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The resurgence of populism and the advent of the Covid-19 pandemic have consolidated an appeal to the language of trust and distrust in the political arena, but any reference to these notions has often turned into an ideological and polarized debate. As a result, the possibility of developing an appropriate picture of the conditions for trust in politics has been undermined. To navigate the different demands for trust raised in the political arena, a notion of political trust must cover two partially unfulfilled tasks. One is to clarify what trust means when referring specifically to the political context. The other is to connect political trust to other notions that populate the debate on trustworthiness in the political arena - those of rational, moral, epistemic, and procedural trust. I will show how the political categories I use to define the scope of a political notion of trust function as normative leverages to develop politics-compatible versions of rational, moral, procedural, and epistemic trust.
Lungensonographie bei Patienten mit HIV und AIDS
Ziele und Methoden: Vor dem Hintergrund mehrerer retrospektiven Studien und Fallserien zur Anwendung des Lungenultraschalls zur Diagnose HIV-assoziierter Lungenerkrankungen führten wir eine prospektive Studie in der Abteilung für Infektiologie am Klinikum der Goethe-Universität Frankfurt durch. Wir schlossen hierbei Patientinnen und Patienten ein, bei denen durch konventionelle Diagnostik eine Lungenerkrankung nachzuweisen oder auszuschließen war, und führten zeitnah zur konventionellen Diagnostik verblindete Ultraschalluntersuchungen durch. Diese wurden zudem verblindet von zwei weiteren Ultraschalluntersuchern reevaluiert, basierend darauf wurde die Interrater-Reliabilität zwischen den drei Befunden errechnet. Die konventionell-radiologischen Untersuchungen wurden verblindet von einem weiteren Radiologen befundet.
Ergebnisse: Wir untersuchten 80 HIV-positive Patienten, von denen 54 nachweislich eine pulmonale Erkrankung hatten. Die häufigsten Diagnosen waren Pneumocystis jirovecii-Pneumonien (21 Fälle), bakterielle Pneumonien (17 Fälle) und andere Diagnosen (16 Fälle). Die Lungenultraschalluntersuchungen zeigten bei 90.7% der Patienten mit pulmonaler Diagnose und bei 34.5% der lungengesunden Patienten Auffälligkeiten. Die CT-Untersuchungen fanden Pathologien in 97.5% der Erkrankten und 27.3% der Gesunden. Röntgenuntersuchungen zeigten bei 78.1% der Erkrankten und bei 25% der Gesunden pathologische Befunde. Die häufigsten Pathologien in allen Modalitäten waren interstitielle Veränderungen. Diese zeigten in der Lungenultraschalluntersuchung keinen signifikanten Unterschied zwischen den verschiedenen Lungenerkrankungen, waren jedoch signifikant häufiger als bei Patienten ohne Lungenerkrankung. Konsolidierungen und Pleuraergüsse waren im Lungenultraschall zwar häufiger bei Erkrankten, aber nicht signifikant gegenüber den Gesunden. Die Interrater-Reliabilität des Lungenultraschalls war hoch für interstitielle Pathologien (ICC=0.82) ohne nennenswerte Änderungen im Studienverlauf (r=-0.11), und niedriger bei Konsolidierungen und Ergüssen (jeweils κ=0.12) mit positivem Zusammenhang zur Studiendauer (r=0.88 für Konsolidierungen, r=0.37 für Ergüsse).
Diskussion: Lungenerkrankungen sind bei HIV-Patienten im Ultraschall am häufigsten durch interstitielle Pathologien nachzuweisen, diese allein erlauben allerdings keine Unterscheidung zwischen verschiedenen Erkrankungen. Die Sensitivität der Ultraschalluntersuchung ist geringer als die der Computertomographie, jedoch höher als die Sensitivität des Röntgens. Interstitielle Pathologien werden bereits nach kurzer Lernphase reliabel identifiziert. Konsolidierungen und Ergüsse waren seltenere Befunde, und scheinen eine längere Lernphase zu benötigen, da die Interrater-Reliabilität im Verlauf der Studie ansteigt. In allen Modalitäten zeigten auch gesunde Patienten bildgebend Auffälligkeiten, was den positiv prädiktiven Wert bei niedrigerer Prävalenz negativ beeinflussen kann.
