610 Medizin und Gesundheit
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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)
The present work deals with the preparation of hydrogels in different size scales for various applications. Thus, macroscopic bulk hydrogels were prepared from differently modified pig gastric mucin (PGM), microgels were made from PGM in combination with hyaluronic acid (HA), as well as from gelatin in combination with poly(ethylene glycol) (PEG), and nanogels were fabricated from poly(glycidol) (PG). According to their size, each hydrogels have different applications. First, it was investigated whether previously existing studies involving the preparation of covalently crosslinked hydrogels via free radical polymerization from bovine submaxillary gland mucin (BSM) could also be carried out with the much cheaper alternative PGM. After this was successfully demonstrated and the hydrogels were systematically investigated for their mechanical properties and biocompatibility, a second hydrogel system was established. Here, PGM was functionalized with allyl glycidyl ether (AGE) and crosslinked in combination with thiolated HA via thiol-ene reaction. These hydrogels were also systematically evaluated and compared with the hydrogels prepared via free radical polymerization. It was confirmed that the more random free radical polymerization leads to more disordered networks than the thiol-ene reaction. In both systems, biocompatibility was demonstrated with both L929 CCL1 murine fibroblasts and human mesenchymal stem cells (hMSCs). Using this knowledge as background and the request to make mucin printable, microgels were prepared via the emulsion technique using the previously established thiol-ene hydrogel precursor solution. Here, applying the recently used photoinitiator 2-hydroxy-4-(2-hydroxyethoxy)-2- methylpropiophenone (Irgacure 2959), which is more soluble in oil than in water, was challenging and did not result in well-crosslinked microgels. Therefore, a third hydrogel system was established, which was based on thiol-ene crosslinked AGE functionalized pig gastric mucin (PGM-AGE)-thiolated hyaluronic acid (HASH) hydrogels and with lithium phenyl-2,4,6- trimethylbenzoylphosphinate (LAP) being used as photoinitiator. Hereby, stably crosslinked microgels could be prepared via the emulsion technique. After the jamming process, which means the extraction of the microgel solution by vacuum, the resulting so-called granular ink could be successfully printed via extrusion-based printing. The widely known challenge of printing living cells was also successfully managed. Cells were encapsulated in the microgels during microgel synthesis. Here, the stirring velocity had to be adjusted to avoid harming the cells during the manufacturing process. The cell-loaded microgels were successfully printed in the same way as the empty microgels in multiple layers resulting in dimensionally stable constructs. Live/dead experiments verified that many viable cells were printable after 24 hours. In the next part of this thesis, microgels were prepared from AGE-functionalized gelatin and thiol-functionalized PEG by the same procedure. Again, cells were incorporated and printed by extrusion-based printing. After the addition of hydroxypropyl-methylcellulose, the right conditions for viable cells and stable constructs were found. The printed constructs were further secondarily crosslinked by immersion in initiator solution after the printing process followed by re-irradiating with light. Hereafter, a strongly increased stability of the constructs could be observed. Microgels for use as cell sensor particles were produced as part of this thesis. Here, microfluidic was applied to prepare microgels with a monodisperse size distribution. After adjusting the oil phase, as well as optimizing the manufacturing parameters to the mucin hydrogel system, the microfluidic setup established by Ilona Paulus in this research group could be used. By setting very fast flow rates, microgels in the size range of cells could be obtained. Furthermore, various parameters affecting the stiffness of the particles were varied. This laid the foundation for follow-up studies within the framework of the SFB TRR225 to be able to produce cellmimicking particles. Further follow-up experiments could include the investigation of hydrogels being based only on mucin, like a crosslinking of thiolated mucin and mucin modified with an allyl function such as the PGM-AGE. Furthermore, the granular mucin ink could serve as a supporting material for other microgels or less stable inks during the printing process and thus expand the field of applicable materials for three dimensional (3D) printing.
