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The gauge principle is fundamental in formulating the Standard Model. Fermion–gauge-boson couplings are the inescapable consequence and the primary determining factor for observable phenomena. Vertices describing such couplings are simple in perturbation theory and yet the existence of strong-interaction bound-states guarantees that many phenomena within the Model are nonperturbative. It is therefore crucial to understand how dynamics dresses the vertices and thereby fundamentally alters the appearance of fermion–gauge-boson interactions. We consider the coupling of a dressed-fermion to an Abelian gauge boson, and describe a unified treatment and solution of the familiar longitudinal Ward–Green–Takahashi identity and its less well known transverse counterparts. Novel consequences for the dressed-fermion–gauge-boson vertex are exposed.
Cellular cytotoxicity is the hallmark of NK cells mediating both elimination of virus-infected or malignant cells, and modulation of immune responses. NK cytotoxicity is triggered upon ligation of various activating NK cell receptors. Among these is the C-type lectin-like receptor NKp80 which is encoded in the human Natural Killer Gene Complex (NKC) adjacent to its ligand, activation-induced C-type lectin (AICL). NKp80-AICL interaction promotes cytolysis of malignant myeloid cells, but also stimulates the mutual crosstalk between NK cells and monocytes.
While many activating NK cell receptors pair with ITAM-bearing adaptors, we recently reported that NKp80 signals via a hemITAM-like sequence in its cytoplasmic domain. Here we molecularly dissect the NKp80 hemITAM and demonstrate that two non-consensus amino acids, in particular arginine 6, critically impair both hemITAM phosphorylation and Syk recruitment. Impaired Syk recruitment results in a substantial attenuation of cytotoxic responses upon NKp80 ligation. Reconstituting the hemITAM consensus or Syk overexpression resulted in robust NKp80-mediated responsiveness. Collectively, our data provide a molecular rationale for the restrained activation potential of NKp80 and illustrate how subtle alterations in signaling motifs determine subsequent cellular responses. They also suggest that non-consensus alterations in the NKp80 hemITAM, as commonly present among mammalian NKp80 sequences, may have evolved to dampen NKp80-mediated cytotoxic responses toward AICL-expressing cells.
Background: The activating NK receptor NKp80 triggers cytotoxicity by human NK cells via a cytoplasmic hemITAM sequence.
Results: A non-consensus hemITAM residue impairs the capacity of NKp80 to recruit Syk kinase and to trigger cytotoxicity.
Conclusion: Unlike typical hemITAM receptors, NKp80 does not efficiently recruit Syk kinase resulting in attenuated effector responses.
Significance: An attenuated cytotoxic responsiveness critically impacts on the immunomodulatory function of NKp80.
In the stomach, neoplastic lesions often arise in the setting of precursor conditions such as gastritis, intestinal metaplasia, or adenomatous lesions. Biopsies may, therefore, underestimate disease severity or even miss the diagnosis (sampling error). Endomicroscopy is able to visualize typical features of such pathologies. It enables in vivo microscopy of gastritis with definition of enhanced vascularity and vascular leakage, but the typical cobblestone appearance of the gastric mucosa is preserved. The presence of intestinal metaplasia is confirmed by columnar absorptive cells with brush border and goblet cells within villiform foveolar epithelium. Gastric neoplasia is characterized by crowded glands with intraluminal folding and glandular budding and branching accompanied by increased density of dilated and distorted capillaries. Finally, in gastric cancer, gland and overall mucosal architecture is progressively lost. These features are shown side by side with white-light endoscopic findings. Endomicroscopy is used in such a setting to rapidly screen larger areas (optical biopsies) and subsequently target tissue sampling to areas with highly suspicious microscopic patterns. In experienced hands, it therefore constitutes an important part especially in the presence of neoplastic lesions within noncircumscript gastric premalignant conditions. This article is part of an expert video encyclopedia.
Dieulafoy's lesion (DL) is a rare source of gastrointestinal tract bleeding that may occur at any site in the gastrointestinal tract and may be difficult to detect by endoscopy. DL is characterized by a large, tortuous arteriole in the submucosa. This is a case of duodenal DL that is detected and treated by endoscopy. This article is part of an expert video encyclopedia.
Peutz–Jeghers syndrome (PJS) is a rare autosomal-dominant inherited disorder characterized by gastrointestinal hamartomas, mucocutaneous pigmentation, and an elevated cancer risk. Moreover, intussusception risk may be as high as 50% at the age of 20 years and is caused by large polyps. There is some evidence that endoscopic surveillance of PJS patients with removal of small intestinal polyps with a diameter of more than 15 mm efficiently prevents intussusceptions. In recent years, capsule endoscopy (CE) has largely replaced small-bowel radiography techniques to screen for small-bowel polyps. Magnetic resonance imaging may be equally efficient as CE for screening of large polyps. Balloon enteroscopy may be used for endoscopic snare resection of polyps. This article is part of an expert video encyclopedia.
The author presents the case of a patient with severe bleeding from a duodenal ulcer that could not be controlled by endoscopic application of metal clips and injection of fibrin glue. Angiographic embolization with placement of coils into the feeding vessel stopped the bleeding. However, 3 days later, a fistula emerged from coil material penetrating into the dorsal duodenum and a peritoneal leakage developed. The fistula was completely closed by placing an over-the-scope clip on the enteral opening of the fistula. This article is part of an expert video encyclopedia.
Small-bowel tumors are rare and account for approximately 5% of all gastrointestinal tumors. Approximately 65% of small-bowel tumors are malignant, and approximately 40% of these tumors are adenocarcinomas. Similar to colorectal adenocarcinoma, premalignant adenomas of the small bowel may progress to carcinoma. This occurs both sporadically and in the context of hereditary tumor syndromes such as familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer (Lynch syndrome). Herein cases with small-bowel adenocarcinomas visualized with both capsule endoscopy and double-balloon enteroscopy are presented. This article is part of an expert video encyclopedia.
A rare cause of recurrent melena was identified by capsule endoscopy: arteriovenous malformation
(2013)
Small bowel endoscopy is indicated for patients with an unidentified bleeding site in esophagogastroduodenoscopy and ileocolonoscopy and symptoms of intestinal blood loss or unexplained anemia. In approximately two-thirds of these cases, capsule endoscopy (CE) detects a lesion within the small bowel that explains the patient's symptoms.
The case of an 80-year-old female patient with recurrent melena and anemia is presented here by the authors. Endoscopy of the upper gastrointestinal tract as well as ileocolonoscopy did not show any pathological findings. CE revealed an area with abnormal mucosa in the middle third of the small bowel, which was strongly suspected of having malignant origin. Surgical exploration led to resection of a small jejunal segment with a palpable mass and increased blood flow. Surprisingly, the final diagnosis determined by the pathologist was arteriovenous malformation (AVM). This article is part of an expert video encyclopedia.
Characteristically, most solid tumors exhibit an increased tumor interstitial fluid pressure (TIFP) that directly contributes to the lowered uptake of macromolecular therapeutics into the tumor interstitium. Abnormalities in the tumor-associated lymph vessels are a central brick in the development and prolonged sustaining of an increased TIFP. In the current study, vascular endothelial growth factor C (VEGF-C) was used to enhance tumor-associated lymphangiogenesis as a new mechanism to actively reduce the TIFP by increased lymphatic drainage of the tumor tissue. Human A431 epidermoid vulva carcinoma cells were inoculated in NMRI nu/nu mice to generate a xenograft mouse model. Seven days after tumor cell injection, VEGF-C was peritumorally injected to induce lymphangiogenesis. Tumor growth and TIFP was lowered significantly over time in VEGF-C-treated tumors in comparison to control or VEGF-A-treated animals. These data demonstrate for the first time that actively induced lymphangiogenesis can lower the TIFP in a xenograft tumor model and apparently reduce tumor growth. This model represents a novel approach to modulate biomechanical properties of the tumor interstitium enabling a lowering of TIFP in vivo.
