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Objectives: The aim of this multicenter retrospective study was to investigate safety and efficacy of direct acting antiviral (DAA) treatment in the rare subgroup of patients with HCV/HIV-coinfection and advanced liver cirrhosis on the liver transplant waiting list or after liver transplantation, respectively.
Methods: When contacting 54 German liver centers (including all 23 German liver transplant centers), 12 HCV/HIV-coinfected patients on antiretroviral combination therapy were reported having received additional DAA therapy while being on the waiting list for liver transplantation (patient characteristics: Child-Pugh A (n = 6), B (n = 5), C (n = 1); MELD range 7–21; HCC (n = 2); HCV genotype 1a (n = 8), 1b (n = 2), 4 (n = 2)). Furthermore, 2 HCV/HIV-coinfected patients were denoted having received DAA therapy after liver transplantation (characteristics: HCV genotype 1a (n = 1), 4 (n = 1)).
Results: Applied DAA regimens were SOF/DAC (n = 7), SOF/LDV/RBV (n = 3), SOF/RBV (n = 3), PTV/r/OBV/DSV (n = 1), or PTV/r/OBV/DSV/RBV (n = 1), respectively. All patients achieved SVR 12, in the end. In one patient, HCV relapse occurred after 24 weeks of SOF/DAC therapy; subsequent treatment with 12 weeks PTV/r/OBV/DSV achieved SVR 12. One patient underwent liver transplantation while on DAA treatment. Analysis of liver function revealed either stable parameters or even significant improvement during DAA therapy and in follow-up. MELD scores were found to improve in 9/13 therapies in patients on the waiting list for liver transplantation; in only 2 patients a moderate increase of MELD scores persisted at the end of follow-up.
Conclusion: DAA treatment was safe and highly effective in this nation-wide cohort of patients with HCV/HIV-coinfection awaiting liver transplantation or being transplanted.
Purpose: Stereotactic radiosurgery (SRS) is an established primary treatment for newly diagnosed brain metastases with high local control rates. However, data about local re-irradiation in case of local failure after SRS (re-SRS) are rare. We evaluated the feasibility, efficacy and patient selection characteristics in treating locally recurrent metastases with a second course of SRS.
Methods: We retrospectively evaluated patients with brain metastases treated with re-SRS for local tumor progression between 2011 and 2017. Patient and treatment characteristics as well as rates of tumor control, survival and toxicity were analyzed.
Results: Overall, 32 locally recurrent brain metastases in 31 patients were irradiated with re-SRS. Median age at re-SRS was 64.9 years. The primary histology was breast cancer and non-small-cellular lung cancer (NSCLC) in respectively 10 cases (31.3%), in 5 cases malignant melanoma (15.6%). In the first SRS-course 19 metastases (59.4%) and in the re-SRS-course 29 metastases (90.6%) were treated with CyberKnife® and the others with Gamma Knife. Median planning target volume (PTV) for re-SRS was 2.5 cm3 (range, 0.1–37.5 cm3) and median dose prescribed to the PTV was 19 Gy (range, 12–28 Gy) in 1–5 fractions to the median 69% isodose (range, 53–80%). The 1-year overall survival rate was 61.7% and the 1-year local control rate was 79.5%. The overall rate of radiological radio-necrosis was 16.1% and four patients (12.9%) experienced grade ≥ 3 toxicities.
Conclusions: A second course of SRS for locally recurrent brain metastases after prior local SRS appears to be feasible with acceptable toxicity and can be considered as salvage treatment option for selected patients with high performance status. Furthermore, this is the first study utilizing robotic radiosurgery for this indication, as an additional option for frameless fractionated treatment.
