmarked by an autoimmune-mediated destruction of the pancreatic β-cell mass resulting in a complete lack of insulin that is in most patients restored by applying a life-long recombinant insulin therapy. Therefore, novel regenerative medicine-based concepts focus on the derivation of bioartificial β-like cells from diverse stem cell sources in vitro that survive and sustain to secrete insulin after implantation in vivo. In this context, the first part of this thesis analyzed multipotent intestinal stem cells (ISCs) as alternative cell source to derive bioartificial, pancreatic β-like cells in vitro. From a translational perspective, intestinal stem cells pose a particularly attractive cell source since intestinal donor tissues could be obtained via minimal invasive endoscopy in an autologous way. Furthermore, intestinal and pancreatic cells both derive from the same developmental origin, the endodermal gut tube, favoring the differentiation process towards functional β-like cells. In this study, pancreas-specific differentiation of ISCs was induced by the ectopic expression of the pancreatic transcription factor 1 alpha (Ptf1a), a pioneer transcriptional regulator of pancreatic fate. Furthermore, pancreatic lineage-specific culture media were applied to support the differentiation process. In general, ISCs grow in vitro in a 3D Matrigel®-based environment. Therefore, a 2D culture platform for ISCs was established to allow delivery and ectopic expression of Ptf1a with high efficiency. Next, several molecular tools were applied and compared with each other to identify the most suitable technology for Ptf1a delivery and expression within ISCs as well as their survival under the new established 2D conditions. Success of differentiation was investigated by monitoring changes in cellular morphology and induction of pancreatic differentiation-specific gene expression profiles. In summary, the data of this project part suggest that Ptf1a harbors the potential to induce pancreatic differentiation of ISCs when applying an adequate differentiation media. However, gene expression analysis indicated rather an acinar lineage-determination than a pancreatic β-cell-like specification. Nevertheless, this study proved ISCs not only as interesting stem cell source for the generation of pancreatic cell types with a potential use in the treatment of T1DM but alsoPtf1a as pioneer factor for pancreatic differentiation of ISCs in general.
Compared to T1DM, T2DM patients suffer from hyperglycemia due to insulin resistance. In T2DM management, the maintenance of blood glucose homeostasis has highest priority and can be achieved by drugs affecting the stabilization of blood glucose levels. Recent therapeutic concepts are aiming at the inhibition of the intestinal glucose transporter Na+-D-Glucose cotransporter 1 (SGLT1). Pharmacological inhibition of SGLT1 results in reduced postprandial blood glucose levels combined with a sustained and increased Glucagon-like peptide 1 (GLP-1) secretion. So far, systemic side effects of this medication have not been addressed in detail. Of note, besides intestinal localization, SGLT1 is also expressed in various other tissues including the pancreas. In context of having a closer look also on the interplay of organs when developing new therapeutic approaches for DM, the second part of this thesis addressed the effects on pancreatic islet integrity after loss of SGLT1. The analyses comprised the investigation of pancreatic islet size, cytomorphology and function by the use of a global SGLT1 knockout (SGLT1-/-) mouse model. As SGLT1-/- mice develop the glucose-galactose malabsorption syndrome when fed a standard laboratory chow, these animals derived a glucose-deficient, fat-enriched (GDFE) diet. Wildtype mice on either standard chow (WTSC) or GDFE (WTDC) allowed the discrimination between diet- and knockout-dependent effects. Notably, GDFE fed mice showed decreased expression and function of intestinal SGLT1, while pancreatic SGLT1 mRNA levels were unaffected. Further, the findings revealed increased isled sizes, reduced proliferation- and apoptosis rates as well as an increased α-cell and reduced β-cell proportion accompanied by a disturbed cytomorphology in islets when SGLT1 function is lost or impaired. In addition, pancreatic islets were dysfunctional in terms of insulin- and glucagon-secretion. Moreover, the release of intestinal GLP-1, an incretin hormone that stimulates insulin-secretion in the islet, was abnormal after glucose stimulatory conditions. In summary, these data show that intestinal SGLT1 expression and function is nutrient dependent. The data obtained from the islet studies revealed an additional and new role of SGLT1 for maintaining pancreatic islet integrity in the context of structural, cytomorphological and functional aspects. With special emphasis on SGLT1 inhibition in diabetic patients, the data of this project indicate an urgent need for analyzing systemic side effects in other relevant organs to prove pharmacological SGLT1 inhibition as beneficial and safe.