Höhergradige Gliome gehören zu den häufigsten malignen Hirntumoren bei
Erwachsenen und gehen mit einer sehr schlechten Prognose einher. Die Patientinnen
und Patienten leiden häufig unter kognitiven Einschränkungen, welche auch auf einen
Integritätsverlust der Weißen Substanz zurückzuführen sind und die Lebensqualität der
Betroffenen stark beeinträchtigen. Um in Zukunft eine Behandlung zu gewährleisten, die
nicht nur das Überleben verlängert, sondern auch den Erhalt der neurokognitiven
Funktionen verbessert, sind zuverlässige Methoden zur Messung von Veränderungen
der neurokognitiven Fähigkeiten in einem frühen Stadium erforderlich. Der direkteste
Weg zur Objektivierung neurokognitiver Eigenschaften sind neuropsychologische Tests.
Wir betrachten das Corpus callosum als eine zuverlässige Struktur zur Identifizierung
der Verschlechterung der Integrität der weißen Substanz. Wir stellten die Hypothese auf,
dass ein Zusammenhang zwischen einer beeinträchtigten strukturellen Integrität in
bestimmten Regionen des Corpus Callosum und neurokognitiven Defiziten bei
Patientinnen und Patienten mit höhergradigem Gliom besteht.
Wir schlossen 25 Patientinnen und Patienten mit höhergradigem Gliom in unsere Studie
ein, die sich präoperativ einer neuropsychologischen Testbatterie und einer MRT mit DTI
Sequenzen unterzogen. Die MRT-Daten wurden mit der Software fsl, Oxford,
verarbeitet. Neuropsychologische Parameter wurden mit der FA in drei Teilen des
Corpus Callosum korreliert: Rostrum bzw. Genu, Truncus und Splenium.
Präoperativ korrelierten die meisten neuropsychologischen Parameter signifikant mit der
FA von mindestens einem Bereich des Corpus Callosum. Höhere FA-Werte wurden mit
besserer Konzentration, Gedächtnis, Schnelligkeit und flüssigem Sprechen in
Verbindung gebracht. Verschiedene Tests untersuchten den gleichen
neuropsychologischen Parameter und korrelierten dann mit der gleichen Region des
Corpus Callosum. So konnten das lexikalische und visuelle Gedächtnis mit dem Genu
und Rostrum in Verbindung gebracht werden, exekutive Funktionen und das
Arbeitsgedächtnis korrelierten mit dem Truncus und die Verarbeitungsgeschwindigkeit
mit dem Splenium. Darüber hinaus stimmte diese Zuordnung mit den Ergebnissen
vorangegangener Studien überein. Wir betrachten Veränderungen der
mikrostrukturellen Integrität der Corpus Callosum als robustes morphologisches Korrelat
für die Untersuchung des neurokognitiven Zustands von Patientinnen und Patienten mit
höhergradigem Gliom.
Background
A significant number of oncological patients are heavily burdened by psychosocial stress. Doctors recommending or referring their patients to psycho-oncologists in the course of routine consultations can positively influence psycho-oncological care. The aim of this study was to analyze the frequency and predictors of such recommendations and to examine the use of these services by patients.
Methods
4,020 cancer patients (mean age 58 years; 51% women) were evaluated in a multicenter, cross-sectional study in Germany. Data was gathered about doctors’ referral practices, patients’ utilization of psycho-oncological care services, and disease-related symptoms. The PHQ-9 depression scale and the GAD-7 anxiety scale were used to measure psychological burden. Descriptive data analysis was conducted on the basis of subgroup comparisons and multivariable analysis was done using binary logistical regression.
Results
21.9% of the respondents reported having been given a recommendation or referral for psycho-oncological care by a doctor within the course of their cancer diagnosis and treatment. This comprises 29.5% of the patients identified by screening as being psychologically burdened. Nearly half of the patients who received a recommendation or referral (49.8%) acted on it. Predictors for seeking out psycho-oncological care included: patient desire (OR = 2.0), previous experience with psycho-oncological care (OR = 1.59), and female gender (OR = 1.57). Multivariable analysis indicated that patients’ level of psychological burden (depression, anxiety) had no effect on whether doctors gave them a recommendation or referral.