Ziel der Arbeit ist es, den frühen Zweitspracherwerb bei Kinder mit einer Spezifischen Sprachentwicklungsstörung (specific language impairment, SLI) zu charakterisieren. Im Vergleich zwischen sprachunauffälligen Kindern mit Deutsch als Zweitsprache (DaZ-TD) und und sprachauffälligen Kindern (DaZ-SLI) wird für die morpho-syntaktischen Bereiche Finitheit und Verbstellung sowie Kasus untersucht, anhand welcher Entwicklungsmuster sich zwischen einem unauffälligen und einem auffälligen DaZ-Erwerb unterscheiden lässt. Dabei werden die folgenden übergeordneten Fragen (F) beantwortet. (F1) Gibt es Unterschiede in Bezug auf Fehlerarten und -häufigkeiten zwischen DaZ-TD und DaZ-SLI Kindern? (F2) Gibt es persistierende Defizite bei DaZ-SLI Kindern verglichen mit DaZ-TD Kindern?
Untersucht wurden über einen Zeitraum von zwei Jahren 33 DaZ-Kinder, elf davon mit einer SLI. Zu Beginn der Erhebungen waren die DaZ-TD Kinder im Durchschnitt 3;8 Jahre alt und hatten 11 KM zum Deutschen. Die DaZ-SLI waren zu MZP 1 durchschnittlich 7;1 Jahre alt (45 KM). Zu insgesamt vier MZP wurden elizitierte Produktionsdaten mittels des standardisierten Verfahrens LiSe-DaZ (Schulz & Tracy 2011) erhoben. Sowohl die Methode der elizitierten Produktion als auch die längsschnittlichen Analysen einer großen Gruppe von Kindern mit DaZ erlaubten es, Aussagen über das Erwerbsalter bzw. persistierende Defizite und Entwicklungsmuster, insbesondere bei SLI, zu treffen. Entwicklungsverzögerungen (delay) und ggf. vom DaZ-TD Erwerb abweichende Entwicklungsmuster (deviance) wurden abgebildet.
Mit der Beantwortung der Fragen leistet die Arbeit in zweierlei Hinsicht einen Beitrag. Erstens wird mit Blick auf die Spracherwerbsforschung gezeigt, dass DaZ-SLI Kinder entwicklungsverzögert sind und sowohl ø-Stämme in V2 als auch Schwierigkeiten im Erwerb von Dativ in Präpositionalphrasen auf eine SLI bei Kindern mit DaZ hinweisen. Zweitens wird aus Sicht der Linguistik dafür argumentiert, dass zum einen ø-Stämme in V2 kovert finit sind und zum anderen in Modellen der Kasuszuweisung von einer dreigliedrigen Struktur, also einer Unterscheidung zwischen strukturellem, lexikalischem und inhärentem Kasus, ausgegangen werden muss.
Die Arbeit knüpft an damit an verschiedene Erwerbsstudien an. Hinsichtlich des Erwerbs von Finitheit und Verbstellung war bisher ungeklärt, ob auch die DaZ-SLI Kinder zwischen en-Infinitiven und ø-Stämmen hinsichtlich der jeweiligen Position im Satz unterscheiden, wie bereits für den DaZ-TD Erwerb nachgewiesen. Die vorliegende Studie wies dieses Erwerbsmuster auch für den DaZ-SLI Erwerb nach und schließt sich damit bisherigen Studien hinsichtlich kovert finiter ø-Stämme in V2 an. Studien zum Kasuserwerb bei DaZ, die auf den linguistisch relevanten Unterschied in der Kasuszuweisung, d.h. strukturell vs. nicht-strukturell (inhärent und lexikalisch), eingehen, gab es nur wenige. Die Frage, ob in der Kasustheorie von einem zwei- oder dreigliedrigen Modell ausgegangen werden muss, war neben der Frage nach möglicherweise abweichenden Erwerbsmustern und persistierenden Erwerbsschwierigkeiten bei DaZ-SLI bislang ungeklärt. In der vorliegenden Studie wurde gezeigt, dass DaZ-SLI Kinder verglichen mit DaZ-TD Kindern ähnliche Fehlermuster zeigen, aber insbesondere der Dativ in PPs stark verzögert erworben wird. Die Studie schließt den Ergebnissen zum simultan bilingualen Erwerb an und postuliert ein dreigliedriges Kasussystem.
