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Continuous blood glucose monitoring reveals enormous circadian variations in pregnant diabetic rats
(2018)
Aim: Diabetes in pregnancy is a major burden with acute and long-term consequences. Its treatment requires adequate diagnosis and monitoring of therapy. Many experimental research on diabetes during pregnancy has been performed in rats. Recently, continuous blood glucose monitoring of non-pregnant diabetic rats revealed an increased circadian variability of blood glucose that made a single blood glucose measurement per day inappropriate to reflect glycemic status. Continuous blood glucose measurement has never been performed in pregnant rats. We wanted to perform continuous blood glucose monitoring in pregnant rats to decipher the influence of pregnancy on blood glucose in diabetic and normoglycemic status.
Methods: We used the transgenic Tet29 diabetes rat model with an inducible knock down of the insulin receptor via RNA interference upon application of doxycycline (DOX) leading to insulin resistant type II diabetes. All Tet29 rats received a HD-XG telemetry implant (Data Sciences International, USA) that measured blood glucose and activity continuously. Rats were divided into four groups and blood glucose was monitored until end of pregnancy or the corresponding period: Tet29 + DOX (diabetic) non-pregnant, Tet29 + DOX (diabetic) pregnant, Tet29 (normoglycemic) non-pregnant, Tet29 (normoglycemic) pregnant.
Results: All analyzed rats displayed a circadian variation in blood glucose concentration. Circadian variability was much more pronounced in pregnant diabetic rats than in normoglycemic pregnant rats. Pregnancy ameliorated variation in blood glucose in diabetic situation. Pregnancy continuously decreased blood glucose during normoglycemic pregnancy. Diabetic rats were less active than normoglycemic rats. We performed a calculation showing that application of continuous blood glucose measurement reduces animal numbers needed to detect a given effect in experimental setting by decreasing variability and SD.
Interpretation: Continuous blood glucose monitoring via a telemetry device in pregnant rats provides a more informative picture of the glycemic situation in comparison to single measurements. This could improve diagnosis and therapy of diabetes, decrease animal numbers within experimental settings, and add another physiological parameter (activity) to the analysis that could be helpful in testing therapeutic concepts targeting blood glucose levels and peripheral muscle function. We propose continuous glucose monitoring as a new tool for the evaluation of pregnant diabetic rats.
Vögel
(1995)
Die untere Havelniederung ist ein bedeutendes Brut-, Rast- und Überwinterungsgebiet für eine arten- und individuenreiche Vogelwelt. Die im Jahre 1978 erfolgte Ausweisung des Deichvorlandes der Havel als Feuchtgebiet von internationaler Bedeutung (FIB) und, einschließlich des Schollener Sees, als Europäisches Vogelschutzgebiet (IBA, seit 1993 als EU SPA bestätigt) unterstreicht die Bedeutung für den Vogelschutz. Gegenwärtig werden 135 bis 140 Brutvogel- und 80 Gastvogelarten zur Avifauna der unteren Havelniederung Sachsen-Anhalts gezählt.
Co-design of a trustworthy AI system in healthcare: deep learning based skin lesion classifier
(2021)
This paper documents how an ethically aligned co-design methodology ensures trustworthiness in the early design phase of an artificial intelligence (AI) system component for healthcare. The system explains decisions made by deep learning networks analyzing images of skin lesions. The co-design of trustworthy AI developed here used a holistic approach rather than a static ethical checklist and required a multidisciplinary team of experts working with the AI designers and their managers. Ethical, legal, and technical issues potentially arising from the future use of the AI system were investigated. This paper is a first report on co-designing in the early design phase. Our results can also serve as guidance for other early-phase AI-similar tool developments.