Hepatology highlights
(2013)
The ALICE detector is ideally suited to study the production of anti- and hyper-matter due to its excellent particle identification capabilities. The measurement of the He¯4-nucleus in Pb–Pb collisons at sNN=2.76TeV is presented. We further show the performance for the reconstruction of the (anti-)hypertriton in the decay to He3+π− (He¯3+π+). In addition to this, two searches have been performed, one for the H-Dibaryon →Λpπ− and one for the Λn bound state (Λn¯→d¯π+). No signals are observed for these exotic states and upper limits have been determined.
The width of the ω meson in cold nuclear matter is computed in a hadronic many-body approach, focusing on a detailed treatment of the medium modifications of intermediate πρ states. The π and ρ propagators are dressed by their self-energies in nuclear matter taken from previously constrained many-body calculations. The pion self-energy includes Nh and Δh excitations with short-range correlations, while the ρ self-energy incorporates the same dressing of its 2π cloud with a full 3-momentum dependence and vertex corrections, as well as direct resonance-hole excitations; both contributions were quantitatively fit to total photo-absorption spectra and πN→ρN scattering. Our calculations account for in-medium decays of type ωN→πN(⁎),ππN(Δ), and 2-body absorptions ωNN→NN(⁎),πNN. This causes deviations of the in-medium ω width from a linear behavior in density, with important contributions from spacelike ρ propagators. The ω width from the ρπ cloud may reach up to 200 MeV at normal nuclear matter density, with a moderate 3-momentum dependence. This largely resolves the discrepancy of linear T–ϱ approximations with the values deduced from nuclear photoproduction measurements.
We investigate the modification of the pion self-energy at finite temperature due to its interaction with a low-density, isospin-symmetric nuclear medium embedded in a constant magnetic background. To one loop, for fixed temperature and density, we find that the pion effective mass increases with the magnetic field. For the π−, interestingly, this happens solely due to the trivial Landau quantization shift ∼|eB|, since the real part of the self-energy is negative in this case. In a scenario in which other charged particle species are present and undergo an analogous trivial shift, the relevant behavior of the effective mass might be determined essentially by the real part of the self-energy. In this case, we find that the pion mass decreases by ∼10% for a magnetic field |eB|∼mπ2, which favors pion condensation at high density and low temperatures.
We investigate the phase structure of strongly interacting matter at non-vanishing isospin before the onset of pion condensation in the framework of the unquenched Polyakov–Quark-Meson model with 2+1 quark flavors. We show results for the order parameters and all relevant thermodynamic quantities. In particular, we obtain a moderate change of the pressure with isospin at vanishing baryon chemical potential, whereas the chiral condensate decreases more appreciably. We compare the effective model to recent lattice data for the decrease of the pseudo-critical temperature with the isospin chemical potential. We also demonstrate the major role played by the value of the pion mass in the curvature of the transition line, and the need for lattice results with a physical pion mass. Limitations of the model at nonzero chemical potential are also discussed.
For the pathologist, the diagnosis of drug induced liver injury (DILI) is challenging, because histopathological features mimic all primary hepatic and biliary diseases, lacking changes that are specific for DILI. Therefore, in any patient of suspected DILI who underwent liver biopsy, the pathologist will assure the clinician that the observed hepatic changes are compatible with DILI, but this information is less helpful due to lack of specificity. Rather, the pathologist should assess liver biopsies blindly, without knowledge of prior treatment by drugs. This will result in a detailed description of the histological findings, associated with suggestions for potential causes of these hepatic changes. Then, it is up to the physician to reassess carefully the differential diagnoses, if not done before. At present, liver histology is of little impact establishing the diagnosis of DILI with the required degree of certainty, and this shortcoming also applies to herb induced liver injury (HILI). To reach at the correct diagnoses of DILI and HILI, clinical and structured causality assessments are therefore better approaches than liver histology results obtained through liver biopsy, an invasive procedure with a low complication rate.
The small intestine is a part of the gastrointestinal tract in which digestion and absorption of nutrients takes place. The small bowel follows the stomach and is followed by the large intestine, reaching from the pylorus to the valve of Bauhin and is separated into the duodenum, the jejunum, and the ileum.
Capsule endoscopy (CE) has the potential to offer a perfect overview of the small-bowel mucosa and complete visualization of the entire small bowel is achieved in most cases. In this video, there is an overview offered on normal findings in small-bowel CE and typical anatomical landmarks are indicated. This article is part of an expert video encyclopedia.
The TolC-like protein HgdD of the filamentous, heterocyst-forming cyanobacterium Anabaena sp. PCC 7120 is part of multiple three-component "AB-D" systems spanning the inner and outer membranes and is involved in secretion of various compounds, including lipids, metabolites, antibiotics, and proteins. Several components of HgdD-dependent tripartite transport systems have been identified, but the diversity of inner membrane energizing systems is still unknown. Here we identified six putative resistance-nodulation-cell division (RND) type factors. Four of them are expressed during late exponential and stationary growth phase under normal growth conditions, whereas the other two are induced upon incubation with erythromycin or ethidium bromide. The constitutively expressed RND component Alr4267 has an atypical predicted topology, and a mutant strain (I-alr4267) shows a reduction in the content of monogalactosyldiacylglycerol as well as an altered filament shape. An insertion mutant of the ethidium bromide-induced all7631 did not show any significant phenotypic alteration under the conditions tested. Mutants of the constitutively expressed all3143 and alr1656 exhibited a Fox(-) phenotype. The phenotype of the insertion mutant I-all3143 parallels that of the I-hgdD mutant with respect to antibiotic sensitivity, lipid profile, and ethidium efflux. In addition, expression of the RND genes all3143 and all3144 partially complements the capability of Escherichia coli ΔacrAB to transport ethidium. We postulate that the RND transporter All3143 and the predicted membrane fusion protein All3144, as homologs of E. coli AcrB and AcrA, respectively, are major players for antibiotic resistance in Anabaena sp. PCC 7120.
There is ample epidemiologic evidence for an association of chronic hepatitis C virus (HCV) infection with B-cell non-Hodgkin lymphoma (B-NHL). B-NHL subtypes most frequently associated with HCV are marginal zone lymphoma and diffuse large B-cell lymphoma. The most convincing evidence for a causal relationship between HCV infection and lymphoma development is the observation of B-NHL regression after HCV eradication by antiviral therapy (AVT). In fact, for indolent HCV-associated B-NHL, first-line AVT instead of standard immune-chemotherapy might be considered. Molecular mechanisms of HCV-NHL development are still poorly understood. Three general theories have emerged to understand the HCV-induced lymphomagenesis: (1) continuous external stimulation of lymphocyte receptors by viral antigens and consecutive proliferation; (2) HCV replication in B cells with oncogenic effect mediated by intracellular viral proteins; (3) permanent B-cell damage, e.g., mutation of tumor suppressor genes, caused by a transiently intracellular virus (“hit and run” theory). This review systematically summarizes the data on epidemiology, interventional studies, and molecular mechanisms of HCV-associated B-NHL.
