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Background: Neuralgic amyotrophy (NA) has been described as a possible extrahepatic manifestation of hepatitis E virus (HEV) infection. Usually, HEV-associated NA occurs bilaterally. The clinical characteristics determining the course of HEV-associated NA have still not been defined. Methods: In this retrospective multicentric case series, 16 patients with HEV-associated NA were studied and compared to 176 HEV patients without NA in terms of their age, sex, and ALT levels. Results: Neither gender distribution (75% vs. 67% male) nor age (47 vs. 48 years median) differed significantly between the NA patients and controls. Eight NA patients (50%) presented with bilateral involvement — seven of these had right-side dominance and one had left-side dominance. Thirteen cases (81%) were hospitalized. Eight of these patients stayed in hospital for five to seven days, and five patients stayed for up to two weeks. The time from the onset of NA to the HEV diagnosis, as well as the diagnostic and therapeutic proceedings, showed a large variability. In total, 13 (81%) patients received treatment: 1/13 (8%) received intravenous immunoglobulins, 8/13 (62%) received glucocorticoids, 3/13 (23%) received ribavirin, and 6/13 (46%) received pregabalin/gabapentin. Patients with ages above the median (47 years) were more likely to be treated (p = 0.001). Conclusion: HEV-associated NA causes a relevant morbidity. In our case series neither the type of treatment nor the time of initiation of therapy had a significant effect on the duration of hospitalization or the course of the disease. The clinical presentation, the common diagnostic and therapeutic procedures, and the patients' characteristics showed large variability, demonstrating the necessity of standardized protocols for this rare but relevant disease.
The EU chemicals strategy for sustainability (CSS) asserts that both human health and the environment are presently threatened and that further regulation is necessary. In a recent Guest Editorial, members of the German competent authority for risk assessment, the BfR, raised concerns about the scientific justification for this strategy. The complexity and interdependence of the networks of regulation of chemical substances have ensured that public health and wellbeing in the EU have continuously improved. A continuous process of improvement in consumer protection is clearly desirable but any initiative directed towards this objective must be based on scientific knowledge. It must not confound risk with other factors in determining policy. This conclusion is fully supported in the present Commentary including the request to improve both, data collection and the time-consuming and bureaucratic procedures that delay the publication of regulations.
Chronotype is defined as the behavioral manifestation of circadian rhythms related to the external light–dark cycle. Evening chronotype has been associated with an increased risk of developing cardiometabolic diseases in obesity. Menopause is a lifestage associated with an increased risk of developing cardiometabolic diseases and a change in circadian rhythmicity compared to pre-menopause. However, the prevalence of chronotype categories in menopause and their role in determining menopause-related cardiometabolic risk, mostly in obesity, have not been investigated. Thus, we aimed to investigate the prevalence of chronotype categories in post-menopausal women with obesity and their role in menopause-related cardiometabolic risk. In this cross-sectional study we enrolled 49 pre-menopausal and 74 post-menopausal women with obesity. Anthropometric parameters, lifestyle habits, adherence to the Mediterranean Diet (MD), sleep quality, chronotype and the presence of type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD) were studied. No significance differences were detected in terms of lifestyle and adherence to the MD between pre- and post-menopausal women. Chronotype was classified as morning in 66 (53.6%), evening in 20 (16.3%) and intermediate in 37 (30.1%) women. In addition, pre-menopausal women with obesity showed a significantly higher chance to have an intermediate chronotype (OR = 2.21, 95% CI 1.28–3.83; p = 0.004), whereas post-menopausal women with obesity showed a trend to have a higher morning chronotype (OR = 1.42, 95% CI 0.98–2.06; p = 0.051), although this did not reach statistical significance. No significant differences were detected in terms of prevalence of evening chronotype between the two groups. However, the evening chronotype had a significantly higher risk to have T2DM compared to the morning (OR = 17.29, 95% CI 2.40–124.27; p = 0.005) and intermediate chronotypes (OR = 30.86, 95% CI 2.05–464.32; p = 0.013) in both pre- and post-menopausal women with obesity. In conclusion, the intermediate chronotype was significantly more prevalent in pre-menopausal women with obesity compared to post-menopausal women. Evening chronotype was associated to T2DM in both pre- and post-menopause. These results support the importance of including the assessment of chronotype in the management of women with obesity in post-menopause.
Realistic and lifelike 3D-reconstruction of virtual humans has various exciting and important use cases. Our and others’ appearances have notable effects on ourselves and our interaction partners in virtual environments, e.g., on acceptance, preference, trust, believability, behavior (the Proteus effect), and more. Today, multiple approaches for the 3D-reconstruction of virtual humans exist. They significantly vary in terms of the degree of achievable realism, the technical complexities, and finally, the overall reconstruction costs involved. This article compares two 3D-reconstruction approaches with very different hardware requirements. The high-cost solution uses a typical complex and elaborated camera rig consisting of 94 digital single-lens reflex (DSLR) cameras. The recently developed low-cost solution uses a smartphone camera to create videos that capture multiple views of a person. Both methods use photogrammetric reconstruction and template fitting with the same template model and differ in their adaptation to the method-specific input material. Each method generates high-quality virtual humans ready to be processed, animated, and rendered by standard XR simulation and game engines such as Unreal or Unity. We compare the results of the two 3D-reconstruction methods in an immersive virtual environment against each other in a user study. Our results indicate that the virtual humans from the low-cost approach are perceived similarly to those from the high-cost approach regarding the perceived similarity to the original, human-likeness, beauty, and uncanniness, despite significant differences in the objectively measured quality. The perceived feeling of change of the own body was higher for the low-cost virtual humans. Quality differences were perceived more strongly for one’s own body than for other virtual humans.
Background: The majority of breast cancer patients are severely psychologically affected by breast cancer diagnosis and subsequent therapeutic procedures. The COVID-19 pandemic and associated restrictions on public life have additionally caused significant psychological distress for much of the population. It is therefore plausible that breast cancer patients might be particularly susceptible to the additional psychological stress caused by the pandemic, increasing suffering. In this study we therefore aimed to assess the level of psychological distress currently experienced by a defined group of breast cancer patients in our breast cancer centre, compared to distress levels preCOVID-19 pandemic.
Methods: Female breast cancer patients of all ages receiving either adjuvant, neoadjuvant, or palliative therapies were recruited for the study. All patients were screened for current or previous COVID-19 infection. The participants completed a self-designed COVID-19 pandemic questionnaire, the Stress and Coping Inventory (SCI), the National Comprehensive Cancer Network (R) (NCCN (R)) Distress Thermometer (DT), the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30, and the BR23.
Results: Eighty-two breast cancer patients were included. Therapy status and social demographic factors did not have a significant effect on the distress caused by the COVID-19 pandemic. The results of the DT pre and during COVID-19 pandemic did not differ significantly. Using the self-designed COVID-19 pandemic questionnaire, we detected three distinct subgroups demonstrating different levels of concerns in relation to SARS-CoV-2. The subgroup with the highest levels of concern reported significantly decreased life quality, related parameters and symptoms.
Conclusions: This monocentric study demonstrated that the COVID-19 pandemic significantly affected psychological health in a subpopulation of breast cancer patients. The application of a self-created "COVID-19 pandemic questionnaire"could potentially be used to help identify breast cancer patients who are susceptible to increased psychological distress due to the COVID-19 pandemic, and therefore may need additional intensive psychological support.
Theoretical and numerical investigation of optimal control problems governed by kinetic models
(2021)
This thesis is devoted to the numerical and theoretical analysis of ensemble optimal control problems governed by kinetic models. The formulation and study of these problems have been put forward in recent years by R.W. Brockett with the motivation that ensemble control may provide a more general and robust control framework for dynamical systems. Following this formulation, a Liouville (or continuity) equation with an unbounded drift function is considered together with a class of cost functionals that include tracking of ensembles of trajectories of dynamical systems and different control costs. Specifically, $L^2$, $H^1$ and $L^1$ control costs are taken into account which leads to non--smooth optimization problems. For the theoretical investigation of the resulting optimal control problems, a well--posedness theory in weighted Sobolev spaces is presented for Liouville and related transport equations. Specifically, existence and uniqueness results for these equations and energy estimates in suitable norms are provided; in particular norms in weighted Sobolev spaces. Then, non--smooth optimal control problems governed by the Liouville equation are formulated with a control mechanism in the drift function. Further, box--constraints on the control are imposed. The control--to--state map is introduced, that associates to any control the unique solution of the corresponding Liouville equation. Important properties of this map are investigated, specifically, that it is well--defined, continuous and Frechet differentiable. Using the first two properties, the existence of solutions to the optimal control problems is shown. While proving the differentiability, a loss of regularity is encountered, that is natural to hyperbolic equations. This leads to the need of the investigation of the control--to--state map in the topology of weighted Sobolev spaces. Exploiting the Frechet differentiability, it is possible to characterize solutions to the optimal control problem as solutions to an optimality system. This system consists of the Liouville equation, its optimization adjoint in the form of a transport equation, and a gradient inequality. Numerical methodologies for solving Liouville and transport equations are presented that are based on a non--smooth Lagrange optimization framework. For this purpose, approximation and solution schemes for such equations are developed and analyzed. For the approximation of the Liouville model and its optimization adjoint, a combination of a Kurganov--Tadmor method, a Runge--Kutta scheme, and a Strang splitting method are discussed. Stability and second--order accuracy of these resulting schemes are proven in the discrete $L^1$ norm. In addition, conservation of mass and positivity preservation are confirmed for the solution method of the Liouville model. As numerical optimization strategy, an adapted Krylow--Newton method is applied. Since the control is considered to be an element of $H^1$ and to obey certain box--constraints, a method for calculating a $H^1$ projection is presented. Since the optimal control problem is non-smooth, a semi-smooth adaption of Newton's method is taken into account. Results of numerical experiments are presented that successfully validate the proposed deterministic framework. After the discussion of deterministic schemes, the linear space--homogeneous Keilson--Storer master equation is investigated. This equation was originally developed for the modelling of Brownian motion of particles immersed in a fluid and is a representative model of the class of linear Boltzmann equations. The well--posedness of the Keilson--Storer master equation is investigated and energy estimates in different topologies are derived. To solve this equation numerically, Monte Carlo methods are considered. Such methods take advantage of the kinetic formulation of the Liouville equation and directly implement the behaviour of the system of particles under consideration. This includes the probabilistic behaviour of the collisions between particles. Optimal control problems are formulated with an objective that is constituted of certain expected values in velocity space and the $L^2$ and $H^1$ costs of the control. The problems are governed by the Keilson--Storer master equation and the control mechanism is considered to be within the collision kernel. The objective of the optimal control of this model is to drive an ensemble of particles to acquire a desired mean velocity and to achieve a desired final velocity configuration. Existence of solutions of the optimal control problem is proven and a Keilson--Storer optimality system characterizing the solution of the proposed optimal control problem is obtained. The optimality system is used to construct a gradient--based optimization strategy in the framework of Monte--Carlo methods. This task requires to accommodate the resulting adjoint Keilson--Storer model in a form that is consistent with the kinetic formulation. For this reason, we derive an adjoint Keilson--Storer collision kernel and an additional source term. A similar approach is presented in the case of a linear space--inhomogeneous kinetic model with external forces and with Keilson--Storer collision term. In this framework, a control mechanism in the form of an external space--dependent force is investigated. The purpose of this control is to steer the multi--particle system to follow a desired mean velocity and position and to reach a desired final configuration in phase space. An optimal control problem using the formulation of ensemble controls is stated with an objective that is constituted of expected values in phase space and $H^1$ costs of the control. For solving the optimal control problems, a gradient--based computational strategy in the framework of Monte Carlo methods is developed. Part of this is the denoising of the distribution functions calculated by Monte Carlo algorithms using methods of the realm of partial differential equations. A standalone C++ code is presented that implements the developed non--linear conjugated gradient strategy. Results of numerical experiments confirm the ability of the designed probabilistic control framework to operate as desired. An outlook section about optimal control problems governed by non--linear space--inhomogeneous kinetic models completes this thesis.