In dieser Arbeit wurde die Kinetik von zwei Ca2-plus-aktivierten Membranproteinen untersucht: zum einen des endogenen Ca2-plus-aktivierten Chloridkanals der Xenopus-Oozytenmembran, zum anderen des heterolog in Oozyten exprimierten Na-plus-Ca2-plus-Austauschers NCX1, kloniert aus dem Meerschweinchen-Herzen. Der Ca2-plus-aktivierte Chloridkanal wird durch intrazelluläres Ca2-plus im submikromolaren Konzentrationsbereich (KD = 0.5 µMCa2-plus) aktiviert und hat eine hohe Permeabilität für Chloridionen. In der ausgereiften Eizelle spielt er eine wichtige Rolle bei der Ausbildung des Fertilisationspotentials und verhindert durch eine Depolarisation der Membran eine Polyspermie. Der Na-plus-Ca2-plus-Austauscher ist in der Herzmuskelzelle für die Ausbildung des Exzitations- Kontraktions-Zyklus von Bedeutung, indem er für die Aufrechterhaltung des Ca2-plus- Gradienten (freies Ca2 intrazellulär ungefähr gleich 100 nm, extrazellulär ungefähr gleich 2 mM) über die Plasmamembran verantwortlich ist. Unter physiologischen Bedingungen transportiert der Na-plus- Ca2-plus-Austauscher ein Ca2-plus-Ion im Austausch gegen drei Na-plus-Ionen aus der Zelle hinaus, und nutzt somit den Na-plus-Gradienten neben dem Membranpotential als treibende Kraft. Als Messmethode wurde die Patch-Clamp-Technik in der inside-out-Makro-Patch- Konfiguration verwendet. Die Patch-Clamp-Technik erlaubt definierte ionale Bedingungen auf beiden Seiten der Membran. Cytoplasmatische Ca2-plus-Konzentrationssprünge wurden zum einen durch Lösungswechsel, insbesondere aber durch die Photolyse von DM-Nitrophen, einem photolabilen Ca2-plus-Chelator, hervorgerufen. Die Photolyse von DM-Nitrophen erlaubte, im Vergleich zum Lösungswechsel, sehr schnelle Ca2-plus- Konzentrationssprünge (Ca2-plus-Freisetzungsrate mindestens 38000 s-1). Die kinetischen Untersuchungen am Ca2-plus-aktivierten Chloridkanal haben neue, über bisherige aus dem Lösungswechselexperiment bekannte hinausgehende, Erkenntnisse ergeben: Nach einem schnellen Ca2-plus-Konzentrationssprung geht dem Signalanstieg auf einen stationären Wert eine deutlich schnellere Verzögerungsphase (lag-phase) voraus. Sowohl der Signalanstieg als auch die Verzögerungsphase zeigen eine starke Ca2-plus-Abhängigkeit, sind aber nur sehr schwach spannungsabhängig. Die Ergebnisse deuten darauf hin, dass der Signalanstieg den spannungsabhängigen Ca2-plus-Bindungs-/Dissoziationsschritt von mindestens zwei Ca2-plus-Ionen widerspiegelt, während das spannungsunabhängige Kanalöffnen/ -Schließen durch die Verzögerungsphase repräsentiert wird. Bei Spannungssprungexperimenten mit hoher Zeitauflösung konnte eine schnelle Inaktivierung nach einer Depolarisation der Membran gesehen werden, die in Gegenwart von sättigenden intrazellulären Ca2-plus-Konzentrationen zu einer Einwärtsgleichrichtung der Strom-Spannungskennlinie des stationären Stroms führt. Mit diesen Erkenntnissen konnte ein Reaktionsmodell für den Ca2-plus-aktivierten Chloridkanal aufgestellt werden, mit dem sich die experimentellen Daten simulieren ließen. Die heterologe Expression des Na-plus-Ca2-plus-Austauschers in Oozyten hat zu einem deutlich verbesserten Signal-Rausch-Verhältnis im Vergleich zu früheren Messungen am nativen Austauscher in Cardio-Myocyten-Membranen geführt. Mit Hilfe der Photolyse von DM-Nitrophen konnte erstmals eine vollständige Ca2-plus- und