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Treatment‐related complications contribute substantially to morbidity and mortality in acute myeloid leukemia (AML) patients undergoing induction chemotherapy. Although AML patients are susceptible to fluid overload (FO) (e.g., in the context of chemotherapy protocols, during sepsis treatment or to prevent tumor lysis syndrome), little attention has been paid to its role in AML patients undergoing induction chemotherapy. AML patients receiving induction chemotherapy between 2014 and 2019 were included in this study. FO was defined as ≥5% weight gain on day 7 of induction chemotherapy compared to baseline weight determined on the day of admission. We found FO in 23 (12%) of 187 AML patients undergoing induction chemotherapy. Application of >100 ml crystalloid fluids/kg body weight until day 7 of induction chemotherapy was identified as an independent risk factor for FO. AML patients with FO suffered from a significantly increased 90-day mortality rate and FO was demonstrated as an independent risk factor for 90-day mortality. Our data suggests an individualized, weight-adjusted calculation of crystalloid fluids in order to prevent FO-related morbidity and mortality in AML patients during induction chemotherapy. Prospective trials are required to determine the adequate fluid management in this patient population.
Background: MicroRNA-21 (miR-21) is up-regulated in tumor tissue of patients with malignant diseases, including hepatocellular carcinoma (HCC). Elevated concentrations of miR-21 have also been found in sera or plasma from patients with malignancies, rendering it an interesting candidate as serum/plasma marker for malignancies. Here we correlated serum miR-21 levels with clinical parameters in patients with different stages of chronic hepatitis C virus infection (CHC) and CHC-associated HCC.
Methodology/Principal Findings: 62 CHC patients, 29 patients with CHC and HCC and 19 healthy controls were prospectively enrolled. RNA was extracted from the sera and miR-21 as well as miR-16 levels were analyzed by quantitative real-time PCR; miR-21 levels (normalized by miR-16) were correlated with standard liver parameters, histological grading and staging of CHC. The data show that serum levels of miR-21 were elevated in patients with CHC compared to healthy controls (P<0.001); there was no difference between serum miR-21 in patients with CHC and CHC-associated HCC. Serum miR-21 levels correlated with histological activity index (HAI) in the liver (r = −0.494, P = 0.00002), alanine aminotransferase (ALT) (r = −0.309, P = 0.007), aspartate aminotransferase (r = −0.495, P = 0.000007), bilirubin (r = −0.362, P = 0.002), international normalized ratio (r = −0.338, P = 0.034) and γ-glutamyltransferase (r = −0.244, P = 0.034). Multivariate analysis revealed that ALT and miR-21 serum levels were independently associated with HAI. At a cut-off dCT of 1.96, miR-21 discriminated between minimal and mild-severe necroinflammation (AUC = 0.758) with a sensitivity of 53.3% and a specificity of 95.2%.
Conclusions/Significance: The serum miR-21 level is a marker for necroinflammatory activity, but does not differ between patients with HCV and HCV-induced HCC.
k-MED entwickelte sich von einem fachbezogenen Projekt im Jahr 1999 zu einem e-Learning-Dienstleister mit umfangreichen Lehr-Lernangeboten sowie einer technischen und organisatorischen Infrastruktur für Autoren und Nutzer. Es bietet heute – Mitte 2006 – 5000 Studierenden, v.a. der Humanmedizin, ca. 170 Lernkurse aus 16 medizinischen Fächern. Das Projekt umfasst erfahrenes Fachpersonal und nutzt eine eigene Online-Autorenumgebung sowie eine internetbasierte Lernplattform, deren Funktionalitäten in Abstimmung mit evaluierten Lehr- und Lern-Szenarien ständig weiter entwickelt werden. Die wichtigste Aufgabe ist die Vollversorgung von Bildungseinrichtungen, darunter vor allem medizinische Fakultäten, mit Lehr-Lern- und Kommunikationsinstrumenten. Aktuelle Informationen sind zu finden unter http://www.k-med.org.
Purpose: Molecular diagnostics including next generation gene sequencing are increasingly used to determine options for individualized therapies in brain tumor patients. We aimed to evaluate the decision-making process of molecular targeted therapies and analyze data on tolerability as well as signals for efficacy.
