610 Medizin und Gesundheit
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Institute
- Medizinische Klinik und Poliklinik I (568)
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Schriftenreihe
Sonstige beteiligte Institutionen
- Johns Hopkins School of Medicine (18)
- IZKF Nachwuchsgruppe Geweberegeneration für muskuloskelettale Erkrankungen (7)
- Clinical Trial Center (CTC) / Zentrale für Klinische Studien Würzburg (ZKSW) (5)
- Johns Hopkins University School of Medicine (5)
- Bernhard-Heine-Centrum für Bewegungsforschung (4)
- Johns Hopkins School of Medicine, Baltimore, MD, U.S. (4)
- Klinikum Fulda (3)
- Zentraleinheit Klinische Massenspektrometrie (3)
- CHC Würzburg (Comprehensive Hearing Center) (2)
- Center for Interdisciplinary Clinical Research, Würzburg University, Würzburg, Germany (2)
ResearcherID
- D-1221-2009 (1)
Intrazerebrale stereotaktische Eingriffe werden zu einem großen Teil ohne direkte Sichtkontrolle durchgeführt. Ein Operateur muss sich deshalb bei der räumlichen Festlegung von Strukturen und beim Anfahren dieser Strukturen auf Hilfsmittel wie stereotaktische Geräte und auf Atlanten, über welche die stereotaktischen Geräte gesteuert werden, verlassen. Trotz großer Fortschritte bei den bildgebenden Verfahren während der letzten dreißig Jahre, ist es gegenwärtig noch nicht möglich, zuverlässig alle subkortikalen Strukturen mit computertomographischen (CT) oder magnetresonanztomographischen (MRT) zu identifizieren oder begrenzen. Eine ganze Reihe zytoarchitektonischer beziehungsweise immunhistochemischer Atlanten wurde veröffentlicht. Dennoch ist es nicht gelungen, die Ergebnisse und Abbildungen dieser Atlanten mit bildgebenden Verfahren bis in die gewünschten Details zu kombinieren, um auf diese Weise das immer noch geringe Auflösungsvermögen radiologischer Methoden zu erhöhen. Deformationen bei der Gewebsentnahme des Gehirns, bei der anschließenden Einbettung, bei der alkoholischen Dehydrierung des Gewebes, Verformungen beim Schneiden und Färben der Schnitte überfordern selbst hoch komplexe mathematische Verfahren und Algorithmen beim Versuch, zytoarchitektonische und immunhistochemische Schnitte mit der gewünschten Präzision den radiologischen Ergebnissen und Bildern und damit indirekt auch den Verhältnissen in vivo anzupassen. Als Alternative verwendeten wir ungewöhnlich dicke (350 – 440 µm) Gallozyanin- (Nissl) gefärbte Serienschnitte durch die Gehirne (ZNS) von drei Personen im Alter von 56, 68 und 36 Jahren. Bei einem Fall wurde das ZNS post mortem mit einem Kernspintomographen vor der Entnahme gescannt. Die Serienschnitte durch dieses Gehirn und das eines zweiten und dritten nicht-gescannten Falles wurden mit Gallozyanin gefärbt, die zytoarchitektonischen Grenzen des Thalamuskomplexes und seiner Unterkerne wurden nach Hassler (1982) identifiziert, jede ihrer Grenzen mit dem Cursor eines Graphiktabletts umfahren und die Gestalt des Thalamuskomplexes und seiner Unterkerne mit Hilfe von Photoshop CS5® und eines computergestützten 3D-Rekonstruktionsprogramms (Amira®) dargestellt. Im Fall 3 ließen sich nach Dunkelfeldbeleuchten die Verteilung markhaltiger Fasern studieren und die zytoarchitektonischen mit myeloarchitektonischen Befunden erweitern und ergänzen. Zusätzlich konnten im Fall 1 die histologischen Serienschnitte und ihre 3D Rekonstruktion mit dem post mortem in cranio MRT registriert werden. Insgesamt kann dieser methodische Ansatz als eine robuste und relativ einfache wenn auch mit umfangreicherer manueller Tätigkeit verbundene Technik zur sehr detailreichen unverformten Korrelation zytoarchitektonischer und kernspinotomographsicher Darstellung des Thalamuskomplexus und seiner Unterkerne angesehen werden. Sie könnte als Grundlage für die Herausgabe eines multimedialen 3D stereotaktischen Atlas des menschlichen Gehirns dienen.