Insgesamt zeigt die vorliegende Studie erstmals anhand elizitierter Längsschnittdaten, dass DaZ-SLI Kinder bis ins Schulalter persistierende Probleme im Erwerb von Finitheit und Verbstellung sowie Kasus haben. Verglichen mit DaZ-TD Kindern erwerben sie diese Bereiche - wenn überhaupt - deutlich verzögert (delay). In den Fehlertypen unterscheiden sich die beiden Erwerbstypen hingegen nicht (deviance).
Indication for combined cardiac surgery and orthotopic liver transplantation is rare and patients are at high risks. Individual surgical strategy must be developed since a general standard of such procedure does not exist. We report the case of a 45-year-old woman who underwent simultaneously modified Bentall procedure and orthotopic liver transplantation. Underlying diseases were end-stage polycystic liver, aneurysm of the ascending aorta, and severe aortic regurgitation. To avoid prolonged bypass times, both teams worked simultaneously. During cardiac reperfusion, time inferior vena cava stayed ligated while the cyst liver was explanted.
Background. The placement of an implant in a previously infected site is an important etiologic factor contributing to implant failure. The aim of this case report is to present the management of retrograde peri-implantitis (RPI) in a first maxillary molar site, 2 years after the implant placement. The RPI was treated using an air-abrasive device, Er,Cr:YSGG laser, and guided bone regeneration (GBR).
Case Description. A 65-year-old Caucasian male presented with a draining fistula associated with an implant at tooth #3. Tooth #3 revealed periapical radiolucency two years before the implant placement. Tooth #3 was extracted, and a ridge preservation procedure was performed followed by implant rehabilitation. A periapical radiograph (PA) showed lack of bone density around the implant apex. The site was decontaminated with an air-abrasive device and Er,Cr:YSGG laser, and GBR was performed. The patient was seen every two weeks until suture removal, followed by monthly visits for 12 months. The periapical X-rays, from 6 to 13 months postoperatively, showed increased bone density around the implant apex, with no signs of residual clinical or radiographic pathology and probing depths ≤4 mm.
Conclusions. The etiology of RPI in this case was the placement of an implant in a previously infected site. The use of an air-abrasive device, Er,Cr:YSGG, and GBR was utilized to treat this case of RPI. The site was monitored for 13 months, and increased radiographic bone density was noted.
Learning, memory consolidation, and retrieval are processes known to be modulated by the circadian (circa: about; dies: day) system. The circadian regulation of memory performance is evolutionarily conserved, independent of the type and complexity of the learning paradigm tested, and not specific to crepuscular, nocturnal, or diurnal organisms. In mammals, long-term memory (LTM) formation is tightly coupled to de novo gene expression of plasticity-related proteins and posttranslational modifications and relies on intact cAMP/protein kinase A (PKA)/protein kinase C (PKC)/mitogen-activated protein kinase (MAPK)/cyclic adenosine monophosphate response element-binding protein (CREB) signaling. These memory-essential signaling components cycle rhythmically in the hippocampus across the day and night and are clearly molded by an intricate interplay between the circadian system and memory. Important components of the circadian timing mechanism and its plasticity are members of the Period clock gene family (Per1, Per2). Interestingly, Per1 is rhythmically expressed in mouse hippocampus. Observations suggest important and largely unexplored roles of the clock gene protein PER1 in synaptic plasticity and in the daytime-dependent modulation of learning and memory. Here, we review the latest findings on the role of the clock gene Period 1 (Per1) as a candidate molecular and mechanistic blueprint for gating the daytime dependency of memory processing.
Modification of SMN2 exon 7 (E7) splicing is a validated therapeutic strategy against spinal muscular atrophy (SMA). However, a target-based approach to identify small-molecule E7 splicing modifiers has not been attempted, which could reveal novel therapies with improved mechanistic insight. Here, we chose as a target the stem-loop RNA structure TSL2, which overlaps with the 5′ splicing site of E7. A small-molecule TSL2-binding compound, homocarbonyltopsentin (PK4C9), was identified that increases E7 splicing to therapeutic levels and rescues downstream molecular alterations in SMA cells. High-resolution NMR combined with molecular modelling revealed that PK4C9 binds to pentaloop conformations of TSL2 and promotes a shift to triloop conformations that display enhanced E7 splicing. Collectively, our study validates TSL2 as a target for small-molecule drug discovery in SMA, identifies a novel mechanism of action for an E7 splicing modifier, and sets a precedent for other splicing-mediated diseases where RNA structure could be similarly targeted.
