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- Institut for Molecular Biology and CMBI, Department of Genomics, Stem Cell Biology and Regenerative Medicine, Leopold-Franzens-University Innsbruck, Innsbruck, Austria (2)
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This work considered the frequency-modulated balanced steady-state free precession (fm-bSSFP) sequence as a tool to provide banding free bSSFP MR images. The sequence was implemented and successfully applied to suppress bandings in various in vitro and in vivo examples. In combination with a radial trajectory it is a promising alternative for standard bSSFP applications. First, two specialized applications were shown to establish the benefits of the acquisition strategy in itself. In real time cardiac imaging, it was shown that the continuous shift in frequency causes a movement of the bandings across the FOV. Thus, no anatomical region is constantly impaired, and a suitable timeframe can be found to examine all important structures. Furthermore, a combination of images with different artifact positions, similar to phase-cycled acquisitions is possible. In this way, fast, banding-free imaging of the moving heart was realized. Second, acquisitions with long TR were shown. While standard bSSFP suffers from increasing incidence of bandings with higher TR values, the frequency-modulated approach provided banding free images, regardless of the TR.
A huge disadvantage of fm-bSSFP, in combination with the radial trajectory, is the decrease in signal intensity. In this work a specialized reconstruction method, the multifrequency reconstruction for frequency-modulated bSSFP (Muffm), was established, which successfully compensated that phenomena. The application of Muffm to several anatomical sites, such as inner ear, legs and cardiac acquisitions, proofed the advantageous SNR of the reconstruction.
Furthermore, fm-bSSFP was applied to the clinically highly relevant task of water-fat separation. Former approaches of a phase-sensitive separation procedure in combination with standard bSSFP showed promising results but failed in cases of high inhomogeneity or high field strengths where banding artifacts become a major issue. The novel approach of using the fm-bSSFP acquisition strategy with the separation approach provided robust, reliable images of high quality. Again, losses in signal intensity could be regained by Muffm, as both approaches are completely compatible.
Opposed to conventional banding suppression techniques, like frequency-scouts or phase-cycling, all reconstruction methods established in this work rely on a single radial acquisition, with scan times similar to standard bSSFP scans. No prolonged measurement times occur and patient time in the scanner is kept as short as possible, improving patient comfort, susceptibility to motion or physiological noise and cost of one scan.
All in all, the frequency-modulated acquisition in combination with specializes reconstruction methods, leads to a completely new quality of images with short acquisition times.
Der postoperative Blutverlust stellt für Patienten, die sich einem herzchirurgischen Eingriff unterziehen müssen, ein nicht zu unterschätzendes Risiko dar. Blutverlust erfordert Revisionen und Bluttransfusionen. Beides kann zu einem längeren Krankenhausaufenthalt und zu perioperativen Komplikationen führen. In Anbetracht der dadurch erhöhten Mortalität und auch der hohen Kosten, die sich durch einen solchen Verlauf ergeben können, ist die Minimierung des Blutverlustes ein wichtiges Ziel. Bei Operationen mit einer Herz-Lungen-Maschine ist die Applikation von Heparin zur Hemmung der Blutgerinnung erforderlich. Nach Beendigung der EKZ erfolgt die Antagonisierung durch Protamin. In unserer Studie haben wir den Einfluss des Protamin-Heparin-Quotienten auf den postoperativen Blutverlust und den Transfusionsbedarf untersucht. An einem Kollektiv von 182 Patienten konnten wir retrospektiv zeigen, dass Frauen von einer strengen Antagonisierung profitieren. In Abhängigkeit vom Geschlecht zeigte sich zunächst ein Unterschied bezüglich des Verbrauchs an EK gesamt (p = 0,019) und intraoperativ (p < 0,001). Zudem konnten wir zeigen, dass Frauen, die mit einem großen Protamin-Heparin-Quotienten antagonisiert wurden, eine niedrigere Verlustrate von Blut, erfasst als Drainagemenge pro KG [ml/kg] (p = 0,032) beziehungsweise pro KOF nach Mosteller [ml/m²] (p = 0,040), aufwiesen. Auch der Transfusionsbedarfs an EK war bei diesem Kollektiv geringer (p = 0,048). In einer Extremgruppenanalyse mit Vergleich der Patienten mit dem höchsten und dem geringsten Protamin-Heparin-Quotienten konnten diese Ergebnisse bestätigt werden. Auch hier zeigten sich Unterschiede bezüglich Drainagemenge pro KG [ml/kg] (p = 0,025) und Gesamtbedarf an EK (p = 0,011).
Entsprechend der erhobenen Ergebnisse ist ein Verhältnis von Protamin zu Heparin von 1:1 im herzchirurgischen Patientenkollektiv anzustreben .
Weitere prospektiv randomisierte und kontrollierte Studien sind nötig, um diese ersten Ergebnisse zu bestätigen und eine Standardisierung der Antagonisierung von Heparin zu erarbeiten. Insbesondere die unterschiedlichen Auswirkungen bei Frauen und Männern bieten einen interessanten Anhaltspunkt, der in der Literatur so noch nicht untersucht wurde.
In Südafrika ist die Tuberkulose die häufigste opportunistische Infektion bei HIV-Patienten. Eine gleichzeitige Therapie mit Rifampicin führt zur Induktion von CYP-Enzymen und folglich zu kritischen Medikamenteninteraktionen mit einem relevanten Risiko für Veränderungen der Medikamentenkonzentration z.B. von EFV. Da Drugmonitoring in Südafrika nicht routinemäßig durchgeführt wird, liegen keine hinreichenden Daten über EFV-Serumkonzentrationen in dieser Population vor. In der vorliegenden Untersuchung wurden daher klinische und pharmakokinetische Daten südafrikanischer HIV-Patienten unter Therapie mit EFV und Rifampicin erhoben und unterschiedliche Einflussfaktoren auf die EFV-Serumkonzentrationen untersucht.
Insgesamt wurden bei 93 erwachsenen HIV-Patienten der HIV-Tageskliniken „Delft Community Health Clinic“ und „Tygerberg hospitals“ die EFV-Serumkonzentrationen während einer Routineuntersuchung, zu einem zufälligen, dem Patienten vorher unbekannten Zeitpunkt bestimmt. Letztlich konnten 80 HIV-Patienten unter antiretroviraler Therapie mit EFV und tuberkulostatischer Therapie mit Rifampicin in die vorliegende Untersuchung einbezogen werden.
Die gemessenen EFV-Serumkonzentrationen lagen zwischen 422 ng/ml und 33.023 ng/ml und ergaben einen Mittelwert von 3.437 ± 4.806 ng/ml. Davon lagen die Serumkonzentrationen bei 68 % (n = 54) der Patienten im angestrebten therapeutischen Bereich; 20 % (n = 16) lagen darüber und 10 % (n = 16) darunter. In der untersuchten Risikopopulation lagen also 32% der EFV-Serumkonzentrationen außerhalb des therapeutischen Bereichs, deutlich mehr Serumkonzentrationen als bei einer Vergleichspopulation in Deutschland (16%). Bei 88% der Patienten lagen jedoch mindestens ausreichende EFV-Serumkonzentrationen vor, obwohl durch die Enzyminduktion durch Rifampicin niedrigere EFV-Serumkonzentrationen zu erwarten gewesen wären.
Es konnte ein signifikanter Unterschied in der Therapiedauer mit Rifampicin im Vergleich der Patientengruppen mit EFV-Serumkonzentrationen innerhalb und oberhalb des angestrebten therapeutischen Bereichs festgestellt werden (p = 0,033). Die Patienten in der Gruppe mit EFV-Serumkonzentrationen innerhalb des therapeutischen Bereichs nahmen Rifampicin im Durchschnitt seit 121 Tagen und somit 35 Tage länger als die Patienten in der Vergleichsgruppe ein. Eine mögliche Ursache könnte die intensivere Enzyminduktion durch konstantere bzw. höhere Serumkonzentrationen von Rifampicin sein. Der Einfluss der Therapiedauer mit Rifampicin auf die Höhe der EFV-Serumkonzentrationen konnte in anderen Studien allerdings nicht gezeigt werden.
EFV-Serumkonzentrationen innerhalb des Therapeutischen Bereichs waren außerdem mit einer signifikant längeren Therapiedauer mit EFV assoziiert (p = 0,044). Dies könnte an einer mit der Therapiedauer zunehmenden Therapieadhärenz liegen, die in mehreren Studien beschrieben wurde. Eine gute Therapieadhärenz ist eine wichtige Voraussetzung für konstante EFV-Serumkonzentrationen. Bezogen auf das gesamte Patientenkollektiv konnte in der vorliegenden Untersuchung jedoch kein signifikanter Zusammenhang zwischen einer guten bzw. einer schlechten Therapieadhärenz und der Höhe der EFV-Serumkonzentrationen gezeigt werden.
EFV-Serumkonzentrationen oberhalb des Therapeutischen Bereichs waren mit signifikant höheren ALT-Werten assoziiert. Unter einer Therapie mit EFV können hepatotoxische Nebenwirkungen auftreten, es scheint jedoch kein eindeutiger Zusammenhang zwischen der Höhe der EFV-Serumkonzentrationen und der Höhe der Transaminasen zu bestehen. Im Einzelfall könnte bei einem HIV-Patienten mit unerklärbarem Transaminasenanstieg eine Bestimmung der EFV-Serumkonzentration sinnvoll sein, um Anhaltspunkte für eine Hepatotoxizität von EFV im Zusammenhang mit EFV-Serumkonzentrationen zu finden.
Zwischen den Patientengruppen mit EFV-Serumkonzentrationen innerhalb und oberhalb des therapeutischen Bereichs zeigte sich außerdem ein signifikanter Unterschied in der ethnischen Zugehörigkeit (p = 0,046). Der Anteil der schwarzen Patienten in der Gruppe mit erhöhten Serumkonzentrationen war mit 75 % (n = 12) signifikant höher als in der Gruppe mit Serumkonzentrationen innerhalb des angestrebten Bereichs (44 %, n = 24).
Der Einfluss der ethnischen Zugehörigkeit auf die EFV-Serumkonzentrationen könnte an dem in der schwarzen Bevölkerung überdurchschnittlich häufig vorkommenden Polymorphismus CYP2B6 516 TT liegen. Dieser Polymorphismus ist mit deutlich höheren EFV-Serumkonzentrationen assoziiert. In einigen Studien fanden sich insbesondere höhere EFV-Serumkonzentrationen bei schwarzen, weiblichen Patientinnen im Vergleich zu weißen, männlichen Patienten. Dieser Einfluss des Geschlechts auf die Höhe der EFV-Serumkonzentrationen konnte in der vorliegenden Untersuchung nicht gezeigt werden.
Weitere Begleitmedikamente scheinen die EFV-Serumkonzentrationen zusätzlich zu beeinflussen. Bei Patienten, die zusätzlich Vitamin C einnahmen (n = 9), konnten signifikant höhere EFV-Serumkonzentrationen im Vergleich zu der Patientengruppe, die kein Vitamin C einnahmen, gemessen werden. Eine mögliche Erklärung ist die durch die Anwendung der Komplementärmedizin geförderte Stärkung des Eigenverantwortungsgefühls des Patienten und der Akzeptanz gegenüber der Schulmedizin und einer damit einhergehenden Verbesserung der Therapieadhärenz.
Es konnte kein Zusammenhang zwischen dem Alter der Patienten, dem WHO-Stadium der Erkrankung, der Höhe der CD4-Zellzahl bzw. der Viruslast oder dem EFV- Dosierungsintervall und der Höhe der EFV-Serumkonzentrationen gezeigt werden.
Zusammenfassend konnten bei HIV-Patienten mit nachgewiesenermaßen enzyminduzierender Begleitmedikation mit Rifampicin weitere Einflussfaktoren auf die EFV-Serumkonzentrationen bestimmt werden. Faktoren wie ethnische Herkunft, weitere Begleitmedikamente und die Therapiedauer scheinen die EFV-Serumkonzentrationen zusätzlich zu beeinflussen. Im untersuchten Patientenkollektiv lagen allerdings bei 88% der Patienten mindestens ausreichende EFV-Serumkonzentrationen vor, sodass die Therapie als ausreichend sicher angesehen werden kann. Die Messung der EFV-Serumkonzentrationen könnte genutzt werden, um den Therapieerfolg bei HIV-Patienten unter einer antiretroviralen Therapie und einer tuberkulostatischen Begleittherapie mit Rifampicin weiter zu verbessern.
This thesis describes the studies of topological superconductivity, which is predicted to
emerge when pair correlations are induced into the surface states of 2D and 3D topolog-
ical insulators (TIs). In this regard, experiments have been designed to investigate the
theoretical ideas first pioneered by Fu and Kane that in such system Majorana bound
states occur at vortices or edges of the system [Phys. Rev. Lett. 100, 096407 (2008), Phys.
Rev. B 79, 161408 (2009)]. These states are of great interest as they constitute a new
quasiparticle which is its own antiparticle and can be used as building blocks for fault
tolerant topological quantum computing.
After an introduction in chapter 1, chapter 2 of the thesis lays the foundation for the
understanding of the field of topology in the context of condensed matter physics with a
focus on topological band insulators and topological superconductors. Starting from a
Chern insulator, the concepts of topological band theory and the bulk boundary corre-
spondence are explained. It is then shown that the low energy Hamiltonian of mercury
telluride (HgTe) quantum wells of an appropriate thickness can be written as two time
reversal symmetric copies of a Chern insulator. This leads to the quantum spin Hall effect.
In such a system, spin-polarized one dimensional conducting states form at the edges
of the material, while the bulk is insulating. This concept is extended to 3D topological
insulators with conducting 2D surface states. As a preliminary step to treating topological
superconductivity, a short review of the microscopic theory of superconductivity, i.e. the
theory of Bardeen, Cooper, and Shrieffer (BCS theory) is presented. The presence of
Majorana end modes in a one dimensional superconducting chain is explained using the
Kitaev model. Finally, topological band insulators and conventional superconductivity
are combined to effectively engineer p-wave superconductivity. One way to investigate
these states is by measuring the periodicity of the phase of the Josephson supercurrent
in a topological Josephson junction. The signature is a 4π-periodicity compared to the
2π-periodicity in conventional Josephson junctions. The proof of the presence of this
effect in HgTe based Josephson junction is the main goal of this thesis and is discussed in
chapters 3 to 6.
Chapter 3 describes in detail the transport of a 3D topological insulator based weak
link under radio-frequency radiation. The chapter starts with a review of the state of
research of (i) strained HgTe as 3D topological insulator and (ii) the progress of induc-
ing superconducting correlations into the topological surface states and the theoretical
predictions of 3D TI based Josephson junctions. Josephson junctions based on strained
HgTe are successfully fabricated. Before studying the ac driven Josephson junctions, the
dc transport of the devices is analysed. The critical current as a function of temperature
is measured and it is possible to determine the induced superconducting gap. Under
rf illumination Shapiro steps form in the current voltage characteristic. A missing first
step at low frequencies and low powers is found in our devices. This is a signature of
a 4π-periodic supercurrent. By studying the device in a wide parameter range - as a
147148 SUMMARY
function of frequency, power, device geometry and magnetic field - it is shown that the
results are in agreement with the presence of a single gapless Andreev doublet and several
conventional modes.
Chapter 4 gives results of the numerical modelling of the I −V dynamics in a Josephson
junction where both a 2π- and a 4π-periodic supercurrents are present. This is done in
the framework of an equivalent circuit representation, namely the resistively shunted
Josephson junction model (RSJ-model). The numerical modelling is in agreement with
the experimental results in chapter 3. First, the missing of odd Shapiro steps can be
understood by a small 4π-periodic supercurrent contribution and a large number of
modes which have a conventional 2π-periodicity. Second, the missing of odd Shapiro
steps occurs at low frequency and low rf power. Third, it is shown that stochastic processes
like Landau Zener tunnelling are most probably not responsible for the 4π contribution.
In a next step the periodicity of Josephson junctions based on quantum spin Hall
insulators using are investigated in chapter 5. A fabrication process of Josephson junctions
based on inverted HgTe quantum wells was successfully developed. In order to achieve a
good proximity effect the barrier material was removed and the superconductor deposited
without exposing the structure to air. In a next step a gate electrode was fabricated which
allows the chemical potential of the quantum well to be tuned. The measurement of the
diffraction pattern of the critical current Ic due to a magnetic field applied perpendicular
to the sample plane was conducted. In the vicinity to the expected quantum spin Hall
phase, the pattern resembles that of a superconducting quantum interference device
(SQUID). This shows that the current flows predominantly on the edges of the mesa.
This observation is taken as a proof of the presence of edge currents. By irradiating the
sample with rf, missing odd Shapiro steps up to step index n = 9 have been observed. This
evidences the presence of a 4π-periodic contribution to the supercurrent. The experiment
is repeated using a weak link based on a non-inverted HgTe quantum well. This material
is expected to be a normal band insulator without helical edge channels. In this device,
all the expected Shapiro steps are observed even at low frequencies and over the whole
gate voltage range. This shows that the observed phenomena are directly connected
to the topological band structure. Both features, namely the missing of odd Shapiro
steps and the SQUID like diffraction pattern, appear strongest towards the quantum spin
Hall regime, and thus provide evidence for induced topological superconductivity in the
helical edge states.
A more direct way to probe the periodicity of the Josephson supercurrent than using
Shapiro steps is the measurement of the emitted radiation of a weak link. This experiment
is presented in chapter 6. A conventional Josephson junction converts a dc bias V to
an ac current with a characteristic Josephson frequency fJ
= eV /h. In a topological
Josephson junction a frequency at half the Josephson frequency fJ /2 is expected. A
new measurement setup was developed in order to measure the emitted spectrum of a
single Josephson junction. With this setup the spectrum of a HgTe quantum well based
Josephson junction was measured and the emission at half the Josephson frequency fJ /2
was detected. In addition, fJ emission is also detected depending on the gate voltage and
detection frequency. The spectrum is again dominated by half the Josephson emission at
low voltages while the conventional emission is determines the spectrum at high voltages.
A non-inverted quantum well shows only conventional emission over the whole gateSUMMARY 149
voltage and frequency range. The linewidth of the detected frequencies gives a measure
on the lifetime of the bound states: From there, a coherence time of 0.3–4ns for the fJ /2
line has been deduced. This is generally shorter than for the fJ line (3–4ns).
The last part of the thesis, chapter 7, reports on the induced superconducting state
in a strained HgTe layer investigated by point-contact Andreev reflection spectroscopy.