Methods: Via retrospective analysis, we identified primary brain tumor patients who were treated off-label with a targeted therapy at the University Hospital Frankfurt, Goethe University. We analyzed which types of molecular alterations were utilized to guide molecular off-label therapies and the diagnostic procedures for their assessment during the period from 2008 to 2021. Data on tolerability and outcomes were collected.
Results: 413 off-label therapies were identified with an increasing annual number for the interval after 2016. 37 interventions (9%) were targeted therapies based on molecular markers. Glioma and meningioma were the most frequent entities treated with molecular matched targeted therapies. Rare entities comprised e.g. medulloblastoma and papillary craniopharyngeoma. Molecular targeted approaches included checkpoint inhibitors, inhibitors of mTOR, FGFR, ALK, MET, ROS1, PIK3CA, CDK4/6, BRAF/MEK and PARP. Responses in the first follow-up MRI were partial response (13.5%), stable disease (29.7%) and progressive disease (46.0%). There were no new safety signals. Adverse events with fatal outcome (CTCAE grade 5) were not observed. Only, two patients discontinued treatment due to side effects. Median progression-free and overall survival were 9.1/18 months in patients with at least stable disease, and 1.8/3.6 months in those with progressive disease at the first follow-up MRI.
Conclusion: A broad range of actionable alterations was targeted with available molecular therapeutics.
However, efficacy was largely observed in entities with paradigmatic oncogenic drivers, in particular with BRAF mutations. Further research on biomarker-informed molecular matched therapies is urgently necessary.
Background: It has been demonstrated that cognitive behavioural therapy (CBT) has a moderate effect on symptom reduction and on general well being of patients suffering from psychosis. However, questions regarding the specific efficacy of CBT, the treatment safety, the cost-effectiveness, and the moderators and mediators of treatment effects are still a major issue. The major objective of this trial is to investigate whether CBT is specifically efficacious in reducing positive symptoms when compared with non-specific supportive therapy (ST) which does not implement CBT-techniques but provides comparable therapeutic attention. Methods: The POSITIVE study is a multicenter, prospective, single-blind, parallel group, randomised clinical trial, comparing CBT and ST with respect to the efficacy in reducing positive symptoms in psychotic disorders. CBT as well as ST consist of 20 sessions altogether, 165 participants receiving CBT and 165 participants receiving ST. Major methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, analysis by intention to treat, data management using remote data entry, measures of quality assurance (e.g. on-site monitoring with source data verification, regular query process), advanced statistical analysis, manualized treatment, checks of adherence and competence of therapists. Research relating the psychotherapy process with outcome, neurobiological research addressing basic questions of delusion formation using fMRI and neuropsychological assessment and treatment research investigating adaptations of CBT for adolescents is combined in this network. Problems of transfer into routine clinical care will be identified and addressed by a project focusing on cost efficiency. Discussion: This clinical trial is part of efforts to intensify psychotherapy research in the field of psychosis in Germany, to contribute to the international discussion on psychotherapy in psychotic disorders, and to help implement psychotherapy in routine care. Furthermore, the study will allow drawing conclusions about the mediators of treatment effects of CBT of psychotic disorders. Trial Registration Current Controlled Trials ISRCTN29242879
We present our recent results on antiheavy-antiheavy-light-light tetraquark systems using lattice QCD. Our study of the b¯b¯us four-quark system with quantum numbers JP=1+ and the b¯c¯ud four-quark systems with I(JP)=0(0+) and I(JP)=0(1+) utilizes scattering operators at the sink to improve the extraction of the low-lying energy levels. We found a bound state for b¯b¯us with Ebind,b¯b¯us=(−86±22±10)MeV, but no indication for a bound state in both b¯c¯ud channels. Moreover, we show preliminary results for b¯b¯ud with I(JP)=0(1+), where we used scattering operators both at the sink and the source. We found a bound state and determined its infinite-volume binding energy with a scattering analysis, resulting in Ebind,b¯b¯ud=(−103±8)MeV.
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.