The use of cardiac troponins (cTn) is the gold standard for diagnosing myocardial infarction. Independent of myocardial infarction (MI), however, sex, age and kidney function affect cTn levels. Here we developed a method to adjust cTnI levels for age, sex, and renal function, maintaining a unified cut-off value such as the 99th percentile. A total of 4587 individuals enrolled in a prospective longitudinal study were used to develop a model for adjustment of cTn. cTnI levels correlated with age and estimated glomerular filtration rate (eGFR) in males/females with rage = 0.436/0.518 and with reGFR = −0.142/−0.207. For adjustment, these variables served as covariates in a linear regression model with cTnI as dependent variable. This adjustment model was then applied to a real-world cohort of 1789 patients with suspected acute MI (AMI) (N = 407). Adjusting cTnI showed no relevant loss of diagnostic information, as evidenced by comparable areas under the receiver operator characteristic curves, to identify AMI in males and females for adjusted and unadjusted cTnI. In specific patients groups such as in elderly females, adjusting cTnI improved specificity for AMI compared with unadjusted cTnI. Specificity was also improved in patients with renal dysfunction by using the adjusted cTnI values. Thus, the adjustments improved the diagnostic ability of cTnI to identify AMI in elderly patients and in patients with renal dysfunction. Interpretation of cTnI values in complex emergency cases is facilitated by our method, which maintains a single diagnostic cut-off value in all patients.
The tumor vasculature differs from normal blood vessels in morphology, composition and stability. Here, we describe a novel tumor vessel-disrupting mechanism. In an HT1080/mouse xenograft tumor model rhodocetin-αβ was highly effective in disrupting the tumor endothelial barrier. Mechanistically, rhodocetin-αβ triggered MET signaling via neuropilin-1. As both neuropilin-1 and MET were only lumen-exposed in a subset of abnormal tumor vessels, but not in normal vessels, the prime target of rhodocetin-αβ were these abnormal tumor vessels. Consequently, cells lining such tumor vessels became increasingly motile which compromised the vessel wall tightness. After this initial leakage, rhodocetin-αβ could leave the bloodstream and reach the as yet inaccessible neuropilin-1 on the basolateral side of endothelial cells and thus disrupt nearby vessels. Due to the specific neuropilin-1/MET co-distribution on cells lining such abnormal tumor vessels in contrast to normal endothelial cells, rhodocetin-αβ formed the necessary trimeric signaling complex of rhodocetin-αβ-MET-neuropilin-1 only in these abnormal tumor vessels. This selective attack of tumor vessels, sparing endothelial cell-lined vessels of normal tissues, suggests that the neuropilin-1-MET signaling axis may be a promising drugable target for anti-tumor therapy, and that rhodocetin-αβ may serve as a lead structure to develop novel anti-tumor drugs that target such vessels.
The etiology of many diseases results from the dysregulation of inflammation. Understanding the molecular mechanisms controlling the inflammatory response is essential to formulate therapeutic strategies for the treatment of inflammatory conditions. In fact, substantial research has unveiled important aspects of the inflammatory machinery, both at the cellular and molecular levels. Recently, sphingolipids (Sph) have emerged as signaling molecules that regulate many cell functions, and ample evidence emphasizes their role in the regulation of inflammatory responses. ...