Conclusions
Along with examining the degree to which patients are burdened (e.g. using screening instruments), determining whether or not patients would like to receive psycho-oncological care is an important aspect of improving referral practices and, by extension, will allow important progress in the field of psycho-oncological care to be made.
Hematopoietic stem cell transplantation (HSCT) has been an effective method for treating a wide range of malignant or non-malignant disorders. In case of an autologous HSCT, patients receive their own stem cells after myeloablation before extraction. Allogeneic HSCT uses stem cells derived from a donor. Despite being associated with a high risk of early and long-term complications, it is often the last curative option. 229 pediatric patients, who between 1 January 2005 and 31 December 2015 received an HSCT at the University Children’s Hospital Wuerzburg, were studied. Correlations between two groups were calculated with the Chi square test or with a 2x2-contingency table. To calculate metric variables, the Mann-Whitney-U-test was used. Survival curves were calculated according to Kaplan and Meier. Significance was assumed for results with a p-value <0.05 (CI (Confident Interval) 95%). We retrospectively analyzed 229 pediatric patients (105 females, 124 males) for early and late complications of allogeneic and autologous hematopoietic stem cell transplantation. Median age at HSCT was seven years. Underlying diseases were leukemia (n = 73), lymphoma (n = 22), solid tumor (n = 65), CNS (central nervous system)- tumor (n = 41), and “other diseases” (n = 28). Survival times, overall survival, and event-free survival were calculated. Of all patients, 80.8% experienced complications of some degree, including mild and transient complications. Allo-HSCT (allogeneic HSCT) carried a significantly higher risk of complications than auto-HSCT (autologous HSCT) (n = 118 vs. n = 67; p = < .001) and the remission rate after allo-HSCT was also higher (58.7% vs. 44,7%; p = .032). Especially infection rates and pulmonary complications are different between auto- and allo-HSCT. Leukemia patients had the highest risk of early and late complications (95,0%; p < .001). Complications within HSCT are major risk factors following morbidity and mortality. In order to detect complications and risk factors early, strict recordings are needed to reduce the rate of complication by recognition and prevention of triggering factors. In the future, these factors should receive greater attention in the planning of HSCT post-transplantation care in order to improve the results of the transplantation and establish protocols to prevent their occurrence.
Objective
Recent preliminary studies indicated a seasonal association of BMI at admission to inpatient treatment for anorexia nervosa (AN), indicating lower BMI in the cold season for restrictive AN. An impaired thermoregulation was proposed as the causal factor, based on findings in animal models of AN. However, findings regarding seasonality of BMI and physical activity levels in the general population indicate lower BMI and higher physical activity in summer than in winter. Therefore, we aimed to thoroughly replicate the findings regarding seasonality of BMI at admission in patients with AN in this study.
Method
AN subtype, age- and gender-standardized BMI scores (BMI-SDS) at admission, mean daily sunshine duration and ambient temperature at the residency of 304 adolescent inpatients with AN of the multi-center German AN registry were analyzed.
Results
A main effect of DSM-5 AN subtype was found (F(2,298) = 6.630, p = .002), indicating differences in BMI-SDS at admission between restrictive, binge/purge and subclinical AN. No main effect of season on BMI-SDS at admission was found (F(1,298) = 4.723, p = .025), but an interaction effect of DSM-5 subtype and season was obtained (F(2,298) = 6.625, p = .001). Post-hoc group analyses revealed a lower BMI-SDS in the warm season for restrictive AN with a non-significant small effect size (t(203.16) = 2.140, p = .033; Hedges′g = 0.28). Small correlations of mean ambient temperature (r = −.16) and daily sunshine duration (r = −.22) with BMI-SDS in restrictive AN were found. However, the data were widely scattered.
Conclusions
Our findings are contrary to previous studies and question the thermoregulatory hypothesis, indicating that seasonality in AN is more complex and might be subject to other biological or psychological factors, for example physical activity or body dissatisfaction. Our results indicate only a small clinical relevance of seasonal associations of BMI-SDS merely at admission. Longitudinal studies investigating within-subject seasonal changes might be more promising to assess seasonality in AN and of higher clinical relevance.