Über die Stärke und Geschwindigkeit der Neubildung bakterieller Biofilme an implantatgetragenem Zahnersatz sind bis lang nur wenige Informationen ver-fügbar. Ziel der durchgeführten Untersuchungen war es daher, die Plaqueneubildungsrate am natürlichen Zahn und Zahnimplantat mit Hilfe der Bestimmung der 24 h Plaque Formation Rate quantitativ zu erfassen und zu vergleichen. 35 Patienten im Alter von 48 - 75 Jahren mit parodontal vorgeschädigtem Ge-biss, welche Keramikkronen auf Zähnen wie auch auf Implantaten aufwiesen, nahmen an der Studie teil. In einem split-mouth Design wurden Metallkeramikkronen, welche einem enossal integrierten Titanimplanat aufsa-ßen, mit Metallkeramikkronen, die natürlichen Zähne aufsaßen und sich im gleichen oder kontrallateralen Kiefersextanten befanden, paarweise zugeordnet. Eine Erfassung der klinischen Parameter Gingiva Index (GI), Papillen-Blutungs-Index (PBI), Probing Attachment Level (PAL) sowie Probeable Pocket Depth (PPD) diente der Dokumentation bekannter, das Wachstum oraler Biofilme modifizierender Faktoren. Nachfolgend wurde das gesamt Gebiss professionell von bakteriellen Biofilmen gereinigt und die Studienteilnehmer angewiesen, für 24 h auf jegliche häusliche Mundhygienemaßnahmen zu verzichten. Nach 24 h Mundhygienekarenz wurde die 24 h Plaqueneubildungsrate (24 h PFR) im gingivanahen Kronendrittel für alle Zahn-Implantat-Paare bestimmt. Die Analyse der Daten offenbarte, dass die 24 h PFR überkronter natürlicher Zähne im Mittel 51,6% betrug und sich signifikant vom 24 h PFR Mittelwert der verpaarten Kronen auf Implantaten mit 32,6% unterschied (p<0,001). Die beobachteten Unterschiede zwischen beiden experimentellen Gruppen bezüglich der klinischen Parameter GI, PBI, PAL sowie PPD waren eher gering und konnten statistisch nicht verifiziert werden. Die Befunde dieser Untersuchung belegen daher, dass bei geringer oder fehlender Entzündung der umgebenden Weichgewebe die Plaqueneubildungsrate im gingivanahen Kronendrittel implantatgetragener Metallkeramikkronen signifikant geringer ausgeprägt ist als auf Metallkeramikkronen, die natürlichen Zähnen aufsitzen. Eine mögliche spekulative Erklärung hierfür könnte in der geringeren Stärke des Austritts nährstoffreichen Sulkusfluids aus dem periimplantären Sulkus bei entzündungsfreiem Zustand der umgebenden Weichgewebe zu suchen sein. Die Daten dieser Studie legen zudem nahe, dass eine übliche, 2 x täglich wiederholte, sorgfältige häusliche Mundhygiene auch für die wirksame Reinigung implatatgetragener Metallkeramikkronen von aufgewachsenen bakteriellen Biofilmen adäquat ist.
In vorliegender Studie wurde an histologischen Präparaten mittels immunhistochemischen Färbungen der Übergangsbereich zwischen oraler Mukosa und transplantiertem Jejunumsegment untersucht. Mit der Fragestellung ob sich die Strukturen im Übergangsbereich zwischen freiem Jejunumtransplantat und oraler Mukosa funktionell verändern und ob die Dünndarmepithelien einer morphologischen Umwandlung unterliegen. Zu diesem Zweck wurden die Gewebeschnitte nach der LSABC Methode mit verschiedenen Antikörpern markiert die spezifisch das zu bestimmende Epithel anfärbten. Die Differentzierung der Epithelien erfolgte durch für jede Epithelart spezifische Zytokeratine. Nachgewiesen wurde eine Abflachung des Zottenreliefs sowie eine numerische Becherzellatrophie. In unseren histologisch nachuntersuchten Gewebeproben stellte sich die Grenze zwischen transplantiertem Jejunumsegment und mehrschichtigem Plattenepithel exakt und scharf begrenzt dar. Weder Zellcluster von mehrschichtigem Plattenepithel im Bereich des Dünndarms, noch eine Transformationszone, wie sie bei Zellmetaplasie vorkommt konnte nachgewiesen werden. Auch hielten die dünndarmeigenen Gefäße die Grenze zwischen den beiden Geweben strikt ein und verliefen ebenso scharf begrenzt. Subepithelial zeigte sich zwar zu Beginn eine entzündlich bedingte Gefäßproliferation mit schütterem leukozytären Infiltrat, welches aber im Laufe der Zeit durch kollagenfasereiches Bindegewebe narbig ersetzt wurde. Die nachweisbaren CD 4 positiven Entzündungszellen waren nicht über das gewöhnliche Ausmaß vermehrt, es kommt zur Ausbildung einer Gewebsgrenze die von beiden Epithelien respektiert wird unter der Vereinigung des subepithelialen Bindegewebes. Dies alles kann als Bestätigung dafür angesehen werden, dass die Rekonstruktion großer Defekte mittels freiem Jejunumtransplantat auch über einen Zeitraum von mehr als 21 Jahren erfolgreich ist und das Transplantat seinen Anforderungen in der neuen Umgebung standhält.