Spannungsabhängigkeit des vorstationären Einwärtsstroms, hervorgerufen durch einen cytoplasmatischen Ca2-plus-Konzentrationssprung, durchgeführt werden. Sowohl im Ca2-plus-Ca2-plus- als auch im Na-plus-Ca2-plus- Austauschmodus zeigt sich ein transientes Einwärtsstromsignal (Anstieg messtechnisch nicht auflösbar), das sehr schnell relaxiert. Im Ca2-plus-Ca2-plus-Austauschmodus zeigt sich nur ein transientes Stromsignal (kein Nettoladungstransport im stationären Zustand), während im Na-plus-Ca2-plus-Austausch sich ein stationärer Einwärtsstrom einstellt. Das transiente Stromsignal hat eine deutliche Ca2-plus-Abhängigkeit sowohl für den Spitzenstrom (KM = 30.9 ± 3.0 µM im Na-plus-Ca2-plus-Austausch, KM = 57 ± 10 µM im Ca2-plus- Ca2-plus-Austausch) als auch für die Geschwindigkeitskonstante 1/t des Signalabfalls (KM = 98.5 ± 21.3 µM im Na-plus-Ca2-plus-Austausch, KM = 76 ± 11 µM im Ca2-plus-Ca2-plus-Austausch) gezeigt. Die Relaxation des Stromtransienten erfolgt sowohl im Ca2-plus-Ca2-plus- als auch im Na-plus-Ca2-plus-Austausch mit einer maximalen Geschwindigkeitskonstanten von ungefähr gleich 10000 s -1 nach sättigenden Ca2-plus-Konzentrationssprüngen. Der Signalabfall hat sich über den gesamten untersuchten Ca2-plus-Konzentrationsbereich als spannungsunabhängig herausgestellt, während der Spitzenstrom bei positiven Membranpotentialen deutlich abnimmt. Dies führt zu einer Spannungsabhängigkeit der verschobenen Ladung (Integral des transienten Stromsignals) im Ca2-plus-Ca2-plus-Austausch. Aus diesen Erkenntnissen konnte für den Ca2-plus- Translokationszweig (im Rahmen eines konsekutiven Transportmodells) folgendes Reaktionsschema aufgestellt werden: Einem spannungsunabhängigen, sehr schnellen Ca2-plus- Bindungs/-Dissoziationsschritt (diffusionskontrolliert) auf der intrazellulären Membranseite folgt ein ebenfalls spannungsunabhängiger, aber ratenlimitierender Schritt (intrazellulärer Okklusionsschritt, asymmetrische Raten: 10000 vs. 1000 s-1). Der nachfolgende Ca2-plus-Translokationschritt muss sehr hohe Hin- und Rückraten aufweisen (ungefähr gleich 20000 s-1). Die Ca2-plus-Dissoziation/-Bindung auf der extrazellulären wird als sehr schnell (diffusionskontrolliert) und spannungsunabhängig angenommen. Weitergehende Einblicke haben der Sr2-plus-Ca2-plus- und der Ba2-plus-Ca2-plus-Austausch geliefert. Während der Sr2-plus-Ca2-plus-Austausch nahezu das gleiche Verhalten wie der Ca2-plus-Ca2-plus-Austausch gezeigt hat, konnte nach einem intrazellulären Ca2-plus-Konzentrationssprung im Ba2-plus-Ca2-plus-Austausch erstmals eine zusätzliche langsame Phase im Abklingen des transienten Einwärtsstromsignals beobachtet werden. Das transiente Signal hat im Vergleich zum Ca2-plus-Ca2-plus-Austausch eine signifikant höhere Ladungsverschiebung aufgewiesen. Dies deutet auf einen zusätzlichen elektrogenen Reaktionsschritt hin (extrazelluläre Ca2-plus-Okklusion). Weitere elektrogene Schritte müssen im Na-plus-Translokationszweig (Na-plus-Bindungs- und Na-plus-Translokationsschritt) liegen. Mit den aus diesen Erkenntnissen aufgestellten Reaktionsschemata ließen sich die experimentellen Daten erfolgreich simulieren. Die Gesamttransportrate im Na-plus-Ca2-plus- Austausch liegt demnach bei ungefähr gleich 1000 s-1 bei Raumtemperatur und stimmt damit mit Literaturwerten von mehreren 1000 s-1 bei physiologischer Temperatur überein.