For the experiment, a HgTe mesa was fabricated with a small constriction. The diameter
of the orifice was chosen to be smaller than the mean free path estimated from magne-
totransport measurements. Thus one gets a ballistic point-contact which allows energy
resolved spectroscopy. One part of the mesa is covered with a superconductor which
induces superconducting correlations into the surface states of the topological insulator.
This experiment therefore probes a single superconductor normal interface. In contrast to
the Josephson junctions studied previously, the geometry allows the acquisition of energy
resolved information of the induced superconducting state through the measurement
of the differential conductance dI/dV as a function of applied dc bias for various gate
voltages, temperatures and magnetic fields. An induced superconducting order parame-
ter of about 70µeV was extracted but also signatures of the niobium gap at the expected
value around Δ Nb
≈ 1.1meV have been found. Simulations using the theory developed by
Blonder, Tinkham and Klapwijk and an extended model taking the topological surface
states into account were used to fit the data. The simulations are in agreement with a
small barrier at the topological insulator-induced topological superconductor interface
and a high barrier at the Nb to topological insulator interface. To understand the full con-
ductance curve as a function of applied voltage, a non-equilibrium driven transformation
is suggested. The induced superconductivity is suppressed at a certain bias value due to
local electron population. In accordance with this suppression, the relevant scattering
regions change spatially as a function of applied bias.
To conclude, it is emphasized that the experiments conducted in this thesis found
clear signatures of induced topological superconductivity in HgTe based quantum well
and bulk devices and opens up the avenue to many experiments. It would be interesting
to apply the developed concepts to other topological matter-superconductor hybrid
systems. The direct spectroscopy and manipulation of the Andreev bound states using
circuit quantum electrodynamic techniques should be the next steps for HgTe based
samples. This was already achieved in superconducting atomic break junctions by the
group in Saclay [Science 2015, 349, 1199-1202 (2015)]. Another possible development
would be the on-chip detection of the emitted spectrum as a function of the phase φ
through the junction. In this connection, the topological junction needs to be shunted
by a parallel ancillary junction. Such a setup would allow the current phase relation
I(φ) directly and the lifetime of the bound states to be measured directly. By coupling
this system to a spectrometer, which can be another Josephson junction, the energy
dependence of the Andreev bound states E(φ) could be obtained. The experiments on
the Andreev reflection spectroscopy described in this thesis could easily be extended to
two dimensional topological insulators and to more complex geometries, like a phase
bias loop or a tunable barrier at the point-contact. This work might also be useful for
answering the question how and why Majorana bound states can be localized in quantum
spin Hall systems.
Schwerpunktmäßig befasst sich diese Arbeit mit den praktischen Vorgängen zur Zählung von Neuronen mit dem optischen Fraktionator unter dem Mikroskop, wobei zur Veranschaulichung die Neuronen in der Substantia Nigra an C57BL/6-Mäusen gezählt wurden. Es wurde erläutert, wie die Einstellungen der jeweiligen Methode vorzunehmen sind und auf die angestrebten Ziele angepasst werden können, um ein effizientes Zählen von Neuronen unter Berücksichtigung grundlegender Zählregeln zu gewährleisten. Gleichzeitig wurde gezeigt, wie die Methoden des optischen Fraktionators die gewünschten präzisen Ergebnisse anhand des CE-Wertes liefern können.
Die in dieser Arbeit präsentierte Axiophot-2-Methode ist in der Lage, selbst mit einem einfachen, kommerziell erhältlichen Lichtmikroskop und einem Standbildaufnahmeprogramm die Gesamtanzahl von Zellen einer gegebenen Struktur unter Beachtung aller stereologischen Regeln zu zählen – und zwar genauso effizient und mit vergleichbaren Ergebnissen wie mit einem speziell für stereologische Untersuchungen vorgefertigtes Komplettsystem. Vergleiche beider Methoden zueinander ergeben folgende Schlussfolgerungen: bei dem Stereo Investigator, ist die Untersuchung zwar wesentlich schneller, da die Bildaufnahme und Auswertung mittels voreingestellten Programmes automatisch durchgeführt werden. Allerdings ist solch ein Komplettsystem sehr kostspielig (ca. 60.000 Euro Anschaffungskosten) und nicht flexibel auf andere Untersuchungsbereiche einsetzbar.
Die Axiophot-2-Methode weist zwar einige Nachteile aufgrund der manuellen Vorarbeiten auf, ist aber dafür wesentlich günstiger und zugänglicher, da sie nur ein konventionelles Mikroskop mit einem Standardprogramm erfordert.
Im Zeitraum von Dezember 1996 bis Februar 2008 wurden an der Orthopädischen
Klinik König-Ludwig-Haus insgesamt 58 Eingriffe zur endoprothetischen Versorgung
bei avaskulärer HKN durchgeführt. Hiervon wurden 37 Patienten, dies entspricht in unserem Fall 40 betroffenen Schultern, im Rahmen unserer Studie nachuntersucht. Das mittlere Operationsalter lag bei 54,4 Jahren, dabei erstreckte sich das Alter von 24 bis 78 Jahren. Die linke und rechte Schulter waren gleich häufig betroffen, je 20mal. Bei 19 Schultergelenken handelte es sich um die dominante Seite (47,5%) und 21mal war die nicht-dominante Seite betroffen (52,5%). 23 Schultern waren bereits voroperiert.
Bei 25 erkrankten Schultern hatte sich die AHN nach einem Trauma entwickelt und bei 15 Schultern war sie atraumatischer Genese. In unserem Patientenkollektiv lagen drei Nekrosestadien vor. Nach Einteilung gemäß der ARCO-Klassifikation befanden sich präoperativ 3 betroffene Schultern im Stadium 3, 28 Schultern befanden sich in einem AHN-Stadium 4 und 9 im Stadium 5.
Bei 12 betroffenen Schultern war die Rotatorenmanschette präoperativ sowohl funktio-nell als auch morphologisch mittels bildgebenden Verfahren evaluiert worden. 18 Schultern waren zwar funktionell intakt, wiesen jedoch morphologische Schäden im Sinne von leichteren Weichteilschäden vor, wobei teils neben der RM auch der Delta-muskel und/oder der M. supraspinatus betroffen waren. Eine Insuffizienz von zwei oder mehr Muskeln der Rotatorenmanschette lag präoperativ bei 10 Schultern vor, vorrangig aufgrund von Atrophie, fettiger Atrophie der Muskulatur und narbiger Verkürzung. Vollständige Defekte, der SSP-, ISP- und SSC-Ruptur traten einmal auf.
Es wurden 20 Hemiprothesen (50%), 8 Totalendoprothesen (20)%), sieben inverse Pro-thesen nach Grammont (17,5%) und fünf Kappenprothesen nach Copeland(12,5%) eingesetzt.
Die klinische und radiologische Nachuntersuchungen zur Studie fanden im Mittel 50,9 Monate (Minimum acht Monate, Maximum 141 Monate) nach der Implantation der jeweiligen Schulterendoprothese statt. Dies geschah im Rahmen der normalen klini-schen Verlaufskontrolle.
Als Bewertungsmaßstab für die Funktion wurde der Constant Score verwendet. Der Constant Score verbesserte sich von präoperativ 24,05 Punkten auf postoperativ 57,45 Punkte.
Auch im alters- und geschlechtsadaptierten Constant Score kam es zu einer signifikan-ten Verbesserung. Hier lag die Differenz zwischen prä- und postoperativ bei 42,7 Punkten. Im Mittel wurde postoperativ 72,1% des alters- und geschlechtsadaptierten CS er-reicht, wobei die Spannweite von 33% bis 117% sehr groß war. Alle Untergruppen des CS wiesen ebenfalls eine Verbesserung auf. Bei allen war eine deutliche Schmerzreduk-tion aufzuweisen. Die Aktivität und der Bewegungsumfang wurden gesteigert. Die geringste Verbesserung war in der Kraft nachzuweisen.
Zum Zeitpunkt der Nachuntersuchung waren 17 Patienten mit dem Resultat der Prothe-senversorgung sehr zufrieden, 21 Patienten waren zufrieden und zwei Patienten waren enttäuscht. Keiner der Patienten war unzufrieden.
In der radiologischen Untersuchung konnte bei einer Patientin mit anatomischer TEP bei posttraumatischer AHN mit Z.n. Radiatio bei Mammakarzinom eine Implantatlocke-rung festgestellt werden, welche jedoch auf Wunsch der Patientin nicht revidiert wurde. Bei vier Fällen einer anatomischen Endoprothese wurde ein Humeruskopfhochstand, vermutlich als Folge einer Subscapularis-Insuffizienz beobachtet.
Ein Glenoid Notching konnte bei 4 von7 inversen TEP nachgewiesen werden, in allen Fällen handelte es sich um ein Grad 1-Notching nach Sirveaux.
Die Ausbildung heterotoper Ossifikationen ließ sich bei zwei Patienten röntgenologisch darstellen. Eine Saumbildung des proximalen Schaftes war in vier Fällen nachweisbar.
Bei einer Patientin mit einer inversen Prothese entwickelte sich sechs Monate postope-rativ ein Ermüdungsbruch des Akromions, welche sich bis 2008 verschlechterte. Ab 2008 war der Verlauf jedoch konstant, ohne Bedarf einer Reoperation. Das Akromion verblieb in 40° nach kaudal gekippt in Fehlstellung verheilt.
Die Patienten mit einer atraumatischen Humeruskopfnekrose erzielten ein signifikant besseres Ergebnis als Patienten mit einer proximalen Humeruskopffraktur in der Vorgeschichte, wobei in der ersten Gruppe der klinische Ausgangsbefund günstiger und die morphologischen Vorschäden an Weichteilen und Knochensubstanz eindeutig geringer waren. Beide Patientengruppen erzielten eine signifikante Steigerung der Schulterfunktion. Im Vergleich gab es keine statistisch signifikanten Unterschiede zwischen den unterschiedlichen Nekrosestadien. In Bezug auf die Ausprägung des Nekrosegrades zeigte sich bei Patienten mit dem Nekrosegrad 3 das beste klinische Ergebnis, dicht gefolgt vom Nekrosegrad 4 und 5, die Unterschiede waren auch hier nicht signifikant.
In einigen Punkten schnitten manche Patienten mit insuffizienter RM sogar leicht besser ab, wobei hier der Einfluss des verwendeten Typs eine wesentliche Rolle spielt (Inverse TEP). Die Bewegungsumfänge waren jedoch postoperativ bei der Gruppe mit der intak-ten RM besser. Bezogen auf den eingesetzten Prothesentyp erhielten die Patienten mit einem Oberflächenersatz die besten Ergebnisse, wobei in dieser Gruppe auch die ge-ringsten Vorschäden an der Gelenkpfanne, der Rotatorenmanschette, des Deltamuskels und im periartikulären Gleitlager vorlagen. Die Unterschiede zwischen den Prothesentypen waren jedoch nicht signifikant. Am schlechtesten schnitt die inverse Prothese ab, wobei die Negativ-Selektion infolge der schlechteren Ausgangsposition zu berücksichtigen ist.
Den Ergebnissen zufolge ist es insbesondere bei atraumatischer Genese am besten einen frühzeitigen Gelenkersatz anzustreben, noch bevor der Gelenkknorpel der Gelenkpfanne zerstört ist und eine sekundäre Einsteifung bzw. kontrakte Verkürzung der Rotatoren-manschette vorliegt. Dies gilt auch für die posttraumatischen Situationen, wobei als Folge der Voreingriffe, z.B. fehlgeschlagener Osteosynthesen, diese oft nicht mehr intakt waren und zudem ausgedehnte narbige Verwachsungen vorlagen. In diesem Stadium war ein akzeptables funktionelles Ergebnis nur noch durch die Implantation einer inversen TEP zu erzielen.
Ziel der Untersuchung war es häufig auftretende Verletzungen beim Telemark sowie dazu führende Risiken zu identifizieren. Die erfassten Verletzungen sollten in Abhängigkeit von technischen Unterschieden mit Verletzungen im Bereich des Ski Alpin verglichen werden. Ebenfalls sollte eine potentiell schädliche Langzeit-Auswirkung des Telemarkens auf das Kniegelenk untersucht werden.
Mittels eines Online-Fragebogens wurden Telemarker verschiedener Skigebiete und Nationalitäten retrospektiv über ihre Sportausübung und bisherige Verletzungen befragt. In einer prospektiven Studie wurden über zwei Skisaisons hinweg monatlich auftretende Verletzungen aufgezeichnet.
Vorrangige Verletzungslokalisationen waren das Knie-, Schulter- und Sprunggelenk sowie der Daumen. Verletzungen der unteren Extremität, insbesondere des Kniegelenks waren wie auch beim Ski Alpin die vorrangige Verletzungslokalisation. Technik bedingt kommt es doch zu Unterschieden in den verletzten Strukturen.
This work is concerned with the numerical approximation of solutions to models that are used to describe atmospheric or oceanographic flows. In particular, this work concen- trates on the approximation of the Shallow Water equations with bottom topography and the compressible Euler equations with a gravitational potential. Numerous methods have been developed to approximate solutions of these models. Of specific interest here are the approximations of near equilibrium solutions and, in the case of the Euler equations, the low Mach number flow regime. It is inherent in most of the numerical methods that the quality of the approximation increases with the number of degrees of freedom that are used. Therefore, these schemes are often run in parallel on big computers to achieve the best pos- sible approximation. However, even on those big machines, the desired accuracy can not be achieved by the given maximal number of degrees of freedom that these machines allow. The main focus in this work therefore lies in the development of numerical schemes that give better resolution of the resulting dynamics on the same number of degrees of freedom, compared to classical schemes.
This work is the result of a cooperation of Prof. Klingenberg of the Institute of Mathe- matics in Wu¨rzburg and Prof. R¨opke of the Astrophysical Institute in Wu¨rzburg. The aim of this collaboration is the development of methods to compute stellar atmospheres. Two main challenges are tackled in this work. First, the accurate treatment of source terms in the numerical scheme. This leads to the so called well-balanced schemes. They allow for an accurate approximation of near equilibrium dynamics. The second challenge is the approx- imation of flows in the low Mach number regime. It is known that the compressible Euler equations tend towards the incompressible Euler equations when the Mach number tends to zero. Classical schemes often show excessive diffusion in that flow regime. The here devel- oped scheme falls into the category of an asymptotic preserving scheme, i.e. the numerical scheme reflects the behavior that is computed on the continuous equations. Moreover, it is shown that the diffusion of the numerical scheme is independent of the Mach number.
In chapter 3, an HLL-type approximate Riemann solver is adapted for simulations of the Shallow Water equations with bottom topography to develop a well-balanced scheme. In the literature, most schemes only tackle the equilibria when the fluid is at rest, the so called Lake at rest solutions. Here a scheme is developed to accurately capture all the equilibria of the Shallow Water equations. Moreover, in contrast to other works, a second order extension is proposed, that does not rely on an iterative scheme inside the reconstruction procedure, leading to a more efficient scheme.
In chapter 4, a Suliciu relaxation scheme is adapted for the resolution of hydrostatic equilibria of the Euler equations with a gravitational potential. The hydrostatic relations are underdetermined and therefore the solutions to that equations are not unique. However, the scheme is shown to be well-balanced for a wide class of hydrostatic equilibria. For specific classes, some quadrature rules are computed to ensure the exact well-balanced property. Moreover, the scheme is shown to be robust, i.e. it preserves the positivity of mass and energy, and stable with respect to the entropy. Numerical results are presented in order to investigate the impact of the different quadrature rules on the well-balanced property.
In chapter 5, a Suliciu relaxation scheme is adapted for the simulations of low Mach number flows. The scheme is shown to be asymptotic preserving and not suffering from excessive diffusion in the low Mach number regime. Moreover, it is shown to be robust under certain parameter combinations and to be stable from an Chapman-Enskog analysis.
Numerical results are presented in order to show the advantages of the new approach.
In chapter 6, the schemes developed in the chapters 4 and 5 are combined in order to investigate the performance of the numerical scheme in the low Mach number regime in a gravitational stratified atmosphere. The scheme is shown the be well-balanced, robust and stable with respect to a Chapman-Enskog analysis. Numerical tests are presented to show the advantage of the newly proposed method over the classical scheme.
In chapter 7, some remarks on an alternative way to tackle multidimensional simulations are presented. However no numerical simulations are performed and it is shown why further research on the suggested approach is necessary.
In three studies, we investigated, if and how different modes of presentation - written, auditory, audiovisual (auditory combined with pictures) - affect comprehension of semantically identical materials. Children, beginning from the age of 7, and adults were included into the studies. A vast amount of studies have shown that pictures can facilitate text comprehension (e.g. Carney & Levin, 2002).
Other than the majority of these previous studies, we assessed text comprehension with methods that we assume to allow more differentiated insights into the cognitive processes that - according to current theories - underlie text comprehension. Text comprehension involves at least three levels of mental representations (see Kintsch, 1998). Moreover, text comprehension means constructing a locally and globally coherent mental representation of the text content.
Using a sentence recognition task (see Schmalhofer & Glavanov, 1986), we examined whether the memory of the text surface, the text base, and the situation model differs between written, auditory, and audiovisual text presentation in a sample of 103 8- and 10-year-olds and adults (Study I), and between auditory and audiovisual text presentation in a sample of 106 7-, 9-, and 11-year-olds (Study II). Furthermore, we examined with 155 9- and 11-year-olds, whether the ability to draw inferences to establish local and global coherence differs between written, auditory, and audiovisual text presentation. These inferences were indicated by reaction times to words associated with a protagonist's super- (global) or subordinate (local) goal.
Overall, the results of these three studies taken together, indicate that children up to age 11 do not only have better memory of not only the text surface, but also of the situation model when pictures are added to an auditory text. This effect became apparent in comparison with both auditory and written texts. For the adults, in contrast, we did not find an effect of the presentation mode. Furthermore, both 9- and 11-year-olds were better at establishing global coherence at audiovisual compared to auditory text presentation. Written presentation turned out to be superior to auditory presentation in terms of both local and global coherence.