A low potential electron carrier ferredoxin (E0′ ≈ −500 mV) is used to fuel the only bioenergetic coupling site, a sodium-motive ferredoxin:NAD+ oxidoreductase (Rnf) in the acetogenic bacterium Acetobacterium woodii. Because ferredoxin reduction with physiological electron donors is highly endergonic, it must be coupled to an exergonic reaction. One candidate is NADH-dependent caffeyl-CoA reduction. We have purified a complex from A. woodii that contains a caffeyl-CoA reductase and an electron transfer flavoprotein. The enzyme contains three subunits encoded by the carCDE genes and is predicted to have, in addition to FAD, two [4Fe-4S] clusters as cofactor, which is consistent with the experimental determination of 4 mol of FAD, 9 mol of iron, and 9 mol of acid-labile sulfur. The enzyme complex catalyzed caffeyl-CoA-dependent oxidation of reduced methyl viologen. With NADH as donor, it catalyzed caffeyl-CoA reduction, but this reaction was highly stimulated by the addition of ferredoxin. Spectroscopic analyses revealed that ferredoxin and caffeyl-CoA were reduced simultaneously, and a stoichiometry of 1.3:1 was determined. Apparently, the caffeyl-CoA reductase-Etf complex of A. woodii uses the novel mechanism of flavin-dependent electron bifurcation to drive the endergonic ferredoxin reduction with NADH as reductant by coupling it to the exergonic NADH-dependent reduction of caffeyl-CoA.
This is the case report of a 58-year-old male patient who presented with recurring abdominal pain of 4 months duration. He had undergone multiple investigations including upper and lower gastrointestinal tract endoscopies and diagnostic laparoscopy, but there were no significant findings detected.
Capsule endoscopy revealed a submucosal small bowel tumor that was suspected to originate from the distal third of the small bowel. Surgery was indicated and a highly differentiated neuroendocrine tumor was found at laparotomy at the distal ileum. An ileocecal resection was performed confirming a neuroendocrine tumor of the small bowel (G2T2N1M1). This article is part of an expert video encyclopedia.
Previous experimental measurements from nuclear collisions have indicated modifications of jets by interaction with the medium created in the collision. Observables from particle correlations in the ALICE detector continue to provide access to key properties of the hot deconfined nuclear matter. New results from two- and three-particle number and transverse momentum correlations are discussed. Specifically, correlation function properties are characterized as a function of transverse momentum and centrality and for different charge combinations. Fourier decompositions are performed, identified particle ratios are studied in the jet-like peak and in the bulk, and the away-side shape is looked at in three-particle correlations.
The proportion of elderly women in the population is rising, and in tandem, the incidence of breast cancer rises with age. Because of health and tolerability concerns, as well as life expectancy, physicians may be reluctant to advise a standard treatment regimen for elderly patients with metastatic breast cancer. To elucidate this issue, we performed a literature review of clinical studies that included women with metastatic breast cancer who were over the age of 65. Our results show that although little clinical evidence exists, what is available suggests that standard treatment is tolerated and beneficial for patients meeting certain criteria. A geriatric assessment may identify specific patient groups (independent, dependent, or frail) and thereby guide treatment. Treatment recommendations for elderly patients with metastatic breast cancer are sparse, although first-line endocrine treatment, usually aromatase inhibitors or tamoxifen, is recommended for hormone-sensitive disease. In general, the evidence from clinical studies suggests that aromatase inhibitors are more effective than either tamoxifen or megestrol acetate as first- or second-line treatment in postmenopausal women with metastatic breast cancer. Ultimately, quality of life, treatment effects, and comorbidities are important aspects in this population and may guide treatment choice. To provide evidence-based treatment guidance, future clinical trials should include more patients over the age of 65 years.
The antineoplastic alkaloid ellipticine is a prodrug, the pharmacological efficiency of which is dependent on its cytochrome P450 (CYP)- and/or peroxidase-mediated activation to species forming DNA adducts in target tissues. Here, we found that this compound is cytotoxic to human BHT-101, B-CPAP and 8505-C thyroid cancer cells and blocks one or more phases of cell cycle in these cancer cells. Ellipticine toxicity to the thyroid cancer cells corresponded to levels of DNA adducts generated by the CYP- and/or peroxidase-mediated ellipticine metabolites, 12-hydroxy- and 13-hydroxyellipticine, in these cells. Cultivation of all tested cells under hypoxic conditions (1 % oxygen) led to a decrease in ellipticine toxicity. Such a lower sensitivity of cells to ellipticine correlates with a decrease in the formation of ellipticine-derived DNA adducts in these cells. Using Western blotting, the expression of CYP1A1, 1B1, 3A4, thyroid peroxidase (TPO), cyclooxygenase-1 (COX-1) and cytochrome b5, the enzymes that catalyze, and/or influence ellipticine metabolism, was investigated in the cancer cells. Furthermore, the effects of ellipticine treatment on the expression levels of these proteins in thyroid cancer cells were also examined. The results indicate that the highest expression levels of cytochrome b5 together with CYP1A1 and 3A4 determine the highest DNA adduct formation and cytotoxicity of ellipticine in B-CPAP cells. They also demonstrate that formation of covalent DNA adducts by ellipticine is the predominant mechanism responsible for its cytotoxicity in studied cells.
Herbal hepatotoxicity is a rare but highly disputed disease because numerous confounding variables may complicate accurate causality assessment. Case evaluation is even more difficult when the WHO global introspection method (WHO method) is applied as diagnostic algorithm. This method lacks liver specificity, hepatotoxicity validation, and quantitative items, basic qualifications required for a sound evaluation of hepatotoxicity cases. Consequently, there are no data available for reliability, sensitivity, specificity, positive and negative predictive value. Its scope is also limited by the fact that it cannot discriminate between a positive and a negative causality attribution, thereby stimulating case overdiagnosing and overreporting. The WHO method ignores uncertainties regarding daily dose, temporal association, start, duration, and end of herbal use, time to onset of the adverse reaction, and course of liver values after herb discontinuation. Insufficiently considered or ignored are comedications, preexisting liver diseases, alternative explanations upon clinical assessment, and exclusion of infections by hepatitis A-C, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), and varicella zoster virus (VZV). We clearly prefer as alternative the scale of CIOMS (Council for International Organizations of Medical Sciences) which is structured, quantitative, liver specific, and validated for hepatotoxicity. In conclusion, causality of herbal hepatotoxicity is best assessed by the liver specific CIOMS scale validated for hepatotoxicity rather than the obsolete WHO method that is liver unspecific and not validated for hepatotoxicity. CIOMS based assessments will ensure the correct diagnosis and exclude alternative diagnosis that may require other specific therapies.
The relationship between achievement of a pathologic complete response (pCR) and favorable long-term outcome varies among breast cancer subtypes. We aimed to highlight which neoadjuvant treatment strategy could be most successful in each breast cancer subtype. A recent FDA meta-analysis on randomized neoadjuvant breast cancer trials suggests that the survival differences of patients with or without a pCR were less pronounced in luminal A-like tumors, despite the overall favorable prognosis of these patients. Moreover, even though the strong prognostic effect of pCR in HER2 positive and TNBC, the NOAH study was the only trial which showed a trend in surrogacy of pCR for long-term outcome in HER2-positive subtype. Results from GeparTrio study suggest that patients with hormone-positive tumors might need a response-guided approach, with either an intensification of treatment in case of an early response or a change to other chemotherapy in case of no early response. Furthermore, data from German neoadjuvant trials confirm that an increasing number of chemotherapy cycles is associated with a higher pCR rate, especially in patients with HER2-positive/hormone-positive tumors. In line with these suggestions, Tryphaena study showed a pCR rate that exceeding the 60% threshold, the highest pCR results presented in a large multicenter study. In TNBC, the highest pCR rate in the German neoadjuvant studies was obtained with the simultaneous application of docetaxel, doxorubicin and cyclophosphamide for 6 cycles. However, as shown in GaparQuinto and NSABP 40 trials, treatment effect in TNBC might be further maximized by adding bevacizumab, and two randomized neoadjuvant trials are expected this year to report data on the efficacy of carboplatin.