Die zielgerichtete Therapie und die Immuncheckpoint-Inhibitoren haben die Tumortherapie revolutioniert. Während erstere die Tumorzellen gezielt angreift, verhindern letztere die Hemmung des Immunsystems durch Immuncheckpoints, um eine robuste Immunantwort zu erreichen. Zusätzlich ist das Nebenwirkungsprofil bei direktem Vergleich mit der konventionellen Chemotherapie günstiger. Beim HNSCC werden beide Ansätze angewendet. Cetuximab ist ein monoklonaler Antikörper, der sich gegen EGFR, welcher bei HNSCC überexprimiert ist, richtet. Nivolumab und Pembrolizumab richten sich gegen das Immuncheckpoint-Protein PD-1. Nach wie vor sind die Resistenzen, sowohl die initialen als auch die erworbenen, die größte zu überwindende Herausforderung. Aufbauend auf dem Ergebnis vorangegangener Arbeiten, die zeigen konnten, dass HGF über c-MET die Expression des Immuncheckpointliganden PD-L1 steigert, setzt sich diese Arbeit weiter mit den intrazellulären nachgeschalteten Signalwegen nach c-MET Aktivierung auseinander. Dies ist von besonderem Interesse, weil diese Signalwege ebenfalls für die Resistenzentwicklung verantwortlich sein können, zeitgleich können diese im Rahmen der zielgerichteten Therapie gezielt inhibiert werden.
Um den HGF-Einfluss auf die intrazellulären Signalwege zu prüfen, wurden vier etablierte HNSCC-Zelllinien herangezogen.
Im ersten Teil der Arbeit wurden die 4 HNSCC-abgeleitete Zelllinien mit HGF stimuliert und mittels Western Blot der PD-L1-Anstieg und die Phosphorylierungsänderung der Schlüsselproteine der einzelnen Signalwege nachgewiesen. Daraus ergab sich, dass HGF die MAPK- und PIK3/AKT-Signalwege aktiviert. Während eine kombinierte Blockade des MAPK-Signalwegs den PD-L1-Anstieg vollständig verhindern konnte, hemmte die PIK3/AKT-Blockade den PD-L1-Anstieg nur partiell.
Im zweiten Teil wurde mit siRNA der hauptsächlich für den PD-L1-Anstieg zuständige MAPK-Signalweg unterbunden, was mittels quantitativer PCR auf der mRNA-Ebene nachgewiesen werden konnte. Mittels Western Blot konnte entsprechend gezeigt werden, dass der PD-L1-Anstieg trotz HGF-Stimulation bei nicht funktionsfähigem MAPK-Signalweg eingeschränkt war.
Weiter wurde der Effekt mit dem Medikament Trametinib, das im Rahmen der zielgerichteten Therapie bei malignem Melanom und NSCLC für die MAPK-Signalweg-Hemmung zugelassen ist, evaluiert. Sowohl im Western Blot als auch in der Durchflusszytometrie konnte bestätigt werden, dass Trametinib den HGF-induzierten Anstieg von PD-L1 signifikant blockiert.
Darüber hinaus konnte im Rahmen der Western Blot-Versuche gezeigt werden, dass die Signalwege und die PD-L1-Expression in den Zelllinien unterschiedlich aktiv bzw. hoch waren. Unter den vier Zelllinien zeigte die FaDu-Zelllinie eine erhöhte PI3K/AKT-Aktivität, Detroit562 und SCC9 eine erhöhte MAPK-Aktivität. Die PD-L1- Expression war in der SCC9-Zelllinie am höchsten.
Die Arbeit zeigt eine einheitliche Reaktion der HNSCC-Zelllinien auf den Wachstumsfaktor HGF, welcher im Tumormilieu von HNSCC oft in hoher Konzentration vorhanden ist. Neben dem EGFR-Antikörper (Cetuximab) kann eine kombinierte Hemmung entweder von c-MET oder von den nachgeschalteten Signalwegen MAPK und PI3K/AKT bei Resistenzen, Progression oder Unverträglichkeiten eine Möglichkeit für eine wirksamere Therapie von HNSCC darstellen. Ein Screening der Signalwege und deren Aktivierungsmechanismen könnte bei Resistenzen oder bei einem Rezidiv/Progress dazu beitragen, gezielt die alternative Aktivierung zu hemmen und möglicherweise die Wirksamkeit einer Immuncheckpointblockade zu verbessern.
Fernale BALB/c mice were administered intragastrically with equimolar amounts of either [2-\(^{14}\)C]2-amino-3,8-dimethyi[ 4,5-J]qulnoxaline (MeiQx) or 2-acetylamino[9-\(^{14}\)C]fluorene (2AAF). DNA was isolated from tissues of mice killed either 6 or 24 h after administration. Analysis of liver DNA nucleotide digests by HPLC analysis revealed that all of the radioactivity was attributable to adduct formation. Tbe specific activities of DNA samples were converted to covalent bindlog indices (CBI, J.LIDOI adduct per mol DNA nucleotides/mmol chemical app6ed per kg animal body weight). CBI values of 25 and 9 were detennined for 2AAF and MeiQx in tbe llvers of mice killed 6 h after dosing. The values were in general agreement with the moderate carcinogenic potency of these compounds. The specific activities of DNA preparations obtained from the lddneys, spleens, stomachs, small intestines and large intestlnes of mice treated witb MeiQx and killed 6 h after doslng were S- to 35-times less tban those obtained witb the llver. DNA isolated from tbe lungs (a target organ for MeiQx tumorigenicity) of MeiQx-treated mice was not radiolabeUed at tbe limit of detection (CBI <0.3). With tbe exception of tbe gastrolntestinal tract, the specific activities of DNA samples isolated from mice killed 6 h after administration were higher than those from mice killed after 24 h.