Humane artifizielle Vollhautmodelle gewinnen im Bereich des Tissue Engineerings zunehmend an Bedeutung und werden mittlerweile in vielen verschiedenen Fachbereichen erforscht, optimiert und sogar als die Grundlagenforschung unterstützende Tierersatzmodelle angewendet. Dieses geht mit hohen Ansprüchen an Qualität und Reproduzierbarkeit dergleichen einher. In der vorliegenden Arbeit wurde erstmals der Einfluss von Kulturbedingen und Spendermaterial auf die Qualität humaner in vitro hergestellter Vollhautmodelle systematisch untersucht. Dazu wurde zunächst ein Katalog an histomorphologischen Qualitätskriterien erarbeitet, der sich an echten humanen Hautbiopsien orientierte und eine Gewichtung dieser Kriterien im Hinblick auf die Verwendung als echte Hautersatzmodelle erlaubte. Für die Herstellung der Hautmodelle wurden die etablierten Medien KGM 2 , KGM 2 variant und EpiLife ® und deren Kultivierungsprotokolle verwendet. Die zelluläre Grundlage der vorliegenden Untersuchungen bildeten die Präputien von sechzehn Kindern nach Zirkumzision. Keratinozyten und Fibroblasten wurden isoliert und mit den drei oben genannten Medien und zugrundeliegenden Kultivierungsprotokollen wurden in jeweils dreifacher Ausführung insgesamt 144 humane Vollhautmodelle erstellt, welche dann entsprechend des Bewertungskataloges beurteilt wurden. Die zugrunde gelegten Bewertungs- und Gütekriterien entsprachen histomorphologischen Parametern. Dazu gehörten die Dicke von Epidermis und Dermis, die Adhärenz zwischen Epidermis und Dermis sowie die Abwesenheit von Zellkernen im Stratum corneum der Epidermis.
Für die Analyse der Einflussfaktoren Spenderalter und Kultivierungsmedium wurden Regressionsmodelle mittels Generalized Estimating Equations angewandt. Das Spenderalter und das Kultivierungsmedium wurden dabei unabhängig voneinander in einer univariaten Analyse untersucht. Bei der Untersuchung des Einflusses des Kulturmediums auf die terminale Differenzierung innerhalb der Epidermis zeigte sich, dass durch Kultivierung mit EpiLife ® signifikant weniger Vollhautmodelle mit Zellkernen im Stratum corneum hergestellt wurden, im Vergleich zur Kultur mit KGM 2 oder KGM 2 variant. Der Einfluss des Kulturmediums auf die Epidermis- und Dermis-Dicke war jeweils nicht signifikant. Trotzdem zeigte sich ein Trend mit einer dünneren Epidermis und Dermis nach EpiLife ® -Kultivierung. Bei der Analyse des Spenderalters konnte ein positiver Einfluss eines jüngeren Spenders auf die Dicke der Epidermis im Vollhautmodell gezeigt werden. Die Epidermis-Dicke war signifikant größer, je jünger ein Vorhautspender war. Ein höheres Spenderalter dagegen führte zu signifikant weniger Ablösung der Epidermis von der Dermis. Keinen Einfluss hatte das Spenderalter auf die Dermis-Dicke und auf die Abwesenheit von Zellkernen in der Hornschicht. Die drei signifikanten Assoziationen in der univariaten Analyse wurden in einer multivariablen Analyse untersucht. Hierbei zeigte sich der Einfluss des Spenderalters auf die Epidermis-Dicke und die dermo-epidermale Adhäsion unter Einfluss der Kulturmedien, der Abwesenheit von Zellkernen in der Hornschicht und der Dermis-Dicke als Kovariablen ebenfalls signifikant. Auch blieb der Einfluss von EpiLife ® auf die Abwesenheit von Zellkernen in der Hornschicht in der multivariablen Analyse signifikant. Es konnte hierbei außerdem ein signifikanter Einfluss der Dermis auf die Epidermis mit Schrumpfung der Epidermis bei Größerwerden der Dermis gezeigt werden. In einer durchgeführten komplexen statistischen Analyse mittels General Linear Model wurde der Einfluss einer Spender-Medium-Interaktion analysiert, ohne das Spenderalter als Variable mit einzubeziehen. Es zeigte sich ein signifikanter Einfluss der Interaktion des Spenders mit dem Kulturmedium auf die Epidermisund Dermis-Dicke und damit auf die Qualität der in vitro hergestellten Vollhautmodelle. Einerseits bestand also ein unabhängiger Einfluss des Spenderalters und des Mediums, andererseits gab es einen Einfluss von der Abhängigkeit einer optimalen Spender-Medium-Kombination auf die Vollhautmodellqualität.
Zusammenfassend konnte in der vorliegenden Arbeit erstmals das komplexe Zusammenspiel von Spenderfaktoren und Kultivierungsbedingungen und deren Auswirkungen auf die Qualität von humanen Vollhautmodellen aufgezeigt werden. Diese Ergebnisse haben Relevanz für den Einsatz dieser Modelle als Tierersatzmodelle in der Forschung. Unter Berücksichtigung dieser Ergebnisse können optimierte organotypische Vollhautmodelle in vitro hergestellt werden, sodass zukünftig komplexere Hautmodelle generiert werden können. In einer Folgearbeit sollen die hier erarbeiteten Grundlagen helfen, Hautmodelle in der Erforschung der akuten GvHD der Haut zu bearbeiten.
Zielsetzung:
Wie genau kann die Computertomographie die einzelnen Stadien der Sigmadivertikulitis abbilden? Inwieweit ist eine Übereinstimmung befunderabhängig?
Material und Methoden:
Grundlage dieser Arbeit waren die Daten von 91 Patienten (43 Männer und 48 Frauen, Durchschnittalter: 60,4 Jahre), die im Zeitraum August 2008 bis Mai 2010 aufgrund einer Sigmadivertikulitis operiert wurden. Das prätherapeutisch mittels Computertomographie (Hansen und Stock-Klassifikation)diagnostizierte Stadium wurde mit dem histopathologisch bestimmten Stadium auf eine Übereinstimmung hin verglichen. Zudem wurden alle CT-Bilder von einem zweiten Radiologen nachbefundet und auf eine Übereinstimmung mit dem Befund des Erstbefunders verglichen.
Ergebnisse:
Die Sensitivität für das phlegmonöse Stadium (H&S IIA) lag bei 83,3%, für das Stadium der gedeckten Perforation (H&S IIB) bei 71,4% und 72,7% für das chronisch-rezidivierende Stadium (H&S III). Die Spezifität lag bei 83,5% für Stadium IIA, 81,0% für Stadium IIB und 92,7% für Stadium III. Die Sensitivität und Spezifität für Stadium IIC (freie Perforation) lag bei 100%. Bei zehn Patienten kam es seitens der Computertomographie zu einer Unterschätzung des Entzündungsausmaßes: hier wurde anhand der CT ein histopathologisch verifiziertes Stadium IIB als Stadium IIA klassifiziert. Der Kappa-Wert der Zwischenbeobachter-Korrelation lag bei 0,598.
Zusammenfassung:
Die Computertomographie ist insgesamt ein zuverlässiges radiologisches Verfahren in der Diagnostik der einzelnen Divertikulitis-Stadien, zeigt aber, insbesondere in der Diagnostik des Stadiums IIB Defizite im Sinne einer Unterschätzung des Entzündungsausmaßes. Auch die moderate Zwischenbeobachter-Übereinstimmung hebt mögliche Defizite der CT im Staging der Sigmadivertikulitis hervor.
Ziel dieser Arbeit war die Herstellung fluoreszent markierter Präpolymere sowie deren Optimierung, die kontrollierte und reproduzierbare Synthese von redox-sensitiven und nicht redox-sensitiven NG mit und ohne Fluoreszenzmarkierung in einem durchschnittlichen Partikelgrößenbereich von 150 – 300 nm und mit einer Konzentration > 10*10 Partikel/ml, die Charakterisierung der NG, ihre Untersuchung bezüglich ihrer Stabilität und des Assoziationsverhaltens zu BSA sowie die Erlangung von Erkenntnissen bezüglich des Aufnahmemechanismus der NG in Abhängigkeit vom Transportpeptid Tat.
Abschließend kann zusammenfassend gesagt werden:
1. Das große Potential von PG-basierten NG für biologische bzw. medizinische Einsatzgebiete konnte weiter untermauert werden.
2. Das mit Cy5-Alkin markierte PG PG-SH-Cy5 erscheint aufgrund des relativ hohen erreichten Markierungsgrades bei der Herstellung als aussichtsreichster Kandidat für weitere Untersuchungen. Diese Umsetzung besitzt noch Optimierungspotentiale bezüglich einer Verringerung des Polymerverlusts bei der Aufarbeitung, des erreichbaren Markierungsgrades und der Markierungsausbeute. Möglichkeiten, dies zu erreichen, wurden diskutiert.
3. Klare Aussagen über den Einfluss des esterhaltigen bzw. esterfreien Ausgangspolymers PG-SH auf die Konzentration und die Partikelgröße konnten aufgrund einer nicht ausreichenden Datenlage nicht getroffen werden.
4. Die esterhaltigen PG-SH-Moleküle erscheinen aufgrund ihrer Labilität gegenüber Hydrolyse für die NP-Synthese weniger geeignet (geringere Stabilität).
5. Die Charakterisierung der aus den markierten und unmarkierten Ausgangspolymeren hergestellten NG, welche teilweise zusätzlich mit dem Transportpeptid Tat funktionalisiert wurden, erfolgte mittels NTA und zeigt für die meisten Spezies relativ schmale, gut definierte, monomodale Größenverteilungen mit einem Maximum um 100-200 nm im Bereich von ca. 40 – max. 400 nm mit Partikelkonzentrationen im Bereich von 1010 - 1011 Partikeln/ml.
6. Insgesamt konnte gezeigt werden, dass der untersuchte, von PG-SH abgeleitete NP-Typ (z. B. NG_3, redox-sensitiv unmarkiert) aufgrund seiner Einheitlichkeit, Partikelgröße und der Reproduzierbarkeit der Herstellung als gut geeignet für den geplanten Einsatz in biologischen Systemen erscheint. Von den weiter derivatisierten NG erscheinen die folgenden aufgrund der oben geschilderten Kriterien als besonders geeignet für den geplanten Einsatz in biologischen Systemen und weiterer Untersuchungen wert: NG680_(TAT)_1-4 (redox-sensitiv, markiert), NGCy5_(TAT)_1 (redox-sensitiv, markiert), NG_MA_2 (nicht redox-sensitiv, unmarkiert), NGCy7_MA_1 (nicht redox-sensitiv, markiert). Aufgrund des relativ hohen erreichbaren Markierungsgrades bei der Markierung der Ausgangspolymere erscheinen die mit Cy5-markierten Verbindungen als besonders vorteilhaft.
7. Die esterfreien, redox-sensitiven NP erwiesen sich bei 14-tägiger Lagerung unter physiologischen Bedingungen als stabil. Ihre Konzentration nahm über 14 Tage um ca. 60 % vom Ausgangswert ab. Gleichzeitig nahm der Teilchendurchmesser während des Beobachtungszeitraums um ca. 25 % zu. Die Abnahme der Teilchenzahl ist - zumindest teilweise - durch eine Vergrößerung des mittleren Teilchendurchmessers und mögliche Adsorptionseffekte an die Gefäßwände des Versuchsaufbaus zu erklären.
8. Die Konzentration der esterfreien, nicht redox-sensitiven NP verringert sich bei 14-tägiger Inkubation unter physiologischen Bedingungen deutlich auf ca. 10 % des Ausgangswerts. Der mittlere Durchmesser der Partikel bleibt innerhalb des Untersuchungszeitraums innerhalb der Fehlergrenzen konstant. Die starke Abnahme der Partikelkonzentration ist wahrscheinlich auf die Hydrolyse des verwendeten esterhaltigen Crosslinkers PEGDA zurückzuführen. Desweiteren sind Adsorptionsphänomene an Oberflächen des Versuchsaufbaus nicht auszuschließen. Insgesamt hervorzuheben ist die wesentlich höhere Stabiliät der redox-sensitiven NP unter den Versuchsbedingungen. Diese Substanzklasse sollte daher weiter verfolgt werden.
9. Es wurde gezeigt, dass sowohl die NG, die das Aufnahmeprotein Tat enthalten, als auch die NG ohne Tat mit Fluoreszenz-markiertem BSA (8,3 µg/ml) wechselwirken und zusammen mit diesem bei der Zentrifugation abgeschieden werden. Über die Art der Wechselwirkung kann keine Aussage getroffen werden.
10. Durch in vitro Zellaufnahmeuntersuchungen an Hela-Zellen konnte gezeigt werden, dass die mit Tat funktionalisierten, redox-sensitiven, Fluoreszenz-markierten NP von den Zellen aufgenommen werden. Die Aufnahme erfolgt über eine deutlich erkennbare Vesikelbildung, die an der Plasmamembran verstärkt beobachtet werden kann. Im Gegensatz hierzu konnte bei den nicht mit Tat funktionalisierten NP keine vergleichbare in vitro Zellaufnahme beobachtet werden.
Die Ergebnisse dieser Arbeit bestätigen insgesamt das große Potential der von Thiol-funktionalisierten PG abgeleiteten NG für die medizinische Forschung und zukünftige Anwendungen in der Diagnostik und Therapie. Es wird eine Reihe von Ansatzpunkten aufgezeigt, auf deren Basis weitere vertiefende Untersuchungen zur Charakterisierung und Optimierung sowie zu zukünftigen nutzbringenden Anwendungen vorgenommen werden sollten.
In order to shrink the size of semiconductor devices and improve their
efficiency at the same time, silicon-based semiconductor devices have
been engineered, until the material almost reaches its performance
limits. As the candidate to be used next in semiconducting devices,
single-wall carbon nanotubes show a great potential due to their
promise of increased device efficiency and their high charge carrier
mobilities in the nanometer size active areas. However, there are
material based problems to overcome in order to imply SWNTs in the
semiconductor devices. SWNTs tend to aggregate in bundles and it is
not trivial to obtain an electronically or chirally homogeneous SWNT
dispersion and when it is done, a homogeneous thin film needs to be
produced with a technique that is practical, easy and scalable. This
work was aimed to solve both of these problems.
In the first part of this study, six different polymers, containing
fluorene or carbazole as the rigid part and bipyridine, bithiophene or
biphenyl as the accompanying copolymer unit, were used to selectively
disperse semiconducting SWNTs. With the data obtained from
absorption and photoluminescence spectroscopy of the corresponding
dispersions, it was found out that the rigid part of the copolymer plays a
primary role in determining its dispersion efficiency and electronic
sorting ability. Within the two tested units, carbazole has a higher π
electron density. Due to increased π−π interactions, carbazole
containing copolymers have higher dispersion efficiency. However, the
electronic sorting ability of fluorene containing polymers is superior.
Chiral selection of the polymers in the dispersion is not directly
foreseeable from the selection of backbone units. At the end, obtaining a monochiral dispersion is found to be highly dependent on the used raw
material in combination to the preferred polymer.
Next, one of the best performing polymers due to high chirality
enrichment and electronic sorting ability was chosen in order to
disperse SWNTs. Thin films of varying thickness between 18 ± 5 to
755o±o5 nm were prepared using vacuum filtration wet transfer method
in order to analyze them optically and electronically.
The scalability and efficiency of the integrated thin film production
method were shown using optical, topographical and electronic
measurements. The relative photoluminescence quantum yield of the
radiative decay from the SWNT thin films was found to be constant for
the thickness scale. Constant roughness on the film surface and linearly
increasing concentration of SWNTs were also supporting the scalability
of this thin film production method. Electronic measurements on bottom
gate top contact transistors have shown an increasing charge carrier
mobility for linear and saturation regimes. This was caused by the
missing normalization of the mobility for the thickness of the active
layer. This emphasizes the importance of considering this dimension for
comparison of different field effect transistor mobilities.
Diese klinisch prospektive Studie basiert auf dem Prinzip, Patienten mit der Indikation zu einer transcatheter aortic valve implantation (TAVI) anhand des transaortalen Flusses und Druckgradientens in verschiedene hämodynamische Gruppen einzuteilen. Ziel war es, die Prävalenz und Physiologie dieser Kohorte nachzuvollziehen und darüber hinaus in einem Nachbeobachtungszeitraum von einem Jahr eine Aussage über das Outcome treffen zu können.
Methoden: Bei 102 Patienten wurden präoperativ vor TAVI eine Reihe invasiver und nicht-invasiver Untersuchungen durchgeführt.
Dazu zählten eine Standardechokardiographie mit Speckle Tracking, eine Herzkatheteruntersuchung, ein MRT zur Detektion einer potentiellen Fibrose, eine ausführliche Anamnese, ein 6-minütiger Gehtest und eine Bestimmung des BNP-Wertes im Blut. Zwölf Monate nach TAVI wurden diese Untersuchungen mit Ausnahme des Herzkatheters wiederholt. Die Auswertung basiert zum einen auf einer echokardiographischen Einteilung der Studienpopulation in vier Gruppen in Anlehnung an den transvalvulären Fluss (Low-Flow=SVi<35ml/min) und Gradienten (Low-Gradient<40mmHg). Ein weiterer Schwerpunkt der Erhebung wurde auf das Outcome dieser Patienten nach einem Jahr gelegt.
Ergebnisse: Bei 57% der Patienten lag eine klassische High-Flow/High-Gradient AS vor. Dagegen fand sich bei 30% eine Low-Gradient Physiologie. In der präoperativen MRT-Untersuchung zeigten sich mit einer Ausprägung von 85% LE-positive Areale, im Sinne einer myokardialen Fibrose. Diese war unabhängig von Fluss und Gradienten gleichermaßen in allen Gruppen vorhanden. In der Kontrolluntersuchung zwölf Monate postoperativ war kein signifikanter Rückgang der Fibrose zu verzeichnen. Bei Patienten mit einer Low-Flow/High-Gradient Physiologie wurde ein gehäuftes Auftreten von Synkopen beobachtet (46%).
Der periprozedurale Erfolg der TAVI, das 30-Tage Überleben und die kardialen Komplikationen nach einem Jahr, waren ebenso unabhängig von der Gruppenzugehörigkeit. Eine signifikante Verbesserung des klinischen Outcomes, zeigte sich lediglich in der High-Flow/High-Gradient Gruppe anhand einer Steigerung der Wegstrecke im 6-Minuten Gehtest.
Schlußfolgerung: Die Prävalenz der Low-Gradient AS ist in der vorliegenden Kohorte mit 30% relativ hoch. Es ist daher von Bedeutung sich im klinischen Alltag mit den hämodynamischen Besonderheiten dieser Entität vertraut zu machen. Patienten mit hohem Gradienten zeigten eine signifikante Verbesserung in Bezug auf das klinische Outcome. Dennoch war in der Low-Flow/Low-Gradient Gruppe keine erhöhte Mortalität oder Komplikationsrate nach TAVI zu erkennen, sodass abschließend festgehalten werden kann, dass eine TAVI für diese Patienten ein erfolgreiches Therapiekonzept darstellt.