This paper is devoted to the numerical analysis of non-smooth ensemble optimal control problems governed by the Liouville (continuity) equation that have been originally proposed by R.W. Brockett with the purpose of determining an efficient and robust control strategy for dynamical systems. A numerical methodology for solving these problems is presented that is based on a non-smooth Lagrange optimization framework where the optimal controls are characterized as solutions to the related optimality systems. For this purpose, approximation and solution schemes are developed and analysed. Specifically, for the approximation of the Liouville model and its optimization adjoint, a combination of a Kurganov–Tadmor method, a Runge–Kutta scheme, and a Strang splitting method are discussed. The resulting optimality system is solved by a projected semi-smooth Krylov–Newton method. Results of numerical experiments are presented that successfully validate the proposed framework.
A relevant issue on the treatment of adrenocortical carcinoma (ACC) concerns the optimal duration of adjuvant mitotane treatment. We tried to address this question, assessing whether a correlation exists between the duration of adjuvant mitotane treatment and recurrence-free survival (RFS) of patients with ACC. We conducted a multicenter retrospective analysis on 154 ACC patients treated for ≥12 months with adjuvant mitotane after radical surgery and who were free of disease at the mitotane stop. During a median follow-up of 38 months, 19 patients (12.3%) experienced recurrence. We calculated the RFS after mitotane (RFSAM), from the landmark time-point of mitotane discontinuation, to overcome immortal time bias. We found a wide variability in the duration of adjuvant mitotane treatment among different centers and also among patients cared for at the same center, reflecting heterogeneous practice. We did not find any survival advantage in patients treated for longer than 24 months. Moreover, the relationship between treatment duration and the frequency of ACC recurrence was not linear after stratifying our patients in tertiles of length of adjuvant treatment. In conclusion, the present findings do not support the concept that extending adjuvant mitotane treatment over two years is beneficial for ACC patients with low to moderate risk of recurrence.
Several new N-substituted 1,2-benzisothiazol-3(2H)-ones (BITs) were synthesised through a facile synthetic route for testing their anti-dengue protease inhibition. Contrary to the conventional multistep synthesis, we achieved structurally diverse BITs with excellent yields using a two-step, one-pot reaction strategy. All the synthesised compounds were prescreened for drug-like properties using the online Swiss Absorption, Distribution, Metabolism and Elimination (SwissADME) model, indicating their favourable pharmaceutical properties. Thus, the synthesised BITs were tested for inhibitory activity against the recombinant dengue virus serotype-2 (DENV-2) NS2BNS3 protease. Dose–response experiments and computational docking analyses revealed that several BITs bind to the protease in the vicinity of the catalytic triad with IC\(_{50}\) values in the micromolar range. The DENV2 infection assay showed that two BITs, 2-(2-chlorophenyl)benzo[d]isothiazol-3(2H)-one and 2-(2,6-dichlorophenyl)benzo[d]isothiazol-3(2H)-one, could suppress DENV replication and virus infectivity. These results indicate the potential of BITs for developing new anti-dengue therapeutics.
These days, we are living in a digitalized world. Both our professional and private lives are pervaded by various IT services, which are typically operated using distributed computing systems (e.g., cloud environments). Due to the high level of digitalization, the operators of such systems are confronted with fast-paced and changing requirements. In particular, cloud environments have to cope with load fluctuations and respective rapid and unexpected changes in the computing resource demands. To face this challenge, so-called auto-scalers, such as the threshold-based mechanism in Amazon Web Services EC2, can be employed to enable elastic scaling of the computing resources. However, despite this opportunity, business-critical applications are still run with highly overprovisioned resources to guarantee a stable and reliable service operation. This strategy is pursued due to the lack of trust in auto-scalers and the concern that inaccurate or delayed adaptations may result in financial losses.
To adapt the resource capacity in time, the future resource demands must be "foreseen", as reacting to changes once they are observed introduces an inherent delay. In other words, accurate forecasting methods are required to adapt systems proactively. A powerful approach in this context is time series forecasting, which is also applied in many other domains. The core idea is to examine past values and predict how these values will evolve as time progresses. According to the "No-Free-Lunch Theorem", there is no algorithm that performs best for all scenarios. Therefore, selecting a suitable forecasting method for a given use case is a crucial task. Simply put, each method has its benefits and drawbacks, depending on the specific use case. The choice of the forecasting method is usually based on expert knowledge, which cannot be fully automated, or on trial-and-error. In both cases, this is expensive and prone to error.
Although auto-scaling and time series forecasting are established research fields, existing approaches cannot fully address the mentioned challenges: (i) In our survey on time series forecasting, we found that publications on time series forecasting typically consider only a small set of (mostly related) methods and evaluate their performance on a small number of time series with only a few error measures while providing no information on the execution time of the studied methods. Therefore, such articles cannot be used to guide the choice of an appropriate method for a particular use case; (ii) Existing open-source hybrid forecasting methods that take advantage of at least two methods to tackle the "No-Free-Lunch Theorem" are computationally intensive, poorly automated, designed for a particular data set, or they lack a predictable time-to-result. Methods exhibiting a high variance in the time-to-result cannot be applied for time-critical scenarios (e.g., auto-scaling), while methods tailored to a specific data set introduce restrictions on the possible use cases (e.g., forecasting only annual time series); (iii) Auto-scalers typically scale an application either proactively or reactively. Even though some hybrid auto-scalers exist, they lack sophisticated solutions to combine reactive and proactive scaling. For instance, resources are only released proactively while resource allocation is entirely done in a reactive manner (inherently delayed); (iv) The majority of existing mechanisms do not take the provider's pricing scheme into account while scaling an application in a public cloud environment, which often results in excessive charged costs. Even though some cost-aware auto-scalers have been proposed, they only consider the current resource demands, neglecting their development over time. For example, resources are often shut down prematurely, even though they might be required again soon.
To address the mentioned challenges and the shortcomings of existing work, this thesis presents three contributions: (i) The first contribution-a forecasting benchmark-addresses the problem of limited comparability between existing forecasting methods; (ii) The second contribution-Telescope-provides an automated hybrid time series forecasting method addressing the challenge posed by the "No-Free-Lunch Theorem"; (iii) The third contribution-Chamulteon-provides a novel hybrid auto-scaler for coordinated scaling of applications comprising multiple services, leveraging Telescope to forecast the workload intensity as a basis for proactive resource provisioning. In the following, the three contributions of the thesis are summarized:
Contribution I - Forecasting Benchmark
To establish a level playing field for evaluating the performance of forecasting methods in a broad setting, we propose a novel benchmark that automatically evaluates and ranks forecasting methods based on their performance in a diverse set of evaluation scenarios. The benchmark comprises four different use cases, each covering 100 heterogeneous time series taken from different domains. The data set was assembled from publicly available time series and was designed to exhibit much higher diversity than existing forecasting competitions. Besides proposing a new data set, we introduce two new measures that describe different aspects of a forecast. We applied the developed benchmark to evaluate Telescope.
Contribution II - Telescope
To provide a generic forecasting method, we introduce a novel machine learning-based forecasting approach that automatically retrieves relevant information from a given time series. More precisely, Telescope automatically extracts intrinsic time series features and then decomposes the time series into components, building a forecasting model for each of them. Each component is forecast by applying a different method and then the final forecast is assembled from the forecast components by employing a regression-based machine learning algorithm. In more than 1300 hours of experiments benchmarking 15 competing methods (including approaches from Uber and Facebook) on 400 time series, Telescope outperformed all methods, exhibiting the best forecast accuracy coupled with a low and reliable time-to-result. Compared to the competing methods that exhibited, on average, a forecast error (more precisely, the symmetric mean absolute forecast error) of 29%, Telescope exhibited an error of 20% while being 2556 times faster. In particular, the methods from Uber and Facebook exhibited an error of 48% and 36%, and were 7334 and 19 times slower than Telescope, respectively.
Contribution III - Chamulteon
To enable reliable auto-scaling, we present a hybrid auto-scaler that combines proactive and reactive techniques to scale distributed cloud applications comprising multiple services in a coordinated and cost-effective manner. More precisely, proactive adaptations are planned based on forecasts of Telescope, while reactive adaptations are triggered based on actual observations of the monitored load intensity. To solve occurring conflicts between reactive and proactive adaptations, a complex conflict resolution algorithm is implemented. Moreover, when deployed in public cloud environments, Chamulteon reviews adaptations with respect to the cloud provider's pricing scheme in order to minimize the charged costs. In more than 400 hours of experiments evaluating five competing auto-scaling mechanisms in scenarios covering five different workloads, four different applications, and three different cloud environments, Chamulteon exhibited the best auto-scaling performance and reliability while at the same time reducing the charged costs. The competing methods provided insufficient resources for (on average) 31% of the experimental time; in contrast, Chamulteon cut this time to 8% and the SLO (service level objective) violations from 18% to 6% while using up to 15% less resources and reducing the charged costs by up to 45%.
The contributions of this thesis can be seen as major milestones in the domain of time series forecasting and cloud resource management. (i) This thesis is the first to present a forecasting benchmark that covers a variety of different domains with a high diversity between the analyzed time series. Based on the provided data set and the automatic evaluation procedure, the proposed benchmark contributes to enhance the comparability of forecasting methods. The benchmarking results for different forecasting methods enable the selection of the most appropriate forecasting method for a given use case. (ii) Telescope provides the first generic and fully automated time series forecasting approach that delivers both accurate and reliable forecasts while making no assumptions about the analyzed time series. Hence, it eliminates the need for expensive, time-consuming, and error-prone procedures, such as trial-and-error searches or consulting an expert. This opens up new possibilities especially in time-critical scenarios, where Telescope can provide accurate forecasts with a short and reliable time-to-result.
