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Zum virologischen Nachweis einer akuten Influenza und zur Überprüfung des Immunstatus steht eine Vielzahl von Untersuchungsmethoden zur Verfügung. Bei Verdacht auf eine Influenzavirusinfektion liefert der Rachenabstrich das geeignete Untersuchungsmaterial. Das tiefe Nasopharynxaspirat ist etwas sensitiver, Sputum etwas weniger ergiebig. Die RT-PCR ermöglicht in 1–2 h nach Materialeingang ein sensitives und spezifisches Ergebnis. Typen, Subtypen und Driftvarianten lassen sich durch geeignete Primersonden, die kommerziell zur Verfügung stehen, einwandfrei identifizieren. Demgegenüber ist die Zellkultur-gestützte Virusisolierung zeitaufwendiger und stärker abhängig von einer sachgerechten Materialgewinnung und –überbringung (Kühlkette). PCR und Virusanzüchtung ermöglichen die geno- bzw. phänotypische Testung auf Therapieresistenzen. Der Antigentest ist eine einfache (bed-side) Schnellmethode. Seine Spezifität ist gut, die Sensitivität limitiert; daher kann der Antigentest nicht zur individuellen Ausschlussdiagnose eingesetzt werden. Influenzavirusspezifische Antikörper erscheinen im Blut erst in der zweiten Krankheitswoche. Die Serodiagnostik erfolgt typenspezifisch mit Komplementbindungsreaktion (KBR), IFT und ELISA über eine signifikante Titerbewegung oder den Nachweis von IgA-Antikörpern. IgG-spezifische IFT und ELISA Methoden geben Auskunft über die Influenzavirus-typspezifische Durchseuchung. Die klinisch relevantere subtypen- und variantenspezifische Influenzavirusimmunität wird mit dem HHT oder NT gemessen.
Die Labordiagnose einer Infektionskrankheit beruht auf dem Nachweis des Infektionserregers oder der spezifischen Immunreaktion unter Berücksichtigung der klinischen Plausibilität. Biologische Testverfahren wie der Zellkulturversuch erbringen nur näherungsweise ein quantitatives Ergebnis und sind mit einer relativ großen Streuung behaftet. Das gilt auch für Antikörperassays, soweit sie über ein biologisches Testsignal abgelesen werden (CPE, Agglutination, Komplementverbrauch). Moderne serologische und molekularbiologische Untersuchungsmethoden der Virologie werden i. d. R. über ein physikochemisches Testssignal abgelesen und quantitativ ausgewertet. Dadurch gelingt die nationale und internationale Standardisierung, die sich in Ringversuchen gut überprüfen lässt. Aus biologischen Gründen ist meist eine log. Ergebnisberechnung angezeigt, was für „ signifikante “ Unterschiede in Verlaufsuntersuchungen zu berücksichtigen ist: Da sowohl Infektion als auch Immunreaktion dynamische Prozesse darstellen, können Normalwerte in der virologischen Labordiagnostik nur restriktiv definiert werden. Ihre Ergebnisse sind mehr oder minder individuell interpretationsbedürftig.
Virus-infected cells are eliminated by cytotoxic T lymphocytes, which recognize viral epitopes displayed on major histocompatibility complex class I molecules at the cell surface. Herpesviruses have evolved sophisticated strategies to escape this immune surveillance. During the lytic phase of EBV infection, the viral factor BNLF2a interferes with antigen processing by preventing peptide loading of major histocompatibility complex class I molecules. Here we reveal details of the inhibition mechanism of this EBV protein. We demonstrate that BNLF2a acts as a tail-anchored protein, exploiting the mammalian Asna-1/WRB (Get3/Get1) machinery for posttranslational insertion into the endoplasmic reticulum membrane, where it subsequently blocks antigen translocation by the transporter associated with antigen processing (TAP). BNLF2a binds directly to the core TAP complex arresting the ATP-binding cassette transporter in a transport-incompetent conformation. The inhibition mechanism of EBV BNLF2a is distinct and mutually exclusive of other viral TAP inhibitors.
The E3 ubiquitin ligase MYCBP2 negatively regulates neuronal growth, synaptogenesis, and synaptic strength. More recently it was shown that MYCBP2 is also involved in receptor and ion channel internalization. We found that mice with a MYCBP2-deficiency in peripheral sensory neurons show prolonged thermal hyperalgesia. Loss of MYCBP2 constitutively activated p38 MAPK and increased expression of several proteins involved in receptor trafficking. Surprisingly, loss of MYCBP2 inhibited internalization of transient receptor potential vanilloid receptor 1 (TRPV1) and prevented desensitization of capsaicin-induced calcium increases. Lack of desensitization, TRPV internalization and prolonged hyperalgesia were reversed by inhibition of p38 MAPK. The effects were TRPV-specific, since neither mustard oil-induced desensitization nor behavioral responses to mechanical stimuli were affected. In summary, we show here for the first time that p38 MAPK activation can inhibit activity-induced ion channel internalization and that MYCBP2 regulates internalization of TRPV1 in peripheral sensory neurons as well as duration of thermal hyperalgesia through p38 MAPK.