Identification of the intermediates and determination of their structures in the reduction of dioxygen to water by cytochrome c oxidase (CcO) are particularly important to understanding both O2 activation and proton pumping by the enzyme. In this work, we report the products of the rapid reaction of O2 with the mixed valence form (CuA(2+), heme a(3+), heme a3(2+)-CuB(1+)) of the enzyme. The resonance Raman results show the formation of two ferryl-oxo species with characteristic Fe(IV)=O stretching modes at 790 and 804 cm(-1) at the peroxy oxidation level (PM). Density functional theory calculations show that the protein environment of the proximal H-bonded His-411 determines the strength of the distal Fe(IV)=O bond. In contrast to previous proposals, the PM intermediate is also formed in the reaction of Y167F with O2. These results suggest that in the fully reduced enzyme, the proton pumping ν(Fe(IV)=O) = 804 cm(-1) to ν(Fe(IV)=O) = 790 cm(-1) transition (P→F, where P is peroxy and F is ferryl) is triggered not only by electron transfer from heme a to heme a3 but also by the formation of the H-bonded form of the His-411-Fe(IV)=O conformer in the proximal site of heme a3. The implications of these results with respect to the role of an O=Fe(IV)-His-411-H-bonded form to the ring A propionate of heme a3-Asp-399-H2O site and, thus, to the exit/output proton channel (H2O) pool during the proton pumping P→F transition are discussed. We propose that the environment proximal to the heme a3 controls the spectroscopic properties of the ferryl intermediates in cytochrome oxidases.
Background: Understanding the coupling of O2 reduction to proton pumping by CcO requires detection of reaction intermediates.
Results: We have detected two oxoferryl intermediates at the PM oxidation state.
Conclusion: The H-bonding properties of the proximal heme a3 His ligand control the strength of the oxoferryl species.
Significance: The role of His-411, Thr-389, Gly-386, and Asp-399 residues in the proton pumping P→F transition is outlined.
In high-energy nuclear collisions, heavy quark potential at finite temperature controls the quarkonium suppression. Including the relaxation of the medium induced by the relative velocity between quarkonia and the deconfined expanding matter, the Debye screening is reduced and the quarkonium dissociation takes place at a higher temperature. As a consequence of the velocity-dependent dissociation temperature, the quarkonium suppression at high transverse momentum is significantly weakened in high-energy nuclear collisions at RHIC and LHC.
In this article, the video demonstrated is an example of a 76-year-old male patient who presented with recurrent intestinal bleeding of unknown origin at the university hospital. Previously performed upper and lower gastrointestinal tract endoscopy did not reveal a bleeding lesion. Capsule endoscopy revealed small-bowel angiectasia that were treated by argon plasma coagulation at subsequent balloon enteroscopy. This article is part of an expert video encyclopedia.
Small bowel varices may be found in less than 5% of patients with suspected small bowel bleeding. These varices are associated with portal hypertension or thrombosis of mesenteric venous vessels and with altered abdominal vascular anatomy with or without prior small bowel surgery. In bleeding small bowel varices, therapeutic options include endoscopic injection of tissue adhesives, endovascular approaches such as balloon-occluded retrograde transvenous or percutaneous obliteration and transjugular intrahepatic portosystemic shunt, and surgical resection. This is a case report of a 53-year-old patient with ethylic liver cirrhosis who presented with severe, life-threatening hematochezia due to small bowel varices. This article is part of an expert video encyclopedia.
This is an example of capsule endoscopy (CE) revealing terminal ileitis in an young male patient with recurrent abdominal pain who had previously been investigated with colonoscopy and esophagogastroduodenoscopy without any significant findings. CE revealed severe inflammation of the terminal ileum. This article is part of an expert video encyclopedia.
Operatively altered anatomy such as Billroth II gastroenterostomy represents a challenge in endoscopic retrograde cholangiopancreatography and might require dedicated instruments. In this article, the authors demonstrate the technique of endoscopic retrograde cholangiography and sphincterotomy in a patient with Billroth's operation-II. Sphincterotomy is performed with a specially designed Billroth papillotome to enable papillotomy in the direction of the papillary roof. This article is part of an expert video encyclopedia.
Here the authors report the case of an elderly woman who had upper abdominal pain, upper gastrointestinal hemorrhage, and jaundice (a symptomatic triad termed the ‘Quincke’ triad) a few days after endoscopic sphincterotomy. Abdominal ultrasonography demonstrated an echo-rich filling of the choledochus consistent with hemobilia. Endoscopic retrograde cholangiography was immediately performed and blood clots were removed from the common bile duct. A nasobiliary catheter was placed to irrigate the bile duct for prevention of recurring obstruction of the bile ducts from blood clots. Further follow-up of the patient was uneventful. This article is part of an expert video encyclopedia.
Small bowel endoscopy is indicated for patients with an unidentified bleeding site in esophagogastroduodenoscopy and ileocolonoscopy and symptoms of intestinal blood loss or unexplained anemia. In approximately two-thirds of these cases, capsule endoscopy (CE) detects a lesion within the small bowel that explains the patient's symptoms. In few cases, though, lesions outside of the small bowel might be revealed by CE. Therefore, attention to all intestines that are visualized by CE might be necessary not to overlook bleeding sites that had not been discovered by prior flexible endoscopy.
Here the case of a 71-year-old male patient with unexplained anemia is presented by the authors. Small-bowel CE revealed minor bleeding from a neoplastic mass in the cecum. The final diagnosis of an adenocarcinoma of the ascending colon was established after the patient underwent a right hemicolectomy. This article is part of an expert video encyclopedia.
Small bowel endoscopy is indicated for patients with an unidentified bleeding site in esophago-gastro-duodenoscopy and ileo-colonoscopy and symptoms of intestinal blood loss or unexplained anemia. In approximately two-thirds of these cases, capsule endoscopy (CE) detects a lesion within the small bowel that explains the patient's symptoms. In few cases, though, lesions outside of the small bowel might be revealed by CE. Therefore, attention to all intestines that are visualized by CE might be necessary not to overlook bleeding sites that had not been discovered by prior flexible endoscopy.
The authors present the case of a 71-year-old male patient who presented to their outpatient clinic for unexplained anemia. Small bowel CE revealed minor bleeding from an adenocarcinoma in the cecum. This article is part of an expert video encyclopedia.
Stent insertion is an established technique of endoscopic retrograde cholangiopancreatography (ERCP) to treat symptomatic malignant or benign biliary strictures, and stent placement is accomplished by using the over-the-wire (OTW) method. In some cases, however, it might be challenging and sometimes time consuming to pass a complex biliary stricture with the guidewire. Stent-exchange technique with a guidewire left in place during stent removal might therefore be helpful to guarantee successful and time-sparing interventions.
A simple method is presented to remove the stent with the guidewire left in place, using the OTW stent-exchange method in ERCP. This technique simplifies stent OTW exchange by using a simple endoscopy snare. This article is part of an expert video encyclopedia.
Operatively altered anatomy might provide a challenge for endoscopic retrograde cholangiopancreatography. However, with the support of the balloon-assisted enteroscopy technique the access route to the biliary system even in long-limb Roux-Y anastomosis is feasible in most cases.
In this video case report, an 81-year-old woman was symptomatic for stone obstruction of the common bile duct (CBD). Complete gastrectomy had been performed in this patient for stomach cancer many years earlier. Balloon-assisted enteroscopy was used for retrograde access of the duodenum via a Roux-Y anastomosis. There was major difficulty in intubating the CBD via the native papilla in this case because access was prevented by the tangential approach of the enteroscope. After performing an incomplete papillectomy, the insertion of a guidewire into the CBD was feasible and the bile duct stone was removed. This article is part of an expert video encyclopedia.
