Year of publication
- Physik (16)
- Medizin (5)
- Exzellenzcluster Die Herausbildung normativer Ordnungen (1)
- Geowissenschaften (1)
- Pharmazie (1)
- Protocol TOP-Study (tacrolimus organ perfusion): a prospective randomized multicenter trial to reduce ischemia reperfusion injury in transplantation of marginal liver grafts with an ex vivo tacrolimus perfusion (2013)
- Background: Critical organ shortage results in the utilization of extended donor criteria (EDC) liver grafts. These marginal liver grafts are prone to increased ischemia reperfusion injury (IRI) which may contribute to deteriorated graft function and survival. Experimental data have shown that the calcineurin inhibitor tacrolimus exerts protective effects on hepatic IRI when applied intravenously or directly as a hepatic rinse. Therefore, the aim of the present study is to examine the effects of an ex vivo tacrolimus perfusion on IRI in transplantation of EDC liver grafts. Methods/Design: The TOP-Study (tacrolimus organ perfusion) is a randomized multicenter trial comparing the ex vivo tacrolimus perfusion of marginal liver grafts with placebo. We hypothesize that a tacrolimus rinse reduces IRI, potentially improving organ survival following transplantation of EDC livers. The study includes livers with two or more EDC, according to Eurotransplant International Foundation’s definition of EDC livers. Prior to implantation, livers randomized to the treatment group are rinsed with tacrolimus at a concentration of 20 ng/ml in 1000 ml Custodiol solution and in the placebo group with Custodiol alone. The primary endpoint is the maximum serum alanine transamninase (ALT) level within the first 48 hours after surgery; however, the study design also includes a 1-year observation period following transplantation. The TOP-Study is an investigator-initiated trial sponsored by the University of Munich Hospital. Seven other German transplant centers are participating (Berlin, Frankfurt, Heidelberg, Mainz, Münster, Regensburg, Tübingen) and aim to include a total of 86 patients. Discussion: Tacrolimus organ perfusion represents a promising strategy to reduce hepatic IRI following the transplantation of marginal liver grafts. This treatment may help to improve the function of EDC grafts and therefore safely expand the donor pool in light of critical organ shortage. Trial register: EudraCT number: 2010-021333-31, ClinicalTrials.gov identifier: NCT01564095
- Baseline MELD Score Predicts Hepatic Decompensation during Antiviral Therapy in Patients with Chronic Hepatitis C and Advanced Cirrhosis (2013)
- Background and Aims: In patients with advanced liver cirrhosis due to chronic hepatitis C virus (HCV) infection antiviral therapy with peginterferon and ribavirin is feasible in selected cases only due to potentially life-threatening side effects. However, predictive factors associated with hepatic decompensation during antiviral therapy are poorly defined. Methods: In a retrospective cohort study, 68 patients with HCV-associated liver cirrhosis (mean MELD score 9.18±2.72) were treated with peginterferon and ribavirin. Clinical events indicating hepatic decompensation (onset of ascites, hepatic encephalopathy, upper gastrointestinal bleeding, hospitalization) as well as laboratory data were recorded at baseline and during a follow up period of 72 weeks after initiation of antiviral therapy. To monitor long term sequelae of end stage liver disease an extended follow up for HCC development, transplantation and death was applied (240weeks, ±SD 136weeks). Results: Eighteen patients (26.5%) achieved a sustained virologic response. During the observational period a hepatic decompensation was observed in 36.8%. Patients with hepatic decompensation had higher MELD scores (10.84 vs. 8.23, p<0.001) and higher mean bilirubin levels (26.74 vs. 14.63 µmol/l, p<0.001), as well as lower serum albumin levels (38.2 vs. 41.1 g/l, p = 0.015), mean platelets (102.64 vs. 138.95/nl, p = 0.014) and mean leukocytes (4.02 vs. 5.68/nl, p = 0.002) at baseline as compared to those without decompensation. In the multivariate analysis the MELD score remained independently associated with hepatic decompensation (OR 1.56, 1.18–2.07; p = 0.002). When the patients were grouped according to their baseline MELD scores, hepatic decompensation occurred in 22%, 59%, and 83% of patients with MELD scores of 6–9, 10–13, and >14, respectively. Baseline MELD score was significantly associated with the risk for transplantation/death (p<0.001). Conclusions: Our data suggest that the baseline MELD score predicts the risk of hepatic decompensation during antiviral therapy and thus contributes to decision making when antiviral therapy is discussed in HCV patients with advanced liver cirrhosis.