Licht ist ein wertvolles Werkzeug zur Regulation biochemischer Reaktionsabläufe. Denn die Applikation von Licht erlaubt eine sehr präzise Einflussnahme auf den Ort und den Startzeitpunkt der zu untersuchenden Reaktionen. Als nichtinvasives Medium bietet die Lichtkontrolle bei der Wahl einer geeigneten Anregungswellenlänge den Vorteil nur minimal in einen lebenden Organismus einzugreifen. Um eine solche lichtbasierte Kontrolle für biologische Anwendungen zu realisieren, ist die Anwesenheit einer lichtsensitiven Verbindung nötig. Ein Konzept der lichtsensitiven Verbindungen ist die sogenannte photolabile Schutzgruppe. Im Allgemeinen handelt es sich hierbei um einen Chromophor der temporär an ein Biomolekül angebracht wurde, um dessen biologische Aktivität zu unterdrücken.
In dieser Arbeit wurde dieses Konzept auf das Antibiotikum Puromycin angewendet, welches durch das synthetische Anbringen der Cumarin-Schutzgruppe DEACM in seiner biologischen Aktivität behindert und durch einen Lichtpuls wieder freigesetzt wurde. DEACM st eine photolabile Schutzgruppe mit breitem Anwendungsspektrum, da es im Vergleich zu anderen Cumarin-Derivaten vorteilhafte photophysikalische Eigenschaften aufweist. Zum einen ist durch den 7-Diethylamino-Substituenten das Absorptionsmaximum dieser Verbindung um etwa 20 nm bathochrom verschoben. Zum anderen zeichnet sich dieses Derivat durch einen erheblich erhöhten Extinktionskoeffizienten aus, sodass eine Freisetzungsreaktion mit einer geringeren Lichtdosis induziert werden kann, was weniger Stress für die Zellen in lebenden Systemen bedeutet.
Die antibiotische Wirkung von Puromycin beruht auf der strukturellen Ähnlichkeit zum5'-Ende von Tyrosyl-tRNA, wodurch sich das Antibiotikum kondonunspezifisch während der Translation der Proteinsynthese an das Ribosom anlagern kann. Anschließend wird die naszierende Polypeptidkette auf das Puromycin transferiert. Da diese neue Bindung unter biologischen Bedingungen nicht spaltbar ist, führt dies zu einer verfrühten Freisetzung des Polypeptid-Puromycin-Fragments. Schließlich ist die Proteinsynthese vollständig abgebrochen.
Die Motivation zur photoinduzierten Kontrolle von Puromycin besteht in der Vielzahl an biologischen Applikationsmöglichkeiten, da die lichtregulierte Freisetzung der biologischen Aktivität als Trigger für sich anschließende biochemische Abläufe verwendet werden kann. Durch das hier gezeigte System kann in Kombination mit anderen Techniken (z.B. NMR) die posttranslationale Proteinfaltung beobachtet werden, welche als hochgradig komplexer Prozess bisher nicht verstanden ist. Eine weitere Motivationsgrundlage ist die Anwendung von DEACM-puromycin in Nervenzellen. Hier kann durch die Photofreisetzung die Proteinsynthese in den Dendriten der Neuronen beobachtet werden, wodurch Rückschlüsse auf neurodegenerative Krankheiten möglich sein sollten, wie z.B. Alzheimer-Krankheit. In dieser Arbeit konnte in-vitro nachgewiesen werden, dass die antibiotische Wirkung von Puromycin mittels Licht kontrollierbar ist. Aus der photophysikalischen Grundcharakterisierung ging hervor, dass DEACM-puromycin einen hohen Extinktionskoeffizienten bei Wellenlängen größer als 380 nm aufweist. Folglich kann zur Induktion der Photolyse eine geringere Lichtdosis mit energiearmer Strahlung als bei dem Vorläufersystem NVOC-puromycin verwendet werden, angesichts dessen ist das hier vorgestellte DEACM-puromycin für Anwendungen in Zellen zu empfehlen.