Purpose: Metabolic changes upon antiangiogenic therapy of recurrent glioblastomas (rGBMs) may provide new biomarkers for treatment efficacy. Since in vitro models showed that phospholipid membrane metabolism provides specific information on tumor growth we employed in-vivo MR-spectroscopic imaging (MRSI) of human rGBMs before and under bevacizumab (BVZ) to measure concentrations of phosphocholine (PCho), phosphoethanolamine (PEth), glycerophosphocholine (GPC), and glyceroethanolamine (GPE).
Methods: 1H and 31P MRSI was prospectively performed in 32 patients with rGBMs before and under BVZ therapy at 8 weeks intervals until tumor progression. Patients were dichotomized into subjects with long overall survival (OS) (>median OS) and short OS (<median OS) survival time from BVZ-onset. Metabolite concentrations from tumor tissue and their ratios were compared to contralateral normal-appearing tissue (control).
Results: Before BVZ, 1H-detectable choline signals (total GPC and PCho) in rGBMs were elevated but significance failed after dichotomizing. For metabolite ratios obtained by 31P MRSI, the short-OS group showed higher PCho/GPC (p = 0.004) in rGBMs compared to control tissue before BVZ while PEth/GPE was elevated in rGBMs of both groups (long-OS p = 0.04; short-OS p = 0.003). Under BVZ, PCho/GPC and PEth/GPE in the tumor initially decreased (p = 0.04) but only PCho/GPC re-increased upon tumor progression (p = 0.02). Intriguingly, in normal-appearing tissue an initial PEth/GPE decrease (p = 0.047) was followed by an increase at the time of tumor progression (p = 0.031).
Conclusion: An elevated PCho/GPC ratio in the short-OS group suggests that it is a negative predictive marker for BVZ efficacy. These gliomas may represent a malignant phenotype even growing under anti-VEGF treatment. Elevated PEth/GPE may represent an in-vivo biomarker more sensitive to GBM infiltration than MRI.
Friedrich Flick zählt zweifellos zu den umstrittensten Protagonisten der deutschen Wirtschafts- und Unternehmensgeschichte des 20. Jahrhunderts – und mittlerweile auch zu den am besten erforschten. Zwischen 2004 und 2008 erschienen gleich vier teilweise recht umfangreiche Arbeiten zur Konzern- und zur Familiengeschichte. Was macht diesen Mann für Geschichtswissenschaft und politisch interessierte Öffentlichkeit so interessant? Ein kühner Unternehmensgründer vom Schlage eines Thyssen oder Siemens – das machen die vier Autoren gleich in der Einleitung deutlich – war er jedenfalls nicht, auch kein genialer Erfinder oder sozialpolitischer Pionier. Sein Name sei vielmehr zum "Synonym für politischen Opportunismus und den skrupellosen Einsatz wirtschaftlicher Macht geworden" (S. 8). Einen gewissermaßen widerwilligen Respekt nötigt allenfalls seine Fähigkeit ab, unter vier verschiedenen politischen Systemen wirtschaftlich erfolgreich zu sein. Schon aus diesem Grund erscheint es den Autoren angezeigt, Flick "als Unternehmer ernst zu nehmen" (S. 9). ...
Gene therapy on the move
(2013)
The first gene therapy clinical trials were initiated more than two decades ago. In the early days, gene therapy shared the fate of many experimental medicine approaches and was impeded by the occurrence of severe side effects in a few treated patients. The understanding of the molecular and cellular mechanisms leading to treatment- and/or vector-associated setbacks has resulted in the development of highly sophisticated gene transfer tools with improved safety and therapeutic efficacy. Employing these advanced tools, a series of Phase I/II trials were started in the past few years with excellent clinical results and no side effects reported so far. Moreover, highly efficient gene targeting strategies and site-directed gene editing technologies have been developed and applied clinically. With more than 1900 clinical trials to date, gene therapy has moved from a vision to clinical reality. This review focuses on the application of gene therapy for the correction of inherited diseases, the limitations and drawbacks encountered in some of the early clinical trials and the revival of gene therapy as a powerful treatment option for the correction of monogenic disorders.
Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by impaired antimicrobial activity in phagocytic cells. As a monogenic disease affecting the hematopoietic system, CGD is amenable to gene therapy. Indeed in a phase I/II clinical trial, we demonstrated a transient resolution of bacterial and fungal infections. However, the therapeutic benefit was compromised by the occurrence of clonal dominance and malignant transformation demanding alternative vectors with equal efficacy but safety-improved features. In this work we have developed and tested a self-inactivating (SIN) gammaretroviral vector (SINfes.gp91s) containing a codon-optimized transgene (gp91(phox)) under the transcriptional control of a myeloid promoter for the gene therapy of the X-linked form of CGD (X-CGD). Gene-corrected cells protected X-CGD mice from Aspergillus fumigatus challenge at low vector copy numbers. Moreover, the SINfes.gp91s vector generates substantial amounts of superoxide in human cells transplanted into immunodeficient mice. In vitro genotoxicity assays and longitudinal high-throughput integration site analysis in transplanted mice comprising primary and secondary animals for 11 months revealed a safe integration site profile with no signs of clonal dominance.
The project focuses on the efficiency of combined technologies to reduce the release of micropollutants and bacteria into surface waters via sewage treatment plants of different size and via stormwater overflow basins of different types. As a model river in a highly populated catchment area, the river Schussen and, as a control, the river Argen, two tributaries of Lake Constance, Southern Germany, are under investigation in this project. The efficiency of the different cleaning technologies is monitored by a wide range of exposure and effect analyses including chemical and microbiological techniques as well as effect studies ranging from molecules to communities.
Angiogenesis, the formation of new blood vessels from existing ones, is a fundamental biological process required for embryonic development; it also plays an important role during postnatal organ development and various physiological and pathological remodeling processes in the adult organism. Vascular endothelial growth factor (VEGF) and its main receptor, VEGF receptor-2 (VEGFR-2), play a central role in angiogenesis. VEGFR-2 expression is strongly upregulated in angiogenic vessels, but the mechanisms regulating VEGFR-2 expression are not well understood. We found in this study that the G-protein α subunit Gα13 plays an important role in the regulation of VEGFR-2 expression. In vitro, we found that knockdown of Gα13 reduced VEGFR-2 expression in human umbilical vein endothelial cells and impaired responsiveness to VEGF-A. This phenotype was rescued by adenoviral normalization of VEGFR-2 expression. Gα13-dependent VEGFR-2 expression involved activation of the small GTPase RhoA and transcription factor NF-κB; it was abrogated by deletion of the NF-κB binding site at position -84 of the VEGFR-2 promoter. In vivo, endothelial cell-specific loss of Gα13 resulted in reduced VEGFR-2 expression, impaired responsiveness towards VEGF-A in Matrigel assays, and reduced retinal angiogenesis. Importantly, also tumor vascularization was diminished in the absence of endothelial Gα13, resulting in reduced tumor growth. Taken together, we identified Gα13-dependent NF-κB activation as a new pathway underlying the transcriptional regulation of VEGFR-2 during retinal and tumor angiogenesis.
Data are presented for 29 chrysomelid species (Coleoptera: Chrysomelidae) occurring in the Cayman Islands, West Indies, 26 of these not having been reported from these islands previously. Altica occidentalis Suffrian is removed from the genus Lysathia Bechyné and reinstated in Altica Geoffroy. Chaetocnema perplexa Blake is synonymized with Chaetocnema confinis Crotch, new synonymy. Omophoita cyanipennis octomaculata (Crotch) is synonymized with Omophoita cyanipennis (Fabricius), new synonymy. The following nine species are named and described: Apraea luciae, Apraea priscilae, Cryptocephalus catharinae, Cryptocephalus kirki, Cryptocephalus paulotigrinus, Longitarsus alisonae, Megistops adiae, Nyctiplanctus bifasciatus, Syphrea thurstonae, all are new species. Taxonomic notes and a key to species, as well as information on plant associations and extralimital distribution, are also provided.