- Shell structure of superheavy nuclei in self-consistent mean-field models (1999)
- We study the extrapolation of nuclear shell structure to the region of superheavy nuclei in self-consistent mean-field models—the Skyrme-Hartree-Fock approach and the relativistic mean-field model—using a large number of parametrizations which give similar results for stable nuclei but differ in detail. Results obtained with the folded-Yukawa potential which is widely used in macroscopic-macroscopic models are shown for comparison. We focus on differences in the isospin dependence of the spin-orbit interaction and the effective mass between the models and their influence on single-particle spectra. The predictive power of the mean-field models concerning single-particle spectra is discussed for the examples of 208Pb and the spin-orbit splittings of selected neutron and proton levels in 16O, 132Sn, and 208Pb. While all relativistic models give a reasonable description of spin-orbit splittings, all Skyrme interactions show a wrong trend with mass number. The spin-orbit splitting of heavy nuclei might be overestimated by 40%–80%, which exposes a fundamental deficiency of the current nonrelativistic models. In most cases the occurrence of spherical shell closures is found to be nucleon-number dependent. Spherical doubly magic superheavy nuclei are found at 184298114, 172292120, or 184310126 depending on the parametrization. The Z=114 proton shell closure, which is related to a large spin-orbit splitting of proton 2f states, is predicted only by forces which by far overestimate the proton spin-orbit splitting in 208Pb. The Z=120 and N=172 shell closures predicted by the relativistic models and some Skyrme interactions are found to be related to a central depression of the nuclear density distribution. This effect cannot appear in macroscopic-microscopic models or semiclassical approaches like the extended Thomas-Fermi-Strutinski integral approach which have a limited freedom for the density distribution only. In summary, our findings give a strong argument for 172292120 to be the next spherical doubly magic superheavy nucleus.
- Potential energy surfaces of superheavy nuclei (1998)
- We investigate the structure of the potential energy surfaces of the superheavy nuclei 158258Fm100, 156264Hs108, 166278112, 184298114, and 172292120 within the framework of self-consistent nuclear models, i.e., the Skyrme-Hartree-Fock approach and the relativistic mean-field model. We compare results obtained with one representative parametrization of each model which is successful in describing superheavy nuclei. We find systematic changes as compared to the potential energy surfaces of heavy nuclei in the uranium region: there is no sufficiently stable fission isomer any more, the importance of triaxial configurations to lower the first barrier fades away, and asymmetric fission paths compete down to rather small deformation. Comparing the two models, it turns out that the relativistic mean-field model gives generally smaller fission barriers.
- Dirac particles in Rindler space (1980)
- We show that a uniformly accelerated observer experiences a "thermal" flux of Dirac particles in the ordinary Minkowski vacuum.
- Fields nonlocal in Clifford space. I. Classical Gauge-invariant nonlinear field theory (1972)
- A fully gauge-invariant, Lorentz-covariant, nonlocal, and nonlinear theory, for coupled spin-½ fields, ψ, and vector fields, A, i.e., "electrons" and "photons," is constructed. The field theory is linear in the ψ fields. The nonlinearity in the A fields arises unambiguously from the requirement of gauge invariance. The coordinates are generalized to admit hypercomplex values, i.e., they are taken to be Clifford numbers. The nonlocality is limited to the hypercomplex component of the coordinates. As the size of the nonlocality is reduced toward zero, the theory goes over into the inhomogeneous Dirac theory. The nonlocality parameter corresponds to an inverse mass and induces self-regulatory properties of the propagators. It is argued that in a gauge-invariant theory a graph-by-graph convergence is impossible in principle, but it is possible that convergence may hold for the complete solution, or for sums over classes of graphs.
- Continuum nuclear structure of O16 in the Eigenchannel reaction theory (1967)
- The total particle-particle SJ matrix of O16 for spin J=1- and excitation energies between 15 and 27 MeV has been calculated in the eigenchannel reaction theory for several parameters of the Saxon-Woods potential and the two-body force. The many-body problem has been treated in the 1-particle-1-hole approximation. The photon channels have been included by perturbation theory. Surprisingly, the most important structure of the experimental cross sections is reproduced quite well in this simple approximation.
- Collective treatment of the giant resonances in spherical nuclei (1966)
- In a collective treatment the energies of the giant resonances are given by the boundary conditions at the nuclear surface, which is subject to vibration in spherical nuclei. The general form of the coupling between these two collective motions is given by angular-momentum and parity conservation. The coupling constants are completely determined within the hydrodynamical model. In the present treatment the influence of the surface vibrations on the total photon-absorption cross section is calculated. It turns out that in most of the spherical nuclei this interaction leads to a pronounced structure in the cross section. The agreement with the experiments in medium-heavy nuclei is striking; many of the experimental characteristics are reproduced by the present calculations. In some nuclei, however, there seem to be indications of single-particle excitations which are not yet contained in this work.
- Photonuclear effect in heavy deformed nuclei (1966)
- The theory of Raman scattering is extended to include electric-quadrupole radiation. The results obtained are used to compute the elastic and Raman scattering cross sections of heavy deformed nuclei. The dipole and quadrupole resonances are described by a previously developed theory which includes surface vibrations and rotations. The computed cross sections are compared with experimental data for all those nuclei where both absorption and scattering cross sections are available. Some discrepances still exist in certain details; however, the over-all agreement between theory and experiment is very good.