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Copeptin is the C-terminal end of pre-provasopressin released equimolar to vasopressin into circulation and recently discussed as promising cardiovascular biomarker amendatory to established markers such as troponins. Vasopressin is a cytokine synthesized in the hypothalamus. A direct release of copeptin from the heart into the circulation is implied by data from a rat model showing a cardiac origin in hearts put under cardiovascular wall stress. Therefore, evaluation of a potential release of copeptin from the human heart in acute myocardial infarction (AMI) has been done.
Noise-induced hearing loss is one of the most common auditory pathologies, resulting from overstimulation of the human cochlea, an exquisitely sensitive micromechanical device. At very low frequencies (less than 250 Hz), however, the sensitivity of human hearing, and therefore the perceived loudness is poor. The perceived loudness is mediated by the inner hair cells of the cochlea which are driven very inadequately at low frequencies. To assess the impact of low-frequency (LF) sound, we exploited a by-product of the active amplification of sound outer hair cells (OHCs) perform, so-called spontaneous otoacoustic emissions. These are faint sounds produced by the inner ear that can be used to detect changes of cochlear physiology. We show that a short exposure to perceptually unobtrusive, LF sounds significantly affects OHCs: a 90 s, 80 dB(A) LF sound induced slow, concordant and positively correlated frequency and level oscillations of spontaneous otoacoustic emissions that lasted for about 2 min after LF sound offset. LF sounds, contrary to their unobtrusive perception, strongly stimulate the human cochlea and affect amplification processes in the most sensitive and important frequency range of human hearing.
Glioblastoma multiforme (GBM) is treated by surgical resection followed by radiochemotherapy. Bevacizumab is commonly deployed for anti‐angiogenic therapy of recurrent GBM; however, innate immune cells have been identified as instigators of resistance to bevacizumab treatment. We identified angiopoietin‐2 (Ang‐2) as a potential target in both naive and bevacizumab‐treated glioblastoma. Ang‐2 expression was absent in normal human brain endothelium, while the highest Ang‐2 levels were observed in bevacizumab‐treated GBM. In a murine GBM model, VEGF blockade resulted in endothelial upregulation of Ang‐2, whereas the combined inhibition of VEGF and Ang‐2 leads to extended survival, decreased vascular permeability, depletion of tumor‐associated macrophages, improved pericyte coverage, and increased numbers of intratumoral T lymphocytes. CD206+ (M2‐like) macrophages were identified as potential novel targets following anti‐angiogenic therapy. Our findings imply a novel role for endothelial cells in therapy resistance and identify endothelial cell/myeloid cell crosstalk mediated by Ang‐2 as a potential resistance mechanism. Therefore, combining VEGF blockade with inhibition of Ang‐2 may potentially overcome resistance to bevacizumab therapy.
This study aims at evaluating the combination of the tumor-necrosis-factor-related apoptosis-inducing ligand (TRAIL)-receptor 2 (TRAIL-R2)-specific antibody Drozitumab and the Smac mimetic BV6 in preclinical glioblastoma models. To this end, the effect of BV6 and/or Drozitumab on apoptosis induction and signaling pathways was analyzed in glioblastoma cell lines, primary glioblastoma cultures and glioblastoma stem-like cells. Here, we report that BV6 and Drozitumab synergistically induce apoptosis and reduce colony formation in several glioblastoma cell lines (combination index<0.1). Also, BV6 profoundly enhances Drozitumab-induced apoptosis in primary glioblastoma cultures and glioblastoma stem-like cells. Importantly, BV6 cooperates with Drozitumab to suppress tumor growth in two glioblastoma in vivo models including an orthotopic, intracranial mouse model, underlining the clinical relevance of these findings. Mechanistic studies reveal that BV6 and Drozitumab act in concert to trigger the formation of a cytosolic receptor-interacting protein (RIP) 1/Fas-associated via death domain (FADD)/caspase-8-containing complex and subsequent activation of caspase-8 and -3. BV6- and Drozitumab-induced apoptosis is blocked by the caspase inhibitor zVAD.fmk, pointing to caspase-dependent apoptosis. RNA interference-mediated silencing of RIP1 almost completely abolishes the BV6-conferred sensitization to Drozitumab-induced apoptosis, indicating that the synergism critically depends on RIP1 expression. In contrast, both necrostatin-1, a RIP1 kinase inhibitor, and Enbrel, a TNFα-blocking antibody, do not interfere with BV6/Drozitumab-induced apoptosis, demonstrating that apoptosis occurs independently of RIP1 kinase activity or an autocrine TNFα loop. In conclusion, the rational combination of BV6 and Drozitumab presents a promising approach to trigger apoptosis in glioblastoma, which warrants further investigation.