Host cell invasion by the facultative intracellular pathogen Listeria monocytogenes requires the invasion protein InlB in many cell types. InlB consists of an N-terminal internalin domain that binds the host cell receptor tyrosine kinase Met and C-terminal GW domains that bind to glycosaminoglycans (GAGs). Met binding and activation is required for host cell invasion, while the interaction between GW domains and GAGs enhances this effect. Soluble InlB elicits the same cellular phenotypes as the natural Met ligand hepatocyte growth factor/scatter factor (HGF/SF), e.g. cell scatter. So far, little is known about the central part of InlB, the B-repeat. Here we present a structural and functional characterization of the InlB B-repeat. The crystal structure reveals a variation of the β-grasp fold that is most similar to small ubiquitin-like modifiers (SUMOs). However, structural similarity also suggests a potential evolutionary relation to bacterial mucin-binding proteins. The B-repeat defines the prototype structure of a hitherto uncharacterized domain present in over a thousand bacterial proteins. Generally, this domain probably acts as a spacer or a receptor-binding domain in extracellular multi-domain proteins. In cellular assays the B-repeat acts synergistically with the internalin domain conferring to it the ability to stimulate cell motility. Thus, the B-repeat probably binds a further host cell receptor and thereby enhances signaling downstream of Met.
This paper compares the shareholder-value-maximizing capital structure and pricing policy of insurance groups against that of stand-alone insurers. Groups can utilise intra-group risk diversification by means of capital and risk transfer instruments. We show that using these instruments enables the group to offer insurance with less default risk and at lower premiums than is optimal for standalone insurers. We also take into account that shareholders of groups could find it more difficult to prevent inefficient overinvestment or cross-subsidisation, which we model by higher dead-weight costs of carrying capital. The tradeoff between risk diversification on the one hand and higher dead-weight costs on the other can result in group building being beneficial for shareholders but detrimental for policyholders.
Depending on the point of time and location, insurance companies are subject to different forms of solvency regulation. In modern regulation regimes, such as the future standard Solvency II in the EU, insurance pricing is liberalized and risk-based capital requirements will be introduced. In many economies in Asia and Latin America, on the other hand, supervisors require the prior approval of policy conditions and insurance premiums, but do not conduct risk-based capital regulation. This paper compares the outcome of insurance rate regulation and risk-based capital requirements by deriving stock insurers’ best responses. It turns out that binding price floors affect insurers’ optimal capital structures and induce them to choose higher safety levels. Risk-based capital requirements are a more efficient instrument of solvency regulation and allow for lower insurance premiums, but may come at the cost of investment efforts into adequate risk monitoring systems. The paper derives threshold values for regulator’s investments into risk-based capital regulation and provides starting points for designing a welfare-enhancing insurance regulation scheme.
Background: Patients with cancer have an increased risk of VTE. We compared VTE rates and bleeding complications in 1) cancer patients receiving LMWH or UFH and 2) patients with or without cancer.
Patients with cancer have an increased risk of VTE. We compared VTE rates and bleeding complications in 1) cancer patients receiving LMWH or UFH and 2) patients with or without cancer.
Methods: Acutely-ill, non-surgical patients ≥70 years with (n = 274) or without cancer (n = 2,965) received certoparin 3,000 UaXa o.d. or UFH 5,000 IU t.i.d. for 8-20 days.
Results: 1) Thromboembolic events in cancer patients (proximal DVT, symptomatic non-fatal PE and VTE-related death) occurred at 4.50% with certoparin and 6.03% with UFH (OR 0.73; 95% CI 0.23-2.39). Major bleeding was comparable and minor bleedings (0.75 vs. 5.67%) were nominally less frequent. 7.5% of certoparin and 12.8% of UFH treated patients experienced serious adverse events. 2) Thromboembolic event rates were comparable in patients with or without cancer (5.29 vs. 4.13%) as were bleeding complications. All cause death was increased in cancer (OR 2.68; 95%CI 1.22-5.86). 10.2% of patients with and 5.81% of those without cancer experienced serious adverse events (OR 1.85; 95% CI 1.21-2.81).
Conclusions: Certoparin 3,000 UaXa o.d. and 5,000 IU UFH t.i.d. were equally effective and safe with respect to bleeding complications in patients with cancer. There were no statistically significant differences in the risk of thromboembolic events in patients with or without cancer receiving adequate anticoagulation.
Trial Registration: clinicaltrials.gov, NCT00451412
Depending on the point of time and location, insurance companies are subject to different forms of solvency regulation. In modern regulation regimes, such as the future standard Solvency II in the EU, insurance pricing is liberalized and risk-based capital requirements will be introduced. In many economies in Asia and Latin America, on the other hand, supervisors require the prior approval of policy conditions and insurance premiums, but do not conduct risk-based capital regulation. This paper compares the outcome of insurance rate regulation and riskbased capital requirements by deriving stock insurers’ best responses. It turns out that binding price floors affect insurers’ optimal capital structures and induce them to choose higher safety levels. Risk-based capital requirements are a more efficient instrument of solvency regulation and allow for lower insurance premiums, but may come at the cost of investment efforts into adequate risk monitoring systems. The paper derives threshold values for regulator’s investments into risk-based capital regulation and provides starting points for designing a welfare-enhancing insurance regulation scheme.
Solving the problem of consciousness remains one of the biggest challenges in modern science. One key step towards understanding consciousness is to empirically narrow down neural processes associated with the subjective experience of a particular content. To unravel these neural correlates of consciousness (NCC) a common scientific strategy is to compare perceptual conditions in which consciousness of a particular content is present with those in which it is absent, and to determine differences in measures of brain activity (the so called "contrastive analysis"). However, this comparison appears not to reveal exclusively the NCC, as the NCC proper can be confounded with prerequisites for and consequences of conscious processing of the particular content. This implies that previous results cannot be unequivocally interpreted as reflecting the neural correlates of conscious experience. Here we review evidence supporting this conjecture and suggest experimental strategies to untangle the NCC from the prerequisites and consequences of conscious experience in order to further develop the otherwise valid and valuable contrastive methodology.