The prize-collecting vehicle routing problem with single and multiple depots and non-linear cost
(2013)
In this paper, we propose a new routing problem to model a highly relevant planning task in small package shipping. We consider the Prize-Collecting Vehicle Routing Problem with Non-Linear cost in its single and multi-depot version, which integrates the option of outsourcing customers to subcontractors instead of serving them with the private fleet. Thereby, a lower bound on the total customer demand to be served by the private fleet guarantees a high utilization of the fleet capacity. To represent the practical situation, where a discount is given by a subcontractor if larger amounts of packages are outsourced, subcontracting costs follow a non-linear function. The considered problem is NP-hard and we propose an Adaptive Variable Neighborhood Search algorithm to solve instances of realistic size. We propose new benchmark sets for the single and the multi-depot problem, which are adapted from test instances of the capacitated VRP and the closely related Multi-Depot VRP with Private fleet and Common carrier. In numerical studies, we investigate the performance of our algorithm on the newly generated test instances and on standard benchmark problems of related problems. Moreover, we study the effect of different cost functions and different values of the minimal demand to be served by the private fleet on the routing solutions obtained.
Bei der Ionenstrahltherapie bestimmt die Energie der Ionen die Eindringtiefe in das Gewebe und damit die Lage des Braggpeaks, in dem der größte Teil der Ionisationsenergie deponiert wird.
Um die gewünschte Dosis möglichst genau im Tumor zu lokalisieren, müssen in den aufeinanderfolgenden Extraktionen die gewünschten unterschiedlichen Energien möglichst genau sein.
In der Beschleunigungsphase werden die Magnetfelder der Magnete im Synchrotron bis zum vorgegebenen Exktraktionswert hochgefahren. Dieser bestimmt zusammen mit der Synchrotronfrequenz die Strahlenergie. Während und insbesondere am Ende dieser Phase, Rampe genannt, sollte das Magnetfeld daher sehr genau dem berechneten Sollwert folgen, um Strahlverluste zu minimieren und die geforderte Strahlqualität zu erreichen.
In der zeitlichen Steuerung der Magnetströme müssen magnetische Effekte, die hauptsächlich im Eisen der Magnete auftreten, wie Wirbelströme und die Hysterese berücksichtigt werden, da sie das Feld verfälschen und damit den Strahl in unerwünschter Weise beeinflussen. Die während der Rampe entstehenden Wirbelströme stören das Magnetfeld, so dass bisher vor der Extraktion des Strahls eine Wartezeit eingeführt wurde, bis die Wirbelströme abgeklungen waren.
Bei beliebig wählbaren Abfolgen der vordefinierten Zyklen kommt es durch die Hysterese des Eisens zu unterschiedlichen Remanenzfeldern, die das Magnetfeld verändern. Um dem vorzubeugen, durchliefen die Magnete eine vordefinierte Hystereseschleife. Ist die geforderte Energie des Strahls erreicht, wird das Magnetfeld konstant gehalten und die Teilchen aus dem Synchrotron extrahiert. Der Rest der Hystereseschleife wurde am Ende des Zyklus durchlaufen.
Die im Rahmen dieser Dissertation entwickelte dynamische Magnetfeldregelung misst das integrale Magnetfeld sehr genau und korrigiert die Feldfehler. Das integrale Magnetfeld folgt damit jederzeit seiner Vorgabe, unabhängig von den dynamischen Störeffekten. Die Wirbelströme und die Hysterese sind zwar immer noch vorhanden, die dadurch verursachten Feldfehler können aber durch eine Rückkopplung auf den Strom des Magneten korrigiert werden.
Es werden verschiedene Verfahren zur Messung der Magnetfelder untersucht. Am besten eignet sich für die dynamische Magnetfeldregelung die Kombination aus einer Hallsonden- und einer Induktionsspulenmessung. Die Messung muss das integrale Magnetfeld des Magneten BL, also das gesamte Feld entlang des Strahlwegs, bestimmen. Die Induktionsspule, oder Pickupspule, liegt deshalb entlang des Strahlrohrs im Magneten und liefert eine Spannung in Abhängigkeit von der Änderung des magnetischen Flusses. Durch die Integration dieser Spannung erhält man das integrale Feld des Magneten. Die Messung wird mit einer Hallsondenmessung zu Beginn des Beschleunigerzyklus auf einen absoluten Messwert geeicht.
Der Hauptteil dieser Arbeit beschäftigt sich mit der Entwicklung des sogenannten HIT Integrators, der die Integration der Pickupspulenspannung übernimmt. Bisher verfügbare Integratoren konnten die notwendigen Anforderungen an Genauigkeit, Echtzeitfähigkeit, automatische Kalibrierung, ständige Messbereitschaft, Temperaturunabhängigkeit und hohe Verfügbarkeit nicht erfüllen. Der neu entwickelte HIT Integrator wurde diesen Anforderungen entsprechend entwickelt. Der Integrator mit dem neuartigen Konzept der gleichzeitigen Messung und Kalibrierung in Echtzeit ist als Patent angemeldet worden. Neben der Entwicklung und Verwirklichung des Gesamtkonzepts war die numerische Integration des stark verrauschten Pickupspulensignals und die sofortige Umsetzung des integralen Werts in ein Steuersignal für die Dipolmagnetstromgeräte eine besondere technische Herausforderung.
Die elektronischen Schaltungen für die dynamische Magnetfeldregelung sind in der Baugruppe des HIT Integrators zusammengefasst. Die Ansteuerung der Hallsonde mit einer temperaturkompensierten Stromquelle, der Signalaufbereitung und Analog-Digital-Wandlung, sowie der Integrator und der Regler bilden eine technische Einheit.
Der HIT Integrator ist speziell für den Einsatz im bestehenden Beschleunigerkontrollsystem und den Magnetnetzgeräten entwickelt worden.
Die Regler der Magnetnetzgeräte wurden so verändert, dass sie einen Zusatzsollwert verarbeiten können, der auf den berechneten Sollwert der Datenversorgung addiert wird.
Die Magnetfeldregelung wurde in den Therapiebeschleuniger integriert, dazu wurde die Datenversorgung und das Kontrollsystem angepasst. Die Magnetfeldregelung stellt ein neues Gerät im Beschleuniger dar, das in die Netzgeräte der Synchrotronmagnete eingebaut worden ist. Die Datenversorgung dieser Geräte beinhaltet u.a. eine neue Methode der Kalibrierung.
Es konnte durch Messungen gezeigt werden, dass die Magnetfeldregelung mit hoher Genauigkeit funktioniert. Es wird eine Genauigkeit von besser als 10^{-4} des maximalen Feldes von 1.5 T erreicht, also weniger als 150uT, der dreifachen Stärke des Erdmagnetfelds. Vor allem die Bestrahlungszeit mit Protonen und die Bestrahlung bei niedrigen Energien profitiert von der Magnetfeldregelung, da hier das Extraktionsniveau der Magnete relativ gering ist und das Durchlaufen der vordefinierten Hystereseschleife prozentual mehr Zeit im Zyklus in Anspruch nimmt. Durch den Wegfall dieser Phase wird daher pro Zyklus mehr Zeit eingespart. Die Messungen zeigen, dass im Beschleunigerzyklus trotz der fehlenden Wartezeiten, die bis zu 24% betragen, eine gleichbleibend gute Strahlqualität erreicht wird. Dies wurde mit Vergleichsmessungen gezeigt, bei denen der Strahl mit und ohne Feldregelung vermessen wurde. Untersucht wurde eine große Stichprobenmenge aus dem Parameterraum, gegeben durch zwei Ionensorten mit jeweils 255 Strahlenergien, 10 verschiedenen Teilchenraten und 4 Strahlbreiten. Außerdem wurde die Energie des Strahls nachgemessen.
