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In der internationalen Norm DIN EN ISO 15189 (kurz ISO 15189) sind für medizinische Laboratorien besondere Anforderungen an die Qualität und Kompetenz festgelegt. Die ISO 15189 gilt für alle medizinischen Laboratorien. Sie wurde für den Bereich der Virologie durch eine gemeinsame Arbeitsgruppe der Gesellschaft für Virologie (GfV) und der Deutschen Vereinigung zur Bekämpfung der Viruskrankheiten (DVV) in Form von fachspezifischen Checklisten konkretisiert.
Viele medizinische Laboratorien lassen sich im Rahmen einer Akkreditierung bestätigen, dass sie die Anforderungen der ISO 15189 erfüllen. Wesentlicher Bestandteil der Akkreditierung ist eine Begutachtung in den Laboratorien. Die Begutachtungen in der Virologie werden von Experten durchgeführt, die von der GfV benannt werden.
Gründe der Laboratorien für eine Akkreditierung können sehr unterschiedlich sein. Sie reichen von der Verbesserung der internen Abläufe und Ermittlung sicherer/richtiger Untersuchungsergebnisse bis zu einer besseren Positionierung am Markt.
Der Artikel stellt die Anforderungen und Probleme virusdiagnostisch tätiger Laboratorien, basierend auf der ISO 15189, als Erfahrungsbericht vor. Dabei wird auf die Infektionsserologie, die molekularbiologische Diagnostik und die Virusisolierung auf Zellkulturen eingegangen.
Febrile neutropenia is a common infectious complication in children and adolescents receiving chemotherapy for cancer, requiring immediate hospitalisation and empirical antibacterial therapy. The risk for a severe infection increases with lower neutrophil counts, but other factors such as underlying malignancy, remission state or the genetic background might also impact on the risk and severity of infection. Initial antibacterial treatment as well as modification and cessation of therapy depends on clinical performance, microbiological findings and haematological recovery. Although paediatric specific guidelines have been developed in the last decade, a number of questions are still unsolved. This article gives an overview on diagnostics and management of paediatric patients presenting with febrile neutropenia, on research gaps and will speculate on future perspective.
Infectious diseases are an existential health threat, potentiated by emerging and re-emerging viruses and increasing bacterial antibiotic resistance. Targeted treatment of infectious diseases requires precision diagnostics, especially in cases where broad-range therapeutics such as antibiotics fail. There is thus an increasing need for new approaches to develop sensitive and specific in vitro diagnostic (IVD) tests. Basic science and translational research are needed to identify key microbial molecules as diagnostic targets, to identify relevant host counterparts, and to use this knowledge in developing or improving IVD. In this regard, an overlooked feature is the capacity of pathogens to adhere specifically to host cells and tissues. The molecular entities relevant for pathogen–surface interaction are the so-called adhesins. Adhesins vary from protein compounds to (poly-)saccharides or lipid structures that interact with eukaryotic host cell matrix molecules and receptors. Such interactions co-define the specificity and sensitivity of a diagnostic test. Currently, adhesin-receptor binding is typically used in the pre-analytical phase of IVD tests, focusing on pathogen enrichment. Further exploration of adhesin–ligand interaction, supported by present high-throughput “omics” technologies, might stimulate a new generation of broadly applicable pathogen detection and characterization tools. This review describes recent results of novel structure-defining technologies allowing for detailed molecular analysis of adhesins, their receptors and complexes. Since the host ligands evolve slowly, the corresponding adhesin interaction is under selective pressure to maintain a constant receptor binding domain. IVD should exploit such conserved binding sites and, in particular, use the human ligand to enrich the pathogen. We provide an inventory of methods based on adhesion factors and pathogen attachment mechanisms, which can also be of relevance to currently emerging pathogens, including SARS-CoV-2, the causative agent of COVID-19.
Diagnostic approaches for invasive aspergillosis—specific considerations in the pediatric population
(2018)
Invasive aspergillosis (IA) is a major cause of morbidity and mortality in children with hematological malignancies and those undergoing hematopoietic stem cell transplantation. Similar to immunocompromised adults, clinical signs, and symptoms of IA are unspecific in the pediatric patient population. As early diagnosis and prompt treatment of IA is associated with better outcome, imaging and non-invasive antigen-based such as galactomannan or ß-D-glucan and molecular biomarkers in peripheral blood may facilitate institution and choice of antifungal compounds and guide duration of therapy. In patients in whom imaging studies suggest IA or another mold infection, invasive diagnostics such as bronchoalveolar lavage and/or bioptic procedures should be considered. Here we review the current data of diagnostic approaches for IA in the pediatric setting and highlight the major differences of performance and clinical utility of the tests between children and adults.
Studies on the focusing performance of a Gabor lens depending on nonneutral plasma properties
(2013)
The concept of the Gabor lens goes back to an idea by Dennis Gabor, who proposed a magnetron-type trap as an effective diverging lens for electron beams (collecting lens for positive ion beams).
Electrons confined inside the lens volume by orthogonal magnetic and electric fields, create an electric space charge field that causes a radial symmetric focusing force on an ion beam passing through the lens volume.
Since the beginning of the 1990s, a new design of this lens type as well as numerical models to describe the confined plasma cloud have been developed at the Institute for Applied Physics (IAP, Johann Wolfgang Goethe-University Frankfurt).
Thanks to an improved understanding of the plasma confinement as a function of the external fields, two lenses have successfully been tested for low beam currents and remain in operation.
In the scope of this work, the performance of a prototype Gabor lens for the transport of intense, i.e. space charge dominated ion beams, was investigated at the High Current Test Injector (HOSTI) of GSI Helmholtzzentrum für Schwerionenforschung GmbH for the first time.
To ensure an optimal focusing performance of the Gabor lens a homogeneous and stable electron confinement is required. Therefore, new non-interceptive diagnostic methods were developed to investigate the parameters and state of the confined nonneutral plasma column as a function of the external fields.
An essential part of the studies was the time-resolved diagnostic of an occurring plasma instability and the determination of the electron temperature via optical spectroscopy. The latter necessitated the detailed investigation of atomic excitation as well as the measurement of optical-emission cross sections.
A comparison of the results from both experiments i.e. the beam transport measurements at GSI and the diagnostic experiments performed at IAP concerning the plasma state, gave first indications of possible interaction processes between the nonneutral plasma and the ion beam.
Although their applications have not yet extended widely due to their incipient state, nano-technologies and nano-medicines may be presumed to be at the origin of the next great technological revolution, foreseeably contributing to a new stage with respect to evolutions in mankind’s progress. Their possibilities are truly immense in enormously varied spheres, but the risks and uncertainties they engender are enormous too. Because access and use of the unceasingly increasing mega-quantity of information they generate will place further strain on the protection of personal life, privacy, the exercise of freedom, as well as the safeguarding of other fundamental principles and rights.