In Magnetic Resonance Imaging (MRI), acquisition of dynamic data may be highly complex due to rapid changes occurred in the object to be imaged. For clinical diagnostic, dynamic MR images require both high spatial and temporal resolution. The speed in the acquisition is a crucial factor to capture optimally dynamics of the objects to obtain accurate diagnosis. In the 90’s, partially parallel MRI (pMRI) has been introduced to shorten scan times reducing the amount of acquired data. These approaches use multi-receiver coil arrays to acquire independently and simultaneously the data.
Reduction in the amount of acquired data results in images with aliasing artifacts. Dedicated methods as such Sensitivity Encoding (SENSE) and Generalized Autocalibrating Partially Parallel Acquisition (GRAPPA) were the basis of a series of algorithms in pMRI.
Nevertheless, pMRI methods require extra spatial or temporal information in order to optimally reconstruct the data. This information is typically obtained by an extra scan or embedded in the accelerated acquisition applying a variable density acquisition scheme.
In this work, we were able to reduce or totally eliminate the acquisition of the training data for kt-SENSE and kt-PCA algorithms obtaining accurate reconstructions with high temporal fidelity.
For dynamic data acquired in an interleaved fashion, the temporal average of accelerated data can generate an artifact-free image used to estimate the coil sensitivity maps avoiding the need of extra acquisitions. However, this temporal average contains errors from aliased components, which may lead to signal nulls along the spectra of reconstructions when methods like kt-SENSE are applied. The use of a GRAPPA filter applied to the temporal average reduces these errors and subsequently may reduce the null components in the reconstructed data. In this thesis the effect of using temporal averages from radial data was investigated. Non-periodic artifacts performed by undersampling radial data allow a more accurate estimation of the true temporal average and thereby avoiding undesirable temporal filtering in the reconstructed images. kt-SENSE exploits not only spatial coil sensitivity variations but also makes use of spatio-temporal correlations in order to separate the aliased signals. Spatio-temporal correlations in kt-SENSE are learnt using a training data set, which consists of several central k-space lines acquired in a separate scan. The scan of these extra lines results in longer acquisition times even for low resolution images. It was demonstrate that limited spatial resolution of training data set may lead to temporal filtering effects (or temporal blurring) in the reconstructed data.
In this thesis, the auto-calibration for kt-SENSE was proposed and its feasibility was tested in order to completely eliminate the acquisition of training data. The application of a prior TSENSE reconstruction produces the training data set for the kt-SENSE algorithm. These training data have full spatial resolution. Furthermore, it was demonstrated that the proposed auto-calibrating method reduces significantly temporal filtering in the reconstructed images compared to conventional kt-SENSE reconstructions employing low resolution training images. However, the performance of auto-calibrating kt-SENSE is affected by the Signal-to-Noise Ratio (SNR) of the first pass reconstructions that propagates to the final reconstructions.
Another dedicated method used in dynamic MRI applications is kt-PCA, that was first proposed for the reconstruction of MR cardiac data. In this thesis, kt-PCA was employed for the generation of spatially resolved M0, T1 and T2 maps from a single accelerated IRTrueFISP or IR-Snapshot FLASH measurement. In contrast to cardiac dynamic data, MR relaxometry experiments exhibit signal at all temporal frequencies, which makes their reconstruction more challenging. However, since relaxometry measurements can be represented by only few parameters, the use of few principal components (PC) in the kt-PCA algorithm can significantly simplify the reconstruction. Furthermore, it was found that due to high redundancy in relaxometry data, PCA can efficiently extract the required information from just a single line of training data.
It has been demonstrated in this thesis that auto-calibrating kt-SENSE is able to obtain high temporal fidelity dynamic cardiac reconstructions from moderate accelerated data avoiding the extra acquisition of training data. Additionally, kt-PCA has been proved to be a suitable method for the reconstruction of highly accelerated MR relaxometry data.
Furthermore, a single central training line is necessary to obtain accurate reconstructions. Both reconstruction methods are promising for the optimization of training data acquisition and seem to be feasible for several clinical applications.
The high infection rates and recent emergence of extremely drug resistant forms of
Mycobacterium tuberculosis pose a significant challenge for global health. The NADH-
dependent enoyl-ACP-reductase InhA of the type II mycobacterial fatty acid biosynthesis
pathway is a well-validated target for inhibiting mycobacterial growth. InhA has been
shown to be inhibited by a variety of compound series. Prominent classes of InhA
inhibitors from literature include diaryl ethers, pyrrolidine carboxamides and arylamides
which can be subjected to further development. Despite the progress in this area, very
few compounds are in clinical development phase. The present work involves a detailed
computational investigation of the binding modes and structure-based optimisation of
pyrrolidine carboxamides as InhA inhibitors.
With substituents of widely varying bulkiness, the pyrrolidine carboxamide dataset
presented a challenge for prediction of binding mode as well as affinity. Using advanced
docking protocols and in-house developed pose selection procedures, the binding modes
of 44 compounds were predicted. The poses from docking were used in short molecular
dynamics (MD) simulations to ascertain the dominant binding conformations for the
bulkier members of the series. Subsequently, an activity-based classification strategy
could be developed to circumvent the affinity prediction problems observed with this
dataset. The prominent motions of the bound ligand and the active site residues were
then ascertained using Essential Dynamics (ED). The information from ED and literature
was subsequently used to design a total of 20 compounds that were subjected to extensive
in-silico evaluations. Finally, the molecular determinants of rapid-reversible binding of
pyrrolidine carboxamides were investigated using long MD simulations.
Die Einlösung und Realisierung hochwertiger Bildungsangebote für alle SchülerInnen sind wesentliche Gelingensbedingungen schulischer Inklusion. Individualisierte Curricula reichen für eine nachhaltige, inklusive Erziehung und Bildung in heterogenen Klassen alleine nicht aus. Dringend benötigt wird ein Unterricht, der den SchülerInnen mit ihren unterschiedlichen Bildungs-, Erziehungs- und Lernbedürfnissen Möglichkeiten der Kooperation an einem gemeinsamen Gegenstand eröffnet.
In Auseinandersetzung mit inklusiven didaktischen Konzepten der Lernwerkstattarbeit und Heil- und Sonderpädagogik werden Zugangsebenen für alle SchülerInnen herausgearbeitet, die den gemeinsamen Gegenstand absichern und ein gemeinsames, sinnstiftendes Lernen ermöglichen. Das Konzept der Zugangsebenen wird theoretisch entwickelt und praktisch dargestellt anhand verschiedener Lernumgebungen zu mathematischen Mustern der Grundschulzeit und darüber hinaus.
Dabei stehen die mathematischen Muster rund um das Pascalsche Dreieck exemplarisch für viele andere gemeinsame Lern- und Bildungsgegenstände, beispielsweise aus der Technik oder Chemie, die weiterhin für heterogene Klassen konzipiert, erprobt und zur Verfügung gestellt werden.
The purpose of the present work was, in the first part, to investigate the potential of iron-based metal complexes in catalytic borylation reactions with alkyl halides as substrates and B2pin2 as the borylation reagent. Moreover, extended studies of the recently reported, copper mediated borylation reactions of aryl halides were performed, including the screening of substrates and alkoxy bases as well as ligand-screening. Investigations were undertaken on the role of Cu-nanoparticles, which might be involved in this catalytic reaction. Furthermore, Cu-phosphine complexes were synthesized as precursors, but attempts to isolate Cu-boryl species which are intermediates in the proposed catalytic cycle were unsuccessful, although 11B NMR evidence for a Cu-boryl complex was obtained.
In the second part of this work, the alternative, Lewis-acidic diboron(4) compound bis(ethylene glycolato)diboron (B2eg2) was synthesized to compare its reactivity with the reactivity of other diboron(4) compounds (e.g. B2neop2, B2cat2, B2pin2 and B2(NMe2)4). Therefore, reactions of B2eg2 with different Lewis-bases, such as NHCs and phosphines, were performed to investigate the possible formation of sp2-sp3 or sp3-sp3 adducts and ring-expansion reactions (RERs).
The aim was to obtain a better general insight into the reactivity of diboron(4) compounds with Lewis-bases because they are both used as reactants in transition metal-catalyzed and metal-free borylation reactions. Understanding the B–B bond activation process promoted by Lewis-bases provides a new perspective on the reaction pathways available for various borylation reactions.
This thesis will outline studies performed on the fluorescence dynamics of phenyl-benzo-
[c]-tetrazolo-cinnolium chloride (PTC) in alcoholic solutions with varying viscosity using
time-resolved fluoro-spectroscopic methods. Furthermore, the properties of femtosecond
Laguerre-Gaussian (LG) laser pulses will be investigated with respect to their temporal
and spatial features and an approach will be developed to measure and control the spatial
intensity distribution on the time scale of the pulse.
Tetrazolium salts are widely used in biological assays for their low oxidation and reduction
thresholds and spectroscopic properties. However, a neglected feature in these applications
is the advantage that detection of emitted light has over the determination of the
absorbance. To corroborate this, PTC as one of the few known fluorescent tetrazolium
salts was investigated with regard to its luminescent features. Steady-state spectroscopy
revealed how PTC can be formed by a photoreaction from 2,3,5-triphenyl-tetrazolium
chloride (TTC) and how the fluorescence quantum yield behaved in alcoholic solvents
with different viscosity. In the same array of solvents time correlated single photon counting
(TCSPC) measurements were performed and the fluorescence decay was investigated.
Global analysis of the results revealed different dynamics in the different solvents, but
although the main emission constant did change with the solvent, taking the fluorescence
quantum yield into consideration resulted in an independence of the radiative rate from
the solvent. The non-radiative rate, however, was highly solvent dependent and responsible
for the observed solvent-related changes in the fluorescence dynamics. Further studies
with the increased time resolution of femtosecond fluorescence upconversion revealed an
independence of the main emission constant from the excitation energy, however the dynamics
of the cooling processes prior to emission were prolonged for higher excitation
energy. This led to a conceivable photoreaction scheme with one emissive state with a
competing non-radiative relaxation channel, that may involve an intermediate state.
LG laser beams and their properties have seen a lot of scientific attention over the past two
decades. Also in the context of new techniques pushing the limit of technology further to
explore new phenomena, it is essential to understand the features of this beam class and
check the consistency of the findings with theoretical knowledge. The mode conversion
of a Hermite-Gaussian (HG) mode into a LG mode with the help of a spiral phase plate
(SPP) was investigated with respect to its space-time characteristics. It was found that
femtosecond LG and HG pulses of a given temporal duration share the same spectrum
and can be characterized using the same well-established methods. The mode conversion
proved to only produce the desired LG mode with its characteristic orbital angular momentum
(OAM), that is conserved after frequency doubling the pulse. Furthermore, it
was demonstrated that temporal shaping of the HG pulse does not alter the result of its
mode-conversion, as three completely different temporal pulse shapes produced the same
LG mode. Further attention was given to the sum frequency generation of fs LG beams
and dynamics of the interference of a HG and a LG pulse. It was found that if both are
chirped with inverse signs the spatial intensity distribution does rotate around the beam
axis on the time scale of the pulse. A strategy was found that would enable a measurement
of these dynamics by upconversion of the interference with a third gate pulse. The results
of which are discussed theoretically and an approach of an experimental realization had
been made. The simulated findings had only been reproduced to a limited extend due to
experimental limitations, especially the interferometric stability of the setup.
Persönlichkeit wird zum einen durch genetische Einflüsse, zum anderen durch Erziehung und Umweltfaktoren geprägt. In heutigen Tagen ist es weitestgehend akzeptiert, dass das menschliche Naturell und die Persönlichkeit durch vielfältige genetische Faktoren beeinflusst werden. In der vorliegenden Arbeit wurde eine Genotypisierung an einer Patientenstichprobe, bestehend aus Patienten der Universitätsklinik Würzburg, mit der gesicherten Diagnose einer Persönlichkeitsstörung, und einem Kollektiv aus gesunden Probanden (Bevölkerungskollektiv) durchgeführt. Es wurden zwei verschiedene Gen-Polymorphismen (rs7275707 und rs722557) des Kandidatengens KCNJ6 hinsichtlich ihrer Beteiligung an Persönlichkeitsstörungen untersucht. Das von diesem Gen codierte Protein ist ein G-protein aktivierter einwärtsgleichrichtender Kaliumkanal (GIRK2). Es konnte zwar ein signifikanter Zusammenhang zwischen einem Single-Nukleotid-Polymorphismus (SNP) in dem Kandidatengen KCNJ6 und der antisozialen sowie Borderline-Persönlichkeitsstörung nachgewiesen werden, die molekulargenetischen Entstehungswege bis hin zur phänotypischen Ausprägung der Persönlichkeitsstörung sind allerdings multifaktoriell und an viele Rezeptor- und Neurotransmittersysteme gekoppelt. Der Ursprung kann auf den Austausch bzw. die Variation einer einzelnen Base im DNA-Strang zurückgeführt werden, im Ganzen betrachtet bleiben die Entstehung der Persönlichkeit und die daran gekoppelten Störungen aber ein multidimensionaler Prozess.
In the context of quantum mechanical calculations, the properties of non-adiabatic coupling in a small system, the Shin-Metiu model, is investigated.
The transition from adiabatic to non-adiabatic dynamics is elucidated in modifying the electron-nuclear interaction. This allows the comparison of weakly correlated electron-nuclear motion with the case where the strong correlations determine the dynamics.
The studies of the model are extended to include spectroscopical transitions being present in two-dimensional and degenerate four-wave mixing spectroscopy.
Furthermore, the quantum and classical time-evolution of the coupled motion in the complete electron-nuclear phase space is compared for the two coupling cases.
Additionally, the numerically exact electron flux within the weak coupling case is compared to the Born-Oppenheimer treatment.
In the last part of the thesis, the model is extended to two dimensions.
The system then possesses potential energy surfaces which exhibit a typical 'Mexican hat'-like structure and a conical intersection in the adiabatic representation.
Thus, it is possible to map properties of the system onto a vibronic coupling (Jahn-Teller) hamiltonian. Exact wave-packet propagations as well as nuclear wave-packet dynamics in the adiabatic and diabatic representation are performed.
Humans are continuously exposed to airborne spores of the saprophytic fungus Aspergillus fumigatus. In healthy individuals, local pulmonary host defence mechanisms can efficiently eliminate the fungus without any overt symptoms. In contrast, A. fumigatus causes devastating infections in immunocompromised patients. However, local host immune responses against A. fumigatus lung infections in immunocompromised conditions have remained largely elusive.
Given the dynamic changes in immune cell subsets within tissues upon immunosuppressive therapy, we dissected the spatiotemporal pulmonary immune response after A. fumigatus infection to reveal basic immunological events that fail to effectively control the invasive fungal disease. In different immunocompromised murine models, myeloid but not lymphoid cells were strongly recruited upon infection. Notably, neutrophils and macrophages were recruited to infected lungs in different immunosuppressed regimens. Other myeloid cells, particularly dendritic cells and monocytes were only recruited in the corticosteroid model after infection. Lymphoid cells, particularly CD4+ or CD8+ T-cells and NK cells were highly reduced upon immunosuppression and were not recruited after A. fumigatus infection. Importantly, adoptive CD11b+ myeloid cell transfer rescued immunosuppressed mice from lethal A. fumigatus infection. These findings illustrate that CD11b+ myeloid cells are critical for anti-A. fumigatus defence under immunocompromised conditions.
Despite improved antifungal agents, invasive A. fumigatus lung infections cause a high rate morbidity and mortality in neutropenic patients. Granulocyte transfusions have been tested as an alternative therapy for the management of high-risk neutropenic patients with invasive A. fumigatus infections. To increase the granulocyte yield for transfusion, donors are treated with corticosteroids. Yet, the efficacy of granulocyte transfusion and the functional defence mechanisms of granulocytes collected from corticosteroid treated donors remain largely elusive.
We aimed to assess the efficacy of granulocyte transfusion and functional defence mechanisms of corticosteroid treated granulocytes using mouse models.
In this thesis, we show that transfusion of granulocytes from corticosteroid treated mice did not protect cyclophosphamide immunosuppressed mice against lethal A. fumigatus infection in contrast to granulocytes from untreated mice. Upon infection, increased levels of inflammatory cytokines helped to recruit granulocytes to the lungs without any recruitment defects in corticosteroid treated and infected mice or in cyclophosphamide immunosuppressed and infected mice that have received the granulocytes from corticosteroid treated mice. However, corticosteroid treated human or mouse neutrophils failed to form neutrophil extracellular traps (NETs) in in vitro and in vivo conditions. Further, corticosteroid treated granulocytes exhibited impaired ROS production against A. fumigatus. Notably, corticosteroids impaired the β-glucan receptor Dectin-1 (CLEC7A) on mouse and human granulocytes to efficiently recognize and phagocytize A. fumigatus, which markedly impaired fungal killing. We conclude that corticosteroid treatment of granulocyte donors for increasing neutrophil yields or patients with ongoing corticosteroid treatment could result in deleterious effects on granulocyte antifungal functions, thereby limiting the benefit of granulocyte transfusion therapies against invasive fungal infections.
Die Reaktivität acyclischer Carbene, N-heterocyclischer Silylene und Germylene gegenüber verschiedenen Boranen sowie die weitere Reaktivtät der erhaltenen Verbindungen wird untersucht. Im zweiten Teil wird die Darstellung und Reaktiviert einiger Thorium- und Lanthanoidhydridoboratkomplexe genauer beleuchtet.
Abstract
Background: Attention-deficit/ hyperactivity disorder (ADHD) ranges among the most common neurodevelopmental disorders worldwide with a prevalence of 3-12% in childhood and 1-5% for adults. Over the last decade extensive genetic research has been conducted in order to determine its causative genetic factors. None of the so far identified susceptibility genes, however, could explain the estimated ADHD heritability of 76%. In this thesis one of the most promising candidates -Cadherin 13 (Cdh13) - was examined in terms of its influence on the central serotonergic (5-HT) system. In addition to that, the Cdh13 protein distribution pattern was analysed over time.
Methods: The developing serotonergic system was compared over three embryonic and postnatal stages (E13.5, E17.5 and P7) in different Cdh13 genotypes (WT, HZ and KO) using immunohistochemistry and various double staining protocols.
Results: The raphe nuclei of the 5-HT system develop in spite of Cdh13 absence and show a comparable mature constellation. The cells in the KO, however, are slightly more scattered than in the WT. Furthermore the dynamics of their formation is altered, with a transient delay in migration at E13.5. In early developmental stages the total amount of serotonergic cells is reduced in KO and HZ, though their proportional distribution to the raphe nuclei stays constant. Strikingly, at P7 the absolute numbers are comparable again.