We present a study characterizing aerosol particles resulting from a skyscraper blasting. High mass concentrations with a maximum of 844.9 μg m-3 were present for a short time period of approximately 15 minutes. They result in a day mean of 32.6 μg m-3 compared to a 27.6 μg m-3 background not exceeding the 50 μg m-3 EU maximum permissive value. The increase in particle number concentration was less pronounced with a maximum concentration of 6.9 ⋅ 104 cm-3 compared to the local background value of 1.8 ⋅ 104 cm-3. The size-resolved number concentration shows a single mode of ultrafine particles at approximately 93 nm. The spatial distribution of deposited dust was investigated with Bergerhoff glass collection vessels, showing a decrease with distance. In the deposited dust samples the concentrations of twelve metals was determined, non of them exceeded the regional background concentrations significantly. The chemical composition of individual particles emitted by the demolition was studied by Scanning Electron Microscopy. They were mainly concrete and steel particles, with 60% calcium carbonates, 19% calcium sulfates, 19% silicates and 2% steel. In energy-dispersive X-Ray Spectroscopy, no fibers like asbestos were observed. Using a broad spectrum of instruments and methods, we obtain comprehensive characterization of the particles emitted by the demolition.
Background: PPARs exhibit anti-inflammatory capacities and are potential modulators of the inflammatory response. We hypothesized that their expression and/or function may be altered in cystic fibrosis (CF), a disorder characterized by an excessive host inflammatory response.
Methods: PPARα, β and γ mRNA levels were measured in peripheral blood cells of CF patients and healthy subjects via RT-PCR. PPARα protein expression and subcellular localization was determined via western blot and immunofluorescence, respectively. The activity of PPARα was analyzed by gel shift assay.
Results: In lymphocytes, the expression of PPARα mRNA, but not of PPARβ, was reduced (-37%; p < 0.002) in CF patients compared with healthy persons and was therefore further analyzed. A similar reduction of PPARα was observed at protein level (-26%; p < 0.05). The transcription factor was mainly expressed in the cytosol of lymphocytes, with low expression in the nucleus. Moreover, DNA binding activity of the transcription factor was 36% less in lymphocytes of patients (p < 0.01). For PPARα and PPARβ mRNA expression in monocytes and neutrophils, no significant differences were observed between CF patients and healthy persons. In all cells, PPARγ mRNA levels were below the detection limit.
Conclusion: Lymphocytes are important regulators of the inflammatory response by releasing cytokines and antibodies. The diminished lymphocytic expression and activity of PPARα may therefore contribute to the inflammatory processes that are observed in CF.
Lattice QCD investigation of a doubly-bottom b̄b̄ud tetraquark with quantum numbers I(JP) = 0(1⁺)
(2019)
We use lattice QCD to investigate the spectrum of the ¯𝑏¯𝑏𝑢𝑑 four-quark system with quantum numbers 𝐼(𝐽𝑃)=0(1+). We use five different gauge-link ensembles with 2+1 flavors of domain-wall fermions, including one at the physical pion mass, and treat the heavy ¯𝑏 quark within the framework of lattice nonrelativistic QCD. Our work improves upon previous similar computations by considering in addition to local four-quark interpolators also nonlocal two-meson interpolators and by performing a Lüscher analysis to extrapolate our results to infinite volume. We obtain a binding energy of (−128±24±10) MeV, corresponding to the mass (10476±24±10) MeV, which confirms the existence of a ¯𝑏¯𝑏𝑢𝑑 tetraquark that is stable with respect to the strong and electromagnetic interactions.
In this work we investigate the existence of bound states for doubly heavy tetraquark systems Q¯Q¯′qq′ in a full lattice-QCD computation, where heavy bottom quarks are treated in the framework of non-relativistic QCD. We focus on three systems with quark content b¯b¯ud, b¯b¯us and b¯c¯ud. We show evidence for the existence of b¯b¯ud and b¯b¯us bound states, while no binding appears to be present for b¯c¯ud. For the bound four-quark states we also discuss the importance of various creation operators and give an estimate of the meson-meson and diquark-antidiquark percentages.