It was previously shown that the estrogen-receptor negative breast cancer cell line MBA-MD-231 expresses high levels of A2B adenosine receptors as the sole adenosine receptor subtype. These receptors couple to both, stimulation of adenylyl cyclase and a Ca2+ signal. In order to establish a potential role of A2B adenosine receptors in tumor growth and development MAPK signaling was investigated in these breast cancer cells. Although it is known that A2B adenosine receptors may stimulate MAPK it was found that in MBA-MD-231 cells ERK1/2 phosphorylation is reduced upon agonist-stimulation of A2B adenosine receptors. This reduction is also triggered by forskolin, but abolished by the PKA inhibitor H89, suggesting an important role for the cAMP-PKA pathway. Likewise, a role for intracellular Ca2+ was established as the Ca2+ chelator 1,2-bis-(o-aminophenoxy)-ethane-N,N,N’,N’-tetraacetic acid, tetraacetoxymethyl ester (BAPTA-AM) abolished the reduction of ERK1/2 phosphorylation triggered by A2B stimulation. It was shown that various pathways downstream from A2B adenosine receptors resulted in a stimulation of MAPK phosphatase-1 (MKP-1) which dephosphorylates phospho ERK1/2, and thus plays a critical role in the regulation of the phosphorylation state of ERK1/2. The reduction of ERK1/2 phosphorylation mediated by A2B adenosine receptors might provide an interesting approach for adjuvant treatment leading to reduced growth of certain tumors expressing the A2B subtype.
We assessed the prevalence, awareness, treatment and control of hypertension in patients with moderate chronic kidney disease (CKD) under nephrological care in Germany. In the German Chronic Kidney Disease (GCKD) study, 5217 patients under nephrology specialist care were enrolled from 2010 to 2012 in a prospective observational cohort study. Inclusion criteria were an estimated glomerular filtration rate (eGFR) of 30–60 mL/min/1.73 m2 or overt proteinuria in the presence of an eGFR>60 mL/min/1.73 m2. Office blood pressure was measured by trained study personnel in a standardized way and hypertension awareness and medication were assessed during standardized interviews. Blood pressure was considered as controlled if systolic < 140 and diastolic < 90 mmHg. In 5183 patients in whom measurements were available, mean blood pressure was 139.5 ± 20.4 / 79.3 ± 11.8 mmHg; 4985 (96.2%) of the patients were hypertensive. Awareness and treatment rates were > 90%. However, only 2456 (49.3%) of the hypertensive patients had controlled blood pressure. About half (51.0%) of the patients with uncontrolled blood pressure met criteria for resistant hypertension. Factors associated with better odds for controlled blood pressure in multivariate analyses included younger age, female sex, higher income, low or absent proteinuria, and use of certain classes of antihypertensive medication. We conclude that blood pressure control of CKD patients remains challenging even in the setting of nephrology specialist care, despite high rates of awareness and medication use.