Objective We assessed the effectiveness and safety of daclatasvir (DCV) plus sofosbuvir (SOF), with or without ribavirin (RBV), in a large real-world cohort, including patients with advanced liver disease.
Design Adults with chronic HCV infection at high risk of decompensation or death within 12 months and with no available treatment options were treated in a European compassionate use programme. The recommended regimen was DCV 60 mg plus SOF 400 mg for 24 weeks; RBV addition or shorter duration was allowed at physicians' discretion. The primary endpoint was sustained virological response at post-treatment week 12 (SVR12).
Results Of the 485 evaluable patients, 359 received DCV+SOF and 126 DCV+SOF+RBV. Most patients were men (66%), white (93%) and treatment-experienced (70%). The most frequent HCV genotypes were 1b (36%), 1a (33%) and 3 (21%), and 80% of patients had cirrhosis (42% Child–Pugh B/C; 46% Model for End-Stage Liver Disease score >10). SVR12 (modified intention-to-treat) was achieved by 91% of patients (419/460); 1 patient had virological breakthrough and 13 patients relapsed. Virological failure was not associated with treatment group (adjusted risk difference DCV+SOF minus DCV+SOF+RBV: 1.06%; 95% CI −2.22% to 4.35%). High SVR12 was observed regardless of HCV genotype or cirrhosis, liver transplant or HIV/HCV coinfection status. Twenty eight patients discontinued treatment due to adverse events (n=18) or death (n=10) and 18 died during follow-up. Deaths and most safety events were associated with advanced liver disease and not considered treatment related.
Conclusions DCV+SOF with or without RBV achieved high SVR12 and was well tolerated in a diverse cohort of patients with severe liver disease.
Trial registration number NCT0209966.
Patients with risks of ischemic injury, e.g. during circulatory arrest in cardiac surgery, or after resuscitation are subjected to therapeutic hypothermia. For aortic surgery, the body is traditionally cooled down to 18 °C and then rewarmed to body temperature. The role of hypothermia and the subsequent rewarming process on leukocyte-endothelial interactions and expression of junctional-adhesion-molecules is not clarified yet. Thus, we investigated in an in-vitro model the influence of temperature modulation during activation and transendothelial migration of leukocytes through human endothelial cells. Additionally, we investigated the expression of JAMs in the rewarming phase. Exposure to low temperatures alone during transmigration scarcely affects leukocyte extravasation, whereas hypothermia during treatment and transendothelial migration improves leukocyte-endothelial interactions. Rewarming causes a significant up-regulation of transmigration with falling temperatures. JAM-A is significantly modulated during rewarming. Our data suggest that transendothelial migration of leukocytes is not only modulated by cell-activation itself. Activation temperatures and the rewarming process are essential. Continued hypothermia significantly inhibits transendothelial migration, whereas the rewarming process enhances transmigration strongly. The expression of JAMs, especially JAM-A, is strongly modulated during the rewarming process. Endothelial protection prior to warm reperfusion and mild hypothermic conditions reducing the difference between hypothermia and rewarming temperatures should be considered.
BACKGROUND: Involuntary exposure to health-threatening environmental tobacco smoke (Combined Mainstream and Side-stream Smoke, CMSS) is a worldwide problem, causing premature death of thousands of people. CMSS consists of particulate matter (PM), one of the main sources of indoor air pollution. PM constitutes a considerable health risk for passive smokers. It is important to inform the public about brand-specific differences in CMSS-associated PM, especially in the case of brands without additives, which are therefore promoted as natural and less health-threatening.