Über die Kombination von quantenchemischen Rechnungen und spektroskopischen Methoden konnten die frühen Schritte der Freisetzungsreaktion bestimmt und quantifiziert werden. Zudem zeigte sich ein Einfluss der Lösungsmittelzusammensetzung auf die Uncaging-Schritte. In Gegenwart eines protischen Lösungsmittels wird der zum Uncaging in Konkurrenz stehende Prozess der Fluoreszenz unterdrückt, wodurch die Freisetzungsschritte effektiver werden. Zudem führt die Präsenz von Protonen zu einer Stabilisierung des ionischen Intermediates, sodass die Bildung dessen beschleunigt ablaufen kann. Die Spaltung der photolabilen Schutzgruppen vom Puromycin findet mit einer Rate von 0,71*10^8 s-1 statt, welche im Vergleich zu Vorgängersystem um eine Größenordnung größer ist. Die Wiederherstellung der biologischen Aktivität resultiert aber erst nach einem anschließenden Decarboxylierungsschritt. Mithilfe von IR-Messungen konnte die Decarboxylierung beobachtet und daraus die Quantenausbeute zu 2,5% determiniert werden. Die so bestimmte Quantenausbeute entspricht etwa dem Zweifachen von NVOC-puromycin, sodass die hier untersuchte Verbindung eindeutig als das effizientere System zu betrachten ist. Die hier beschriebenen Ergebnisse zeigen, dass DEACM-puromycin vorteilhafte photophysikalische Eigenschafen aufweist, die diese Verbindung zu einem wertvollen Hilfsmittel für eine Vielzahl von lichtkontrollierten Untersuchungen in biologischer Umgebung macht. Zudem wurden Einblicke in den Reaktionsmechanismus gegeben, die das Verständnis der photolytischen Spaltung von Carbamat-geschützten Cumarinen erstmals auf der ultrakurzen Zeitskala ermöglicht.
B lymphocytes are key players in humoral immunity, expressing diverse surface immunoglobulin receptors directed against specific antigenic epitopes. The development and profile of distinct subpopulations have gained awareness in the setting of primary immunodeficiency disorders, primary or secondary autoimmunity and as therapeutic targets of specific antibodies in various diseases. The major B cell subpopulations in peripheral blood include naïve (CD19+ or CD20+IgD+CD27−), non-switched memory (CD19+ or CD20+IgD+CD27+) and switched memory B cells (CD19+ or CD20+IgD−CD27+). Furthermore, less common B cell subpopulations have also been described as having a role in the suppressive capacity of B cells to maintain self-tolerance. Data on reference values for B cell subpopulations are limited and only available for older age groups, neglecting the continuous process of human B cell development in children and adolescents. This study was designed to establish an exponential regression model to produce continuous reference values for main B cell subpopulations to reflect the dynamic maturation of the human immune system in healthy children.
An iridium(III/IV/V) redox series featuring a terminal imido complex with triplet ground state
(2018)
The iridium(III/IV/V) imido redox series [Ir(NtBu){N(CHCHPtBu2)2}]0/+/2+ was synthesized and examined spectroscopically, magnetically, crystallographically and computationally. The monocationic iridium(IV) imide exhibits an electronic doublet ground state with considerable ‘imidyl’ character as a result of covalent Ir–NtBu bonding. Reduction gives the neutral imide [Ir(NtBu){N(CHCHPtBu2)2}] as the first example of an iridium complex with a triplet ground state. Its reactivity with respect to nitrene transfer to selected electrophiles (CO2) and nucleophiles (PMe3), respectively, is reported.
Organoboranes are among the most versatile and widely used reagents in synthetic chemistry. A significant further expansion of their application spectrum would be achievable if boron-containing reactive intermediates capable of inserting into C–H bonds or performing nucleophilic substitution reactions were readily available. However, current progress in the field is still hampered by a lack of universal design concepts and mechanistic understanding. Herein we report that the doubly arylene-bridged diborane(6) 1H2 and its B[double bond, length as m-dash]B-bonded formal deprotonation product Li2[1] can activate the particularly inert C(sp3)–H bonds of added H3CLi and H3CCl, respectively. The first case involves the attack of [H3C]− on a Lewis-acidic boron center, whereas the second case follows a polarity-inverted pathway with nucleophilic attack of the B[double bond, length as m-dash]B double bond on H3CCl. Mechanistic details were elucidated by means of deuterium-labeled reagents, a radical clock, α,ω-dihaloalkane substrates, the experimental identification of key intermediates, and quantum-chemical calculations. It turned out that both systems, H3CLi/1H2 and H3CCl/Li2[1], ultimately funnel into the same reaction pathway, which likely proceeds past a borylene-type intermediate and requires the cooperative interaction of both boron atoms.