Altogether, the findings of both project parts of this thesis demonstrate that focusing on the molecular and cellular relationship and interplay of the small intestine and the pancreas could be of high importance in context of developing new therapeutic strategies for future applications in DM patients.
Intra- and interobserver reliability of glenoid fracture classifications by Ideberg, Euler and AO
(2018)
Background:
Representing 3%-5% of shoulder girdle injuries scapula fractures are rare. Furthermore, approximately 1% of scapula fractures are intraarticularfractures of the glenoid fossa. Because of uncertain fracture morphology and limited experience, the treatment of glenoid fossa fractures is difficult. The glenoid fracture classification by Ideberg (1984) and Euler (1996) is still commonly used in literature. In 2013 a new glenoid fracture classification was introduced by the AO. The purpose of this study was to examine the new AO classification in clinical practice in comparison with the classifications by Ideberg and Euler.
Methods:
In total CT images of 84 patients with glenoid fossa fractures from 2005 to 2018 were included. Parasagittal, paracoronary and axial reconstructions were examined according to the classifications of Ideberg, Euler and the AO by 3 investigators (orthopedic surgeon, radiologist, student of medicine) at three individual time settings. Inter- and intraobserver reliability of the three classification systems were ascertained by computing Inter- and Intraclass (ICCs) correlation coefficients using Spearman's rank correlation coefficient, 95%-confidence intervals as well as F-tests for correlation coefficients.
Results:
Inter- and intraobserver reliability for the AO classification showed a perspicuous coherence (R = 0.74 and R = 0.79). Low to moderate intraobserver reliability for Ideberg (R = 0.46) and Euler classification (R = 0.41) was found. Furthermore, data show a low Interobserver reliability for both Ideberg and Euler classification (R < 0.2). Both the Inter- and Intraclass reliability using AO is significantly higher than those using Ideberg and Euler (p < 0.05). Using the new AO classification, it was possible to find a proper class for every glenoid fossa fracture. On average, according to Euler classification 10 of 84 fractures were not classifiable whereas to Ideberg classification 21 of 84 fractures were not classifiable.
Conclusion:
The new AO classification system introduced 2013 facilitates reliable grading of glenoid fossa fractures with high inter- and intraobserver reliability in 84 patients using CT images. It should possibly be applied in order to enable a valid, reliable and consistent academic description of glenoid fossa fractures. The established classifications by Euler and Ideberg are not capable of providing a similar reliability.
The use of inverse methods allow efficient model calibration. This study employs PEST to calibrate a large catchment scale transient flow model. Results are demonstrated by comparing manually calibrated approaches with the automated approach. An advanced Tikhonov regularization algorithm was employed for carrying out the automated pilot point (PP) method. The results indicate that automated PP is more flexible and robust as compared to other approaches. Different statistical indicators show that this method yields reliable calibration as values of coefficient of determination (R-2) range from 0.98 to 0.99, Nash Sutcliffe efficiency (ME) range from 0.964 to 0.976, and root mean square errors (RMSE) range from 1.68 m to 1.23 m, for manual and automated approaches, respectively. Validation results of automated PP show ME as 0.969 and RMSE as 1.31 m. The results of output sensitivity suggest that hydraulic conductivity is a more influential parameter. Considering the limitations of the current study, it is recommended to perform global sensitivity and linear uncertainty analysis for the better estimation of the modelling results.
Transforming modern agriculture towards both higher yields and greater sustainability is critical for preserving biodiversity in an increasingly populous and variable world. However, the intensity of agricultural practices varies strongly between crop systems. Given limited research capacity, it is crucial to focus efforts to increase sustainability in the crop systems that need it most. In this study, we investigate the match (or mismatch) between the intensity of pesticide use and the availability of knowledge on the ecosystem service of natural pest control across various crop systems. Using a systematic literature search on pest control and publicly available pesticide data, we find that pest control literature is not more abundant in crops where insecticide input per hectare is highest. Instead, pest control literature is most abundant, with the highest number of studies published, in crops with comparatively low insecticide input per hectare but with high world harvested area. These results suggest that a major increase of interest in agroecological research towards crops with high insecticide input, particularly cotton and horticultural crops such as citrus and high value-added vegetables, would help meet knowledge needs for a timely ecointensification of agriculture.