Life-threatening systemic infections often occur due to the translocation of pathogens across the gut barrier and into the bloodstream. While the microbial and host mechanisms permitting bacterial gut translocation are well characterized, these mechanisms are still unclear for fungal pathogens such as Candida albicans, a leading cause of nosocomial fungal bloodstream infections. In this study, we dissected the cellular mechanisms of translocation of C. albicans across intestinal epithelia in vitro and identified fungal genes associated with this process. We show that fungal translocation is a dynamic process initiated by invasion and followed by cellular damage and loss of epithelial integrity. A screen of >2,000 C. albicans deletion mutants identified genes required for cellular damage of and translocation across enterocytes. Correlation analysis suggests that hypha formation, barrier damage above a minimum threshold level, and a decreased epithelial integrity are required for efficient fungal translocation. Translocation occurs predominantly via a transcellular route, which is associated with fungus-induced necrotic epithelial damage, but not apoptotic cell death. The cytolytic peptide toxin of C. albicans, candidalysin, was found to be essential for damage of enterocytes and was a key factor in subsequent fungal translocation, suggesting that transcellular translocation of C. albicans through intestinal layers is mediated by candidalysin. However, fungal invasion and low-level translocation can also occur via non-transcellular routes in a candidalysin-independent manner. This is the first study showing translocation of a human-pathogenic fungus across the intestinal barrier being mediated by a peptide toxin. IMPORTANCE Candida albicans, usually a harmless fungus colonizing human mucosae, can cause lethal bloodstream infections when it manages to translocate across the intestinal epithelium. This can result from antibiotic treatment, immune dysfunction, or intestinal damage (e.g., during surgery). However, fungal processes may also contribute. In this study, we investigated the translocation process of C. albicans using in vitro cell culture models. Translocation occurs as a stepwise process starting with invasion, followed by epithelial damage and loss of epithelial integrity. The ability to secrete candidalysin, a peptide toxin deriving from the hyphal protein Ece1, is key: C. albicans hyphae, secreting candidalysin, take advantage of a necrotic weakened epithelium to translocate through the intestinal layer.
Introduction.
Mobile health (mHealth) integrates mobile devices into healthcare, enabling remote monitoring, data collection, and personalized interventions. Machine Learning (ML), a subfield of Artificial Intelligence (AI), can use mHealth data to confirm or extend domain knowledge by finding associations within the data, i.e., with the goal of improving healthcare decisions. In this work, two data collection techniques were used for mHealth data fed into ML systems: Mobile Crowdsensing (MCS), which is a collaborative data gathering approach, and Ecological Momentary Assessments (EMA), which capture real-time individual experiences within the individual’s common environments using questionnaires and sensors. We collected EMA and MCS data on tinnitus and COVID-19. About 15 % of the world’s population suffers from tinnitus.
Materials & Methods.
This thesis investigates the challenges of ML systems when using MCS and EMA data. It asks: How can ML confirm or broad domain knowledge? Domain knowledge refers to expertise and understanding in a specific field, gained through experience and education. Are ML systems always superior to simple heuristics and if yes, how can one reach explainable AI (XAI) in the presence of mHealth data? An XAI method enables a human to understand why a model makes certain predictions. Finally, which guidelines can be beneficial for the use of ML within the mHealth domain? In tinnitus research, ML discerns gender, temperature, and season-related variations among patients. In the realm of COVID-19, we collaboratively designed a COVID-19 check app for public education, incorporating EMA data to offer informative feedback on COVID-19-related matters. This thesis uses seven EMA datasets with more than 250,000 assessments. Our analyses revealed a set of challenges: App user over-representation, time gaps, identity ambiguity, and operating system specific rounding errors, among others. Our systematic review of 450 medical studies assessed prior utilization of XAI methods.
Results.
ML models predict gender and tinnitus perception, validating gender-linked tinnitus disparities. Using season and temperature to predict tinnitus shows the association of these variables with tinnitus. Multiple assessments of one app user can constitute a group. Neglecting these groups in data sets leads to model overfitting. In select instances, heuristics outperform ML models, highlighting the need for domain expert consultation to unveil hidden groups or find simple heuristics.
Conclusion.
This thesis suggests guidelines for mHealth related data analyses and improves estimates for ML performance. Close communication with medical domain experts to identify latent user subsets and incremental benefits of ML is essential.
Tinnitus is an auditory phantom perception in the absence of an external sound stimulation. People with tinnitus often report severe constraints in their daily life. Interestingly, indications exist on gender differences between women and men both in the symptom profile as well as in the response to specific tinnitus treatments. In this paper, data of the TrackYourTinnitus platform (TYT) were analyzed to investigate whether the gender of users can be predicted. In general, the TYT mobile Health crowdsensing platform was developed to demystify the daily and momentary variations of tinnitus symptoms over time. The goal of the presented investigation is a better understanding of gender-related differences in the symptom profiles of users from TYT. Based on two questionnaires of TYT, four machine learning based classifiers were trained and analyzed. With respect to the provided daily answers, the gender of TYT users can be predicted with an accuracy of 81.7%. In this context, worries, difficulties in concentration, and irritability towards the family are the three most important characteristics for predicting the gender. Note that in contrast to existing studies on TYT, daily answers to the worst symptom question were firstly investigated in more detail. It was found that results of this question significantly contribute to the prediction of the gender of TYT users. Overall, our findings indicate gender-related differences in tinnitus and tinnitus-related symptoms. Based on evidence that gender impacts the development of tinnitus, the gathered insights can be considered relevant and justify further investigations in this direction.