Although Telescope was applied for this thesis in the field of cloud computing, there is absolutely no limitation regarding the applicability of Telescope in other domains, as demonstrated in the evaluation. Moreover, Telescope, which was made available on GitHub, is already used in a number of interdisciplinary data science projects, for instance, predictive maintenance in an Industry 4.0 context, heart failure prediction in medicine, or as a component of predictive models of beehive development. (iii) In the context of cloud resource management, Chamulteon is a major milestone for increasing the trust in cloud auto-scalers. The complex resolution algorithm enables reliable and accurate scaling behavior that reduces losses caused by excessive resource allocation or SLO violations. In other words, Chamulteon provides reliable online adaptations minimizing charged costs while at the same time maximizing user experience.
Prerequisite to any biological laboratory assay employing living animals is consideration about its necessity, feasibility, ethics and the potential harm caused during an experiment. The imperative of these thoughts has led to the formulation of the 3R-principle, which today is a pivotal scientific standard of animal experimentation worldwide. The rising amount of laboratory investigations utilizing living animals throughout the last decades, either for regulatory concerns or for basic science, demands the development of alternative methods in accordance with 3R to help reduce experiments in mammals. This demand has resulted in investigation of additional vertebrate species displaying favourable biological properties. One prominent species among these is the zebrafish (Danio rerio), as these small laboratory ray-finned fish are well established in science today and feature outstanding biological characteristics. In this review, we highlight the advantages and general prerequisites of zebrafish embryos and larvae before free-feeding stages for toxicological testing, with a particular focus on cardio-, neuro, hepato- and nephrotoxicity. Furthermore, we discuss toxicokinetics, current advances in utilizing zebrafish for organ toxicity testing and highlight how advanced laboratory methods (such as automation, advanced imaging and genetic techniques) can refine future toxicological studies in this species.
Treatment-induced neuropathy in diabetes (TIND) — Developing a disease model in type 1 diabetic rats
(2021)
Treatment-induced neuropathy in diabetes (TIND) is defined by the occurrence of an acute neuropathy within 8 weeks of an abrupt decrease in glycated hemoglobin-A1c (HbA1c). The underlying pathogenic mechanisms are still incompletely understood with only one mouse model being explored to date. The aim of this study was to further explore the hypothesis that an abrupt insulin-induced fall in HbA1c may be the prime causal factor of developing TIND. BB/OKL (bio breeding/OKL, Ottawa Karlsburg Leipzig) diabetic rats were randomized in three groups, receiving insulin treatment by implanted subcutaneous osmotic insulin pumps for 3 months, as follows: Group one received 2 units per day; group two 1 unit per day: and group three 1 unit per day in the first month, followed by 2 units per day in the last two months. We serially examined blood glucose and HbA1c levels, motor- and sensory/mixed afferent conduction velocities (mNCV and csNCV) and peripheral nerve morphology, including intraepidermal nerve fiber density and numbers of Iba-1 (ionized calcium binding adaptor molecule 1) positive macrophages in the sciatic nerve. Only in BB/OKL rats of group three, with a rapid decrease in HbA1c of more than 2%, did we find a significant decrease in mNCV in sciatic nerves (81% of initial values) after three months of treatment as compared to those group three rats with a less marked decrease in HbA1c <2% (mNCV 106% of initial values, p ≤ 0.01). A similar trend was observed for sensory/mixed afferent nerve conduction velocities: csNCV were reduced in BB/OKL rats with a rapid decrease in HbA1c >2% (csNCV 90% of initial values), compared to those rats with a mild decrease <2% (csNCV 112% of initial values, p ≤ 0.01). Moreover, BB/OKL rats of group three with a decrease in HbA1c >2% showed significantly greater infiltration of macrophages by about 50% (p ≤ 0.01) and a decreased amount of calcitonin gene related peptide (CGRP) positive nerve fibers as compared to the animals with a milder decrease in HbA1c. We conclude that a mild acute neuropathy with inflammatory components was induced in BB/OKL rats as a consequence of an abrupt decrease in HbA1c caused by high-dose insulin treatment. This experimentally induced neuropathy shares some features with TIND in humans and may be further explored in studies into the pathogenesis and treatment of TIND.
Inflammatory mechanisms in the pathophysiology of diabetic peripheral neuropathy (DN) — new aspects
(2021)
The pathogenesis of diabetic neuropathy is complex, and various pathogenic pathways have been proposed. A better understanding of the pathophysiology is warranted for developing novel therapeutic strategies. Here, we summarize recent evidence from experiments using animal models of type 1 and type 2 diabetes showing that low-grade intraneural inflammation is a facet of diabetic neuropathy. Our experimental data suggest that these mild inflammatory processes are a likely common terminal pathway in diabetic neuropathy associated with the degeneration of intraepidermal nerve fibers. In contrast to earlier reports claiming toxic effects of high-iron content, we found the opposite, i.e., nutritional iron deficiency caused low-grade inflammation and fiber degeneration while in normal or high non-heme iron nutrition no or only extremely mild inflammatory signs were identified in nerve tissue. Obesity and dyslipidemia also appear to trigger mild inflammation of peripheral nerves, associated with neuropathy even in the absence of overt diabetes mellitus. Our finding may be the experimental analog of recent observations identifying systemic proinflammatory activity in human sensorimotor diabetic neuropathy. In a rat model of type 1 diabetes, a mild neuropathy with inflammatory components could be induced by insulin treatment causing an abrupt reduction in HbA1c. This is in line with observations in patients with severe diabetes developing a small fiber neuropathy upon treatment-induced rapid HbA1c reduction. If the inflammatory pathogenesis could be further substantiated by data from human tissues and intervention studies, anti-inflammatory compounds with different modes of action may become candidates for the treatment or prevention of diabetic neuropathy.
The Antarctic Ice Sheet stores ~91% of the global ice volume which is equivalent to a sea-level rise of 58.3 meters. Recent disintegration events of ice shelves and retreating glaciers along the Antarctic Peninsula and West Antarctica indicate the current vulnerable state of the Antarctic Ice Sheet. Glacier tongues and ice shelves create a safety band around Antarctica with buttressing effects on ice discharge. Current decreases in glacier and ice shelf extent reduce the effective buttressing forces and increase ice discharge of grounded ice. The consequence is a higher contribution to sea-level rise from the Antarctic Ice Sheet. So far, it is unresolved which proportion of Antarctic glacier retreat can be attributed to climate change and which part to the natural cycle of growth and decay in the lifetime of a glacier. The quantitative assessment of the magnitude, spatial extent, distribution, and dynamics of circum-Antarctic glacier and ice shelf retreat is of utmost importance to monitor Antarctica’s weakening safety band. In remote areas like Antarctica, earth observation provides optimal properties for large-scale mapping and monitoring of glaciers and ice shelves. Nowadays, the variety of available satellite sensors, technical advancements regarding spatial resolution and revisit times, as well as open satellite data archives create an ideal basis for monitoring calving front change. A systematic review conducted within this thesis revealed major gaps in the availability of glacier and ice shelf front position measurements despite the improved satellite data availability. The previously limited availability of satellite imagery and the time-consuming manual delineation of calving fronts did neither allow a circum-Antarctic assessment of glacier retreat nor the assessment of intra-annual changes in glacier front position. To advance the understanding of Antarctic glacier front change, this thesis presents a novel automated approach for calving front extraction and explores drivers of glacier retreat.
A comprehensive review of existing methods for glacier front extraction ascertained the lack of a fully automatic approach for large-scale monitoring of Antarctic calving fronts using radar imagery. Similar backscatter characteristics of different ice types, seasonally changing backscatter values, multi-year sea ice, and mélange made it challenging to implement an automated approach with traditional image processing techniques. Therefore, the present abundance of satellite data is best exploited by integrating recent developments in big data and artificial intelligence (AI) research to derive circum-Antarctic calving front dynamics. In the context of this thesis, the novel AI-based framework “AntarcticLINES” (Antarctic Glacier and Ice Shelf Front Time Series) was created which provides a fully automated processing chain for calving front extraction from Sentinel-1 imagery. Open access Sentinel-1 radar imagery is an ideal data source for monitoring current and future changes in the Antarctic coastline with revisit times of less than six days and all-weather imaging capabilities. The developed processing chain includes the pre-processing of dual-polarized Sentinel-1 imagery for machine learning applications. 38 Sentinel-1 scenes were used to train the deep learning architecture U-Net for image segmentation. The trained weights of the neural network can be used to segment Sentinel-1 scenes into land ice and ocean. Additional post-processing ensures even more accurate results by including morphological filtering before extracting the final coastline. A comprehensive accuracy assessment has proven the correct extraction of the coastline. On average, the automatically extracted coastline deviates by 2-3 pixels (93 m) from a manual delineation. This accuracy is in range with deviations between manually delineated coastlines from different experts.
For the first time, the fully automated framework AntarcticLINES enabled the extraction of intra-annual glacier front fluctuations to assess seasonal variations in calving front change. Thereby, for example, an increased calving frequency of Pine Island Glacier and a beginning disintegration of Glenzer Glacier were revealed. Besides, the extraction of the entire Antarctic coastline for 2018 highlighted the large-scale applicability of the developed approach. Accurate results for entire Antarctica were derived except for the Western Antarctic Peninsula where training imagery was not sufficient and should be included in future studies.
Furthermore, this dissertation presents an unprecedented record of circum-Antarctic calving front change over the last two decades. The newly extracted coastline for 2018 was compared to previous coastline products from 2009 and 1997. This revealed that the Antarctic Ice Sheet shrank 29,618±1193 km2 in extent between 1997-2008 and gained an area of 7,108±1029 km2 between 2009-2018. Glacier retreat concentrated along the Antarctic Peninsula and West Antarctica. The only East Antarctic coastal sector primarily experiencing calving front retreat was Wilkes Land in 2009-2018. Finally, potential drivers of circum-Antarctic glacier retreat were identified by combining data on glacier front change with changes in climate variables. It was found that strengthening westerlies, snowmelt, rising sea surface temperatures, and decreasing sea ice cover forced glacier retreat over the last two decades. Relative changes in mean air temperature could not be identified as a driver for glacier retreat and further investigations on extreme events in air temperature are necessary to assess the effect of atmospheric forcing on frontal retreat. The strengthening of all identified drivers was closely connected to positive phases of the Southern Annular Mode (SAM). With increasing greenhouse gases and ozone depletion, positive phases of SAM will occur more often and force glacier retreat even further in the future.