Für die Einführung in den Therapiebetrieb musste eine Impactanalyse gemacht werden, die mögliche Auswirkungen des neuen Verfahrens behandelt. Das Risiko für Patienten, Mitarbeiter und Dritte darf durch die Magnetfeldregelung nicht erhöht werden. Daraus entstand auch die Forderung nach einem redundanten System, das Fehler erkennt und die Bestrahlung abbricht.
Die mittlere Leistungsaufnahme des Beschleunigers des Heidelberger Ionenstrahltherapiezentrums liegt bei etwa 1 MW, bei einem Jahresenergieverbrauch von 8 GWh mit Kosten von etwa 1 Million Euro. Dies entspricht einer deutschen Kleinstadt mit 10000 Einwohnern. Die Verkürzung der Zykluszeiten wirkt sich direkt auf die Bestrahlungszeit und auf die Energiekosten aus. Würde man die Anlage durch die Zeiteinsparungen kürzer betreiben, würde man etwa 2 GWh pro Jahr sparen, was die Stromkosten um etwa 250000 Euro reduziert.
Zusätzlich zu den eingesparten Kosten wird auch die Bestrahlungszeit kürzer und damit auch die Zeit, die der Patient bei der Behandlung fixiert wird. Die Behandlung für die Patienten wird angenehmer. Man kann aber auch durch die eingesparte Bestrahlungszeit pro Patient entsprechend mehr Patienten behandeln. Das heißt man kann an Stelle von 700 Patienten im Jahr 910 Patienten mit einem Tumor behandeln. Dieser für die Patienten willkommene Effekt bedeutet auf der anderen Seite für HIT aber auch Mehreinnahmen von 4.2 Millionen Euro im Jahr.
Das Konzept der Magnetfeldregelung kann auch an anderen Beschleunigeranlagen zum Einsatz kommen. Dazu müssen die Magnete mit den Sonden bestückt werden und die Magnetnetzgeräte einen Eingang für einen Zusatzsollwert bekommen. Das Beschleunigerkontrollsystem kann erweitert werden, damit es einen Sollwert mit allen notwendigen Kalibrierungen berechnen kann. Der HIT Integrator wird dann als eigenständiges Gerät in das Kontrollsystem eingebunden.
Das Heidelberger Ionenstrahl Therapiezentrum (HIT) ist die erste klinische Anlage in Europa, an der die Strahlentherapie zur Tumorbekämpfung mit schwereren Ionen als Protonen möglich ist. Seit November 2009 wurden mehr als 1500 Patienten bei HIT behandelt.
Dabei kommt das beim GSI Helmholtzzentrum für Schwerionenforschung GmbH in Darmstadt entwickelte Rasterscan-Verfahren zum Einsatz. In der Bestrahlungsplanung wird der Tumor in Schichten gleicher Ionen-Energie und jede Schicht in einzelne Rasterpunkte eingeteilt. Für jeden Rasterpunkt wird eine individuelle Teilchenzahl appliziert, die am Ende zu der gewünschten Dosisverteilung führt. Dabei kann sich die benötigte Teilchenbelegung der einzelnen Rasterpunkte auch innerhalb einer Schicht um mehr als zwei Größenordnungen unterscheiden.
Ein auf wenige Millimeter Durchmesser fokussierter Teilchenstrahl kann in allen Raumrichtungen variiert werden, so dass selbst für unregelmäßig geformte Tumoren eine hochgenaue Dosiskonformität erreicht wird. Messkammern, die in der Ionen-Flugbahn kurz vor dem Patienten installiert sind, überwachen kontinuierlich Position, Form und Intensität des Strahls und ermöglichen so die Rasterpunkt-abhängige Dosisabgabe.
Zur Bereitstellung des Teilchenstrahls ist eine komplexe Beschleunigeranlage nötig, die eine große Bibliothek an möglichen Strahlparametern erzeugen kann. Das Herzstück der Anlage ist ein Synchrotron, in dem die Ionen auf die gewünschte Energie beschleunigt und anschließend über mehrere Sekunden extrahiert werden. Diese langsame Extraktion ist nötig, um dem Bestrahlungssystem genug Zeit für die korrekte, punktgenaue Dosisabgabe zu geben. Die zeitliche Struktur der beim Patienten ankommenden Strahlintensität wird Spill genannt.
Der verwendete Extraktionsmechanismus ist die transversale RF-Knockout Extraktion, die auf dem Prinzip der langsamen Resonanzextraktion beruht. Die im Synchrotron umlaufenden Teilchen werden dabei transversal angeregt, bis nach und nach ihre Schwingungsamplitude so groß ist, dass sie in den Extraktionskanal gelangen. Das für diese Anregung verantwortliche Gerät ist der RF-KO-Exciter. Er ist so eingestellt, dass ein möglichst konstanter Teilchenstrom das Synchrotron verlässt.
Bereits beim Befüllen des Synchrotrons variiert jedoch die injizierte Teilchenzahl und deren Verteilung im Phasenraum, so dass die voreingestellte Amplitudenfunktion des RF-KO-Exciters keinen idealen Spill liefern kann. Es kommt unweigerlich zu Schwankungen der Intensität am Strahlziel. Die erreichbare Leistungsfähigkeit der Therapieanlage hängt jedoch in hohem Maße von der Spillqualität ab. Je besser diese ist, umso schneller kann die individuelle Bestrahlung erfolgen und um so mehr Patienten können in gleicher Zeit behandelt werden.
Die vorliegende Arbeit beschäftigt sich mit der Verbesserung der Spillqualität am Bestrahlungsplatz. Dazu wird ein Regelkreis zwischen den Strahl-detektierenden Messkammern und dem die Extraktion steuernden RF-KO-Exciter geschlossen. Ionisationskammern, die auch zur Dosisbestimmung verwendet werden, messen die aktuelle Intensität. Das Therapiekontrollsystem, das den gesamten Bestrahlungsprozess steuert, gibt den Sollwert vor und leitet alle Informationen zur Reglereinrichtung. Dort wird in Abhängigkeit der Abweichung aus gewünschter und tatsächlich vorhandener Intensität sowie dem Regelalgorithmus ein Korrektursignal errechnet und dem RF-KO-Exciter zugeführt. Eine der Herausforderungen bestand dabei im Auffinden der geeigneten Regelparameter, die entsprechend der Strahlparameter Energie und Intensität gewählt werden müssen.
In einem ersten Schritt kann so der extrahierte Teilchenstrahl auf dem jeweils geforderten, konstanten Niveau gehalten werden. Diese Stufe wird seit April 2013 vollständig im Routinebetrieb der Therapieanlage verwendet. Der zweite Schritt besteht in der Anpassung der Extraktionsrate an den individuellen Bestrahlungsplan. So können die Rasterpunkte, die eine hohe Dosis benötigen, mit einer höheren Intensität bestrahlt werden, was die Bestrahlungszeit deutlich reduziert. Die Vollendung dieser Stufe ist bis Ende 2013 vorgesehen.
Im Rahmen dieser Arbeit wurden zwei Testsysteme sowie die Implementierung in den Routinebetrieb des Therapiebeschleunigers einer solchen Intensitäts- oder Spillregelung realisiert. Dies beinhaltet den Aufbau der Systeme, die Bereitstellung von Soll- und Istwert sowie die Auslegung und Einstellung des Regelkreises. Der erste Testaufbau für ein Strahlziel des Beschleunigers diente generellen Studien zur Machbarkeit einer solchen Regelung. Die dabei gesammelten Erfahrungen über nötige Erweiterungen führten zur zweiten Generation einer Testumgebung auf Basis eines Echtzeit-Ethernet-Systems. Dieses ermöglichte bereits die Regelung an allen Strahlzielen der HIT-Anlage sowie die Verwendung von unterschiedlichen Regelalgorithmen.