Lungensonographie bei Patienten mit COVID-19
Ziele und Methoden: Im Rahmen der seit Ende 2019 andauernden COVID-19 Pandemie boten sich die erlernten Sonographiekenntnisse für die bettseitige Diagnostik dieser neuen Lungenerkrankung an. Aufgrund der Pathogenität des neuartigen Erregers wandten wir die Lungensonographie zur Diagnostik unter Isolationsbedingungen an, um Transporte für konventionelle Bildgebung zu reduzieren. Bettseitig durchgeführte Lungensonographien bei SARS-CoV-2-positiven Patientinnen und Patienten wurden mit durchgeführter konventioneller Bildgebung im Rahmen dieser retrospektiven Fallserie verglichen.
Ergebnisse: Die Ultraschalluntersuchungen von 17 Patientinnen und Patienten wurden ausgewertet, hiervon zeigten 14 Untersuchungen Pathologien. In neun Fällen wurden interstitielle Pathologien beobachtet, fünf dieser Fälle zeigten zusätzlich Konsolidierungen.
Drei Patienten hatten außer Konsolidierungen keine weiteren Pathologien. Pleuraergüsse wurden in drei Fällen beobachtet, Pleuraplaques bei einem Patienten. In 5 von 7 Fällen mit auffälligem Thorax-CT zeigte die Lungensonographie Pathologien. Die Lungensonographie zeigte in jedem Fall Pathologien, in dem auch das Röntgen auffällig war.
Diskussion: Diese Fallserie zeigt die Anwendung der Sonographie als bettseitige Lungendiagnostik unter Isolationsbedingungen. Interstitielle Pathologien und Konsolidierungen scheinen die relevantesten Hinweise auf eine pulmonale Beteiligung im Rahmen der COVID-19-Erkrankung zu sein. Wegen der geringen Fallzahl und des retrospektiven Designs ist die Aussagekraft dieser Substudie gering, jedoch zeigt sie die Umsetzbarkeit der Sonographie als bildgebendes Verfahren, wenn aufgrund notwendiger Isolationsmaßnahmen und hoher Fallzahlen konventionelle Bildgebung erschwert ist.
Electrospinning is a versatile and promising drug delivery technology for the development of tailor-made drug delivery systems for various clinical applications. By applying high voltages to drug-loaded polymer solutions, solid polymeric nanofibers can be generated, which encapsulate active pharmaceutical ingredients (APIs) into their polymer matrix. During the electrospinning process, the fibers are deposited on a collector and form a nonwoven network of drug-loaded polymer fibers. These fibers are spatially distributed in aligned or random orientation, providing the opportunity to design highly tunable structural and mechanical properties, which can be adapted to the biological requirements of the intended application site. The mechanically flexible fiber networks can therapeutically be administered to a multitude of pharmaceutical application sites. Their highly porous fiber structure exhibits a large surface-to-volume ratio, which is ideal for controlled drug release kinetics from the polymer matrix upon contact with biological fluids, such as tear fluid, saliva, mucus, wound exudate or gastro-intestinal fluid. For application at the target site, fiber mats are cut into patches. As the patch size determines the quantity of applied API, the electrospinning process must ensure homogeneous distribution of the API throughout the entire fiber mat area.
In this thesis, electrospinning was established as a formulation technology for the rational fabrication of tailor-made multifunctional drug carrier systems for local and site-specific drug delivery to the epithelial interfaces skin, oral mucosa as well as cornea. For adequate characterization and analysis of the drug delivery systems, a broad panel of robust and predictive analytical tools, based of novel investigation techniques for physicochemical characterization of electrospun fibers, was developed.
The initial part of the thesis thematically focuses on the development of predictive analytical techniques, to determine fiber morphology and physicochemical properties, as well as fiber composition and drug release. By designing two model formulations with contrasting properties, and subsequent analysis and characterization with a set of newly developed techniques and state-of-the-art methods, a comprehensive toolset has been made available and evaluated, aiming at advancing and standardizing respective techniques in the scientific field of electrospun drug delivery systems.
Starting with the initiation of the electrospinning formulation process, which often relies on empirical data rather than analytical methods to predict successful processability, analysis of rheological properties of electrospinning solutions was used to rationally detect the minimum polymer concentration required for electrospinning.
For analysis of fiber morphology, scanning electron microscopy is a common technique. However, little attention is given to underlying readout parameters. By analyzing the fiber orientation and diameter of the respective fibers, predictive results regarding mechanical properties could be obtained, which were subsequently confirmed by measuring elongation force with tensile testing. Confocal Raman microscopy, a label-free method for chemically- selective imaging of the fiber samples, was introduced as a complementary visualization technique, enabling the detection of fiber composition and drug distribution.