On the observation of mesospheric air inside the arctic stratospheric polar vortex in early 2003
(2005)
During several balloon flights inside the Arctic polar vortex in early 2003, unusual trace gas distributions were observed, which indicate a strong influence of mesospheric air in the stratosphere. The tuneable diode laser (TDL) instrument SPIRALE (Spectroscopie InFrarouge par Absorption de Lasers Embarqués) measured unusually high CO values (up to 600 ppb) on 27 January at about 30 km altitude. The cryosampler BONBON sampled air masses with very high molecular Hydrogen, extremely low SF6 and enhanced CO values on 6 March at about 25 km altitude. Finally, the MIPAS (Michelson Interferometer for Passive Atmospheric Sounding) Fourier Transform Infra-Red (FTIR) spectrometer showed NOy values which are significantly higher than NOy* (the NOy derived from a correlation between N2O and NOy under undisturbed conditions), on 21 and 22 March in a layer centred at 22 km altitude. Thus, the mesospheric air seems to have been present in a layer descending from about 30 km in late January to 25 km altitude in early March and about 22 km altitude on 20 March. We present corroborating evidence from a model study using the KASIMA (KArlsruhe Simulation model of the Middle Atmosphere) model that also shows a layer of mesospheric air, which descended into the stratosphere in November and early December 2002, before the minor warming which occurred in late December 2002 lead to a descent of upper stratospheric air, cutting of a layer in which mesospheric air is present. This layer then descended inside the vortex over the course of the winter. The same feature is found in trajectory calculations, based on a large number of trajectories started in the vicinity of the observations on 6 March. Based on the difference between the mean age derived from SF6 (which has an irreversible mesospheric loss) and from CO2 (whose mesospheric loss is much smaller and reversible) we estimate that the fraction of mesospheric air in the layer observed on 6 March, must have been somewhere between 35% and 100%.
MIPAS-Envisat is a satellite-borne sensor which measured vertical profiles of a wide range of trace gases from 2002 to 2012 using IR emission spectroscopy. We present geophysical validation of the MIPAS-Envisat operational retrieval (version 6.0) of N2O, CH4, CFC-12, and CFC-11 by the European Space Agency (ESA). The geophysical validation data are derived from measurements of samples collected by a cryogenic whole air sampler flown to altitudes of up to 34 km by means of large scientific balloons. In order to increase the number of coincidences between the satellite and the balloon observations, we applied a trajectory matching technique. The results are presented for different time periods due to a change in the spectroscopic resolution of MIPAS in early 2005. Retrieval results for N2O, CH4, and CFC-12 show partly good agreement for some altitude regions, which differs for the periods with different spectroscopic resolution. The more recent low spectroscopic resolution data above 20 km altitude show agreement with the combined uncertainties, while there is a tendency of the earlier high spectral resolution data set to underestimate these species above 25 km. The earlier high spectral resolution data show a significant overestimation of the mixing ratios for N2O, CH4, and CFC-12 below 20 km. These differences need to be considered when using these data. The CFC-11 results from the operation retrieval version 6.0 cannot be recommended for scientific studies due to a systematic overestimation of the CFC-11 mixing ratios at all altitudes.
MIPAS-Envisat is a satellite-borne sensor which measured vertical profiles of a wide range of trace gases from 2002 to 2012 using IR emission spectroscopy. We present geophysical validation of the MIPAS-Envisat operational retrieval (version 6.0) of N2O, CH4, CFC-12, and CFC-11 by the European Space Agency (ESA). The geophysical validation data are derived from measurements of samples collected by a cryogenic whole air sampler flown to altitudes of up to 34 km by means of large scientific balloons. In order to increase the number of coincidences between the satellite and the balloon observations, we applied a trajectory matching technique. The results are presented for different time periods due to a change in the spectroscopic resolution of MIPAS in early 2005. Retrieval results for N2O, CH4, and CFC-12 show partly good agreement for some altitude regions, which differs for the periods with different spectroscopic resolution. The more recent low spectroscopic resolution data above 20 km altitude show agreement with the combined uncertainties, while there is a tendency of the earlier high spectral resolution data set to underestimate these species above 25 km. The earlier high spectral resolution data show a significant overestimation of the mixing ratios for N2O, CH4, and CFC-12 below 20 km. These differences need to be considered when using these data. The CFC-11 results from the operation retrieval version 6.0 cannot be recommended for scientific studies due to a systematic overestimation of the CFC-11 mixing ratios at all altitudes.