Mit den Systemen wurden Messungen zur Charakterisierung der Spillregelung im Parameterraum des Beschleunigers durchgeführt, um so ihre Möglichkeiten und Grenzen zu untersuchen. Erkenntnisse aus dieser Testphase flossen direkt in die Implementierung des für den Patientenbetrieb eingesetzten Systems ein, für das ein hohes Maß an Betriebs-Stabilität erforderlich ist. Es wurde in das Beschleuniger-Kontrollsystem unter Berücksichtigung des Sicherheitskonzeptes der Anlage integriert.
Die reine Bestrahlungszeit wird durch die Realisierung der ersten Stufe um bis zu 25% reduziert, nach Vollendung der zweiten Stufe wird sie um weitere bis zu 50% verringert. Strahlzeiten für Nachjustierungen der Spillqualität werden ebenfalls zum Teil eingespart. Insgesamt konnte durch die Spillregelung die Effizienz der Anlage deutlich gesteigert werden.
We show that the optimal consumption of an individual over the life cycle can have the hump shape (inverted U-shape) observed empirically if the preferences of the individual exhibit internal habit formation. In the absence of habit formation, an impatient individual would prefer a decreasing consumption path over life. However, because of habit formation, a high initial consumption would lead to high required consumption in the future. To cover the future required consumption, wealth is set aside, but the necessary amount decreases with age which allows consumption to increase in the early part of life. At some age, the impatience outweighs the habit concerns so that consumption starts to decrease. We derive the optimal consumption strategy in closed form, deduce sufficient conditions for the presence of a consumption hump, and characterize the age at which the hump occurs. Numerical examples illustrate our findings. We show that our model calibrates well to U.S. consumption data from the Consumer Expenditure Survey.
Der Eintritt des Lesers in die Welt der "Wächter"-Romane Sergej Lukianenkos mutet geradezu konventionell an. Der Ich-Erzähler und Protagonist Anton Gorodezki, lichter "Anderer", Nachtwache Moskau, durchstreift die nächtlichen Straßen in wichtiger Mission: er folgt dem Ruf eines dunklen "Anderen", eines Vampirs, um das damit angelockte menschliche Opfer zu retten. Nach und nach entfaltet sich die Welt der Wächter. In der uns bekannten Welt leben neben den normalen Menschen die magiebegabten "Anderen", Vampire und Werwölfe, Hexen und Zauberer etc. Von den Menschen, zumindest den Menschen der Moderne, weitgehend unbemerkt leben sie unter uns und bestimmen wesentlich die Ereignisse der Weltgeschichte.
Gemeinsam ist allen "Anderen" die Fähigkeit, in die magische Parallelwelt des Zwielichts eintauchen zu können. Getrennt sind sie durch ihre Zugehörigkeit zu den Lichten beziehungsweise zu den Dunklen, die sich in einem immerwährenden Kampf gegeneinander und um die Seelen der Menschen befinden. Zu Nutz und Frommen der Menschen kämpft das Gute gegen das Böse, Magie ist auch im Spiel – ein bekanntes Muster der Fantasy.
In literaturwissenschaftlichen Analysen des Genres spielt "Gut gegen Böse" dennoch ein weitgehendes Schattendasein. Definitionsversuche der Fantasy etwa von Pesch und Weinreich nennen das Begriffspaar nicht, eben sowenig das Phantastikhandbuch unter dem Lemma "Fantasy", allerdings als Grundmotiv der Apokalypse. Abraham führt es nicht als Teil seiner Definition, aber immerhin als einen Unterpunkt von "Dichotomien abendländischer Fantastik". Wiewohl Abraham insbesondere für neuere Werke und Adaptionen ausführt, dass nicht "ein einfacher Schwarz-Weiß-Kontrast [...], sondern tatsächlich eine Dichotomie" zwischen Gut und Böse vorliege und einzelnen Figuren psychologische Tiefe in diesem Bereich verliehen werde, so mag das relative Desinteresse an diesem Bereich auch daran liegen, dass ein oft recht holzschnittartig gearbeiteter Gegensatz ein wenig ergiebiges Arbeitsfeld oder Definitionskriterium darstellt. Auffällig ist, dass Abrahams vergleichsweise ausführliches Eingehen auf das Thema in einer "Einführung für Schule und Hochschule", unter einer spezifisch "medien- und rezeptionsorientierten Perspektive" stattfindet.
Background: After induction of DNA double strand breaks (DSBs), the DNA damage response (DDR) is activated. One of the earliest events in DDR is the phosphorylation of serine 139 on the histone variant H2AX (gH2AX) catalyzed by phosphatidylinositol 3-kinases-related kinases. Despite being extensively studied, H2AX distribution[1] across the genome and gH2AX spreading around DSBs sites[2] in the context of different chromatin compaction states or transcription are yet to be fully elucidated.
Materials and methods: gH2AX was induced in human hepatocellular carcinoma cells (HepG2) by exposure to 10 Gy X-rays (250 kV, 16 mA). Samples were incubated 0.5, 3 or 24 hours post irradiation to investigate early, intermediate and late stages of DDR, respectively. Chromatin immunoprecipitation was performed to select H2AX, H3 and gH2AX-enriched chromatin fractions. Chromatin-associated DNA was then sequenced by Illumina ChIP-Seq platform. HepG2 gene expression and histone modification (H3K36me3, H3K9me3) ChIP-Seq profiles were retrieved from Gene Expression Omnibus (accession numbers GSE30240 and GSE26386, respectively).
Results: First, we combined G/C usage, gene content, gene expression or histone modification profiles (H3K36me3, H3K9me3) to define genomic compartments characterized by different chromatin compaction states or transcriptional activity. Next, we investigated H3, H2AX and gH2AX distributions in such defined compartments before and after exposure to ionizing radiation (IR) to study DNA repair kinetics during DDR. Our sequencing results indicate that H2AX distribution followed H3 occupancy and, thus, the nucleosome pattern. The highest H2AX and H3 enrichment was observed in transcriptionally active compartments (euchromatin) while the lowest was found in low G/C and gene-poor compartments (heterochromatin). Under physiological conditions, the body of highly and moderately transcribed genes was devoid of gH2AX, despite presenting high H2AX levels. gH2AX accumulation was observed in 5’ or 3’ flanking regions, instead. The same genes showed a prompt gH2AX accumulation during the early stage of DDR which then decreased over time as DDR proceeded.
Finally, during the late stage of DDR the residual gH2AX signal was entirely retained in heterochromatic compartments. At this stage, euchromatic compartments were completely devoid of gH2AX despite presenting high levels of non-phosphorylated H2AX.
Conclusions: We show that gH2AX distribution ultimately depends on H2AX occupancy, the latter following H3 occupancy and, thus, nucleosome pattern. Both H2AX and H3 levels were higher in actively transcribed compartments. However, gH2AX levels were remarkably low over the body of actively transcribed genes suggesting that transcription levels antagonize gH2AX spreading. Moreover, repair processes did not take place uniformly across the genome; rather, DNA repair was affected by genomic location and transcriptional activity. We propose that higher H2AX density in euchromaticcompartments results in high relative gH2AXconcentration soon after the activation of DDR, thus favoring the recruitment of the DNA repair machinery to those compartments. When the damage is repaired and gH2AX is removed, its residual fraction is retained in the heterochromatic compartments which are then targeted and repaired at later times.