METHODS: Mean concentrations and the area under the curve of PM10, PM2.5 and PM1 generated by Natural American Spirit cigarettes without additives and the 3R4F standard research cigarette (University of Kentucky, USA) were measured, analyzed and compared with each other. An automatic environmental tobacco smoke emitter was used to smoke 100 cigarettes, 20 of each brand, according to a standardized smoking protocol.
RESULTS: This study could show that CMSS-associated PM released from tobacco brands without additives, which are therefore promoted as natural and less harmful, are higher than expected.
CONCLUSIONS: It is highly improbable that Natural American Spirit tobacco products are a less harmful choice-at least not for passive smokers as this study could show. We conclude, the CMSS-associated PM level of every single customized brand should be measured because the origin of the tobacco and not the amount of CO, tar and nicotine (given as product information) seem to be responsible for the brand-specific PM release. This data is urgently needed to adequately inform the public about CMSS-associated PM exposure and the related health risk especially for passive smokers.
BACKGROUND: Vermeulen et al. 2014 published a meta-regression analysis of three relevant epidemiological US studies (Steenland et al. 1998, Garshick et al. 2012, Silverman et al. 2012) that estimated the association between occupational diesel engine exhaust (DEE) exposure and lung cancer mortality. The DEE exposure was measured as cumulative exposure to estimated respirable elemental carbon in μg/m(3)-years. Vermeulen et al. 2014 found a statistically significant dose-response association and described elevated lung cancer risks even at very low exposures.
METHODS: We performed an extended re-analysis using different modelling approaches (fixed and random effects regression analyses, Greenland/Longnecker method) and explored the impact of varying input data (modified coefficients of Garshick et al. 2012, results from Crump et al. 2015 replacing Silverman et al. 2012, modified analysis of Moehner et al. 2013).
RESULTS: We reproduced the individual and main meta-analytical results of Vermeulen et al. 2014. However, our analysis demonstrated a heterogeneity of the baseline relative risk levels between the three studies. This heterogeneity was reduced after the coefficients of Garshick et al. 2012 were modified while the dose coefficient dropped by an order of magnitude for this study and was far from being significant (P = 0.6). A (non-significant) threshold estimate for the cumulative DEE exposure was found at 150 μg/m(3)-years when extending the meta-analyses of the three studies by hockey-stick regression modelling (including the modified coefficients for Garshick et al. 2012). The data used by Vermeulen and colleagues led to the highest relative risk estimate across all sensitivity analyses performed. The lowest relative risk estimate was found after exclusion of the explorative study by Steenland et al. 1998 in a meta-regression analysis of Garshick et al. 2012 (modified), Silverman et al. 2012 (modified according to Crump et al. 2015) and Möhner et al. 2013. The meta-coefficient was estimated to be about 10-20 % of the main effect estimate in Vermeulen et al. 2014 in this analysis.
CONCLUSIONS: The findings of Vermeulen et al. 2014 should not be used without reservations in any risk assessments. This is particularly true for the low end of the exposure scale.
Algorithms for the Maximum Cardinality Matching Problem which greedily add edges to the solution enjoy great popularity. We systematically study strengths and limitations of such algorithms, in particular of those which consider node degree information to select the next edge. Concentrating on nodes of small degree is a promising approach: it was shown, experimentally and analytically, that very good approximate solutions are obtained for restricted classes of random graphs. Results achieved under these idealized conditions, however, remained unsupported by statements which depend on less optimistic assumptions.
The KarpSipser algorithm and 1-2-Greedy, which is a simplified variant of the well-known MinGreedy algorithm, proceed as follows. In each step, if a node of degree one (resp. at most two) exists, then an edge incident with a minimum degree node is picked, otherwise an arbitrary edge is added to the solution.