Within this thesis, a comprehensive review on existing Antarctic glacier and ice shelf front studies was conducted revealing major gaps in Antarctic calving front records. Therefore, a fully automated processing chain for glacier and ice shelf front extraction was implemented to track circum-Antarctic calving front fluctuations on an intra-annual basis. The large-scale applicability was certified by presenting two decades of circum-Antarctic calving front change. In combination with climate variables, drivers of recent glacier retreat were identified. In the future, the presented framework AntarcticLINES will greatly contribute to the constant monitoring of the Antarctic coastline under the pressure of a changing climate.
Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents.
Most drugs are no longer produced in their own countries by the pharmaceutical companies, but by contract manufacturers or at manufacturing sites in countries that can produce more cheaply. This not only makes it difficult to trace them back but also leaves room for criminal organizations to fake them unnoticed. For these reasons, it is becoming increasingly difficult to determine the exact origin of drugs. The goal of this work was to investigate how exactly this is possible by using different spectroscopic methods like nuclear magnetic resonance and near- and mid-infrared spectroscopy in combination with multivariate data analysis. As an example, 56 out of 64 different paracetamol preparations, collected from 19 countries around the world, were chosen to investigate whether it is possible to determine the pharmaceutical company, manufacturing site, or country of origin. By means of suitable pre-processing of the spectra and the different information contained in each method, principal component analysis was able to evaluate manufacturing relationships between individual companies and to differentiate between production sites or formulations. Linear discriminant analysis showed different results depending on the spectral method and purpose. For all spectroscopic methods, it was found that the classification of the preparations to their manufacturer achieves better results than the classification to their pharmaceutical company. The best results were obtained with nuclear magnetic resonance and near-infrared data, with 94.6%/99.6% and 98.7/100% of the spectra of the preparations correctly assigned to their pharmaceutical company or manufacturer.
Background
Effective inhibition of thrombosis without generating bleeding risks is a major challenge in medicine. Accumulating evidence suggests that this can be achieved by inhibition of coagulation factor XII (FXII), as either its knock-out or inhibition in animal models efficiently reduced thrombosis without affecting normal hemostasis. Based on these findings, highly specific inhibitors for human FXII(a) are under development. However, currently, in vivo studies on their efficacy and safety are impeded by the lack of an optimized animal model expressing the specific target, that is, human FXII.
Objective
The primary objective of this study is to develop and functionally characterize a humanized FXII mouse model.
Methods
A humanized FXII mouse model was generated by replacing the murine with the human F12 gene (genetic knock-in) and tested it in in vitro coagulation assays and in in vivo thrombosis models.
Results
These hF12\(^{KI}\) mice were indistinguishable from wild-type mice in all tested assays of coagulation and platelet function in vitro and in vivo, except for reduced expression levels of hFXII compared to human plasma. Targeting FXII by the anti-human FXIIa antibody 3F7 increased activated partial thromboplastin time dose-dependently and protected hF12\(^{KI}\) mice in an arterial thrombosis model without affecting bleeding times.
Conclusion
These data establish the newly generated hF12\(^{KI}\) mouse as a powerful and unique model system for in vivo studies on anti-FXII(a) biologics, supporting the development of efficient and safe human FXII(a) inhibitors.
Platelets, small anucleate cell fragments in the blood stream, derive from large precursor cells, so-called megakaryocytes (MK) residing in the bone marrow (BM). In addition to their role in wound healing, platelets have been shown to play a significant role during inflammatory bleeding. Above all, the immunoreceptor tyrosine-based activation motif (ITAM) receptors GPVI as well as CLEC-2 have been identified as main regulators of vascular integrity.
In addition to ITAM-bearing receptors, our group identified GPV as another potent regulator of hemostasis and thrombosis. Surprisingly, concomitant lack of GPV and CLEC-2 deteriorated blood-lymphatic misconnections observed in Clec2-/- mice resulting in severe edema formation and intestinal inflammation. Analysis of lymphatic and vascular development in embryonic mesenteries revealed severely defective blood-lymph-vessel separation, which translated into thrombocytopenia and increased vascular permeability due to reduced tight junction density in mesenteric blood vessels and consequent leakage of blood into the peritoneal cavity.
Recently, platelet granule release has been proposed to ameliorate the progression of retinopathy of prematurity (ROP), a fatal disease in newborns leading to retinal degradation. The mechanisms governing platelet activation in this process remained elusive nonetheless, which prompted us to investigate a possible role of ITAM signaling. In the second part of this thesis, granule release during ROP was shown to be GPVI- and partly CLEC-2-triggered since blockade or loss of these receptors markedly deteriorated ROP progression.
Proplatelet formation from MKs is highly dependent on a functional microtubule and actin cytoskeleton, the latter of which is regulated by several actin-monomer binding proteins including Cofilin1 and Twinfilin1 that have been associated with actin-severing at pointed ends. In the present study, a redundancy between both proteins especially important for the guided release of proplatelets into the bloodstream was identified, since deficiency in both proteins markedly impaired MK functionality mainly due to altered actin-microtubule crosstalk.
Besides ITAM-triggered activation, platelets and MKs are dependent on inhibitory receptors, which prevent overshooting activation. We here identified macrothrombocytopenic mice with a mutation within Mpig6b encoding the ITIM-bearing receptor G6b-B. G6b-B-mutant mice developed a severe myelofibrosis associated with sex-specific bone remodeling defects resulting in osteosclerosis and -porosis in female mice. Moreover, G6b-B was shown to be indispensable for MK maturation as verified by a significant reduction in MK-specific gene expression in G6b-B-mutant MKs due to reduced GATA-1 activity.
Summary
Bees, like many other organisms, evolved an endogenous circadian clock, which enables them to foresee daily environmental changes and exactly time foraging flights to periods of floral resource availability. The social lifestyle of a honey bee colony has been shown to influence circadian behavior in nurse bees, which do not exhibit rhythmic behavior when they are nursing. On the other hand, forager bees display strong circadian rhythms. Solitary bees, like the mason bee, do not nurse their offspring and do not live in hive communities, but face the same daily environmental changes as honey bees. Besides their lifestyle mason and honey bees differ in their development and life history, because mason bees overwinter after eclosion as adults in their cocoons until they emerge in spring. Honey bees do not undergo diapause and have a relatively short development of a few weeks until they emerge. In my thesis, I present a comparison of the circadian clock of social honey bees (Apis mellifera) and solitary mason bees (Osmia bicornis and Osmia cornuta) on the neuroanatomical level and behavioral output level.
I firstly characterized in detail the localization of the circadian clock in the bee brain via the expression pattern of two clock components, namely the clock protein PERIOD (PER) and the neuropeptide Pigment Dispersing Factor (PDF), in the brain of honey bee and mason bee. PER is localized in lateral neuron clusters (which we called lateral neurons 1 and 2: LN1 and LN2) and dorsal neuron clusters (we called dorsal lateral neurons and dorsal neurons: DLN, DN), many glia cells and photoreceptor cells. This expression pattern is similar to the one in other insect species and indicates a common ground plan of clock cells among insects. In the LN2 neuron cluster with cell bodies located in the lateral brain, PER is co-expressed with PDF. These cells build a complex arborization network throughout the brain and provide the perfect structure to convey time information to brain centers, where complex behavior, e.g. sun-compass orientation and time memory, is controlled. The PDF arborizations centralize in a dense network (we named it anterio-lobular PDF hub: ALO) which is located in front of the lobula. In other insects, this fiber center is associated with the medulla (accessory medulla: AME). Few PDF cells build the ALO already in very early larval development and the cell number and complexity of the network grows throughout honey bee development. Thereby, dorsal regions are innervated first by PDF fibers and, in late larval development, the fibers grow laterally to the optic lobe and central brain. The overall expression pattern of PER and PDF are similar in adult social and solitary bees, but I found a few differences in the PDF network density in the posterior protocerebrum and the lamina, which may be associated with evolution of sociality in bees.
Secondly, I monitored activity rhythms, for which I developed and established a device to monitor locomotor activity rhythms of individual honey bees with contact to a mini colony in the laboratory. This revealed new aspects of social synchronization and survival of young bees with indirect social contact to the mini colony (no trophalaxis was possible). For mason bees, I established a method to monitor emergence and locomotor activity rhythms and I could show that circadian emergence rhythms are entrainable by daily temperature cycles. Furthermore, I present the first locomotor activity rhythms of solitary bees, which show strong circadian rhythms in their behavior right after emergence. Honey bees needed several days to develop circadian locomotor rhythms in my experiments. I hypothesized that honey bees do not emerge with a fully matured circadian system in the hive, while solitary bees, without the protection of a colony, would need a fully matured circadian clock right away after emergence. Several indices in published work and preliminary studies support my hypothesis and future studies on PDF expression in different developmental stages in solitary bees may provide hard evidence.
Identification and characterization of TAT-5 interactors that regulate extracellular vesicle budding
(2021)
Cells from bacteria to man release extracellular vesicles (EV) such as microvesicles (MV) that carry signaling molecules like morphogens and miRNAs to control intercellular communication during health and disease. MV release also sculpts membranes, e.g. repairing damaged membranes to avoid cell death. HIV viruses also bud from the plasma membrane in a similar fashion. In order to determine the in vivo functions of MVs and regulate their release, we need to understand the mechanisms of MV release by plasma membrane budding (ectocytosis).
The conserved phospholipid flippase TAT-5 maintains the asymmetric localization of phosphatidylethanolamine (PE) in the plasma membrane and was the only known inhibitor of ESCRT-mediated ectocytosis in C. elegans. Loss of TAT-5 lipid flipping activity increased the externalization of PE and accumulation of MVs. However, it was unclear how cells control TAT-5 activity to release the right amount of MVs at the right time, since no upstream regulators of TAT-5 were known.
To identify conserved TAT-5 regulators we looked for new proteins that inhibit MV release. To do so, we first developed a degradation-based technique to specifically label MVs. We tagged a plasma membrane reporter with the endogenous ZF1 degradation tag (degron) and expressed it in C. elegans embryos. This reporter is protected from degradation inside MVs, but is degraded inside the cell. Thus, the fluorescence is selectively maintained inside MVs, creating the first MV-specific reporter. We identified four MV release inhibitors associated with retrograde recycling, including the class III PI3Kinase VPS-34, Beclin1 homolog BEC-1, DnaJ protein RME-8, and the uncharacterized Dopey homolog PAD-1. We found that VPS-34, BEC-1, RME-8, and redundant sorting nexins are required for the plasma membrane localization of TAT-5, which is important to maintain PE asymmetry and inhibit MV release. Although we confirmed that PAD-1 and the GEF-like protein MON-2 are required for endosomal recycling, they only traffic TAT-5 in the absence of sorting nexin-mediated recycling. Instead, PAD-1 is specifically required for the lipid flipping activity of TAT-5 that inhibits MV release.