Concerning the Cdh13 protein, it shows high concentrations on fibres running through hindbrain and midbrain areas at E13.5. This, however, changes over time, and it becomes more evenly spread until P7. Furthermore, its presence in serotonergic cells could be visualised using confocal microscopy. Since the described pattern is only in parts congruent to the localisation of serotonergic neurons, it is most likely that Cdh13 is present in other developing neurotransmitter systems, such as the dopaminergic one, as well.
Conclusion: It could be proven that Cdh13 is expressed in serotonergic cells and that its knockout does affect the developing serotonergic system to some degree. Its absence, however, only slightly and transiently affects the measured parameters of serotonergic system development, indicating a possible compensation of CDH13 function by other molecules in the case of Cdh13 deficiency. In addition further indicators could be found for an influence of Cdh13 on outgrowth and path finding of neuronal processes.
Patientencharakteristik und Einsatzlogistik beim Interhospitaltransport kritisch kranker Patienten
(2018)
Der steigende Bedarf an Interhospitaltransporten, erforderte die Einführung einer zusätzlichen Transportoption für den arztbegleiteten Patiententransport in Bayern. Mit der Überarbeitung des Bayerischen Rettungsdienstgesetzes wurde die gesetzliche Grundlage für die Einführung und Tätigkeit des Verlegungsarztes (VA) in Bayern geschaffen. Dem voraus ging eine Analyse des Instituts für Notfallmedizin und Medizinmanagement München im Auftrag des Freistaats Bayern, die in verschiedenen Szenarien ermitteln sollte, wie der hohen Nachfrage an arztbegleiteten Verlegungen ohne die Einführung weiterer Intensivtransportmittel begegnet werden kann. Die vom Gesetzgeber beschlossene Variante war das Rendezvous-System aus VEF und RTW.
Ziel der vorliegenden Dissertation war es, den Intensivtransportwagen (ITW) und das Verlegungsarzteinsatzfahrzeug (VEF) hinsichtlich ihrer Einsatz- und Patientenstruktur zu analysieren und näher zu beschreiben. Des Weiteren sollte untersucht werden, ob sich durch die Anwendung der überarbeiteten Alarmierungsstrukturen Unterversorgungen und damit potenzielle Patientenschädigungen verhindern ließen.
Zu diesem Zweck, wurden retrospektiv mehr als 1500 Datensätze ausgewertet, die in einem Zeitraum von über zwei Jahren zur Qualitätssicherung prospektiv gesammelt wurden. Die beiden Transportvarianten (ITW oder VA+RTW) unterscheiden sich durch die personelle und materielle Ausstattung und sollten deshalb zielgerichtet zur Anwendung kommen.
Die Patienten-Fahrzeug-Zuteilung, wie sie durch den von Wurmb et al. konstruierten Algorithmus, sowie den neueingeführten Indikationskatalog erfolgte, fand in mehr als 90% der Fälle im Arzt-zu-Arzt-Gespräch Bestätigung, und ermöglichte dementsprechend eine zuverlässige, schnelle und gut anwendbare Einsatzdisposition. Fehldispositionen wurden sicher verhindert. ITW und VEF wurden meist zur lückenlosen Fortführung einer Intensivtherapie, und zu etwa gleichgroßen Anteilen für disponible und nicht-disponible Transporte eingesetzt. Auch wenn der Transport von Intensivpatienten mittels VA eine Ausnahme bleiben muss, so konnte doch gezeigt werden, dass eine Verlegung von invasiv beatmeten oder katecholaminpflichtigen Patienten nicht automatisch eine Unterversorgung zur Folge hat. Die Patienten des Intensivtransportwagens waren insgesamt schwerer erkrankt, deutlich häufiger invasiv beatmet oder katecholaminpflichtig als die VA-Patienten. Eine Patientengefährdung oder Schädigung konnte aus keinem der dokumentierten Fällen ermittelt werden.
Da sich beide Transportmittel im täglichen Routinebetrieb gut ergänzen, erscheint es sinnvoll an der dualen Struktur des arztbesetzten bodengebundenen Patiententransports festzuhalten.
Der Stellenwert des Interhospitaltransfers wird voraussichtlich auch in Zukunft weiter steigen, da die Bildung von Regionalen Behandlungsnetzwerken, sowie die zunehmende Spezialisierung von Fachkliniken einen erhöhten Austausch von Patienten zwischen unterschiedlichen Behandlungseinrichtungen erfordert. Aus diesem Grund wäre es notwendig in regelmäßigen Abständen die Situation des arztbegleiteten Patiententransports zu analysieren, sowohl um Optimierungsbedarf zu entdecken, als auch um Versorgungsengpässe, wie sie in der Vergangenheit zu verzeichnen waren, vorzubeugen. Mit den vorliegenden Ergebnissen stellt sich abschließend die Frage, ob das in Bayern erfolgreiche System, auch auf weitere Bundesländer übertragen werden könnte. Diese Arbeit könnte als Grundlage weiterer Untersuchungen dienen, um die Qualität und Effizienz des ärztlich begleiteten Patiententransports weiter zu verbessern.
Aktivierung des MEK5/ Erk5-Signalwegs durch inhibitorische Substanzen des Mevalonatstoffwechsels
(2018)
Die Osteoporose ist eine Erkrankung, die durch verminderte Dichte und erhöhte Fragilität des Knochens gekennzeichnet ist. Sie zählt zu den häufigsten Erkrankungen weltweit und geht mit erheblicher Einschränkung der Lebensqualität und erhöhter Mortalität einher. Eine Behandlungsmöglichkeit dieses schwerwiegenden Krankheitsbilds ist die Therapie mit Bisphosphonaten. Diese hemmen mit ihren antiresorptiven Eigenschaften den Knochenabbau und fördern vermutlich gleichzeitig den Knochenaufbau. Obwohl schon lange die Wirkungsweise der Bisphosphonate erforscht wird, ist noch nicht sicher geklärt, wie beispielsweise osteoanabole oder antitumoröse Effekte vermittelt werden. Einen Erklärungsansatz bietet der MEK5/ Erk5-Signalweg. Diesem werden unter anderem antiangiogenetische, antiinflammatorische und antiproliferative Eigenschaften zugesprochen. In früheren Studien konnte gezeigt werden, dass Statine Erk5 und Erk5-abhängige Gene aktivieren können. Statine wiederum inhibieren ebenfalls den Mevalonatstoffwechsel, jedoch weiter upstream als Bisphosphonate. Da Statine zudem osteoanabole Effekte aufweisen, lag die These nahe, dass auch Bisphosphonate ihre Wirkung über den MEK5/Erk5-Signalweg vermitteln könnten. Die These konnte im Rahmen dieser Arbeit bestätigt werden: Stickstoffhaltige, nicht aber stickstofffreie Bisphosphonate aktivieren Erk5 sowohl in Endothelzellen als auch in Osteoblasten. Es gilt jedoch zu bedenken, dass eine Weiterentwicklung der Substanzen mit verbesserter Aufnahme in die Zelle zur Vermeidung von Apoptose-Induktion anzustreben ist.
Des Weiteren konnte gezeigt werden, dass ein Knock-down der FDPS, dem Angriffspunkt der Bisphosphonate im Mevalonatstoffwechsel, ebenfalls eine Erk5-Phosphorylierung zur Folge hat. Durch Inhibition der FDPS wird die Prenylierung kleiner G-Proteine wie Cdc42 unterbunden, was eine veränderte Funktion der Proteine zur Folge hat. Ein Knock-down von Cdc42 mittels siRNA führt wiederum zu einer Aktivierung von Erk5. Auf diese Weise wurde nicht nur ein neuer Wirkungsweg der Bisphosphonate identifiziert, sondern auch ein möglicher Aktivierungsmechanismus der MEK5/ Erk5-Signalkaskade aufgedeckt.
Erk5 wandert nach seiner Aktivierung in den Zellkern und beeinflusst dort die Genexpression. Im Rahmen dieser Arbeit wurden knochenrelevante Gene identifiziert, die durch Zoledronat-Stimulation induziert werden konnten. Zu diesen zählen INPP4B, das die Osteoklastogenese inhibiert, und PTHLH sowie FOSL1, welche die Osteoblastogenese fördern. Somit kann davon ausgegangen werden, dass die Aktivierung des MEK5/ Erk5-Signalwegs durch Zoledronat eine Geninduktion zur Folge hat, die sowohl die osteoanabole Wirkung unterstützt, als auch die katabolen Effekte hemmt. Auf diese Weise konnte neben den bereits bekannten Wirkungswegen der Bisphosphonate ein neuer identifiziert werden, der auch einen möglichen Ansatz für weitere, bisher ungeklärte Effekte von Bisphosphonaten darstellt.
Bei Prostatakrebspatienten zeigte sich eine niedrige Tendenz zu Benefit Finding am Behandlungsbeginn und drei Monate später (Mt1 = 2,87; SDt1 = 0,96; Mt2 = 2,92; SDt2 = 0,94). Die gesundheitsbezogene Lebensqualität sank dagegen im Verlauf der 12 Wochen nach Therapiebeginn deutlich (Mt1 = 74,06; SDt1 = 18,70; Mt2 = 70,81; SDt2 = 19,19). Benefit Finding und gesundheitsbezogene Lebensqualität korrelierten zu beiden Untersuchungsterminen jeweils schwach negativ miteinander. Der Zusammenhang beider Variablen war jedoch in Regressionsanalysen für den zeitlichen Verlauf über drei Monate nicht reproduzierbar. Zusammenfassend muss deshalb postuliert werden, dass sich Benefit Finding unmittelbar bei Therapiebeginn für Prostatatkrebspatienten nicht als Prädiktor für verbesserte Lebensqualität nach drei Monaten eignet und vice versa.
The analysis of how a general change, an economic shock and a modified institutional framework condition affect the HRM process, provide the motivation for the present dissertation. Thereby, the dissertation concentrates on certain areas of the HRM process, namely compensation, further training and retention, as well as changes and challenges that have been subject to a high degree of public interest in recent years. It consists of three essays, all self-contained and independently readable.
The first essay investigates whether it is possible to keep employees in the establishment by offering further training measures. Therefore, this essay uses a comparison group approach and compares only training participants with those employees who had been selected by the employer to participate in training but had to cancel it for exogenous reasons. From a methodological point of view, by means of Fixed Effects and Diff GMM estimations, the essay also controls for time-variant and invariant unobserved heterogeneity as well as endogeneity of training participation. By simultaneously considering the components from the human capital theory as well as the monopsony theory, the essay shows that portability of general human capital contents and visibility of training, induced by training certificates, independently reduce the retention effect of training. The negative effect is much stronger if training is certified by external institutions and therefore credible. In addition, the effects of visibility and portability are distinct and thus also reduce the retention effect of training separately. However, the total effect of portable, visible and credible training on retention is still positive. Therefore, further training appears to be an effective measure to keep the qualified employees in the establishment.
Second, the attention is on a short-term unpredictable economic shock: Essay 2 analyses whether and to what extent the Great Recession in 2008 and 2009 has had an impact on the individual training behaviour in establishments. From a theoretical point of view, the effects of the crisis on establishments' training activities are ambiguous. On the one hand, the reduced opportunity costs of training argue more in favour of an increase in further training. On the other hand, economic theory suggests decreasing training activities in the crisis because of reduced financial resources, uncertain future prospects, and, therefore, unclear returns on training. Using Difference-in-Differences analyses, this essay avoids endogeneity problems caused by unobservable third factors. The Great Recession in 2008 and 2009 can be seen as an exogenous and time-limited shock: this quasi-experimental setting helps to reveal the causal impact of the crisis on the training intensity and the number of training measures. Results indicate that there is a direct effect of the crisis on individual training activities in 2009 and 2010. This effect is stronger for unskilled employees than for employees with higher skill levels. Furthermore, the negative effect sets in with a time lag and lasts until the year 2010 (although there is already an economic upswing). Numerous analyses are used to check additional heterogeneities in training activities for other employee groups.
Among others, particularly the area of executive compensation was affected by the economic crisis and the ensuing regulations in institutional framework conditions. The third essay of this dissertation deals with the question whether these changes had an impact on the compensation level and structure of executive board members. The focus is on the extent to which executive compensation is converging within and between different exchange segments in Germany. Based on a sample of CEOs and non-CEOs of German DAX and MDAX establishments, the evolution of executive compensation levels and structures (i.e., fractions of base pay, short- and long-term incentives) are examined during the period from 2006 until 2012. The results of descriptive as well as multivariate Fixed Effects analyses indicate isomorphism of both, pay levels and pay structures within (intra-segment-convergence) and between (inter-segment convergence) stock exchange segments especially for CEOs. However, for the other members of the management board (non-CEOs), there is only a convergence of the compensation structure within the segments. The results do not indicate either intra- or inter-segment convergence of salary levels.
Altogether, the three essays of this dissertation provide a selection of the current changes and challenges that HRM has to deal with. From a methodological perspective, all three essays use different applied econometric estimation strategies. In order to eliminate estimation problems caused by time-invariant and variant unobserved heterogeneity and endogeneity, Fixed Effects, Diff GMM as well as Difference-in-Differences approaches are applied. In addition, sample selection, research design as well as identification strategy attempts to avoid estimation bias. The first two essays are based on a linked-employer-employee panel data set and adopt a personnel economic perspective. The third essay uses establishment-level data and is based on institutional theory. The first essay was written in cooperation with Thomas Zwick and the third essay was written in cooperation with Nathalie Haidegger-Rieß and Robert Wagner.
Die miR-146b Expression war signifikant supprimiert im Prostatakarzinomgewebe im Vergleich zum benignen Prostatahyperplasiegewebe. Dies konnte anhand eines Prostatakarzinompatientenkollektivs signifikant nachgewiesen werden. Nach ektoper Steigerung der miR-146b Expression in LNCaP-Zellen mittels transienter Transfektion zeigte sich eine signifikante Proliferationsinhibierung. N-Ras konnte als direktes Target der miR-146b nachgewiesen werden: mittels qRT-PCR zeigte sich eine inverse Expression von miR-146b und N-Ras in transfizierten LNCaP-Zellen. Der Luciferase-Assay bestätigte N-Ras als direktes Target der miR-146b. Die Targetbeziehung von N-Ras und miR-146b konnte auch in vivo (Prostatakarzinompatientenkollektiv) bestätigt werden.
Die Rolle der B-Linien gestützten Lungensonographie in der Differentialdiagnostik der akuten Dyspnoe
(2018)
Die akute Dyspnoe ist ein häufiger Aufnahmegrund für Patienten in einer internistischen Notaufnahme. Die für eine schnelle Behandlung notwendige Differenzierung zwischen pulmonalen Ursachen wie einer akut exazerbierten COPD und kardialen Ursachen wie der akuten, dekompensierten Herzinsuffizienz ist dabei initial oftmals nicht sicher möglich. Weit verbreitet in der Diagnostik ist das Röntgenbild des Thorax, welches jedoch einige Zeit in Anspruch nimmt und oftmals nicht unmittelbar nach Aufnahme durchgeführt werden kann. Weitere Instrumente, wie die körperliche Untersuchung und genaue Anamnese sind wichtig, oft aber auch nicht eindeutig. Nicht zuletzt leiden zahlreiche Patienten an mehreren Krankheiten gleichzeitig. Insbesondere bei COPD- Patienten zeigen sich häufig gleichzeitig auch kardiale Symptomatiken.
Eine Möglichkeit zur schnellen Differenzierung zwischen pulmonalen und kardialen Dyspnoeursachen stellt die Lungensonographie mit der Frage nach dem Vorhandensein und der Anzahl von B-Linien dar. Dabei handelt es sich um Ultraschallartefakte, die vermutlich an den Grenzflächen von Wasser und Luft entstehen und ein Hinweis auf Flüssigkeit in der Lunge darstellen. In der hier vorliegenden Untersuchung konnten durch den Autor in der internistischen Notaufnahme der Universitätsklinik Würzburg 39 Patienten, die mit einer Dyspnoesymptomatik aufgenommen wurden, mittels Lungensonographie untersucht werden. Dafür wurde ein kleines, tragbares Gerät mit Sektorschallkopf benutzt. Die Ergebnisse der Lungensonographie wurden mit den Ergebnissen der Röntgenbilder und der Abschlussdiagnose im Entlassbrief verglichen. Es zeigte sich, dass Patienten mit pulmonaler Dyspnoeursache in der Regel keine bzw. nur sehr vereinzelt auftretende B-Linien aufweisen, während kardial dekompensierte Patienten meist zahlreiche und in verschiedenen Schallpositionen vorkommende Artefakte zeigen.
Daneben handelt es sich bei der Lungensonographie um eine leicht zu erlernende, schnell und einfach durchführbare Methode, die schon in der internistischen Notaufnahme direkt beim Patienten anwendbar ist.
In order to mimic the extracellular matrix for tissue engineering, recent research approaches often involve 3D printing or electrospinning of fibres to scaffolds as cell carrier material. Within this thesis, a micron fibre printing process, called melt electrospinning writing (MEW), combining both additive manufacturing and electrospinning, has been investigated and improved. Thus, a unique device was developed for accurate process control and manufacturing of high quality constructs. Thereby, different studies could be conducted in order to understand the electrohydrodynamic printing behaviour of different medically relevant thermoplastics as well as to characterise the influence of MEW on the resulting scaffold performance.
For reproducible scaffold printing, a commonly occurring processing instability was investigated and defined as pulsing, or in extreme cases as long beading. Here, processing analysis could be performed with the aim to overcome those instabilities and prevent the resulting manufacturing issues. Two different biocompatible polymers were utilised for this study: poly(ε-caprolactone) (PCL) as the only material available for MEW until then and poly(2-ethyl-2-oxazoline) for the first time. A hypothesis including the dependency of pulsing regarding involved mass flows regulated by the feeding pressure and the electrical field strength could be presented. Further, a guide via fibre diameter quantification was established to assess and accomplish high quality printing of scaffolds for subsequent research tasks.
By following a combined approach including small sized spinnerets, small flow rates and high field strengths, PCL fibres with submicron-sized fibre diameters (fØ = 817 ± 165 nm) were deposited to defined scaffolds. The resulting material characteristics could be investigated regarding molecular orientation and morphological aspects. Thereby, an alignment and isotropic crystallinity was observed that can be attributed to the distinct acceleration of the solidifying jet in the electrical field and by the collector uptake. Resulting submicron fibres formed accurate but mechanically sensitive structures requiring further preparation for a suitable use in cell biology. To overcome this handling issue, a coating procedure, by using hydrophilic and cross-linkable star-shaped molecules for preparing fibre adhesive but cell repellent collector surfaces, was used.