Prediction of tinnitus perception based on daily life mHealth data using country origin and season
(2022)
Tinnitus is an auditory phantom perception without external sound stimuli. This chronic perception can severely affect quality of life. Because tinnitus symptoms are highly heterogeneous, multimodal data analyses are increasingly used to gain new insights. MHealth data sources, with their particular focus on country- and season-specific differences, can provide a promising avenue for new insights. Therefore, we examined data from the TrackYourTinnitus (TYT) mHealth platform to create symptom profiles of TYT users. We used gradient boosting engines to classify momentary tinnitus and regress tinnitus loudness, using country of origin and season as features. At the daily assessment level, tinnitus loudness can be regressed with a mean absolute error rate of 7.9% points. In turn, momentary tinnitus can be classified with an F1 score of 93.79%. Both results indicate differences in the tinnitus of TYT users with respect to season and country of origin. The significance of the features was evaluated using statistical and explainable machine learning methods. It was further shown that tinnitus varies with temperature in certain countries. The results presented show that season and country of origin appear to be valuable features when combined with longitudinal mHealth data at the level of daily assessment.
Ziel der prospektiven, klinischen und monozentrischen Beobachtungsstudie war es, die Eigenschaften der durch die DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) eingeführten neuen Schemata der Schmerzzeichnung für Patienten mit Gesichtsschmerzen zu untersuchen. Der Fokus lag dabei zum einen auf der Reliabilität der Schmerzzeichnung sowie auf der Korrelation mit dem Grad der Schmerzchronifizierung und einer potentiellen psychischen Störung.
218 Patienten mit orofazialen Schmerzen wurden konsekutiv rekrutiert und bearbeiteten einen Fragebogen mit GCPS V.2, PHQ-9 und der Schmerzzeichnung. Eine Untergruppe füllte den Fragebogen nach einer fünfwöchigen Akupunkturtherapie zur Erhebung einer möglichen Veränderung der Schmerzintensität erneut aus. Eine weitere Untergruppe bearbeitete die Fragebögen erneut am selben Tag. Mit einem mehrschrittigen Auswertungsverfahren wurden alle Schmerzzeichnungen ausgewertet.
Die Studienpopulation bestand mit 77,1% aus weiblichen Patienten. Für 44,5% der Kohorte ergab sich eine durch orofaziale Schmerzen bedingte Beeinträchtigung. Die Auswertungsmethoden der Schmerzzeichnung ergaben starke geschlechtsspezifische Unterschiede. Das laterale Kopfschema wies sowohl für Frauen als auch für Männer mit Schmerzbeeinträchtigung signifikant mehr markierte Regionen auf im Vergleich zu Patienten ohne Schmerzbeeinträchtigung. Männer mit dysfunktionalen Schmerzen zeigten zudem eine signifikant höhere prozentual markierte Schmerzoberfläche. Für die männlichen Patienten zeigte sich außerdem für die Anzahl der Regionen und die prozentuale Markierung einen signifikanten Zusammenhang mit einer depressiven Störung. Für Frauen konnten diesbezüglich kein Zusammenhang festgestellt werden und auch der modifizierte Ransford-Score stellte für beide Geschlechter kein valides Screeninginstrument dar, um psychische Beeinträchtigungen zu identifizieren. Die Wiederholungszuverlässigkeit der Schmerzzeichnung war signifikant hoch für das Kopfschema und das intraorale Schema, nicht aber für das Ganzkörperschema.
Insgesamt erwiesen sich die neuen Schemata der Schmerzzeichnung im Rahmen einer CMD Diagnostik als vorteilhaft. Das Geschlecht des Patienten, schmerzbedingte Funktionsstörungen sowie psychische Beeinträchtigungen beeinflussen die durch die Schmerzzeichnung erzielten Ergebnisse unterschiedlich und bestätigen eine vielschichtige Ätiologie der Erkrankung. Die Ergebnisse verweisen zudem auf die Relevanz einer getrennten Betrachtung der Geschlechter in zukünftigen Studien mit orofazialen Schmerzpatienten. Die Summe aller Regionen des Kopfschemas von lateral könnte hinsichtlich der Einschätzung des Ausmaßes einer Schmerzchronifizierung künftig als Auswertungskriterium der Schmerzzeichnung Anwendung finden.
Background:
Competing risks methodology allows for an event-specific analysis of the single components of composite time-to-event endpoints. A key feature of competing risks is that there are as many hazards as there are competing risks. This is not always well accounted for in the applied literature.
Methods:
We advocate a simulation point of view for understanding competing risks. The hazards are envisaged as momentary event forces. They jointly determine the event time. Their relative magnitude determines the event type. 'Empirical simulations' using data from a recent study on cardiovascular events in diabetes patients illustrate subsequent interpretation. The method avoids concerns on identifiability and plausibility known from the latent failure time approach.