We analyze the approximation ratio of both algorithms on graphs of degree at most D. Families of graphs are known for which the expected approximation ratio converges to 1/2 as D grows to infinity, even if randomization against the worst case is used. If randomization is not allowed, then we show the following convergence to 1/2: the 1-2-Greedy algorithm achieves approximation ratio (D-1)/(2D-3); if the graph is bipartite, then the more restricted KarpSipser algorithm achieves the even stronger factor D/(2D-2). These guarantees set both algorithms apart from other famous matching heuristics like e.g. Greedy or MRG: these algorithms depend on randomization to break the 1/2-barrier even for paths with D=2. Moreover, for any D our guarantees are strictly larger than the best known bounds on the expected performance of the randomized variants of Greedy and MRG.
To investigate whether KarpSipser or 1-2-Greedy can be refined to achieve better performance, or be simplified without loss of approximation quality, we systematically study entire classes of deterministic greedy-like algorithms for matching. Therefore we employ the adaptive priority algorithm framework by Borodin, Nielsen, and Rackoff: in each round, an adaptive priority algorithm requests one or more edges by formulating their properties---like e.g. "is incident with a node of minimum degree"---and adds the received edges to the solution. No constraints on time and space usage are imposed, hence an adaptive priority algorithm is restricted only by its nature of picking edges in a greedy-like fashion. If an adaptive priority algorithm requests edges by processing degree information, then we show that it does not surpass the performance of KarpSipser: our D/(2D-2)-guarantee for bipartite graphs is tight and KarpSipser is optimal among all such "degree-sensitive" algorithms even though it uses degree information merely to detect degree-1 nodes. Moreover, we show that if degrees of both nodes of an edge may be processed, like e.g. the Double-MinGreedy algorithm does, then the performance of KarpSipser can only be increased marginally, if at all. Of special interest is the capability of requesting edges not only by specifying the degree of a node but additionally its set of neighbors. This enables an adaptive priority algorithm to "traverse" the input graph. We show that on general degree-bounded graphs no such algorithm can beat factor (D-1)/(2D-3). Hence our bound for 1-2-Greedy is tight and this algorithm performs optimally even though it ignores neighbor information. Furthermore, we show that an adaptive priority algorithm deteriorates to approximation ratio exactly 1/2 if it does not request small degree nodes. This tremendous decline of approximation quality happens for graphs on which 1-2-Greedy and KarpSipser perform optimally, namely paths with D=2. Consequently, requesting small degree nodes is vital to beat factor 1/2.
Summarizing, our results show that 1-2-Greedy and KarpSipser stand out from known and hypothetical algorithms as an intriguing combination of both approximation quality and conceptual simplicity.
Dokumentation von Best-Practice-Beispielen zum Umgang mit dem Fahren ohne (gültigen) Fahrschein
(2016)
In Deutschland und Europa versuchen Verkehrsunternehmen und -verbünde bereits seit längerer Zeit gegen das Fahren ohne (gültigen) Fahrschein vorzugehen, ihre Fahrgeldeinnahmen zu sichern und zu steigern sowie die Quote der Personen, die den ÖPNV ohne (gültiges) Ticket nutzen, zu minimieren. Auf Grundlage des ersten Arbeitspaketes (Literaturanalyse zum Stand der Forschung: Schwerdtfeger et al. 2016) wurden Maßnahmen untersucht, die zum Erreichen der genannten Ziele beitragen. Der Fokus liegt dabei auf Best Practice Beispielen, also Maßnahmen, die in der Praxis als erfolgreich hinsichtlich der Reduzierung des Fahrens ohne (gültigen) Fahrschein sowie hinsichtlich der Einnahmesicherung und -steigerung angesehen werden. Das Ergebnis der Untersuchung ist eine umfangreiche Auseinandersetzung mit Best Practice Beispielen in Bezug auf das Fahren ohne (gültigen) Fahrschein. Außerdem wurden aktuell diskutierte Ansätze alternativer Finanzierungsinstrumente hinsichtlich ihrer Eignung zur Finanzierung des ÖPNV untersucht. Zwar können alternative Finanzierungsinstrumente derzeit noch nicht als Best Practice eingestuft werden, allerdings stehen sie in direkter Beziehung zur Einnahmesicherung im ÖPNV-Sektor.