Thus, our work pinpoints TAT-5 and PE as key regulators of plasma membrane budding, further supporting the model that PE externalization drives ectocytosis. In addition, we uncovered redundant intracellular trafficking pathways, which affect organelle size and revealed new regulators of TAT-5 flippase activity. These newly identified ectocytosis inhibitors provide a toolkit to test the in vivo roles of MVs. In the long term, our work will help to identify the mechanisms that govern MV budding, furthering our understanding of the mechanisms that regulate disease-mediated EV release, membrane sculpting and viral budding.
Physical and mental well-being during the COVID-19 pandemic is typically assessed via surveys, which might make it difficult to conduct longitudinal studies and might lead to data suffering from recall bias. Ecological momentary assessment (EMA) driven smartphone apps can help alleviate such issues, allowing for in situ recordings. Implementing such an app is not trivial, necessitates strict regulatory and legal requirements, and requires short development cycles to appropriately react to abrupt changes in the pandemic. Based on an existing app framework, we developed Corona Health, an app that serves as a platform for deploying questionnaire-based studies in combination with recordings of mobile sensors. In this paper, we present the technical details of Corona Health and provide first insights into the collected data. Through collaborative efforts from experts from public health, medicine, psychology, and computer science, we released Corona Health publicly on Google Play and the Apple App Store (in July 2020) in eight languages and attracted 7290 installations so far. Currently, five studies related to physical and mental well-being are deployed and 17,241 questionnaires have been filled out. Corona Health proves to be a viable tool for conducting research related to the COVID-19 pandemic and can serve as a blueprint for future EMA-based studies. The data we collected will substantially improve our knowledge on mental and physical health states, traits and trajectories as well as its risk and protective factors over the course of the COVID-19 pandemic and its diverse prevention measures.
Bloch oscillations are a phenomenon well known from quantum mechanics where electrons in a lattice experience an oscillatory motion in the presence of an electric field gradient. Here, the authors report on Bloch oscillations of hybrid light−matter particles, called exciton‐polaritons (polaritons), being confined in an array of coupled microcavity waveguides. To this end, the waveguide widths and their mutual couplings are carefully designed such that a constant energy gradient is induced perpendicular to the direction of motion of the propagating polaritons. This technique allows us to directly observe and study Bloch oscillations in real‐ and momentum‐space. Furthermore, the experimental findings are supported by numerical simulations based on a modified Gross–Pitaevskii approach. This work provides an important transfer of basic concepts of quantum mechanics to integrated solid state devices, using quantum fluids of light.
Diabetic polyneuropathy (DPN) is the most common complication in diabetes and can be painful in up to 26% of all diabetic patients. Peripheral nerves are shielded by the blood-nerve barrier (BNB) consisting of the perineurium and endoneurial vessels. So far, there are conflicting results regarding the role and function of the BNB in the pathophysiology of DPN. In this study, we analyzed the spatiotemporal tight junction protein profile, barrier permeability, and vessel-associated macrophages in Wistar rats with streptozotocin-induced DPN. In these rats, mechanical hypersensitivity developed after 2 weeks and loss of motor function after 8 weeks, while the BNB and the blood-DRG barrier were leakier for small, but not for large molecules after 8 weeks only. The blood-spinal cord barrier remained sealed throughout the observation period. No gross changes in tight junction protein or cytokine expression were observed in all barriers to blood. However, expression of Cldn1 mRNA in perineurium was specifically downregulated in conjunction with weaker vessel-associated macrophage shielding of the BNB. Our results underline the role of specific tight junction proteins and BNB breakdown in DPN maintenance and differentiate DPN from traumatic nerve injury. Targeting claudins and sealing the BNB could stabilize pain and prevent further nerve damage.
Background
Right ventricular dysfunction after CABG is associated with poor peri- and postoperative outcomes. We aimed to identify clinical and experimental predictors for preoperative inapparent right ventricular dysfunction and therefore hypothesized that reduced myofilament force development as well as altered levels of biomarkers might predict inapparent right ventricular dysfunction.
Methods
From 08/2016 to 02/2018, 218 patients scheduled for CABG were divided into two groups (TAPSE ≥ 20 mm, n = 178; TAPSE < 20 mm, n = 40). Baseline serum samples for biomarkers (Galectin, TGFß1, N Acyl-SDMA, Arginine, ADMA and Pentraxin-3), clinical laboratory and transthoracic echocardiographic parameters were evaluated. To examine the myocardial apparatus of the right ventricle intraoperative right auricular tissue was harvested for stepwise skinned fiber force measurements.
Results
Patients with TAPSE < 20 mm had a higher incidence of DM (55 vs. 34%, p = 0.018), preoperative AFib (43 vs. 16%, p < 0.001), reduced GFR (67 ± 18 vs. 77 ± 24 ml/min/1.73 m\(^2\), p = 0.013), larger LA area (22 ± 6 vs. 20 ± 5 cm\(^2\), p = 0.005) and reduced LVEF (50 vs. 55%, p = 0.008). Furthermore, higher serum ADMA (0.70 ± 0.13 vs. 0.65 ± 0.15 µmol/l, p = 0.046) and higher serum Pentraxin-3 levels (3371 ± 1068 vs. 2681 ± 1353 pg/dl, p = 0.004) were observed in these patients. Skinned fiber force measurements showed significant lower values at almost every step of calcium concentration (pCa 4.52 to pCa 5.5, p < 0.01 and pCa 5.75–6.0, p < 0.05). Multivariable analysis revealed DM (OR 2.53, CI 1.12–5.73, Euro Score II (OR 1.34, CI 1.02–1.78), preoperative AF (OR 4.86, CI 2.06–11.47), GFR (OR 7.72, CI 1.87–31.96), albumin (OR 1.56, CI 0.52–2.60), Pentraxin-3 (OR 19.68, CI 14.13–25.24), depressed LVEF (OR 8.61, CI 6.37–10.86), lower force values: (pCa 5.4; OR 2.34, CI 0.40–4.29 and pCa 5.2; OR 2.00, CI 0.39–3.60) as predictors for clinical inapparent right heart dysfunction.
Conclusions
These preliminary data showed that inapparent right heart dysfunction in CAD is already associated with reduced force development of the contractile apparatus.
Single-molecule super-resolution microscopy (SMLM) techniques like dSTORM can reveal biological structures down to the nanometer scale. The achievable resolution is not only defined by the localization precision of individual fluorescent molecules, but also by their density, which becomes a limiting factor e.g., in expansion microscopy. Artificial deep neural networks can learn to reconstruct dense super-resolved structures such as microtubules from a sparse, noisy set of data points. This approach requires a robust method to assess the quality of a predicted density image and to quantitatively compare it to a ground truth image. Such a quality measure needs to be differentiable to be applied as loss function in deep learning. We developed a new trainable quality measure based on Fourier Ring Correlation (FRC) and used it to train deep neural networks to map a small number of sampling points to an underlying density. Smooth ground truth images of microtubules were generated from localization coordinates using an anisotropic Gaussian kernel density estimator. We show that the FRC criterion ideally complements the existing state-of-the-art multiscale structural similarity index, since both are interpretable and there is no trade-off between them during optimization. The TensorFlow implementation of our FRC metric can easily be integrated into existing deep learning workflows.
Fluids in Gravitational Fields – Well-Balanced Modifications for Astrophysical Finite-Volume Codes
(2021)
Stellar structure can -- in good approximation -- be described as a hydrostatic state, which which arises due to a balance between gravitational force and pressure gradient. Hydrostatic states are static solutions of the full compressible Euler system with gravitational source term, which can be used to model the stellar interior. In order to carry out simulations of dynamical processes occurring in stars, it is vital for the numerical method to accurately maintain the hydrostatic state over a long time period. In this thesis we present different methods to modify astrophysical finite volume codes in order to make them \emph{well-balanced}, preventing them from introducing significant discretization errors close to hydrostatic states. Our well-balanced modifications are constructed so that they can meet the requirements for methods applied in the astrophysical context: They can well-balance arbitrary hydrostatic states with any equation of state that is applied to model thermodynamical relations and they are simple to implement in existing astrophysical finite volume codes. One of our well-balanced modifications follows given solutions exactly and can be applied on any grid geometry. The other methods we introduce, which do no require any a priori knowledge, balance local high order approximations of arbitrary hydrostatic states on a Cartesian grid. All of our modifications allow for high order accuracy of the method. The improved accuracy close to hydrostatic states is verified in various numerical experiments.
In recent years, research in the fields of optoelectronics, anion sensors and bioimaging agents have been greatly influenced by novel compounds containing triarylborane motifs. Such compounds possess an empty p‐orbital at boron which results in useful optical and electronic properties. Such a diversity of applications was not expected when the first triarylborane was reported in 1885. Synthetic approaches to triarylboranes underwent various changes over the following century, some of which are still used in the present day, such as the generally applicable routes developed by Krause et al. in 1922, or by Grisdale et al. in 1972 at Eastman Kodak. Some other developments were not pursued further after their initial reports, such as the synthesis of two triarylboranes bearing three different aromatic groups by Mikhailov et al. in 1958. This review summarizes the development of synthetic approaches to triarylboranes from their first report nearly 135 years ago to the present.
The synthesis, photophysical, and electrochemical properties of selectively mono-, bis- and tris-dimethylamino- and trimethylammonium-substituted bis-triarylborane bithiophene chromophores are presented along with the water solubility and singlet oxygen sensitizing efficiency of the cationic compounds Cat\(^{1+}\), Cat\(^{2+}\), Cat(i)\(^{2+}\), and Cat\(^{3+}\). Comparison with the mono-triarylboranes reveals the large influence of the bridging unit on the properties of the bis-triarylboranes, especially those of the cationic compounds. Based on these preliminary investigations, the interactions of Cat\(^{1+}\), Cat\(^{2+}\), Cat(i)\(^{2+}\), and Cat\(^{3+}\) with DNA, RNA, and DNApore were investigated in buffered solutions. The same compounds were investigated for their ability to enter and localize within organelles of human lung carcinoma (A549) and normal lung (WI38) cells showing that not only the number of charges but also their distribution over the chromophore influences interactions and staining properties.