G protein-coupled receptors (GPCRs) form the biggest receptor family that is encoded in the human genome and represent the most druggable target structure for modern therapeutics respectively future drug development. Belonging to aminergic class A GPCRs muscarinic Acetylcholine receptors (mAChRs) are already now of clinical relevance and are also seen as promising future drug targets for treating neurodegenerative diseases like Alzheimer or Parkinson. The mAChR family consist of five subtypes showing high sequence identity for the endogenous ligand binding region and thus it is challenging until now to selectively activate a single receptor subtype. A well accepted method to study ligand binding, dynamic receptor activation and downstream signaling is the fluorescence resonance energy transfer (FRET) application. Here, there relative distance between two fluorophores in close proximity (<10 nm) can be monitored in a dynamic manner. The perquisite for that is the spectral overlap of the emission spectrum of the first fluorophore with the excitation spectrum of the second fluorophore. By inserting two fluorophores into the molecular receptor structure receptor FRET sensors can serve as a powerful tool to study dynamic receptor pharmacology.
Dualsteric Ligands consist of two different pharmacophoric entities and are regarded as a promising ligand design for future drug development. The orthosteric part interacts with high affinity with the endogenous ligand binding region whereas the allosteric part binds to a different receptor region mostly located in the extracellular vestibule. Both moieties are covalently linked. Dualsteric ligands exhibit a dynamic ligand binding. The dualsteric binding position is characterized by a simultaneous binding of the orthosteric and allosteric moiety to the receptor and thus by receptor activation. In the purely allosteric binding position no receptor activation can be monitored.
In the present work the first receptor FRET sensor for the muscarinic subtype 1 (M1) was generated and characterized. The M1-I3N-CFP sensor showed an unaltered physiological behavior as well as ligand and concentration dependent responses. The sensor was used to characterize different sets of dualsteric ligands concerning their pharmacological properties like receptor activation. It was shown that the hybrids consisting of the synthetic full agonist iperoxo and the positive allosteric modulator of BQCA type is very promising. Furthermore, it was shown for orthosteric as well as dualsteric ligands that the degree of receptor activation is highly dependent on the length of and the chemical properties of the linker moiety. For dualsteric ligands a bell-shaped activation characteristic was reported for the first time, suggesting that there is an optimal linker length for dualsteric ligands. The gained knowledge about hybrid design was then used to generate and characterize the first photo-switchable dualsteric ligand. The resulting hybrids were characterized with the M1-I3N-CFP sensor and were described as photo-inactivatable and dimmable. In addition to the ligand characterization the ligand application methodology was further developed and improved. Thus, a fragment-based screening approach for dualsteric ligands was reported in this study for the first time. With this approach it is possible to investigate dualsteric ligands in greater detail by applying either single ligand fragments alone or in a mixture of building blocks. These studies revealed the insights that the effect of dualsteric ligands on a GPCR can be rebuild by applying the single building blocks simultaneously. The fragment-based screening provides high potential for the molecular understanding of dualsteric ligands and for future screening approaches. Next, a further development of the standard procedure for measuring FRET by sensitized emission was performed. Under normal conditions single cell FRET is measured on glass coverslips. After coating the coverslips surface with a 20 nm thick gold layer an increased FRET efficiency up to 60 % could be reported. This finding was validated in different approaches und in different configurations. This FRET enhancement by plasmonic surfaces was until yet unreported in the literature for physiological systems and make FRET for future projects even more powerful.
Among external stimuli used to trigger release of a drug from a polymeric carrier, ultrasound has gained increasing attention due to its non-invasive nature, safety and low cost. Despite this attention, there is only limited knowledge about how materials available for the preparation of drug carriers respond to ultrasound. This study investigates the effect of ultrasound on the release of a hydrophobic drug, dexamethasone, from poly(2-oxazoline)-based micelles. Spontaneous and ultrasound-mediated release of dexamethasone from five types of micelles made of poly(2-oxazoline) block copolymers, composed of hydrophilic poly(2-methyl-2-oxazoline) and hydrophobic poly(2-n-propyl-2-oxazoline) or poly(2-butyl-2-oxazoline-co-2-(3-butenyl)-2-oxazoline), was studied. The release profiles were fitted by zeroorder and Ritger-Peppas models. The ultrasound increased the amount of released dexamethasone by 6% to 105% depending on the type of copolymer, the amount of loaded dexamethasone, and the stimulation time point. This study investigates for the first time the interaction between different poly(2-oxazoline)-based micelle formulations and ultrasound waves, quantifying the efficacy of such stimulation in modulating dexamethasone release from these nanocarriers.