TRIANNI mice carry an entire set of human immunoglobulin V region gene segments and are a powerful tool to rapidly isolate human monoclonal antibodies. After immunizing these mice with DNA encoding the spike protein of SARS-CoV-2 and boosting with spike protein, we identified 29 hybridoma antibodies that reacted with the SARS-CoV-2 spike protein. Nine antibodies neutralize SARS-CoV-2 infection at IC50 values in the subnanomolar range. ELISA-binding studies and DNA sequence analyses revealed one cluster of three clonally related neutralizing antibodies that target the receptor-binding domain and compete with the cellular receptor hACE2. A second cluster of six clonally related neutralizing antibodies bind to the N-terminal domain of the spike protein without competing with the binding of hACE2 or cluster 1 antibodies. SARS-CoV-2 mutants selected for resistance to an antibody from one cluster are still neutralized by an antibody from the other cluster. Antibodies from both clusters markedly reduced viral spread in mice transgenic for human ACE2 and protected the animals from SARS-CoV-2-induced weight loss. The two clusters of potent noncompeting SARS-CoV-2 neutralizing antibodies provide potential candidates for therapy and prophylaxis of COVID-19. The study further supports transgenic animals with a human immunoglobulin gene repertoire as a powerful platform in pandemic preparedness initiatives.
We present our recent results on antiheavy-antiheavy-light-light tetraquark systems using lattice QCD. Our study of the b¯b¯us four-quark system with quantum numbers JP=1+ and the b¯c¯ud four-quark systems with I(JP)=0(0+) and I(JP)=0(1+) utilizes scattering operators at the sink to improve the extraction of the low-lying energy levels. We found a bound state for b¯b¯us with Ebind,b¯b¯us=(−86±22±10)MeV, but no indication for a bound state in both b¯c¯ud channels. Moreover, we show preliminary results for b¯b¯ud with I(JP)=0(1+), where we used scattering operators both at the sink and the source. We found a bound state and determined its infinite-volume binding energy with a scattering analysis, resulting in Ebind,b¯b¯ud=(−103±8)MeV.
In this work we investigate the existence of bound states for doubly heavy tetraquark systems Q¯Q¯′qq′ in a full lattice-QCD computation, where heavy bottom quarks are treated in the framework of non-relativistic QCD. We focus on three systems with quark content b¯b¯ud, b¯b¯us and b¯c¯ud. We show evidence for the existence of b¯b¯ud and b¯b¯us bound states, while no binding appears to be present for b¯c¯ud. For the bound four-quark states we also discuss the importance of various creation operators and give an estimate of the meson-meson and diquark-antidiquark percentages.
We present first results of a recently started lattice QCD investigation of antiheavy-antiheavy-light-light tetraquark systems including scattering interpolating operators in correlation functions both at the source and at the sink. In particular, we discuss the importance of such scattering interpolating operators for a precise computation of the low-lying energy levels. We focus on the b¯b¯ud four-quark system with quantum numbers I(JP)=0(1+), which has a ground state below the lowest meson-meson threshold. We carry out a scattering analysis using Lüscher's method to extrapolate the binding energy of the corresponding QCD-stable tetraquark to infinite spatial volume. Our calculation uses clover u, d valence quarks and NRQCD b valence quarks on gauge-link ensembles with HISQ sea quarks that were generated by the MILC collaboration.
We use lattice QCD to investigate the existence of strong-interaction-stable antiheavy-antiheavy-light-light tetraquarks. We study the ¯𝑏¯𝑏𝑢𝑠 system with quantum numbers 𝐽𝑃=1+ as well as the ¯𝑏¯𝑐𝑢𝑑 systems with quantum numbers 𝐼(𝐽𝑃)=0(0+) and 𝐼(𝐽𝑃)=0(1+). We carry out computations on five gauge-link ensembles with 2+1 flavors of domain-wall fermions, including one at the physical pion mass. The bottom quarks are implemented using lattice nonrelativistic QCD, and the charm quarks using an anisotropic clover action. In addition to local diquark-antidiquark and local meson-meson interpolating operators, we include nonlocal meson-meson operators at the sink, which facilitates the reliable determination of the low-lying energy levels. We find clear evidence for the existence of a strong-interaction-stable ¯𝑏¯𝑏𝑢𝑠 tetraquark with binding energy (−86±22±10) MeV and mass (10609±22±10) MeV. For the ¯𝑏¯𝑐𝑢𝑑 systems we do not find any indication for the existence of bound states, but cannot rule out their existence either.