Results:
The 'empirical simulations' served as a proof of concept. Additionally manipulating baseline hazards and treatment effects illustrated both scenarios that require greater care for interpretation and how the simulation point of view aids the interpretation. The simulation algorithm applied to real data also provides for a general tool for study planning.
Conclusions:
There are as many hazards as there are competing risks. All of them should be analysed. This includes estimation of baseline hazards. Study planning must equally account for these aspects.
Viele humane Sarkome sind durch spezifische chromosomale Translokationen oder typische genetische Amplifikationen definiert, welche in der Differentialdiagnostik insbesondere in Fällen, bei denen klinische Daten, Morphologie und Immunhistochemie alleine nicht ausreichend wegweisend sind. Die Formalin-fixiertem Paraffin-eingebetteten (FFPE-) Gewebe von 15 Ewing-Sarkomen, 4 Klarzellsarkomen, 9 Synovialsarkomen, 4 alveolären und 7 embryonalen Rhabdomyosarkomen und 25 Liposarkomen verschiedenen Subtyps wurden mittels Fluoreszenz-in-situ-Hybridisierung (FISH) untersucht um ein Sarkom-spezifisches FISH-Sondenset zur Detektion spezifischer chromosomaler Aberrationen in der Routinediagnostik zu etablieren. Es konnte gezeigt werden, dass die FISH in diesem Aufgabenfeld im Vergleich zur PCR ebenfalls eine hoch effiziente zytogenetische Methode mit hoher Spezifität und hohen positiven Vorhersagewerten mit dem Vorteil der unproblematischen Anwendung an FFPE-Geweben ist. Zur Detektion des Isochromosom 12p , i(12p), als Beispiel für komplexere chromosmale Aberrationen, wurden 7 FFPE-Gewebe aus Keimzelltumoren mit 12p- und 12q-detektierenden FISH-Sonden hybridisiert. Die Detektion des i(12p) konnte im Rahmen dieser Arbeit mittels FISH nicht erreicht werden. Zusammenfassend ist die FISH eine hoch effiziente zytogenetische Methode zur Detektion spezifischer chromosomaler Aberrationen in FFPE-Geweben aus humanen Sarkomen mit hoher Eignung zur Anwendung in der Routinediagnostik.
The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approaches. In total, 451 COPD patients participated in a 3-week Pulmonary Rehabilitation (PR) programme (58 years, 65% male, 43 pack-years, GOLD stage II/III/IV 50/39/11%). Techniques used to assess the MCID were anchor-based approaches, including patient-referencing, criterion-referencing and questionnaire-referencing, and the distribution-based methods standard error of measurement (SEM), 1.96SEM and half standard deviation (0.5s.d.). Patient- and criterion-referencing led to MCID estimates of 0.56 and 0.62 (CCQ); 3.12 and 2.96 (CAT); and 8.40 and 9.28 (SGRQ). Questionnaire-referencing suggested MCID ranges of 0.28–0.61 (CCQ), 1.46–3.08 (CAT) and 6.86–9.47 (SGRQ). The SEM, 1.96SEM and 0.5s.d. were 0.29, 0.56 and 0.46 (CCQ); 3.28, 6.43 and 2.80 (CAT); 5.20, 10.19 and 6.06 (SGRQ). Pooled estimates were 0.52 (CCQ), 3.29 (CAT) and 7.91 (SGRQ) for improvement. MCID estimates differed depending on the method used. Pooled estimates suggest clinically relevant improvements needing to exceed 0.40 on the CCQ, 3.00 on the CAT and 7.00 on the SGRQ for moderate to very severe COPD patients. The MCIDs of the CAT and SGRQ in the literature might be too low, leading to overestimation of treatment effects for patients with COPD.
Background: There is much evidence that T cells are strongly involved in the pathogenesis of localized and systemic forms of scleroderma (SSc). A dysbalance between FoxP3+ regulatory CD4+ T cells (Tregs) and inflammatory T-helper (Th) 17 cells has been suggested. Methods: The study aimed (1) to investigate the phenotypical and functional characteristics of Th17 and Tregs in SSc patients depending on disease manifestation (limited vs. diffuse cutaneous SSc, dcSSc) and activity, and (2) the transcriptional level and methylation status of Th17- and Treg-specific transcription factors. Results: There was a concurrent accumulation of circulating peripheral IL-17-producing CCR6+ Th cells and FoxP3+ Tregs in patients with dcSSc. At the transcriptional level, Th17- and Treg-associated transcription factors were elevated in SSc. A strong association with high circulating Th17 and Tregs was seen with early, active, and severe disease presentation. However, a diminished suppressive function on autologous lymphocytes was found in SSc-derived Tregs. Significant relative hypermethylation was seen at the gene level for RORC1 and RORC2 in SSc, particularly in patients with high inflammatory activity. Conclusions: Besides the high transcriptional activity of T cells, attributed to Treg or Th17 phenotype, in active SSc disease, Tregs may be insufficient to produce high amounts of IL-10 or to control proliferative activity of effector T cells in SSc. Our results suggest a high plasticity of Tregs strongly associated with the Th17 phenotype. Future directions may focus on enhancing Treg functions and stabilization of the Treg phenotype.