Effect of progesterone on Smad signaling and TGF-β/Smad-regulated genes in lung epithelial cells
(2018)
The effect of endogenous progesterone and/or exogenous pre- or postnatal progesterone application on lung function of preterm infants is poorly defined. While prenatal progesterone substitution may prevent preterm birth, in vitro and in vivo data suggest a benefit of postnatal progesterone replacement on the incidence and severity of bronchopulmonary dysplasia (BPD). However, the molecular mechanisms responsible for progesterone’s effects are undefined. Numerous factors are involved in lung development, airway inflammation, and airway remodeling: the transforming growth factor beta (TGF-β)/mothers against decapentaplegic homolog (Smad) signaling pathway and TGF-β-regulated genes, such as connective tissue growth factor (CTGF), transgelin (TAGLN), and plasminogen activator inhibitor-1 (PAI-1). These processes contribute to the development of BPD. The aim of the present study was to clarify whether progesterone could affect TGF-β1-activated Smad signaling and CTGF/transgelin/PAI-1 expression in lung epithelial cells. The pharmacological effect of progesterone on Smad signaling was investigated using a TGF-β1-inducible luciferase reporter and western blotting analysis of phosphorylated Smad2/3 in A549 lung epithelial cells. The regulation of CTGF, transgelin, and PAI-1 expression by progesterone was studied using a promoter-based luciferase reporter, quantitative real-time PCR, and western blotting in the same cell line. While progesterone alone had no direct effect on Smad signaling in lung epithelial cells, it dose-dependently inhibited TGF-β1-induced Smad3 phosphorylation, as shown by luciferase assays and western blotting analysis. Progesterone also antagonized the TGF-β1/Smad-induced upregulation of CTGF, transgelin, and PAI-1 at the promoter, mRNA, and/or protein levels. The present study highlights possible new molecular mechanisms involving progesterone, including inhibition of TGF-β1-activated Smad signaling and TGF-β1-regulated genes involved in BPD pathogenesis, which are likely to attenuate the development of BPD by inhibiting TGF-β1-mediated airway remodeling. Understanding these mechanisms might help to explain the effects of pre- or postnatal application of progesterone on lung diseases of preterm infants.
The role of the subthalamic nucleus in human locomotion is unclear although relevant, given the troublesome management of gait disturbances with subthalamic deep brain stimulation in patients with Parkinson’s disease. We investigated the subthalamic activity and inter-hemispheric connectivity during walking in eight freely-moving subjects with Parkinson’s disease and bilateral deep brain stimulation. In particular, we compared the subthalamic power spectral densities and coherence, amplitude cross-correlation and phase locking value between resting state, upright standing, and steady forward walking. We observed a phase locking value drop in the β-frequency band (≈13-35Hz) during walking with respect to resting and standing. This modulation was not accompanied by specific changes in subthalamic power spectral densities, which was not related to gait phases or to striatal dopamine loss measured with [123I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane and single-photon computed tomography. We speculate that the subthalamic inter-hemispheric desynchronization in the β-frequency band reflects the information processing of each body side separately, which may support linear walking. This study also suggests that in some cases (i.e. gait) the brain signal, which could allow feedback-controlled stimulation, might derive from network activity.
Information on circulating miRNAs in frontotemporal lobar degeneration is very limited and conflicting results have complicated an interpretation in Alzheimer’s disease thus far. In the present study we I) collected samples from multiple clinical centers across Germany, II) defined 3 homogenous patient groups with high sample sizes (bvFTD n = 48, AD n = 48 and cognitively healthy controls n = 44), III) compared expression levels in both CSF and serum samples and IV) detected a limited set of miRNAs by using a MIQE compliant protocol based on SYBR-green miRCURY assays that have proven reliable to generate reproducible results. We included several quality controls that identified and reduced technical variation to increase the reliability of our data. We showed that the expression levels of circulating miRNAs measured in CSF did not correlate with levels in serum. Using cluster analysis we found expression pattern in serum that, in part, reflects the genomic organization and affiliation to a specific miRNA family and that were specifically altered in bvFTD, AD, and control groups. Applying factor analysis we identified a 3-factor model characterized by a miRNA signature that explained 80% of the variance classifying healthy controls with 97%, bvFTD with 77% and AD with 72% accuracy. MANOVA confirmed signals like miR-320a and miR-26b-5p at BH corrected significance that contributed most to discriminate bvFTD cases with 96% sensitivity and 90% specificity and AD cases with 89% sensitivity and specificity compared to healthy controls, respectively. Correlation analysis revealed that miRNAs from the 3-factor model also correlated with levels of protein biomarker amyloid-beta1-42 and phosphorylated neurofilament heavy chain, indicating their potential role in the monitoring of progressive neuronal degeneration. Our data show that miRNAs can be reproducibly measured in serum and CSF without pre-amplification and that serum includes higher expressed signals that demonstrate an overall better ability to classify bvFTD, AD and healthy controls compared to signals detected in CSF.