Arid environments cover almost one-third of the land over the world. Plant life in hot arid regions is prone to the water shortage and associated high temperatures. Drought-stressed plants close the stomata to reduce water loss. Under such conditions, the remaining water loss exclusively happens across the plant cuticle. The cuticular water permeability equals the minimum and inevitable water loss from the epidermal cells to the atmosphere under maximally stomatal closure. Thus, low cuticular water permeability is primordial for plant survival and viability under limited water source. The assumption that non-succulent xerophytes retard water loss due to the secretion of a heavier cuticle is often found in the literature. Intuitively, this seems to be plausible, but few studies have been conducted to evaluate the cuticular permeability of xerophilous plants. In chapter one, we investigated whether the cuticular permeability of Quercus coccifera L. grown in the aridest Mediterranean-subtype climate is indeed lower than that of individuals grown under temperate climate conditions. Also, the cuticular wax chemical compositions of plants grown in both habitats were qualitatively and quantitatively analysed by gas-chromatography. In few words, our findings showed that although the cuticular wax deposition increased in plants under Mediterranean climate, the cuticular permeability remained unaltered, regardless of habitat.
The associated high temperatures in arid regions can drastically increase the cuticular water permeability. Thereby, the thermal stability of the cuticular transpirational barrier is decisive for safeguarding non-succulent xerophytes against desiccation. The successful adaptation of plants to hot deserts might be based on finding different solutions to cope with water and heat stresses. Water-saver plants close the stomata before the leaf water potential drastically changes in order to prevent damage, whereas water-spender plants reduce the leaf water potential by opening the stomata, which allow them to extract water from the deep soil to compensate the high water loss by stomatal transpiration. In chapter two, we compare the thermal stability of the cuticular transpiration barrier of the desert water-saver Phoenix dactylifera L. and the water-spender Citrullus colocynthis (L.) Schrad. In short, the temperature-dependent increase of the cuticular permeability of P. dactylifera was linear over the whole temperature range (25-50°C), while that of C. colocynthis was biphasic with a steep increase at temperatures ≥ 40°C. This drastic increase of cuticular permeability indicates a thermally induced breakdown of the C. colocynthis cuticular transpiration barrier, which does not occur in P. dactylifera. We further discussed how the specific chemical composition of the cutin and cuticular waxes might contribute to the pronounced thermal resistance of the P. dactylifera cuticular transpiration barrier.
A multitude of morpho and physiological modifications, including photosynthetic thermal tolerance and traits related to water balance, led to the successful plant colonisation of hot arid regions over the globe. High evaporative demand and elevated temperatures very often go along together, thereby constraining the plant life in arid environments. In chapter 3, we surveyed cuticular permeability, leaf thermal tolerance, and cuticular wax chemical composition of 14 non-succulent plant species native from some of the hottest and driest biomes in South-America, Europe, and Asia. Our findings showed that xerophilous flowering plants present high variability for cuticular permeability and leaf thermal tolerance, but both physiological features could not be associated with the species original habitat. We also provide substantial evidence that non-succulent xerophytes with more efficient cuticular transpirational barrier have higher leaf thermal tolerance, which might indicate a potential coevolution of these features in hot arid biomes. We further discussed the efficiency of the cuticular transpiration barrier in function to the cuticular wax chemical composition in the general discussion section.
Peptide receptor radionuclide therapy (PRRT) is a molecular targeted radiation therapy involving the systemic administration of radiolabeled somatostatin receptor binding peptides designed to target with high affinity and specificity receptors overexpressed on tumors. Peptides are applied which either target as agonist (with internalization) or antagonist (little to no internalization). Recently, two novel antagonistic agents have been developed for clinical use: OPS202 and OPS201. 68Ga-labelled OPS202 is used for diagnostic purposes with positron emission tomography and 177Lu-labelled OPS201 is used for the therapy in patients with neuroendocrine tumors (NETs). Both agents are presently under clinical evaluation. Despite the very low internalization rate, the use of somatostatin receptor antagonists which target more binding sites on receptors are expected to result in higher specificity, more favorable pharmacokinetics and higher tumor retention and better visualization than the agonists. The main goal of this thesis was analyzing the biodistribution, biokinetics and internal dosimetry of the recently developed somatostatin receptor antagonists (OPS201 and OPS202) for therapeutic and diagnostic purposes in different species (mice, pigs and patients). In addition, an analysis of the influence of image quantification and the integration of time activity curves on kidney dosimetry in a pig model was carried out. Furthermore, extrapolation methods, which are used for predicting organ absorbed doses for humans based on preclinical animal models, were systematically compared for blood, liver, and kidneys of OPS201 injected species. Based on the OPS202 injected patients’ investigations, 68Ga-OPS202 shows promising biodistribution and imaging properties with tumor contrast which is optimal one hour after injection of the radiotracer. OPS202 is well tolerated and delivers absorbed doses to organs that are lower than those by 18F-FDG and similar to other 68Ga-labeled somatostatin receptor ligands. As a result of 68Ga OPS202 injection, the highest absorbed doses were observed in the urinary bladder (0.10 mGy/MBq) and kidneys (0.84 mGy/MBq). The calculated mean effective dose coefficient of 68Ga-OPS202 injected patients was 0.024 mSv/MBq (3.6 mSv for 150 MBq 68Ga-OPS202 injection) which is similar to other 68Ga-labeled compounds. Based on the OPS201 biokinetics and dosimetry investigations, after the injection of 177Lu-OPS201, a fast blood clearance of the compound is observed in the first phase (half-life: 1.83 h) for each species. 10 min after injection, less than 5% of the injected activity per milliliter of blood circulates in pigs and humans. The analysis of the mice, pig and preliminary patient data provides evidence that, patients enrolled in a phase 1 177Lu-OPS201 trial would not be at risk of overexposure. Based on our results, for 177Lu labelled studies, late time points after 72 h have a great impact on absorbed dose calculations. That is why follow-up times especially at late time points (more than 72 h) are required for the time-integrated activity coefficient (TIAC) calculations in order to represent the area under the curve appropriately and to analyze both biokinetics and dosimetry accurately. In addition, to find the most adequate extrapolation methods that minimize the interspecies differences of dosimetry data, several extrapolation methods from animal to human have been tested. For OPS201 time scaling or combination of relative mass and time scaling results in most similar TIAC values, if the organ mass ratios between the species are high. In time scaling, the scan/sampling time is scaled by using the ratio of the whole body masses of the respective species. In relative mass scaling, the TIACs are scaled based on the ratio of the whole body and organ mass of respective species. Other methods tested showed higher deviations. For the study on the influence of image quantification and the choice of the optimal scanning time points, a study in a pig model, which was performed in collaboration with Aalborg University and Octreopharm Sciences GmbH, was reanalyzed. As kidneys are organs-at-risk in PRRT with 177Lu labelled peptides, several quantification methods, based on 2D and 3D quantitative imaging were chosen. For this purpose, a 3D printed pig kidney phantom was prepared and measured with/without background activities representing the activities in the pig SPECT/CT scans. The phantom dosimetry data based on multiple SPECT/CT images and based on multiple planar images in combination with one SPECT/CT scan (MP1S Imaging) were compared to the pig dosimetry. The calculated TIACs of the phantom with background based on multiple SPECT/CT and MP1S imaging were quite similar to the multiple SPECT/CT based pig TIAC. In addition, in order to investigate the effect of late time points on dosimetry and absorbed dose values in 177Lu therapies, the difference, associated with eliminating the late two scan time points, on the TIACs was analyzed. When the TIACs (including all time points) of the pig based on multiple SPECT/CT and MP1S imaging were investigated, the use of MP1S imaging results in considerably lower TIAC values to the kidney (by a factor of 1.4). With eliminating late time points from the created time activity curve, the factor increases up to 2.4 times with a corresponding increase in TIAC uncertainties. As a consequence, further evaluation of 68Ga-OPS202 for PET/CT imaging and 177Lu-OPS201 for the treatments of NET patients is necessary. In particular, a head-to-head comparison of agonists and OPS peptides with respect to biokinetics, biodistribution and dosimetry would be helpful. In addition, the influence of the late scan time points on dosimetry needs further attention in particular for kidney dosimetry
The human pathogen Bordetella pertussis targets the respiratory epithelium and causes whooping cough. Its virulence factor adenylate cyclase toxin (CyaA) plays an important role in the course of infection. Previous studies on the impact of CyaA on human epithelial cells have been carried out using cell lines derived from the airways or the intestinal tract. Here, we investigated the interaction of CyaA and its enzymatically inactive but fully pore-forming toxoid CyaA-AC– with primary human airway epithelial cells (hAEC) derived from different anatomical sites (nose and tracheo-bronchial region) in two-dimensional culture conditions. To assess possible differences between the response of primary hAEC and respiratory cell lines directly, we included HBEC3-KT in our studies. In comparative analyses, we studied the impact of both the toxin and the toxoid on cell viability, intracellular cAMP concentration and IL-6 secretion. We found that the selected hAEC, which lack CD11b, were differentially susceptible to both CyaA and CyaA-AC–. HBEC3-KT appeared not to be suitable for subsequent analyses. Since the nasal epithelium first gets in contact with airborne pathogens, we further studied the effect of CyaA and its toxoid on the innate immunity of three-dimensional tissue models of the human nasal mucosa. The present study reveals first insights in toxin–cell interaction using primary hAEC.
Patients with atrial fibrillation and previous ischemic stroke (IS) are at increased risk of cerebrovascular events despite anticoagulation. In these patients, treatment with non-vitamin K oral anticoagulants (NOAC) such as edoxaban reduced the probability and severity of further IS without increasing the risk of major bleeding. However, the detailed protective mechanism of edoxaban has not yet been investigated in a model of ischemia/reperfusion injury. Therefore, in the current study we aimed to assess in a clinically relevant setting whether treatment with edoxaban attenuates stroke severity, and whether edoxaban has an impact on the local cerebral inflammatory response and blood–brain barrier (BBB) function after experimental IS in mice. Focal cerebral ischemia was induced by transient middle cerebral artery occlusion in male mice receiving edoxaban, phenprocoumon or vehicle. Infarct volumes, functional outcome and the occurrence of intracerebral hemorrhage were assessed. BBB damage and the extent of local inflammatory response were determined. Treatment with edoxaban significantly reduced infarct volumes and improved neurological outcome and BBB function on day 1 and attenuated brain tissue inflammation. In summary, our study provides evidence that edoxaban might exert its protective effect in human IS by modulating different key steps of IS pathophysiology, but further studies are warranted.