During several balloon flights inside the Arctic polar vortex in early 2003, unusual trace gas distributions were observed, which indicate a strong influence of mesospheric air in the stratosphere. The tuneable diode laser (TDL) instrument SPIRALE (Spectroscopie InFrarouge par Absorption de Lasers Embarqués) measured unusually high CO values (up to 600 ppb) on 27 January at about 30 km altitude. The cryosampler BONBON sampled air masses with very high molecular Hydrogen, extremely low SF6 and enhanced CO values on 6 March at about 25 km altitude. Finally, the MIPAS (Michelson Interferometer for Passive Atmospheric Sounding) Fourier Transform Infra-Red (FTIR) spectrometer showed NOy values which are significantly higher than NOy* (the NOy derived from a correlation between N2O and NOy under undisturbed conditions), on 21 and 22 March in a layer centred at 22 km altitude. Thus, the mesospheric air seems to have been present in a layer descending from about 30 km in late January to 25 km altitude in early March and about 22 km altitude on 20 March. We present corroborating evidence from a model study using the KASIMA (KArlsruhe Simulation model of the Middle Atmosphere) model that also shows a layer of mesospheric air, which descended into the stratosphere in November and early December 2002, before the minor warming which occurred in late December 2002 lead to a descent of upper stratospheric air, cutting of a layer in which mesospheric air is present. This layer then descended inside the vortex over the course of the winter. The same feature is found in trajectory calculations, based on a large number of trajectories started in the vicinity of the observations on 6 March. Based on the difference between the mean age derived from SF6 (which has an irreversible mesospheric loss) and from CO2 (whose mesospheric loss is much smaller and reversible) we estimate that the fraction of mesospheric air in the layer observed on 6 March, must have been somewhere between 35% and 100%.
Introduction: The German PID-NET registry was founded in 2009, serving as the first national registry of patients with primary immunodeficiencies (PID) in Germany. It is part of the European Society for Immunodeficiencies (ESID) registry. The primary purpose of the registry is to gather data on the epidemiology, diagnostic delay, diagnosis, and treatment of PIDs.
Methods: Clinical and laboratory data was collected from 2,453 patients from 36 German PID centres in an online registry. Data was analysed with the software Stata® and Excel.
Results: The minimum prevalence of PID in Germany is 2.72 per 100,000 inhabitants. Among patients aged 1–25, there was a clear predominance of males. The median age of living patients ranged between 7 and 40 years, depending on the respective PID. Predominantly antibody disorders were the most prevalent group with 57% of all 2,453 PID patients (including 728 CVID patients). A gene defect was identified in 36% of patients. Familial cases were observed in 21% of patients. The age of onset for presenting symptoms ranged from birth to late adulthood (range 0–88 years). Presenting symptoms comprised infections (74%) and immune dysregulation (22%). Ninety-three patients were diagnosed without prior clinical symptoms. Regarding the general and clinical diagnostic delay, no PID had undergone a slight decrease within the last decade. However, both, SCID and hyper IgE- syndrome showed a substantial improvement in shortening the time between onset of symptoms and genetic diagnosis. Regarding treatment, 49% of all patients received immunoglobulin G (IgG) substitution (70%—subcutaneous; 29%—intravenous; 1%—unknown). Three-hundred patients underwent at least one hematopoietic stem cell transplantation (HSCT). Five patients had gene therapy.
Conclusion: The German PID-NET registry is a precious tool for physicians, researchers, the pharmaceutical industry, politicians, and ultimately the patients, for whom the outcomes will eventually lead to a more timely diagnosis and better treatment.
Children’s and adolescents’ lives drastically changed during COVID lockdowns worldwide. To compare accident- and injury-related admissions to pediatric intensive care units (PICU) during the first German COVID lockdown with previous years, we conducted a retrospective multicenter study among 37 PICUs (21.5% of German PICU capacities). A total of 1444 admissions after accidents or injuries during the first lockdown period and matched periods of 2017–2019 were reported and standardized morbidity ratios (SMR) were calculated. Total PICU admissions due to accidents/injuries declined from an average of 366 to 346 (SMR 0.95 (CI 0.85–1.05)). Admissions with trauma increased from 196 to 212 (1.07 (0.93–1.23). Traffic accidents and school/kindergarten accidents decreased (0.77 (0.57–1.02 and 0.26 (0.05–0.75)), whereas household and leisure accidents increased (1.33 (1.06–1.66) and 1.34 (1.06–1.67)). Less neurosurgeries and more visceral surgeries were performed (0.69 (0.38–1.16) and 2.09 (1.19–3.39)). Non-accidental non-suicidal injuries declined (0.73 (0.42–1.17)). Suicide attempts increased in adolescent boys (1.38 (0.51–3.02)), but decreased in adolescent girls (0.56 (0.32–0.79)). In summary, changed trauma mechanisms entailed different surgeries compared to previous years. We found no evidence for an increase in child abuse cases requiring intensive care. The increase in suicide attempts among boys demands investigation.