Printing PCL fibre patterns below the critical translation speed (CTS) revealed the opportunity to manufacture sinusoidal shaped fibres analogously to those observed using purely viscous fluids falling on a moving belt. No significant influence of the high voltage field during MEW processing could be observed on the buckling phenomenon. A study on the sinusoidal geometry revealed increasing peak-to-peak values and decreasing wavelengths as a function of decreasing collector speeds sc between CTS > sc ≥ 2/3 CTS independent of feeding pressures. Resulting scaffolds printed at 100 %, 90 %, 80 % and 70 % of CTS exhibited significantly different tensile properties, foremost regarding Young’s moduli (E = 42 ± 7 MPa to 173 ± 22 MPa at 1 – 3 % strain). As known from literature, a changed morphology and mechanical environment can impact cell performance substantially leading to a new opportunity of tailoring TE scaffolds.
Further, poly(L-lactide-co-ε-caprolactone-co-acryloyl carbonate) as well as poly(ε-caprolactone-co-acryloyl carbonate) (PCLAC) copolymers could be used for MEW printing. Those exhibit the opportunity for UV-initiated radical cross-linking in a post-processing step leading to significantly increased mechanical characteristics. Here, single fibres of the polymer composed of 90 mol.% CL and 10 mol.% AC showed a considerable maximum tensile strength of σmax = 53 ± 16 MPa. Furthermore, sinusoidal meanders made of PCLAC yielded a specific tensile stress-strain characteristic mimicking the qualitative behaviour of tendons or ligaments. Cell viability by L929 murine fibroblasts and live/dead staining with human mesenchymal stem cells revealed a promising biomaterial behaviour pointing out MEW printed PCLAC scaffolds as promising choice for medical repair of load-bearing soft tissue.
Indeed, one apparent drawback, the small throughput similar to other AM methods, may still prevent MEW’s industrial application yet. However, ongoing research focusses on enlargement of manufacturing speed with the clear perspective of relevant improvement. Thereby, the utilisation of large spinneret sizes may enable printing of high volume rates, while downsizing the resulting fibre diameter via electrical field and mechanical stretching by the collector uptake. Using this approach, limitations of FDM by small nozzle sizes could be overcome. Thinking visionary, such printing devices could be placed in hospitals for patient-specific printing-on-demand therapies one day. Taking the evolved high deposition precision combined with the unique small fibre diameter sizes into account, technical processing of high performance membranes, filters or functional surface finishes also stands to reason.
This work summarizes the results of studies on three major aspects of platelet signaling and of the pathogenesis of immune thrombocytopenia. Therefore, this thesis is divided into three parts. i) Platelet activation and subsequent thrombus formation at sites of vascular injury is crucial for normal hemostasis, but it can also trigger myocardial infarction and stroke. The initial capture of flowing platelets to the injured vessel wall is mediated by the interaction of the glycoprotein (GP) Ib-V-IX complex with von Willebrand factor (vWF) immobilized on the exposed subendothelial extracellular matrix (ECM). The central importance of GPIb for platelet adhesion is well established, whereas GPV is generally considered to be of minor relevance for platelet physiology and thrombus formation. This study intended to clarify the relevance of this receptor during thrombus formation using Gp5-/- mice and mice with different double-deficiencies in GPV and in other platelet receptors. It was found that GPV and the collagen receptor integrin a2b1 have partially redundant functions in collagentriggered platelet aggregation. Further, it was revealed that GPV limits thrombus formation and impairs hemostasis in vivo. The data presented here demonstrate that the protective effect of GPVI-deficiency (another platelet collagen receptor) in arterial thrombosis and ischemic stroke depends on the expression of GPV. Moreover, it was demonstrated that lack of GPV restores the hemostatic function of mice lacking both GPVI and a2b1 or mice lacking GPVI and the C-type lectin receptor 2 (CLEC-2). Conclusively, GPV-depletion or blockade might have the potential to treat hemorrhagic disease states. ii) Platelets contain the two phospholipase (PL) D isoforms, PLD1 and PLD2, both of which presumably become activated upon platelet stimulation. However, the function of PLD in the process of platelet activation and aggregation has not been definitively explored. Thus, PLD-deficient mice were analyzed. Mice lacking PLD1 or PLD2 were viable, fertile and had normal platelet counts. PLD1 was found to be responsible for the inducible PLD-activity in platelets and to contribute to efficient integrin activation under static conditions. Moreover, flow adhesion experiments revealed that PLD1 is essential for efficient GPIb-mediated integrin activation. Consequently, Pld1-/- mice were protected from arterial thrombosis and ischemic brain infarction without affecting tail bleeding times. Hence, inhibition of PLD1 might be a novel approach for antithrombotic therapy. iii) Cellular activation of platelets or immune cells results in increased cytosolic calcium (Ca2+) levels. Store-operated calcium entry (SOCE) via the STIM1-Orai1 axis is the main route of Ca2+ entry downstream of immunoreceptor tyrosine-based activating motif (ITAM) receptor stimulation in mast cells and T cells. However, the requirement of Ca2+-mobilization in Fcg receptor (FcgR)-signaling and the relevance of STIM2 for T cell SOCE have been unclear. To address these questions, genetically modified mice lacking central molecules of the SOCE machinery were analyzed. Ca2+-measurements revealed that both STIM isoforms contribute to Ca2+-mobilization downstream of T cell receptor activation. Additionally, it was found that FcgR stimulation results in SOCE and is mediated by STIM1 and probably Orai1. Animal models of immune thrombocytopenia (ITP) revealed that SOCE is essential for platelet clearance and that both STIM isoforms contribute to the pathology of ITP. Moreover, in this work it was also demonstrated that STIM1 and Orai1 are essential in IgG-mediated systemic anaphylaxis. STIM2 contributes to IgG-mediated, but not to IgE-mediated anaphylaxis. The data indicate that interference with SOCE might become a new strategy to prevent or treat IgG-dependent autoimmune diseases.
Ein adäquater Impfschutz gehört zu den wichtigsten präventiven Maßnahmen für das Personal im Gesundheitsdienst, inklusive der Medizinstudenten. Einerseits werden die Geimpften vor der Ansteckung geschützt, andererseits wird die Übertragung von impfpräventablen Infektionen durch medizinisches Personal auf Patienten vermieden. Im Rahmen des verpflichtenden Praktikums Impfkurs an der Julius-Maximilians-Universität Würzburg wurde von 2004 bis 2014 der Impfstatus von Medizinstudenten im sechsten Semester erfasst.
Das Ziel dieser Arbeit war es, herauszufinden, welchen Impfschutz Medizinstudenten im sechsten Semester an der Universität Würzburg gegen die impfpräventablen Erkrankungen (IPIE) Tetanus, Diphtherie, Pertussis, Masern, Mumps, Röteln, Varizellen und Hepatitis B aufweisen. Dazu wurden von April 2004 bis September 2014 Daten von insgesamt 1388 Medizinstudenten ausgewertet. Im Einzelnen wurden Daten zur Impfanamnese zu allen genannten IPIE ausgewertet, die Erkrankungsanamnese bei Varizellen und serologische Daten zu den IPIE Röteln, Varizellen und Hepatitis B. Die Besonderheit dieser Arbeit ist die Datenerfassung über einen sehr langen Zeitraum und die Verfügbarkeit von anamnestischen Angaben zum Impfstatus als auch die serologi-schen Befunde aus Blutentnahmen, die im Impfkurs durchgeführt wurden. Ergänzend wurde im WS 2014/15 vor Stattfinden des Impfkurses eine Befragung zum Wissensstand und zur Impfmotivation durchgeführt.
Ein hoher Anteil der Studenten hatte keinen den STIKO-Empfehlungen entsprechenden vollständigen Impfstatus gegen die untersuchten IPIE. Der höchste Anteil lag hier bei Pertussis (76%). Etwa ein Viertel der Studenten konnte keine genaue Aussage machen, ob sie eine frühere Varizellenerkrankung durchgemacht hatten. Etwa 5% der Studenten wiesen zudem einen negativen Serostatus für die untersuchten IPIE auf (außer bei Varizellen). Bei Studenten, die keine Impfungen erhalten hatten, waren zu 13% (Masern) bis 68% (Hepatitis B) keine Antikörper nachweisbar. Studenten, die einen den STIKO-Empfehlungen entsprechenden vollständigen Impfstatus bzw. anamnestisch eine frühere Varizellenerkrankung aufwiesen, hatten zu 81% (Hepatitis B) bis 98% (Varizellen) einen positiven Antikörpertiter. Die Geschlechterunterschiede waren beim Röteln-Impfstatus und Röteln-Serostatus am deutlichsten. 30% der Männer hatten bisher keine Röteln-Impfung erhalten und 12% der Männer wiesen einen negativen Röteln-Serostatus auf.
Die Bereitschaft der Studenten, im Impfkurs eine Nachholimpfung durchführen zu lassen, war sehr hoch. So konnten im Impfkurs bestehende Impflücken geschlossen werden. Die Kosten für die Impfstoffe übernahm die Universität Würzburg.
Des Weiteren konnte durch den Fragebogen zum Wissensstand über Impfprävention und zur Impfmotivation nachgewiesen werden, dass die Studenten nicht ausreichend über IPIE informiert sind. Dies wurde besonders dadurch deutlich, dass die Studenten das Ansteckungsrisiko von Hepatitis B mit 64,4% als hoch oder sehr hoch einschätzten und damit überschätzten und die IPIE Varizellen und Pertussis in ihrem Übertragungsrisiko mit 56,2% und 15,1% zu niedrig einschätzten und damit unterschätzten. Interessant ist, dass die Medizinstudenten in der Befragung das Nebenwirkungsrisiko von Impfungen als gering einschätzten. Die Angst vor Nebenwirkungen scheint kaum eine Rolle bei der Entscheidung zu spielen, ob die Medizinstudenten eine Impfung durchführen lassen oder nicht.
In Zusammenschau der Ergebnisse lässt sich sagen, dass es Nachholbedarf zum Erlangen eines den STIKO-Empfehlungen entsprechenden Impfschutzes für Medizinstudenten gibt. An erster Stelle sind die Studenten selbst für ihren Impfstatus verant-wortlich. An zweiter Stelle sollten jedoch die Universität, an der die Studenten ihr Medizinstudium absolvieren, sowie das Lehrkrankenhaus an welchem die Studenten ihre praktische Ausbildung erhalten, sich für den Impfschutz ihrer Studenten verantwortlich fühlen; zum einen im Sinne des Schutzes ihrer Auszubildenden und Praktikanten, zum anderen im Interesse des Schutzes ihrer Patienten vor der Ansteckung mit impfpräventablen Erkrankungen. Medizinstudenten in die Definition „medizinisches Personal“ ein-zuschließen, kann für einen besseren Anschluss an den Betriebsärztlichen Dienst des Lehrkrankenhauses sorgen. Zudem ist die Erstellung von speziellen Impfempfehlungen für Medizinstudenten sinnvoll um einen adäquaten Schutz gegen IPIE zu erzielen. Die Kostenübernahme für Impfungen für Medizinstudenten muss hierfür geklärt werden. Veranstaltungen, wie der verpflichtende Impfkurs an der Universität Würzburg bieten in der medizinischen Ausbildung die doppelte Chance, den Wissensstand von Medizinstudenten über Impfungen und impfpräventable Infektionserkrankungen zu verbessern und Impflücken zu schließen.
A complete simulation system is proposed that can be used as an educational tool by physicians in training basic skills of Minimally Invasive Vascular Interventions. In the first part, a surface model is developed to assemble arteries having a planar segmentation. It is based on Sweep Surfaces and can be extended to T- and Y-like bifurcations. A continuous force vector field is described, representing the interaction between the catheter and the surface. The computation time of the force field is almost unaffected when the resolution of the artery is increased.
The mechanical properties of arteries play an essential role in the study of the circulatory system dynamics, which has been becoming increasingly important in the treatment of cardiovascular diseases. In Virtual Reality Simulators, it is crucial to have a tissue model that responds in real time. In this work, the arteries are discretized by a two dimensional mesh and the nodes are connected by three kinds of linear springs. Three tissue layers (Intima, Media, Adventitia) are considered and, starting from the stretch-energy density, some of the elasticity tensor components are calculated. The physical model linearizes and homogenizes the material response, but it still contemplates the geometric nonlinearity. In general, if the arterial stretch varies by 1% or less, then the agreement between the linear and nonlinear models is trustworthy.
In the last part, the physical model of the wire proposed by Konings is improved. As a result, a simpler and more stable method is obtained to calculate the equilibrium configuration of the wire. In addition, a geometrical method is developed to perform relaxations. It is particularly useful when the wire is hindered in the physical method because of the boundary conditions. The physical and the geometrical methods are merged, resulting in efficient relaxations. Tests show that the shape of the virtual wire agrees with the experiment. The proposed algorithm allows real-time executions and the hardware to assemble the simulator has a low cost.
Fremdschämen or Fremdscham, a negative emotion which arises while observing someone behave inappropriately, comes to fame after the turn of the millennium in german speaking countries. There, they name it literally „other‘s shame“ and it becomes obvious that this emotion happens most commonly while watching TV: reality shows, talent shows and bad comedies. The word even makes it to the dictionaries starting 2009, as its use increases unstoppably in everyday language, starting to get used in more and more situations, seemingly as a synonym of embarrassing or shameful. Still, a look in the emotional research on the subject returns exactly zero results as of 2011, leaving open the question as of what this emotion might be, and what it is not. The present wort aims at explaining not only the phenomenon of Fremdschämen, but also the Emotion behind it - Embarrassment -, at a process level.
Ziel: Die Einblicke in die physiologischen Wachstumsprozesse des Säuglingskopfes, besonders innerhalb des ersten Lebensjahres, sind wichtiger Bestandteil in der Diagnostik und Therapie von Schädeldeformitäten. In der vorliegenden, prospektiv angelegten Longitudinalstudie wurden Wachstumsdurchschnittswerte des Säuglingskopfes in den ersten Lebensmonaten erhoben sowie dynamische Wachstumsprozesse evaluiert.
Material und Methode: Es wurden dreidimensionale stereophotogrammetrische Aufnahmen des Säuglingskopfes von insgesamt 40 Säuglingen mit unauffälliger Kopfform durchgeführt. Die Aufnahmen erfolgten in einem Intervall von 2 Monaten zum 4., 6., 8. und 10. Lebensmonat. Es wurden wachstumsbezogene Variablen (horizontale, sagittale und koronare Zirkumferenz, Länge, Breite, Breite-Längen-Verhältnis CI, Höhe) und symmetriebezogene Variablen (30°Diagonalendifferenz, Ear Offset, anteriorer und posteriorer kranialer Asymmetrieindex) zur Analyse erhoben.
Ergebnisse: Wachstumsbezogene Variablen: Mit Ausnahme des CI nahmen alle wachstumsbezogenen Variablen zum jeweils folgenden Scantermin signifikant zu. Der CI zeigte erst ab dem 6. Lebensmonat eine signifikante Verringerung. Die größte Wachstumsdynamik war zwischen dem 4. und 6. Lebensmonat zu beobachten. Der relative Zuwachs des Gesamtvolumens liegt hier bei 12,94%. Die Werte der männlichen Probanden lagen erwartungsgemäß signifikant über denen der weiblichen Probanden (Ausnahme: CI, Breite und Höhe zum 4. Lebensmonat). Die zeitliche Entwicklung des Gesamtvolumens und der horizontalen Zirkumferenz konnte mithilfe einer nichtlinearen Regression als Wachstumskurve dargestellt werden. Symmetriebezogene Variablen: Bei den symmetriebezogenen Variablen konnten keine signifikanten Veränderungen festgestellt werden.
Schlussfolgerung: In dieser Longitudinalstudie konnten erstmals physiologische Wachstumsprozesse des Kopfes im Säuglingsalter analysiert werden.
Within three self-contained chapters, this dissertation provides new insights into the macroeconomic consequences of income inequality from a global perspective. Following an introduction, which summarizes the main findings and offers a brief overview of trends in income distribution, Chapter 2 evaluates the relationship between the labor share of income and the evolution of aggregate demand. Chapter 3 analyzes the link between income inequality and aggregate saving; and Chapter 4 directly estimates the effect of inequality and public redistribution on economic growth.
During the last decades the number of biologics increased dramatically and several biopharmaceutical drugs such as peptides, therapeutic proteins, hormones, enzymes, vaccines, monoclonal antibodies and antibody-drug conjugates conquered the market. Moreover, administration and local delivery of growth factors has gained substantial importance in the field of tissue engineering. Despite progress that has been made over the last decades formulation and delivery of therapeutic proteins is still a challenge. Thus, we worked on formulation and delivery strategies of therapeutic proteins to improve their biological performance.
Phase I of this work deals with protein stability with the main focus on a liquid protein formulation of the dimeric fusion protein PR-15, a lesion specific platelet adhesion inhibitor. In order to develop an adequate formulation ensuring the stability and bioactivity of PR-15 during storage at 4 °C, a pH screening, a forced degradation and a Design of Experiments (DoE) was performed. First the stability and bioactivity of PR-15 in 50 mM histidine buffer in relation to pH was evaluated in a short-term storage stability study at 25 °C and 40 °C for 4 and 8 weeks using different analytical methods. Additionally, potential degradation pathways of PR-15 were investigated under stressed conditions such as heat treatment, acidic or basic pH, freeze-thaw cycles, light exposure, induced oxidation and induced deamidation during the forced degradation study. Moreover, we were able to identify the main degradation product of PR-15 by performing LC/ESI-MS analysis. Further optimization of the injectable PR 15 formulation concerning pH, the choice of buffer and the addition of excipients was studied in the following DoE and finally an optimal PR-15 formulation was found.
The growth factors BMP-2, IGF-I and TGF-β3 were selected for the differentiation of stem cells for tissue engineering of cartilage and bone in order to prepare multifunctionalized osteochondral implants for the regeneration of cartilage defects.
Silk fibroin (SF) was chosen as biomaterial because of its biocompatibility, mechanical properties and its opportunity for biofunctionalization. Ideal geometry of SF scaffolds with optimal porosity was found in order to generate both tissues on one scaffold.
The growth factors BMP-2 and IGF-I were modified to allow spatially restricted covalent immobilization on the generated porous SF scaffolds. In order to perform site-directed covalent coupling by the usage of click chemistry on two opposite sides of the scaffold, we genetically engineered BMP-2 (not shown in this work; performed by Barbara Tabisz) and IGF-I for the introduction of alkyne or azide bearing artificial amino acids. TGF β3 was immobilized to beads through common EDC/NHS chemistry requiring no modification and distributed in the pores of the entire scaffold.