Hereditary retinal degenerations like retinitis pigmentosa (RP) are among the leading causes of blindness in younger patients. To enable in vivo investigation of cellular and molecular mechanisms responsible for photoreceptor cell death and to allow testing of therapeutic strategies that could prevent retinal degeneration, animal models have been created. In this study, we deeply characterized the transcriptional profile of mice carrying the transgene rhodopsin V20G/P23H/P27L (VPP), which is a model for autosomal dominant RP. We examined the degree of photoreceptor degeneration and studied the impact of the VPP transgene-induced retinal degeneration on the transcriptome level of the retina using next generation RNA sequencing (RNASeq) analyses followed by weighted correlation network analysis (WGCNA). We furthermore identified cellular subpopulations responsible for some of the observed dysregulations using in situ hybridizations, immunofluorescence staining, and 3D reconstruction. Using RNASeq analysis, we identified 9256 dysregulated genes and six significantly associated gene modules in the subsequently performed WGCNA. Gene ontology enrichment showed, among others, dysregulation of genes involved in TGF-β regulated extracellular matrix organization, the (ocular) immune system/response, and cellular homeostasis. Moreover, heatmaps confirmed clustering of significantly dysregulated genes coding for components of the TGF-β, G-protein activated, and VEGF signaling pathway. 3D reconstructions of immunostained/in situ hybridized sections revealed retinal neurons and Müller cells as the major cellular population expressing representative components of these signaling pathways. The predominant effect of VPP-induced photoreceptor degeneration pointed towards induction of neuroinflammation and the upregulation of neuroprotective pathways like TGF-β, G-protein activated, and VEGF signaling. Thus, modulation of these processes and signaling pathways might represent new therapeutic options to delay the degeneration of photoreceptors in diseases like RP.
The strategic planning of Emergency Medical Service systems is directly related to the probability of surviving of the affected humans. Academic research has contributed to the evaluation of these systems by defining a variety of key performance metrics. The average response time, the workload of the system, several waiting time parameters as well as the fraction of demand that cannot immediately be served are among the most important examples. The Hypercube Queueing Model is one of the most applied models in this field. Due to its theoretical background and the implied high computational times, the Hypercube Queueing Model has only been recently used for the optimization of Emergency Medical Service systems. Likewise, only a few system performance metrics were calculated with the help of the model and the full potential therefore has not yet been reached. Most of the existing studies in the field of optimization with the help of a Hypercube Queueing Model apply the expected response time of the system as their objective function. While it leads to oftentimes balanced system configurations, other influencing factors were identified. The embedding of the Hypercube Queueing Model in the Robust Optimization as well as the Robust Goal Programming intended to offer a more holistic view through the use of different day times. It was shown that the behavior of Emergency Medical Service systems as well as the corresponding parameters are highly subjective to them. The analysis and optimization of such systems should therefore consider the different distributions of the demand, with regard to their quantity and location, in order to derive a holistic basis for the decision-making.
Mortality in critically ill coronavirus disease 2019 (COVID-19) patients is high and pharmacological treatment strategies remain limited. Early-stage predictive biomarkers are needed to identify patients with a high risk of severe clinical courses and to stratify treatment strategies. Macrophage migration inhibitory factor (MIF) was previously described as a potential predictor for the outcome of critically ill patients and for acute respiratory distress syndrome (ARDS), a hallmark of severe COVID-19 disease. This prospective observational study evaluates the predictive potential of MIF for the clinical outcome after severe COVID-19 infection. Plasma MIF concentrations were measured in 36 mechanically ventilated COVID-19 patients over three days after intensive care unit (ICU) admission. Increased compared to decreased MIF was significantly associated with aggravated organ function and a significantly lower 28-day survival (sequential organ failure assessment (SOFA) score; 8.2 ± 4.5 to 14.3 ± 3, p = 0.009 vs. 8.9 ± 1.9 to 12 ± 2, p = 0.296; survival: 56% vs. 93%; p = 0.003). Arterial hypertension was the predominant comorbidity in 85% of patients with increasing MIF concentrations (vs. decreasing MIF: 39%; p = 0.015). Without reaching significance, more patients with decreasing MIF were able to improve their ARDS status (p = 0.142). The identified association between an early MIF response, aggravation of organ function and 28-day survival may open future perspectives for biomarker-based diagnostic approaches for ICU management of COVID-19 patients.
The implantation of any foreign material into the body automatically starts an immune reaction that serves as the first, mandatory step to regenerate tissue. The course of this initial immune reaction decides on the fate of the implant: either the biomaterial will be integrated into the host tissue to subsequently fulfill its intended function (e.g., tissue regeneration), or it will be repelled by fibrous encapsulation that determines the implant failure. Especially neutrophils and macrophages play major roles during this inflammatory response and hence mainly decide on the biomaterial's fate. For clinically relevant tissue engineering approaches, biomaterials may be designed in shape and morphology as well as in their surface functionality to improve the healing outcome, but also to trigger stem cell responses during the subsequent tissue regeneration phase.
The main focus of this thesis was to unravel the influence of scaffold characteristics, including scaffold morphology and surface functionality, on primary human innate immune cells (neutrophils and macrophages) and human mesenchymal stromal cells (hMSCs) to assess their in vitro immune response and tissue regeneration capacity, respectively. The fiber-based constructs were produced either via melt electrowriting (MEW), when the precise control over scaffold morphology was required, or via solution electrospinning (ES), when the scaffold design could be neglected. All the fiber-based scaffolds used throughout this thesis were composed of the polymer poly(ε caprolactone) (PCL).
A novel strategy to model and alleviate the first direct cell contact of the immune system with a peptide-bioactived fibrous material was presented in chapter 3 by treating the material with human neutrophil elastase (HNE) to imitate the neutrophil attack. The main focus of this study was put on the effect of HNE towards an RGDS-based peptide that was immobilized on the surface of a fibrous material to improve subsequent L929 cell adhesion. The elastase efficiently degraded the peptide-functionality, as evidenced by a decreased L929 cell adhesion, since the peptide integrated a specific HNE-cleavage site (AAPV-motif). A sacrificial hydrogel coating based on primary oxidized hyaluronic acid (proxHA), which dissolved within a few days after the neutrophil attack, provided an optimal protection of the peptide-bioactivated fibrous mesh, i.e, the hydrogel alleviated the neutrophil attack and largely ensured the biomaterial's integrity. Thus, according to these results, a means to protect the biomaterial is required to overcome the neutrophil attack.
Chapter 4 was based on the advancement of melt electrowriting (MEW) to improve the printing resolution of MEW scaffolds in terms of minimal inter-fiber distances and a concomitant high stacking precision. Initially, to gain a better MEW understanding, the influence of several parameters, including spinneret diameter, applied pressure, and collector velocity on mechanical properties, crystallinity, fiber diameter and fiber surface morphology was analyzed. Afterward, innovative MEW designs (e.g., box-, triangle-, round , and wall-shaped scaffolds) have been established by pushing the printing parameters to their physical limits. Further, the inter-fiber distance within a standardized box-structured scaffold was successfully reduced to 40 µm, while simultaneously a high stacking precision was maintained. In collaboration with a co-worker of my department (Tina Tylek, who performed all cell-based experiments in this study), these novel MEW scaffolds have been proven to facilitate human monocyte-derived macrophage polarization towards the regenerative M2 type in an elongation-driven manner with a more pronounced effect with decreasing pore sizes.
Finally, a pro-adipogenic platform for hMSCs was developed in chapter 5 using MEW scaffolds with immobilized, complex ECM proteins (e.g., human decellularized adipose tissue (DAT), laminin (LN), and fibronectin (FN)) to test for the adipogenic differentiation potential in vitro. Within this thesis, a special short-term adipogenic induction regime enabled to more thoroughly assess the intrinsic pro-adipogenic capacity of the composite biomaterials and prevented any possible masking by the commonly used long-term application of adipogenic differentiation reagents. The scaffolds with incorporated DAT consistently showed the highest adipogenic outcome and hence provided an adipo-inductive microenvironment for hMSCs, which holds great promise for applications in soft tissue regeneration.
Future studies should combine all three addressed projects in a more in vivo-related manner, comprising a co-cultivation setup of neutrophils, macrophages, and MSCs. The MEW-scaffold, particularly due to its ability to combine surface functionality and adjustable morphology, has been proven to be a successful approach for wound healing and paves the way for subsequent tissue regeneration.
Biointerface engineering is a wide-spread strategy to improve the healing process and subsequent tissue integration of biomaterials. Especially the integration of specific peptides is one promising strategy to promote the regenerative capacity of implants and 3D scaffolds. In vivo, these tailored interfaces are, however, first confronted with the innate immune response. Neutrophils are cells with pronounced proteolytic potential and the first recruited immune cells at the implant site; nonetheless, they have so far been underappreciated in the design of biomaterial interfaces. Herein, an in vitro approach is introduced to model and analyze the neutrophil interaction with bioactivated materials at the example of nano-bioinspired electrospun surfaces that reveals the vulnerability of a given biointerface design to the contact with neutrophils. A sacrificial, transient hydrogel coating that demonstrates optimal protection for peptide-modified surfaces and thus alleviates the immediate cleavage by neutrophil elastase is further introduced.
Purpose
This study investigates the redislocation rate and functional outcome at a minimum follow-up of five years after medial patellofemoral ligament (MPFL) reconstruction with soft tissue patellar fixation for patella instability.
Methods
Patients were retrospectively identified and knees were evaluated for trochlea dysplasia according to Dejour, for presence of patella alta and for presence of cartilage lesion at surgery. At a minimum follow-up of five years, information about an incident of redislocation was obtained. Kujala, Lysholm, and Tegner questionnaires as well as range of motion were used to measure functional outcome.
Results
Eighty-nine knees were included. Follow-up rate for redislocation was 79.8% and for functional outcome 58.4%. After a mean follow-up of 5.8 years, the redislocation rate was 5.6%. There was significant improvement of the Kujala score (68.8 to 88.2, p = 0.000) and of the Lysholm score (71.3 to 88.4, p = 0.000). Range of motion at follow-up was 149.0° (115–165). 77.5% of the knees had patella alta and 52.9% trochlear dysplasia types B, C, or D. Patellar cartilage legions were present in 54.2%. Redislocations occurred in knees with trochlear dysplasia type C in combination with patella alta.
Conclusion
MPFL reconstruction with soft tissue patellar fixation leads to significant improvement of knee function and low midterm redislocation rate. Patients with high-grade trochlear dysplasia should be considered for additional osseous correction.
Diagnosis of chronic infection at total hip arthroplasty revision is a question of definition
(2021)
Purpose. Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision. Test quality of prerevision aspiration was evaluated for the different PJI definitions. Methods. 256 THA revisions were retrospectively classified to be infected or not infected. Classification was performed according to the 4 different definitions proposed by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA), the International Consensus Meeting (ICM), and the European Bone and Joint Infection Society (EBJIS). Only chronic PJIs were included. Results. PJI prevalence at revision significantly correlated with the applied PJI definition (p=0.01, Cramer's V=0.093). PJI prevalence was 20.7% for the MSIS, 25.4% for the ICM, 28.1% for the IDSA, and 32.0% for the EBJIS definition. For synovial fluid white blood cell count, the best ROC-AUC for predicting PJI was 0.953 in combination with the MSIS definition. Conclusion. PJI definition significantly influences the rate of diagnosed PJIs at THA revision. Synovial fluid white blood cell count is a reliable means to rule out PJI. In cases with a borderline high synovial white blood cell count before THA revision as the only sign of chronic PJI, an extended diagnostic work-up should be considered.