Quercetin is a flavonoid that is ubiquitously found in vegetables and fruits. Like other flavonoids, it is active in balancing cellular reactive oxygen species (ROS) levels and has a cyto-protective function. Previously, a link between ROS balancing, aging, and the activity of O-methyltransferases was reported in different organisms including the aging model Podospora anserina. Here we describe a role of the S-adenosylmethionine-dependent O-methyltransferase PaMTH1 in quercetin-induced lifespan extension. We found that effects of quercetin treatment depend on the methylation state of the flavonoid. Specifically, we observed that quercetin treatment increases the lifespan of the wild type but not of the PaMth1 deletion mutant. The lifespan increasing effect is not associated with effects of quercetin on mitochondrial respiration or ROS levels but linked to the induction of the PaMth1 gene. Overall, our data demonstrate a novel role of O-methyltransferase in quercetin-induced longevity and identify the underlying pathway as part of a network of longevity assurance pathways with the perspective to intervene into mechanisms of biological aging.
Purpose: DINO and DACOTA were prospective, noninterventional studies assessing the health status and quality of life of patients with COPD newly treated with roflumilast 500 µg once-daily add-on therapy.
Patients and methods: Patients were evaluated over 6 months. Clinical COPD questionnaire (CCQ) and COPD assessment test (CAT) scores were recorded at baseline and after 3 and 6 months. In DACOTA, post-bronchodilator FEV1 was recorded at each time point.
Results: Of 5,462 and 3,645 patients recruited into DINO and DACOTA, respectively, 3,274 patients in DINO and 916 patients in DACOTA completed the 6-month visit. Almost all patients had severe or very severe airway obstruction; mean baseline CCQ total score was 3.9 in DINO and 3.7 in DACOTA. Overall, 33.8% of patients in DACOTA and 30.6% in DINO discontinued treatment prematurely. Significant and clinically relevant improvements in CCQ total scores were observed in both studies (mean change from baseline of 1.36 in DINO and 0.91 in DACOTA at Month 6 [all P<0.001]). Changes in CAT total score from baseline to Month 6 indicated that the average clinical impact of COPD was reduced from a severe (score: 21–30) to a moderate (score: 11–20) impairment. In DACOTA, mean change in post-bronchodilator FEV1 was 202 mL (P<0.001). Diarrhea, nausea, and weight decrease were the most frequently reported adverse drug reactions.
Conclusion: In real-life clinical practice, roflumilast treatment as an add-on therapy is associated with clinically relevant improvements in health status and quality of life.
In this thesis we introduce the imaginary projection of (multivariate) polynomials as the projection of their variety onto its imaginary part, I(f) = { Im(z_1, ... , z_n) : f(z_1, ... , z_n) = 0 }. This induces a geometric viewpoint to stability, since a polynomial f is stable if and only if its imaginary projection does not intersect the positive orthant. Accordingly, the thesis is mainly motivated by the theory of stable polynomials.
Interested in the number and structure of components of the complement of imaginary projections, we show as a key result that there are only finitely many components which are all convex. This offers a connection to the theory of amoebas and coamoebas as well as to the theory of hyperbolic polynomials.
For hyperbolic polynomials, we show that hyperbolicity cones coincide with components of the complement of imaginary projections, which provides a strong structural relationship between these two sets. Based on this, we prove a tight upper bound for the number of hyperbolicity cones and, respectively, for the number of components of the complement in the case of homogeneous polynomials. Beside this, we investigate various aspects of imaginary projections and compute imaginary projections of several classes explicitly.
Finally, we initiate the study of a conic generalization of stability by considering polynomials whose roots have no imaginary part in the interior of a given real, n-dimensional, proper cone K. This appears to be very natural, since many statements known for univariate and multivariate stable polynomials can be transferred to the conic situation, like the Hermite-Biehler Theorem and the Hermite-Kakeya-Obreschkoff Theorem. When considering K to be the cone of positive semidefinite matrices, we prove a criterion for conic stability of determinantal polynomials.