Introduction
Juvenile idiopathic arthritis is a heterogeneous T cell-mediated autoimmune disease with symptoms of premature aging of the immune system (immunosenescence). The present work is an investigation of immunosenescence parameters, such as quantity of naive and CD28- T cells, T cell receptor excision circles, relative telomere length and alterations of peripheral T cell replication, and was performed via comparison of a case of acute exacerbation of juvenile idiopathic arthritis against six patients with juvenile idiopathic arthritis with disease remission and six age-matched healthy donors over a follow-up course of 12 months.
Case presentation
Phenotypical T cell characterization and intracellular interferon γ, tumor necrosis factor α, and interleukin 2 production were studied in peripheral blood mononuclear cells from seven patients with juvenile idiopathic arthritis and six healthy control donors, with findings determined by flow cytometry. T cell receptor excision circles and relative telomere length quantification were performed on deoxyribonucleic acid isolated from naive (CD4+CD28+CD45RA+) T cells and investigated via reverse transcription polymerase chain reaction. Ki67 expression was studied by immunohistochemistry on naive T cells. The non-parametric Mann-Whitney U test and Wilcoxon test for two independent groups of variables were used to compare healthy donors with patients with juvenile idiopathic arthritis. During follow-up, patients with juvenile idiopathic arthritis showed lower total counts of naive and CD28-expressing T cells compared to healthy donors. Acute exacerbation led to low naive and CD28+ T cell populations and elevated proportions of Ki67-expressing CD4+ naive T cells. In conditions of exacerbation, T cell receptor excision circle numbers were in the lower range in patients with juvenile idiopathic arthritis and increased after follow-up. Healthy donors showed significantly higher relative telomere lengths compared to patients with juvenile idiopathic arthritis.
Conclusions
This investigation illustrates that the changes in T cell homeostasis in patients with juvenile idiopathic arthritis may be the result of several mechanisms, such as diminished thymus function and peripheral exertions to maintain the peripheral T cell pool. The results also demonstrate that hallmarks of immunosenescence such as decreased naive T cell levels and lower T cell receptor excision circle numbers can only be interpreted together with replication markers such as relative telomere length or Ki67 expression.
Background
Optical coherence tomography angiography is a novel imaging technique that allows dyeless in vivo visualization of the retinal and choroidal vasculature. The purpose of this study was to describe optical coherence tomography (OCT) angiography findings in patients with retinal arterial macroaneurysms (RAMs).
Methods
Three eyes of three patients with RAMs were retrospectively included. Fundus photography, OCT, fluorescein angiography (FA), and OCT angiography were performed. The entire imaging data was analyzed in detail.
Results
OCT angiography could detect the RAMs noninvasively without dye injection. By simultaneously observing the OCT scans, it was possible to determine the depth of the RAMs in the retina, to detect the exact localization in relation to the main vessel, and to determine the level of blood flow in the RAMs.
Conclusions
OCT angiography can clearly visualize RAMs without use of a dye. It also allows layer-specific observation of blood flow in each layer of the RAM. OCT angiography provides additional dynamic information on RAMs, which is not obtained with FA and facilitates a better understanding of its morphology and activity. This information in combination with ICG and fluorescein angiography can help to optimize direct laser treatment.
The olive tree is a venerable Mediterranean plant and often used in traditional medicine. The main aim of the present study was to evaluate the effect of Olea europaea L. cv. Arbosana leaf extract (OLE) and its encapsulation within a spanlastic dosage form on the improvement of its pro-oxidant and antiproliferative activity against HepG-2, MCF-7, and Caco-2 human cancer cell lines. The LC-HRESIMS-assisted metabolomic profile of OLE putatively annotated 20 major metabolites and showed considerable in vitro antiproliferative activity against HepG-2, MCF-7, and Caco-2 cell lines with IC\(_{50}\) values of 9.2 ± 0.8, 7.1 ± 0.9, and 6.5 ± 0.7 µg/mL, respectively. The encapsulation of OLE within a (spanlastic) nanocarrier system, using a spraying method and Span 40 and Tween 80 (4:1 molar ratio), was successfully carried out (size 41 ± 2.4 nm, zeta potential 13.6 ± 2.5, and EE 61.43 ± 2.03%). OLE showed enhanced thermal stability, and an improved in vitro antiproliferative effect against HepG-2, MCF-7, and Caco-2 (IC\(_{50}\) 3.6 ± 0.2, 2.3 ± 0.1, and 1.8 ± 0.1 µg/mL, respectively) in comparison to the unprocessed extract. Both preparations were found to exhibit pro-oxidant potential inside the cancer cells, through the potential inhibitory activity of OLE against glutathione reductase and superoxide dismutase (IC\(_{50}\) 1.18 ± 0.12 and 2.33 ± 0.19 µg/mL, respectively). These inhibitory activities were proposed via a comprehensive in silico study to be linked to the presence of certain compounds in OLE. Consequently, we assume that formulating such a herbal extract within a suitable nanocarrier would be a promising improvement of its therapeutic potential.