1. The oil‐collecting bee Centris analis (Fabricius, 1804) is an important pollinator for the Neotropical region. The species can be attracted to nest in human‐made cavities. Such trap nests or insect hotels offer the opportunity to study the behaviour of populations in semifield conditions.
2. We studied a newly established trap nest aggregation of C. analis in Mato Grosso do Sul, Brazil and tested the effect that differentially painted nesting options have on the rate of nest foundation, and on the ability of relocating the nest when returning from a foraging trip (homing behaviour). Moreover, we tested if the duration of foraging trips decreased with time.
3. We found that females preferred to nest in painted nests compared to unpainted nests, with blue nests being the most occupied ones, followed by purple, yellow, white, and green. Furthermore, bees improved their homing behaviour with time, however, nest colour did not seem to have an effect on this process. Moreover, we found that bees reduce the duration of their foraging trips with time. This could be an indicator of improved foraging efficiency through learning.
4. These findings could inform a new and fruitful line of research on the behaviour and ecology of trap nesting solitary bees.
The aim of this pilot study was to investigate the diagnostic potential of TMEM119 as a useful microglia-specific marker in combination with immunostainings for phagocytic function and infiltrating capacity of monocytes in cases of lethal monosubstance intoxications by morphine (MOR), methamphetamine (METH), and of ethanol-associated death (ETH) respectively. Human brain tissue samples were obtained from forensic autopsies of cases with single substance abuse (MOR, n = 8; ETH, n = 10; METH, n = 9) and then compared to a cohort of cardiovascular fatalities as controls (n = 9). Brain tissue samples of cortex, white matter, and hippocampus were collected and stained immunohistochemically with antibodies against TMEM119, CD68KiM1P, and CCR2. We could document the lowest density of TMEM119-positive cells in MOR deaths with highly significant differences to the control densities in all three regions investigated. In ETH and METH deaths, the expression of TMEM119 was comparable to cell densities in controls. The results indicate that the immunoreaction in brain tissue is different in these groups depending on the drug type used for abuse.
In the last few years, quantitative analysis of metabolites in body fluids using LC/MS has become an established method in laboratory medicine and toxicology. By preparing metabolite profiles in biological specimens, we are able to understand pathophysiological mechanisms at the biochemical and thus the functional level. An innovative investigative method, which has not yet been used widely in the forensic context, is to use the clinical application of metabolomics. In a metabolomic analysis of 41 samples of postmortem cerebrospinal fluid (CSF) samples divided into cohorts of four different causes of death, namely, cardiovascular fatalities, isoIated torso trauma, traumatic brain injury, and multi-organ failure, we were able to identify relevant differences in the metabolite profile between these individual groups. According to this preliminary assessment, we assume that information on biochemical processes is not gained by differences in the concentration of individual metabolites in CSF, but by a combination of differently distributed metabolites forming the perspective of a new generation of biomarkers for diagnosing (fatal) TBI and associated neuropathological changes in the CNS using CSF samples.
The aim of this study was to investigate if the biomarkers myelin basic protein (MBP) and neurofilament-H (NF-H) yielded informative value in forensic diagnostics when examining cadaveric cerebrospinal fluid (CSF) biochemically via an enzyme-linked immunosorbent assay (ELISA) and comparing the corresponding brain tissue in fatal traumatic brain injury (TBI) autopsy cases by immunocytochemistry versus immunohistochemistry. In 21 trauma and 19 control cases, CSF was collected semi-sterile after suboccipital puncture and brain specimens after preparation. The CSF MBP (p = 0.006) and NF-H (p = 0.0002) levels after TBI were significantly higher than those in cardiovascular controls. Immunohistochemical staining against MBP and against NF-H was performed on cortical and subcortical samples from also biochemically investigated cases (5 TBI cases/5 controls). Compared to the controls, the TBI cases showed a visually reduced staining reaction against MBP or repeatedly ruptured neurofilaments against NF-H. Immunocytochemical tests showed MBP-positive phagocytizing macrophages in CSF with a survival time of > 24 h. In addition, numerous TMEM119-positive microglia could be detected with different degrees of staining intensity in the CSF of trauma cases. As a result, we were able to document that elevated levels of MBP and NF-H in the CSF should be considered as useful neuroinjury biomarkers of traumatic brain injury.
The Vacaciones en Paz programme (VeP) started in 1979 shortly after Morocco illegally occupied Western Sahara, which since 1975 has been a disputed territory pending a referendum for self-determination. The programme consists of Sahrawi children being hosted during summer by Spanish families who try to raise awareness for the Sahrawi cause and temporarily alleviate the children’s living conditions. Meanwhile, approximately 170,000 Sahrawi refugees live in camps near Tindouf (Algeria) heavily dependent on humanitarian aid for their survival.
This study aimed to determine the impact of the VeP programme on the promotion of children’s rights based on the perspective of Sahrawi children. Research has shown that it serves as a temporary platform to implement some of those rights. This qualitative study is based on a literature review of the principles of the VeP programme, alongside a thematic analysis of the field data provided by Sahrawi children and teenagers. Analysis of the VeP programme demonstrated that the Convention of the Rights of the Child is not mentioned in its discourse. Notwithstanding, the results indicate an impact on the promotion of Sahrawi children’s rights. On this basis, it is recommended to implement a children’s rights-based discourse within the principles of the VeP programme, since the theoretical knowledge of their rights may be a key factor for strategic empowerment of Sahrawi children and teenagers in their representation of the Sahrawi cause.
The Glycosylphosphatidylinositol Anchor: A Linchpin for Cell Surface Versatility of Trypanosomatids
(2021)
The use of glycosylphosphatidylinositol (GPI) to anchor proteins to the cell surface is widespread among eukaryotes. The GPI-anchor is covalently attached to the C-terminus of a protein and mediates the protein’s attachment to the outer leaflet of the lipid bilayer. GPI-anchored proteins have a wide range of functions, including acting as receptors, transporters, and adhesion molecules. In unicellular eukaryotic parasites, abundantly expressed GPI-anchored proteins are major virulence factors, which support infection and survival within distinct host environments. While, for example, the variant surface glycoprotein (VSG) is the major component of the cell surface of the bloodstream form of African trypanosomes, procyclin is the most abundant protein of the procyclic form which is found in the invertebrate host, the tsetse fly vector. Trypanosoma cruzi, on the other hand, expresses a variety of GPI-anchored molecules on their cell surface, such as mucins, that interact with their hosts. The latter is also true for Leishmania, which use GPI anchors to display, amongst others, lipophosphoglycans on their surface. Clearly, GPI-anchoring is a common feature in trypanosomatids and the fact that it has been maintained throughout eukaryote evolution indicates its adaptive value. Here, we explore and discuss GPI anchors as universal evolutionary building blocks that support the great variety of surface molecules of trypanosomatids.
Current systemic treatment options for patients with adrenocortical carcinomas (ACCs) are far from being satisfactory. DNA damage/repair mechanisms, which involve, e.g., ataxia-telangiectasia-mutated (ATM) and ataxia-telangiectasia/Rad3-related (ATR) protein signaling or ribonucleotide reductase subunits M1/M2 (RRM1/RRM2)-encoded ribonucleotide reductase (RNR) activation, commonly contribute to drug resistance. Moreover, the regulation of RRM2b, the p53-induced alternative to RRM2, is of unclear importance for ACC. Upon extensive drug screening, including a large panel of chemotherapies and molecular targeted inhibitors, we provide strong evidence for the anti-tumoral efficacy of combined gemcitabine (G) and cisplatin (C) treatment against the adrenocortical cell lines NCI-H295R and MUC-1. However, accompanying induction of RRM1, RRM2, and RRM2b expression also indicated developing G resistance, a frequent side effect in clinical patient care. Interestingly, this effect was partially reversed upon addition of C. We confirmed our findings for RRM2 protein, RNR-dependent dATP levels, and modulations of related ATM/ATR signaling. Finally, we screened for complementing inhibitors of the DNA damage/repair system targeting RNR, Wee1, CHK1/2, ATR, and ATM. Notably, the combination of G, C, and the dual RRM1/RRM2 inhibitor COH29 resulted in previously unreached total cell killing. In summary, we provide evidence that RNR-modulating therapies might represent a new therapeutic option for ACC.
Crizotinib was a first generation of ALK tyrosine kinase inhibitor approved for the treatment of ALK-positive non-small-cell lung carcinoma (NSCLC) patients. COMPARE and cluster analyses of transcriptomic data of the NCI cell line panel indicated that genes with different cellular functions regulated the sensitivity or resistance of cancer cells to crizotinib. Transcription factor binding motif analyses in gene promoters divulged two transcription factors possibly regulating the expression of these genes, i.e., RXRA and GATA1, which are important for leukemia and erythroid development, respectively. COMPARE analyses also implied that cell lines of various cancer types displayed varying degrees of sensitivity to crizotinib. Unexpectedly, leukemia but not lung cancer cells were the most sensitive cells among the different types of NCI cancer cell lines. Re-examining this result in another panel of cell lines indeed revealed that crizotinib exhibited potent cytotoxicity towards acute myeloid leukemia and multiple myeloma cells. P-glycoprotein-overexpressing CEM/ADR5000 leukemia cells were cross-resistant to crizotinib. NCI-H929 multiple myeloma cells were the most sensitive cells. Hence, we evaluated the mode of action of crizotinib on these cells. Although crizotinib is a TKI, it showed highest correlation rates with DNA topoisomerase II inhibitors and tubulin inhibitors. The altered gene expression profiles after crizotinib treatment predicted several networks, where TOP2A and genes related to cell cycle were downregulated. Cell cycle analyses showed that cells incubated with crizotinib for 24 h accumulated in the G\(_2\)M phase. Crizotinib also increased the number of p-H3(Ser10)-positive NCI-H929 cells illustrating crizotinib's ability to prevent mitotic exit. However, cells accumulated in the sub-G\(_0\)G\(_1\) fraction with longer incubation periods, indicating apoptosis induction. Additionally, crizotinib disassembled the tubulin network of U2OS cells expressing an α-tubulin-GFP fusion protein, preventing migration of cancer cells. This result was verified by in vitro tubulin polymerization assays. In silico molecular docking also revealed a strong binding affinity of crizotinib to the colchicine and Vinca alkaloid binding sites. Taken together, these results demonstrate that crizotinib destabilized microtubules. Additionally, the decatenation assay showed that crizotinib partwise inhibited the catalytic activity of DNA topoisomerase II. In conclusion, crizotinib exerted kinase-independent cytotoxic effects through the dual inhibition of tubulin polymerization and topoisomerase II and might be used to treat not only NSCLC but also multiple myeloma.
Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.