For this reason protein modification, protein engineering, protein immobilization and bioconjugation are investigated in phase II. Beside the synthesis the focus was on the characterization of such modified proteins and its conjugates. The field of protein engineering offers a wide range of possibilities to modify existing proteins or to design new proteins with prolonged serum half-life, increased conformational stability or improved release rates according to their clinical use.
Site-directed click chemistry and non-site-directed EDC/NHS chemistry were used for bioconjugation and protein immobilization with the aim to underline the preferences of site-directed coupling.
We chose three strategies for the incorporation of alkyne or azide functionality for the performance of click reaction into the protein of interest: diazonium coupling reaction, PEGylation and genetic engineering. Azido groups were successfully introduced into SF by implementation of diazonium coupling and alkyne, amino or acid functionality was incorporated into FGF-2 as model protein by means of thiol PEGylation. The proper folding of FGF-2 after PEGylation was assessed by fluorescence spectroscopy, WST-1 proliferation assay ensured moderate bioactivity and the purity of PEGylated FGF-2 samples was monitored with RP-HPLC. Moreover, the modification of native FGF-2 with 10 kDa PEG chains resulted in enhanced thermal stability.
Additionally, we genetically engineered one IGF-I mutant by incorporating the unnatural amino acid propargyl-L-lysine (plk) at position 65 into the IGF-I amino acid sequence and were able to express hardly verifiable amounts of plk-IGF-I. Consequently, plk-IGF-I expression has to be further optimized in future studies in order to generate plk-IGF-I with higher yields.
Bioconjugation of PEGylated FGF-2 with functionalized silk was performed in solution and was successful for click as well as EDC/NHS chemistry. However, substantial amounts of unreacted PEG-FGF-2 were adsorbed to SF and could not be removed from the reaction mixture making it impossible to expose the advantages of click chemistry in relation to EDC/NHS chemistry. The immobilization of PEG-FGF-2 to microspheres was a trial to increase product yield and to remove unreacted PEG-FGF-2 from reaction mixture. Bound PEG-FGF-2 was visualized by fluorescence imaging or flow cytometry and bioactivity was assessed by analysis of the proliferation of NIH 3T3 cells. However, immobilization on beads raised the same issue as in solution: adsorption caused by electrostatic interactions of positively charged FGF-2 and negatively charged SF or beads. Finally, we were not able to prove superiority of site-directed click chemistry over non-site-directed EDC/NHS.
The skills and knowledge in protein immobilization as well as protein characterization acquired during phase II helped us in phase III to engineer cartilage tissue in biofunctionalized SF scaffolds.
The approach of covalent immobilization of the required growth factors is relevant because of their short in vivo half-lives and aimed at controlling their bioavailability. So TGF-β3 was covalently coupled by means of EDC/NHS chemistry to biocompatible and biostable PMMA beads. Herein, we directly compared bioactivity of covalently coupled and adsorbed TGF-β3. During the so-called luciferase assay bioactivity of covalent coupled as well as adsorbed TGF-β3 on PMMA beads was ensured. In order to investigate the real influence of EDC/NHS chemistry on TGF-β3’s bioactivity, the amount of immobilized TGF-β3 on PMMA beads was determined. Therefore, an ELISA method was established. The assessment of total amount of TGF-β3 immobilized on the PMMA beads allowed as to calculate coupling efficiency. A significantly higher coupling efficiency was determined for the coupling of TGF-β3 via EDC/NHS chemistry compared to the reaction without coupling reagents indicating a small amount of adsorbed TGF-β3. These results provide opportunity to determine the consequence of coupling by means of EDC/NHS chemistry for TGF β3 bioactivity. At first sight, no statistically significant difference between covalent immobilized and adsorbed TGF-β3 was observed regarding relative luciferase activities. But during comparison of total and active amount of TGF-β3 on PMMA beads detected by ELISA or luciferase assay, respectively, a decrease of TGF-β3’s bioactivity became apparent. Nevertheless, immobilized TGF β3 was further investigated in combination with SF scaffolds in order to drive BMSCs to the chondrogenic lineage. According to the results obtained through histological and immunohistochemical studies, biochemical assays as well as qRT-PCR of gene expression from BMSCs after 21 days in culture immobilized TGF-β3 was able to engineer cartilage tissue. These findings support the thesis that local presentation of TGF β3 is superior towards exogenous TGF β3 for the development of hyaline cartilage. Furthermore, we conclude that covalent immobilized TGF β3 is not only superior towards exogenously supplemented TGF-β3 but also superior towards adsorbed TGF-β3 for articular hyaline cartilage tissue engineering. Diffusion processes were inhibited through covalent immobilization of TGF-β3 to PMMA beads and thereby a stable and consistent TGF-β3 concentration was maintained in the target area.
With the knowledge acquired during phase II and III as well as during the studies of Barbara Tabisz concerning the expression and purification of plk-BMP-2 we made considerable progress towards the formation of multifunctionalized osteochondral implants for the regeneration of cartilage defects. However, further studies are required for the translation of these insights into the development of multifunctionalized osteochondral SF scaffolds.
Fanconi Anämie (FA) gehört zu den seltenen Chromsomeninstabilitäts-Syndromen. Ursächlich für die Erkrankung sind biallelische Mutationen mit autosomal rezessiver Vererbung in einem der bisher bekannten 21 Genen (FANCA, -B, -C, -D1, -D2, -E, -F, -G, -I, -J, -L, -M, -N, -O, -P, -Q, -R, -S, -T, -U und –V). Eine Ausnahme stellen FANCB und FANCS dar, die X-chromosomal rezessiv bzw. mit einem dominant negativen Effekt vererbt werden. Die Genprodukte sind als Teil des FA/BRCA-DNA-Reparatur Netzwerks bei der Beseitigung von DNA-Interstrang-Quervernetzungen (ICL) involviert. ICLs führen zu einer Stagnation der Replikationsgabel und blockieren somit wichtige zelluläre Prozesse wie Replikation und Transkription, sodass eine Aufrechterhaltung der Genomstabilität nicht mehr gewährleistet ist.
FA ist gekennzeichnet durch angeborene Fehlbildungen, fortschreitendes Knochenmarkversagen und eine erhöhte Prädisposition gegenüber Krebserkrankungen. Die Diagnose basiert auf phänotypischen Auffälligkeiten und wird auf zellulärer Ebene durch die Hypersensititvät gegenüber DNA-quervernetzenden Substanzen wie Mitomycin C (MMC) bestätigt. Da nicht jeder Patient einer bisher bekannten Komplementationsgruppe zugeordnet werden kann und herkömmliche molekulare Diagnostikverfahren mit der steigenden Anzahl an FA-Genen mühsam, zeitaufwändig und teuer geworden sind, war es nötig, neue molekulare Verfahren wie Whole Exome Sequencing (WES) zu etablieren. Im Rahmen dieser Arbeit wurde das Potential dieser Methode im Bezug auf die FA-Genotypisierung erforscht. Bei der Suche nach einer optimalen Anwendung des WES, untersuchten wir verschiedene Anreicherungs- und Sequenziertechniken. Dennoch führen Fehler in den Datenbanken sowie Pseudogene zu falschen Dateninterpretationen und –darstellungen und stellen somit eine Herausforderung dar. Trotzdem zeigen unserer Daten, dass WES eine wertvolle Methode in der Molekulardiagnostik von FA ist. Dies bestätigte sich durch die Zuordnung mehrerer, vorher unklassifizierter FA-Patienten zu den bekannten Komplementationsgruppen und der Ergänzung eines siebten Patienten zum Subtyp FA-P, im Rahmen von zwei Next Generation Sequencing (NGS) Publikationen.
Außerdem wurden mit Hilfe von WES zwei neue FA-Gene (FANCQ und FANCW) im Rahmen dieser Arbeit gefunden, wobei XPF (FANCQ) das erste Gen überhaupt war, welches anhand von NGS detektiert wurde. ERCC4/XPF ist eine strukturspezifische Endonuklease, die durch ein Gen kodiert wird, welches bereits vorher mit den Krankheiten Xeroderma Pigmentosum (XP) und dem segmentalen XFE progeroid Syndrom in Verbindung gebracht wurde. Unsere Daten zeigen, dass abhängig von der Mutation in XPF, Patienten eine der drei unterschiedlichen Funktionsstörungen aufweisen. Dies hebt die multifunktionale Stellung der XPF Endonuklease im Rahmen der Genomstabilität und von humanen Erkrankungen hervor. Das zweite Gen, das während dieser Arbeit entdeckt wurde, ist die WD40-Domäne tragende E3 Ubiquitin Ligase RFWD3, die kürzlich mit DNA Reparatur und insbesondere HR verknüpft wurde. Wir konnten zeigen, dass eine RFWD3 Mutation in der WD40-Domäne bei einem FA-Patienten mit der genetischen Erkrankung Fanconi Anämie assoziiert ist. Die HR ist in RFWD3 (FANCW) mutierten Zellen gestört, was auf einer verminderten Relokalisation von mutiertem RFWD3 an das Chromatin und einer defekten Interaktion mit RPA beruht. Des Weiteren weisen Rfwd3 defiziente Mäuse typische Merkmale anderer FA-Mausmodelle auf, wie verminderte Fertilität, ovarielle und testikuläre Atrophie sowie eine reduzierte Lebenserwartung.
Insgesamt zeigt diese Arbeit, dass neue molekulare Ansätze wie NGS ein wertvolles Hilfsmittel in der FA-Diagnostik sind um bisher unklassifizierte Patienten einer Komplementationsgruppe zuordnen zu können. Zudem konnten mit Hilfe dieser Technik zwei neue Gene identifiziert werden. Deren Charakterisierung trägt zu einer Vervollständigung und weiteren Aufklärung des FA/BRCA-DNA-Reparatur-Netzwerks bei.
Generation of early human neuroepithelial progenitors from primary cells for biomedical applications
(2018)
Patient-specific induced pluripotent stem cells (iPSCs) emerged as a promising cell source for disease modeling and drug screening as well as a virtually unlimited source for restorative therapy. The thesis deals with three major topics to help realizing biomedical applications with neural stem cells.
To enable the generation of transgene-free iPSCs, alternatives to retroviral reprogramming were developed. Hence, the adaptation and evaluation of reprogramming using excisable lentiviral constructs, Sendai virus (SeV) and synthetic mRNA-based methods was assessed in the first part of this thesis. hiPSCs exhibit the pluripotency markers OCT4, SSEA-4, TRA1-60 which were confirmed by immunofluorescence and flow cytometry. Besides, the potential to differentiate in cell types of all three germ layers was detected, confirming pluripotent identity of proliferating colonies resulting from various reprogramming strategies. However, major differences such as high efficiency with SeV in contrast to a relatively low efficiency with mRNA in regard to passage number and the phenotype of starting fibroblasts were observed. Furthermore, a prolonged clone- and passage-dependent residual presence of viral RNA genes was identified in SeV-iPSCs for up to 23 passages using RT-PCR underlining the importance of careful monitoring of clone selection. In contrast, viral-free reprogramming by synthetic mRNA represents a fully non-integrative approach but requires further refinement to be efficiently applicable to all fibroblasts.
The second part of this thesis deals with the establishment of a rapid monolayer approach to differentiate neural progenitor cells from iPSCs. To achieve this, a two-step protocol was developed allowing first the formation of a stable, primitive NPC line within 7 days which was expanded for 2-3 passages. In a second step, a subsequent adaptation to conditions yielding neural rosette-like NPCs followed. Both neural lines were demonstrated to be expandable, cryopreservable and negative for the pluripotency marker OCT4. Furthermore, a neural precursor identity including SOX1, SOX2, PAX6, Nestin was confirmed by immunofluorescence and quantitative RT-PCR. Moreover, the differentiation resulted in TUJ1-positive neurons and GFAP-positive astrocytes. Nonetheless, the outcome of glial differentiation from primitive NSCs remained low, whereas FGF/EGF-NPCs were efficiently differentiated into GFAP-positive astrocytes which were implicated in a cellular model of the blood brain barrier.
The third and major objective of this study was to generate human early neural progenitor cells from fetal brain tissue with a wide neural differentiation capacity. Therefore, a defined medium composition including small molecules and growth factors capable of modulation of crucial signaling pathways orchestrating early human development such as SHH and FGF was assessed. Indeed, specific culture conditions containing TGFβ inhibitor SB431542, SHH agonist Purmorphamine, GSK3β inhibitor CHIR99021 and basic FGF, but no EGF enabled robust formation of early neuroepithelial progenitor (eNEP) colonies displaying a homogeneous morphology and a high proliferation rate. Moreover, primary eNEPs exhibit a relatively high clonogenicity of more than 23 % and can be monoclonally expanded for more than 45 passages carrying a normal karyotype. Characterization by immunofluorescence, flow cytometry and quantitative RT-PCR revealed a distinct NPC profile including SOX1, PAX6, Nestin and SOX2 and Prominin. Furthermore, primary eNEPs show NOTCH and HES5 activation in combination with non-polarized morphology, indicative of an early neuroepithelial identity. Microarray analysis unraveled SOX11, BRN2 and other HES-genes as characteristic upregulated genes. Interestingly, eNEPs were detected to display ventral midbrain/hindbrain regional identity. The validation of yielded cell types upon differentiation indicates a strong neurogenic potential with more than 90 % of TUJ1-positive neurons. Moreover, astrocytes marked by GFAP and putative myelin structures indicating oligodendrocytes were identified. Electrophysiological recordings revealed functionally active neurons and immunofluorescence indicate GABAergic, glutamatergic, dopaminergic and serotonergic subtypes. Additionally, putative physiological synapse formation was observed by the presence of Synapsin and PSD-95 as well as by ultrastructural examination. Notably, rare neurons stained positive for the peripheral neuronal marker Peripherin suggesting the potential of eNEPS to give rise to cells of neural tube and neural crest origin. By the application of specific differentiation protocols an increase of TH-positive neurons or neural crest-derivatives such as putative A- and C-sensory neurons and mesenchymal cells was identified. Taken together, primary eNEPs might help to elucidate mechanisms of early human neurodevelopment and will serve as a novel source for cell replacement and further biomedical applications.
Luminescent organotransition metal complexes are of much current interest. As the large spin-orbit coupling of 2nd and 3rd row transition metals usually leads to rapid intersystem crossing from S1 to T1, which enables phosphorescence, there is a special interest in using triplet-emitting materials in organic or organometallic light emitting diodes (OLEDs). Marder et al. have found that, reductive coupling of both para-R-substituted diarylbutadiynes and diaryldodecatetraynes on Rh(PMe3)4X leads to quantitative yields of bis(arylethynyl)-rhodacyclopentadienes with complete regiospecificity (R = BMes2, H, Me, OMe, SMe, CF3, CN, CO2Me, NMe2, NO2, C≡C-TMS and X = -C≡C-TMS, -C≡C-C6H4-4-NMe2, -C≡C-C≡C-C6H4-4-NPh2, Me, Cl).47,49 Unexpectedly, these compounds show intense fluorescence rather than phosphorescence (ɸf = 0.33-0.69, t = 1.2 3.0 ns). The substituent R has a significant influence on the photophysical properties, as absorption and emission are both bathochromically shifted compared to R = H, especially for R = π-acceptor.
To clarify the mechanism of the formation of the rhodacyclopentadienes, and to investigate further their unique photophysical properties, a series of novel, luminescent rhodacyclopentadienes with dithiocarbamate as a bidentate ligand at the rhodium centre has been synthesised and characterised (R = NO2, CO2Me, Me, NMe2, SMe, Ar = C6F4-4-OMe). The rhodacyclopentadienes have been formed via reductive coupling of diaryl undecatetraynes with [Rh(k2-S,S`-S2CNEt2)(PMe3)2]. The structures of a series of such compounds were solved by single crystal X-ray diffraction and are discussed in this work. The compounds were fully characterised via NMR, UV/Vis and photoluminescence spectroscopy as well as by elemental analysis, high-resolution mass spectrometry (HRMS) and X-ray diffraction.
When heating the reactions, another isomer is formed to a certain extent. The so-called dibenzorhodacyclopentadienes already appeared during earlier studies of Marder et al., when acetylacetonate (acac) was employed as the bidentate ligand at the Rh-centre. They are probably formed via a [4+2] cycloaddition reaction and C-H activation, followed by a β-H shift.
Use of the perfluorinated phenyl moiety Ar = C6F4-4-OMe provided a total new insight into the mechanism of formation of the rhodacyclopentadiene isomers and other reactions. Besides the formation of the expected rhodacyclopentadiene, a bimetallic compound was generated, isolated and characterised via X-ray crystallography and NMR spectroscopy, elemental analysis and high resolution mass spectrometry.
For further comparison, analogous reactions with [Rh(k2 S,S` S2CNEt2)(PPh3)2] and a variety of diaryl undecatetraynes (R = NO2 CO2Me, Me, NMe2, SMe, Ar = C6F4-4-OMe) were carried out. They also yield the expected rhodacyclopentadienes, but quickly react with a second or even third equivalent of the tetraynes to form, catalytically, alkyne cyclotrimerisation products, namely substituted benzene derivatives (dimers and trimers), which are highly luminescent. The rhodacyclopentadienes (R = NO2, CO2Me, Me, SMe, Ar = C6F4-4-OMe) are stable and were isolated. The structures of a series of these compounds were obtained via single crystal X-ray crystallography and the compounds were fully characterised via NMR, UV/Vis and photoluminescence spectroscopy as well as by elemental analysis and HRMS.
Another attempt to clarify the mechanism of formation of the rhodacyclopentadienes involved reacting a variety of diaryl 1,3-butadiynes (R = CO2Me, Me, NMe2, naphthyl) with [Rh(k2 S,S` S2CNEt2)(PMe3)2]. The reactions stop at an intermediate step, yielding a 1:1 trans π-complex, confirmed by single crystal X-ray diffraction and NMR spectroscopy. Only after several weeks, or under forcing conditions (µw / 80 °C, 75 h), the formation of another major product occurs, having bound a second diaryl 1,3-butadiyne. Based on earlier results of Murata, the product is identified as an unusual [3+2] cycloaddition product, ϭ-bound to the rhodium centre.