Frizzled (FZD) are highly conserved receptors that belong to class F of the G protein-coupled receptor (GPCR) superfamily. They are involved in a great variety of processes during embryonic development, organogenesis, and adult tissue homeostasis. In particular, FZD5 is an important therapeutic target due to its involvement in several pathologies, such as tumorigenesis. Nevertheless, little is known regarding the activation of FZD receptors and the signal initiation, and their GPCR nature has been debated. In order to investigate the activation mechanism of these receptors, FRET (Förster Resonance Energy Transfer)-based biosensors for FZD5 have been developed and characterized. A cyan fluorescent protein (CFP) was fused to the C-terminus of the receptor and the specific FlAsH-binding sequence (CCPGCC) was inserted within the 2nd or the 3rd intracellular loop. Single-cell FRET experiments performed using one of these sensors, V5-mFZD5-FlAsH436-CFP, reported structural rearrangements in FZD5 upon stimulation with the endogenous ligand WNT-5A. These movements are similar to those observed in other GPCRs using the same technique, which suggests an activation mechanism for FZD reminiscent of GPCRs. Furthermore, stimulation of the FZD5 FRET-based sensor with various recombinant WNT proteins in a microplate FRET reader allowed to obtain concentration-response curves for several ligands, being possible to distinguish between full and partial agonists. This technology allowed to address the selectivity between WNTs and FZD5 using a full-length receptor in living cells. In addition, G protein FRET-based sensors revealed that WNT-5A specifically induced Gαq activation mediated by FZD5, but not Gαi activation. Other WNT proteins were also able to induce Gαq activation, but with lower efficacy than WNT-5A. In addition, a dual DAG/calcium sensor further showed that WNT-5A stimulation led to the activation of the Gαq-dependent signaling pathway mediated by FZD5, which outcome was the activation of Protein Kinase C (PKC) and the release of intracellular calcium. Altogether, these data provide evidence that the activation process of FZD5 resembles the general characteristics of class A and B GPCR activation, and this receptor also mediates the activation of the heterotrimeric Gαq protein and its downstream signaling pathway. In addition, the FZD5 receptor FRET-based sensor provides a valuable tool to characterize the pharmacological properties of WNTs and other potential ligands for this receptor.
In this work we wanted to investigate the role of NFATc1 in lymphocyte physiology and in pathological conditions (eg. psoriasis). NFATc1 is part of the signal transduction
pathways that regulates B cells activation and function. NFATc1 has different isoforms that are due to different promoters (P1 and P2), polyadenylation and alternative splicing. Moreover, we tried to elucidate the points of interactions between the NFAT and the NF-κB pathways in
activated B-cell fate. NFAT and NF-κB factors share several properties, such as a similar mode of induction and architecture in their DNA binding domain. We used mice which over-express a constitutive active version of NFATc1/α in their B cells with -or without- an ablated IRF4. IRF4 inhibits cell cycle progression of germinal center B cell-derived Burkitt’s lymphoma cells and
induces terminal differentiation toward plasma cells. Our experiments showed that a ‘double hit’ in factors affecting B cell activation (NFATc1 in this case) and late B cell Differentiation (IRF4 in this case) alter the development of the B cells, lead to increase in their numbers and increase in stimulation induced proliferation. Therefore, the overall picture indicates a link between these 2 genes and probable carcinogenic alterations that may occur in B cells.
We also show that in splenic B cells, c-Rel (of the NF-κB canonical pathway) Support the induction of NFATc1/αA through BCR signals. We also found evidence that the lack of NFATc1 affects the expression of Rel-B (of the NF-κB non-canonical pathway). These data suggest a tight interplay between NFATc1 and NF-κB in B cells, influencing the competence of B cells and their functions in peripheral tissues.
We also used IMQ-induced psoriasis-like inflammation on mice which either lack NFATc1 from B cell. Psoriasis is a systemic chronic immunological disease characterized
primarily by abnormal accelerated proliferation of the skin keratinocytes. In psoriasis, the precipitating event leads to immune cell activation. Our experiments showed that NFATc1 is needed for the development of psoriasis. It also showed that IL-10 is the link that enables NFAT
from altering the B cell compartment (eg Bregs) in order to affect inflammation. The important role of B cell in psoriasis is supported by the flared up psoriasis-like inflammation in mice that lack B cells. Bregs is a special type of B cells that regulate other B cells and T cells; tuning the immunological response through immunomodulatory cytokines.
NFATc1 supports imiquimod-induced skin inflammation by suppressing IL-10 synthesis in B cells
(2016)
Epicutaneous application of Aldara cream containing the TLR7 agonist imiquimod (IMQ) to mice induces skin inflammation that exhibits many aspects of psoriasis, an inflammatory human skin disease. Here we show that mice depleted of B cells or bearing interleukin (IL)-10-deficient B cells show a fulminant inflammation upon IMQ exposure, whereas ablation of NFATc1 in B cells results in a suppression of Aldara-induced inflammation. In vitro, IMQ induces the proliferation and IL-10 expression by B cells that is blocked by BCR signals inducing NFATc1. By binding to HDAC1, a transcriptional repressor, and to an intronic site of the Il10 gene, NFATc1 suppresses IL-10 expression that dampens the production of tumour necrosis factor-α and IL-17 by T cells. These data indicate a close link between NFATc1 and IL-10 expression in B cells and suggest NFATc1 and, in particular, its inducible short isoform, NFATc1/αA, as a potential target to treat human psoriasis.