A novel technique for investigation of water contact angles on the fiber surface of highly hydrophilic polymers was introduced, which provides predictive data regarding interaction with body fluids and the resulting drug release kinetics. Subsequent release testing in a newly developed setup for analyzing drug release from electrospun fibers in low-volume body compartments, confirmed the anticipated drug release kinetics from measurement of the surface hydrophilicity.
By combining complementary analytical methods, including spectral composition analysis, morphology visualization, characterization of physico-chemical properties and drug release kinetics, as well as the application of multivariate data analysis, a robust and predictive toolset has been established, which can support comparability of future electrospinning studies and the translation from the lab bench into clinics.
Based on the analytical toolset, the main part of the thesis focuses on the development and preparation of electrospun platform drug delivery systems for application on epithelial barriers. Electrospun fiber mats are thin, flat, and mechanically flexible, which allows close adherence to epithelial surfaces and reduction of diffusion paths, which enables efficient drug delivery to the skin, oral mucosa, as well as the cornea.
Electrospun fibers bear a high potential for application as wound dressings, while simultaneously controlling the local delivery of APIs to the wound area. Their close resemblance to the extracellular matrix of human skin provides a suitable microenvironment for cellular proliferation and migration for wound closure. In this work, insulin, a fragile proteohormone with growth factor characteristics, was successfully encapsulated into the core of coaxially electrospun fibers, thus maintaining bioactivity throughout and after the electrospinning process. The shell has been designed from biocompatible polymers, which, upon contact with aqueous wound exudate, partially dissolve and form pores through which bioactive insulin is released in a controlled manner. The shell layer provides a hydrophilic surface for interaction with body fluids and skin cells, and possesses substantial mechanical strength, flexibility, and high tensile elongation required for application on wounds. The biocompatibility of the wound dressing was investigated by interaction with primary human dermal fibroblasts and keratinocytes, which displayed healthy cell morphologies without indicating any elevated levels of cytotoxicity markers.
To investigate the effect of insulin on cell migration, in vitro scratch assays on human skin cells were performed. Increased cellular migration speed and wound closure could be observed, indicating improved wound healing. Bio relevance of in vitro wound healing potential results was advanced by development of 3D ex vivo human epidermal skin wound models from reduction surgery donor material. These complex wound models were treated with electrospun insulin fibers and analyzed by proteome analysis to reveal significant increases in wound healing-associated signaling pathways, which could be attributed to a material-driven remarkably positive impact on wound healing of the electrospun fibers...
Ziel der Arbeit ist es die Eigenschaften und die Häufigkeit von Rezidiven der primär und sekundär therapierten Basalzellkarzinome der MKPG, insbesondere in Abhängigkeit der Lokalisation und des Resektionsstatus zu evaluieren und mit den Ergebnissen der Literatur zu vergleichen, um ein optimiertes chirurgisches Vorgehen zu sichern.
leporello #19
(2024)
Uni-Highlights Januar 2024 : Einladungen zu ausgewählten Veranstaltungen der Goethe-Universität
(2024)
Uni-Highlights Februar 2024 : Einladungen zu ausgewählten Veranstaltungen der Goethe-Universität
(2024)
Graphium chironides malayanum Eliot, 1982 was described as a taxon occurring sympatrically with G. bathycles bathycloides in Peninsular Malaysia. However, the validity of the subspecies has been questioned in a recent publication that was based on a study of DNA and morphology, implying that G. c. malayanum is a synonym of G. b. bathycloides and G. chironides is absent from the Peninsula. A re-examination of male wing morphology, genitalia and DNA shows that G. c. malayanum is a valid taxon distinguished from G. b. bathycloides by wider discal markings, a less falcate forewing, distinct differences in the arms of the harpe in the male genitalia and clearly divergent mtDNA COI genes. In the DNA analysis, G. c. malayanum formed a monophyletic clade closely related to G. chironides from China, and both were well-separated from the G. b. bathycloides clade. An examination of characters used in the previous study showed that the conclusions reached were due to misinterpretation of diagnostic characters, misidentification of specimens and the absence of G. c. malayanum among the specimens examined. When these characters were correctly interpreted, each specimen was readily assigned to the correct taxon. Diagnostic morphological characters are reclarified based on the current data.