The molecular architecture of the meiotic chromosome axis as revealed by super-resolution microscopy
(2018)
During meiosis proteins of the chromosome axis are important for monitoring chromatin structure and condensation, for pairing and segregation of chromosomes, as well as for accurate recombination. They include HORMA-domain proteins, proteins of the DNA repair system, synaptonemal complex (SC) proteins, condensins and cohesins. To understand more about their function in shaping the meiotic chromosome it is crucial to establish a defined model of their molecular architecture. Up to now their molecular organization was analysed using conventional methods, like confocal scanning microscopy (CLSM) and transmission electron microscopy (TEM). Unfortunately, these techniques are limited either by their resolution power or their localization accuracy. In conclusion, a lot of data on the molecular organization of chromosome axis proteins stays elusive. For this thesis the molecular structure of the murine synaptonemal complex (SC) and the localization of its proteins as well as of three cohesins was analysed with isotropic resolution, providing new insights into their architecture and topography on a nanoscale level. This was done using immunofluorescence labelling in combination with super-resolution microscopy, line profiles and average position determination. The results show that the murine SC has a width of 221.6 nm ± 6.1 nm including a central region (CR) of 148.2 nm ± 2.6 nm. In the CR a multi-layered organization of the central element (CE) proteins was verified by measuring their strand diameters and strand distances and additionally by imaging potential anchoring sites of SYCP1 (synaptonemal complex protein 1) to the lateral elements (LEs). We were able to show that the two LEs proteins SYCP2 and SYCP3 do co-localize alongside their axis and that there is no significant preferential localization towards the inner LE axis of SYCP2.
The presented results also predict an orderly organization of murine cohesin complexes (CCs) alongside the chromosome axis in germ cells and support the hypothesis that cohesins in the CR of the SC function independent of CCs.
In the end new information on the molecular organization of two main components of the murine chromosome axis were retrieved with nanometer precision and previously unknown details of their molecular architecture and topography were unravelled.
In recent decades the international migration has increased worldwide. The influx of people from different cultures and ethnic groups poses new challenges to the labor market and the welfare state of the host countries and causes changes in the social fabric. In general, immigration benefits the economy of the host country. However, these gains from immigration are unevenly distributed among the native population. Natives who are in direct competition with the new workers expect wage losses and a higher probability of getting unemployed, whereas remaining natives foresee either no feedback effects or even wage gains. On the other hand, the tax and transfer system benefits disproportionally from an influx of highly skilled immigrants. Examinations of 20 European countries in 2010 show that a higher proportion of low-skilled immigrants in the immediate neighborhood of the natives increases the difference in the demand for redistribution between high-skilled and low-skilled natives. Thus, high-skilled natives are more opposed to an expansion of the governmental redistribution. On the one hand, a higher proportion of low-skilled immigrants generates a higher fiscal burden on the welfare state. On the other hand, high-skilled natives' wages increase due to an influx of low-skilled immigrants, since relative supply of high-skilled labor increases.
In addition to the economic impact of immigration, the inflow of new citizens is accompanied by natives' fear of changes in the social environment as well as in symbolic values, such as cultural identity or natives' set of values. The latter might generate negative attitudes towards immigrants and increase the demand for a more restrictive immigration policy. On the other hand, more interethnic contact due to a higher ethnic diversity could reduce natives' information gaps, prejudices and stereotypes. This, in turn, could enhance more tolerance and solidarity towards immigrants among natives. Examinations of 18 European countries in 2014 show that more interethnic contact during everyday life reduces both the natives' social distance from immigrants and their fear of social upheaval by the presence of immigrants. However, natives' social distance from immigrants has no effect on their preference for redistribution, but their perceived threat to the national culture and social life by the presence of immigrants has a significantly negative impact on their demand for redistribution. Thus, natives’ concern about the preservation of symbolic norms and values affects the solidarity channel of their redistribution preference.
An individual's upward mobility over time or in relation to his or her parents determines his or her attitude towards the welfare state as well as the transfer of his or her opinions to his or her own children. With regard to intergenerational income mobility, Germany shows a value in the international midfield; higher than the United States (lower mobility) and lower than the Scandinavian countries (higher mobility). For example, if a father's lifetime income increases by 10 percent, his son's lifetime income increases by 4.9 percent in the United States and by 3.1 percent in Germany. Additionally, in Germany, fathers' lifetime income tends to show a higher impact on their sons' income if their incomes are higher. In the United States, fathers' lifetime incomes have a stronger influence on their sons' income at the lower and the upper end of the income distribution compared to the middle.
Taking a closer look at the intragenerational wage mobility and wage inequality in Germany, the development at the current edge is rather sobering. Since 2000 there is a steady decline in wage mobility. Furthermore, wage mobility in the services sector has been significantly lower than in the manufacturing sector since the beginning of the 2000s. This result is mainly driven by the decrease of wage mobility in the health care and social services sector. Moreover, a worker's unemployment spells and occupation have become more important in the meantime. Since 2006 the increase in the German wage inequality has markedly slowed down and wage growth between 2006 and 2013 has been even polarized, i.e. wages at the lower and at the upper end of the wage distribution have increased more than wages in the middle. However, this development can be partly attributed to the computerization and automation of the production processes. Although, there was substitution of manual routine tasks between 2001 and 2013, cognitive routine tasks are still more pronounced in the middle and at the upper end of the wage distribution. Furthermore, the latter experienced an increase in wage mobility since 2000. On the other hand, manual non-routine tasks are localized disproportionally in the middle and at the lower end of the wage distribution. Thus, the wage gains of these occupations at the lower end were compensated for by the wage losses in the middle.
Solitary bees in seasonal environments have to align their life-cycles with favorable environmental conditions and resources. Therefore, a proper timing of their seasonal activity is highly fitness relevant. Most species in temperate environments use temperature as a trigger for the timing of their seasonal activity. Hence, global warming can disrupt mutualistic interactions between solitary bees and plants if increasing temperatures differently change the timing of interaction partners. The objective of this dissertation was to investigate the mechanisms of timing in spring-emerging solitary bees as well as the resulting fitness consequences if temporal mismatches with their host plants should occur. In my experiments, I focused on spring-emerging solitary bees of the genus Osmia and thereby mainly on O. cornuta and O. bicornis (in one study which is presented in Chapter IV, I additionally investigated a third species: O. brevicornis).
Chapter II presents a study in which I investigated different triggers solitary bees are using to time their emergence in spring. In a climate chamber experiment I investigated the relationship between overwintering temperature, body size, body weight and emergence date. In addition, I developed a simple mechanistic model that allowed me to unite my different observations in a consistent framework. In combination with the empirical data, the model strongly suggests that solitary bees follow a strategic approach and emerge at a date that is most profitable for their individual fitness expectations. I have shown that this date is on the one hand temperature dependent as warmer overwintering temperatures increase the weight loss of bees during hibernation, which then advances their optimal emergence date to an earlier time point (due to an earlier benefit from the emergence event). On the other hand I have also shown that the optimal emergence date depends on the individual body size (or body weight) as bees adjust their emergence date accordingly. My data show that it is not enough to solely investigate temperature effects on the timing of bee emergence, but that we should also consider individual body conditions of solitary bees to understand the timing of bee emergence.
In Chapter III, I present a study in which I investigated how exactly temperature determines the emergence date of solitary bees. Therefore, I tested several variants degree-day models to relate temperature time series to emergence data. The basic functioning of such degree-day models is that bees are said to finally emerge when a critical amount of degree-days is accumulated. I showed that bees accumulate degree-days only above a critical temperature value (~4°C in O. cornuta and ~7°C in O. bicornis) and only after the exceedance of a critical calendar date (~10th of March in O. cornuta and ~28th of March in O. bicornis). Such a critical calendar date, before which degree-days are not accumulated irrespective of the actual temperature, is in general less commonly used and, so far, it has only been included twice in a phenology model predicting bee emergence. Furthermore, I used this model to retrospectively predict the emergence dates of bees by applying the model to long-term temperature data which have been recorded by the regional climate station in Würzburg. By doing so, the model estimated that over the last 63 years, bees emerged approximately 4 days earlier.
In Chapter IV, I present a study in which I investigated how temporal mismatches in bee-plant interactions affect the fitness of solitary bees. Therefore, I performed an experiment with large flight cages serving as mesocosms. Inside these mesocosms, I manipulated the supply of blossoms to synchronize or desynchronize bee-plant interactions. In sum, I showed that even short temporal mismatches of three and six days in bee-plant interactions (with solitary bee emergence before flower occurrence) can cause severe fitness losses in solitary bees. Nonetheless, I detected different strategies by solitary bees to counteract impacts on their fitness after temporal mismatches. However, since these strategies may result in secondary fitness costs by a changed sex ratio or increased parasitism, I concluded that compensation strategies do not fully mitigate fitness losses of bees after short temporal mismatches with their food plants. In the event of further climate warming, fitness losses after temporal mismatches may not only exacerbate bee declines but may also reduce pollination services for later-flowering species and affect populations of animal-pollinated plants.
In conclusion, I showed that spring-emerging solitary bees are susceptible to climate change as in response to warmer temperatures bees advance their phenology and show a decreased fitness state. As spring-emerging solitary bees not only consider overwintering temperature but also their individual body condition for adjusting emergence dates, this may explain differing responses to climate warming within and among bee populations which may also have consequences for bee-plant interactions and the persistence of bee populations under further climate warming. If in response to climate warming plants do not shift their phenologies according to the bees, bees may experience temporal mismatches with their host plants. As bees failed to show a single compensation strategy that was entirely successful in mitigating fitness consequences after temporal mismatches with their food plants, the resulting fitness consequences for spring-emerging solitary bees would be severe. Furthermore, I showed that spring-emerging solitary bees use a critical calendar date before which they generally do not commence the summation of degree-days irrespective of the actual temperature. I therefore suggest that further studies should also include the parameter of a critical calendar date into degree-day model predictions to increase the accuracy of model predictions for emergence dates in solitary bees. Although our retrospective prediction about the advance in bee emergence corresponds to the results of several studies on phenological trends of different plant species, we suggest that more research has to be done to assess the impacts of climate warming on the synchronization in bee-plant interactions more accurately.
The rotation of the earth around its axis causes recurring and predictable changes in the environment. To anticipate those changes and adapt their physiology and behavior accordingly, most organisms possess an endogenous clock. The presence of such a clock has been demonstrated for several ant species including Camponotus ants, but its involvement in the scheduling of daily activities within and outside the ant nest is fairly unknown. Timing of individual behaviors and synchronization among individuals is needed to generate a coordinated collective response and to maintain colony function. The aim of this thesis was to investigate the presence of a circadian clock in different worker castes, and to determine the daily timing of their behavioral tasks within the colonies of two nectar-collecting Camponotus species.
In chapter I, I describe the general temporal organization of work throughout the worker life in the species Camponotus rufipes. Continuous tracking of behavioral activity of individually- marked workers for up to 11 weeks in subcolonies revealed an age-dependent division of labor between interior and exterior workers. After eclosion, the fairly immobile young ants were frequently nurtured by older nurses, yet they started nursing the brood themselves within the first 48 hours of their life. Only 60% of workers switched to foraging at an age range of one to two weeks, likely because of the reduced needs within the small scale of the subcolonies. Not only the transition rates varied between subcolonies, but also the time courses of the task sequences between workers did, emphasizing the timed allocation of workers to different tasks in response to colony needs.
Most of the observed foragers were present outside the nest only during the night, indicating a distinct timing of this behavioral activity on a daily level as well. As food availability, humidity and temperature levels were kept constant throughout the day, the preference for nocturnal activity seems to be endogenous and characteristic for C. rufipes. The subsequent monitoring of locomotor activity of workers taken from the subcolonies revealed the presence of a functional endogenous clock already in one-day old ants. As some nurses displayed activity rhythms in phase with the foraging rhythm, a synchronization of these in-nest workers by social interactions with exterior workers can be hypothesized.
Do both castes use their endogenous clock to schedule their daily activities within the colony? In chapter II, I analyzed behavioral activity of C. rufipes foragers and nurses within the social context continuously for 24 hours. As time-restricted access to food sources may be one factor affecting daily activities of ants under natural conditions, I confronted subcolonies with either daily pulses of food availability or ad libitum feeding. Under nighttime and ad libitum feeding, behavioral activity of foragers outside the nest was predominantly nocturnal, confirming the results from the simple counting of exterior workers done in chapter I. Foragers switched to diurnality during daytime feeding, demonstrating the flexible and adaptive timing of a daily behavior. Because they synchronized their activity with the short times of food availability, these workers showed high levels of inactivity. Nurses, in contrast, were active all around the clock independent of the feeding regime, spending their active time largely with feeding and licking the brood. After the feeding pulses, however, a short bout of activity was observed in nurses. During this time period, both castes increasingly interacted via trophallaxis within the nest. With this form of social zeitgeber, exterior workers were able to entrain in-nest workers, a phenomenon observed already in chapter I. Under the subsequent monitoring of locomotor activity under LD conditions the rhythmic workers of both castes were uniformly nocturnal independent of the feeding regime. This endogenous activity pattern displayed by both worker castes in isolation was modified in the social context in adaption to task demands.
Chapter III focuses on the potential factors causing the observed plasticity of daily rhythms in the social context in the ant C. rufipes. As presence of brood and conspecifics are likely indicators of the social context, I tested the effect of these factors on the endogenous rhythms of otherwise isolated individuals. Even in foragers, the contact to brood triggered an arrhythmic activity pattern resembling the arrhythmic behavioral activity pattern seen in nurses within the social context. As indicated in chapter I and II, social interaction could be one crucial factor for the synchronization of in nest activities. When separate groups were entrained to phase-shifted light-dark-cycles and monitored afterwards under constant conditions in pairwise contact through a mesh partitioning, both individuals shifted parts of their activity towards the activity period of the conspecific. Both social cues modulated the endogenous rhythms of workers and contribute to the context dependent plasticity in ant colonies.
Although most nursing activities are executed arrhythmically throughout the day (chapter II), previous studies reported rhythmic translocation events of the brood in Camponotus nurses. As this behavior favors brood development, the timing of the translocations within the dark nest seems to be crucial. In chapter IV, I tracked translocation activity of all nurses within subcolonies of C. mus. Under the confirmed synchronized conditions of a LD-cycle, the daily pattern of brood relocation was based on the rhythmic, alternating activity of subpopulations with preferred translocation direction either to the warm or to the cold part of the temperature gradient at certain times of the day. Although the social interaction after pulse feeding had noticeable effects on the in-nest activity in C. rufipes (chapter I and II), it was not sufficient to synchronize the brood translocation rhythm of C. mus under constant darkness (e.g. when other zeitgebers were absent). The free-running translocation activity in some nurses demonstrated nevertheless the involvement of an endogenous clock in this behavior, which could be entrained under natural conditions by other potential non-photic zeitgebers like temperature and humidity cycles.
Daily cycling of temperature and humidity could not only be relevant for in-nest activities, but also for the foraging activity outside the nest. Chapter V focuses on the monitoring of field foraging rhythms in the sympatric species C. mus and C. rufipes in relation to abiotic factors. Although both species had comparable critical thermal limits in the laboratory, foragers in C. mus were strictly diurnal and therefore foraged under higher temperatures than the predominant nocturnal foragers in C. rufipes. Marking experiments in C. rufipes colonies with higher levels of diurnal activity revealed the presence of temporally specialized forager subpopulations. These results suggest the presence of temporal niches not only between the two Camponotus species, but as well between workers within colonies of the same species.
In conclusion, the temporal organization in colonies of Camponotus ants involves not only the scheduling of tasks performed throughout the worker life, but also the precise timing of daily activities. The necessary endogenous clock is already functioning in all workers after eclosion. Whereas the light-dark cycle and food availability seem to be the prominent zeitgebers for foragers, nurses may rely more on non-photic zeitgeber like social interaction, temperature and humidity cycles.
BD is a severe and highly prevalent psychiatric illness characterized by oscillating mood episodes, where patients express either depressed mood, anhedonia, decreased activation along with concentration difficulties and sleep disturbances, or elevated mood with hyperactivity and loss of inhibitions. Between mood episodes, patients return to a relatively normal state of functioning without mood symptoms. Previous research on underlying neuronal mechanisms has led to a model of neuronal dysfunction in BD which states that BD arises from disruption in early development within brain networks that modulate emotional behavior. These abnormalities in the structure and function of key emotional control networks then lead to decreased connectivity among ventral prefrontal networks and limbic brain regions. This in turn creates a loss of emotional homeostasis, putting bipolar patients at risk for developing extreme mood states and switching among mood states. Two core components for BD have been identified, a hyperactive emotion processing system and a hypoactive cognitive functions system. It is controversial whether these deficits are still detectable in euthymia, so it is unclear if hyper- and hypoactivations represent state or trait-like characteristics. The aim of this study was to research both core components of BD with a paradigm eliciting differential activations in both cognitive and emotion processing networks. For this, an emotional word working memory paradigm was constructed to test for differences between manic, depressive, and remitted patients as well as a healthy control group. Differences were assessed in behavior, brain activation (as a correlate for the hypoactive cognitive functions system), measured with near-infrared spectroscopy (fNIRS), and electrophysiological changes in the late positive potential (as a correlate for the hyperactive emotion processing system), an event-related potential (ERP) measured with electroencephalography. 47 patients in the acutely ill phase and 45 healthy controls were measured. Of the 47 patients, 18 returned to the clinic for a second testing while in remission for at least 3 months. Acutely ill patients were classified into 4 groups according to their disorder status: a mildly depressed group, a depressed group, a manic group, and a mixed group along DSM-IV criteria. Analyses were calculated for 3 load conditions (1-back, 2-back and 3-back) and 3 valence conditions (negative, neutral, positive) for behavioral measures reaction time and omission errors, for brain activation and event related potential changes.
Results indicate that ill patients differed from controls in their behavioral performance, but the difference in performance was modulated by the mood state they were in. Depressed patients showed the most severe differences in all behavioral measures, while manic and mixed patients differed from controls only upon different valence conditions. Brain activation changes were most pronounced in mildly depressed and manic patients, depressed patients and mixed patients did not differ as much from controls. ERP changes showed a significant difference only between mixed patients and controls, where mixed patients had an overall much higher ERP amplitude. When remitted patients were compared to controls, no differences in behavior, brain activation or ERP amplitude could be found. However, the same was true for differences in patients between acutely ill and remitted state. When looking at the overall data, the following conclusion can be drawn: assuming that the brain activation seen in the prefrontal cortex is part of the dorsal cognitive system, then this is the predominantly disturbed system in depressed patients who show only small changes in the ERP. In contrast, the predominantly disturbed system in manic and mixed patients is the ventral emotion processing system, which can be seen in a hyper-activation of ERP related neural correlates in mixed and hypo-activated neural correlates of the LPP in manic patients. When patients are remitted, the cognitive system regains temporary stability, and can be compared to that of healthy controls, while the emotion processing system remains dysfunctional and underlies still detectable performance deficits.