The endoplasmic-reticulum-associated protein degradation pathway ensures quality control of newly synthesized soluble and membrane proteins of the secretory pathway. Proteins failing to fold into their native structure are processed in a multistep process and finally ubiquitinated and degraded by the proteasome in order to protect the cell from proteotoxic stress. My thesis covers structural as well as functional studies of various protein components that constitute the protein complexes that are responsible for this process.
One sub-project addressed the mechanism of glycan recognition by Yos9 as part of the ERAD substrate selection. NMR solution structures of the mannose-6-phosphate homology (MRH) domain of Yos9 both in a free and glycan bound conformation reveal a gripping movement of loop regions upon binding of correctly processed glycan structures.
The main projects focused on revealing the mechanism of efficient ubiquitin chain assembly by the ERAD ubiquitination machinery. This included the investigation of the role of the ERAD components Cue1 and Ubc7 in processive ubiquitin chain formation, how ubiquitin chain conformations change during elongation, how the conformation of a chain is impacted by interacting proteins and finally understand the activity regulation of the ERAD E2 enzyme Ubc7 by its cognate RING E3 ligases. Nuclear magnetic resonance (NMR) analysis and fluorescence-based ubiquitination assays show that the CUE domain of Cue1 contributes with its proximal binding preference as well as with its position dependent accelerating effect to efficient ubiquitin chain formation. This is required to efficiently drive degradation of substrates. Specific ubiquitin binding events dictate and coordinate the spatial arrangement of the E2 enzyme relative to the distal tip of a chain. This process can be further accelerated by RING E3 ligases that promote Ubc7 activity by more than ~20 fold via inducing allosteric changes around the catalytic cysteine. My results additionally suggest a model where Ubc7 dimerization results in proximity induced activation of the E2. This data ensures rapid diubiquitin formation that is followed by a CUE domain assisted chain elongation mechanism where Cue1 acts in an E4 like fashion.
How ubiquitin binding events can modulate the conformations of a ubiquitin chain were investigated by pulsed electron-electron double resonance (PELDOR) spectroscopy combined with molecular modeling. This shows that K48-linked diubiquitin samples a broad conformational space which can be modulated in distinct ways. The CUE domain of Cue1 uses conformational selection of pre-populated open conformations to support ubiquitin chain elongation. In contrast, deubiquitinating enzymes shift the conformational distribution to weakly or even non-populated conformations to allow cleavage of the isopeptide bond that connects adjacent ubiquitins. Ubiquitin chain elongation increases the sampled conformational space and suggests that this high conformational flexibility might contribute to efficient proteasomal recognition.
Background: Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC).
Methods: Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test.
Results: Out of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3–367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04).
Conclusions: In large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.
Consistent individual differences in behavioral tendencies (animal personality) can affect individual mate choice decisions. We asked whether personality traits affect male and female mate choice decisions similarly and whether potential personality effects are consistent across different mate choice situations. Using western mosquitofish (Gambusia affinis) as our study organism, we characterized focal individuals (males and females) twice for boldness, activity, and sociability/shoaling and found high and significant behavioral repeatability. Additionally, each focal individual was tested in two different dichotomous mate choice tests in which it could choose between computer-animated stimulus fish of the opposite sex that differed in body size and activity levels, respectively. Personality had different effects on female and male mate choice: females that were larger than average showed stronger preferences for large-bodied males with increasing levels of boldness/activity (i.e., towards more proactive personality types). Males that were larger than average and had higher shoaling tendencies showed stronger preferences for actively swimming females. Size-dependent effects of personality on the strength of preferences for distinct phenotypes of potential mating partners may reflect effects of age/experience (especially in females) and social dominance (especially in males). Previous studies found evidence for assortative mate choice based on personality types or hypothesized the existence of behavioral syndromes of individuals’ choosiness across mate choice criteria, possibly including other personality traits. Our present study exemplifies that far more complex patterns of personality-dependent mate choice can emerge in natural systems.