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Im Rahmen dieser Arbeit wurden grundlegende Eigenschaften von GEM-Verstärkungsstrukturen untersucht. Dies waren der Einfluss des Alignmenteffektes auf die Reproduzierbarkeit von Messungen, die Elektronenextraktionseffizienz von GEMs im allgemeinen und die Auswirkungen von Druckschwankungen auf die Gasverstärkung. Weiterhin wurden verschiedene vierlagige GEM-Verstärkungssysteme mit einer MP-GEM an erster Stelle in Hinblick auf Ionenrückfluss und Energieauflösung untersucht.
Der Alignmenteffekt ist noch nicht vollkommen verstanden und verlangt weitere Untersuchungen. Was aber definitiv gesagt werden kann ist, dass das Drehen der GEMs um 90° die Reproduzierbarkeit der Messergebnisse sicherstellt.
Die unterschiedlichen Elektronenextraktionseffizienzen der verschiedenen GEM-Typen sind noch unverstanden. Auch wenn die grundsätzliche Zunahme der Extraktion mit zunehmenden Transferfeld verständlich ist, so bleibt vor allem das Verhalten einer LP-GEM in diesem Kontext bis jetzt unerklärlich.
Die Versuche mit einer MP-GEM an erster Stelle einer vierlagigen Verstärkungsstruktur haben sich als keine Verbesserung im Vergleich zu den S-Konfigurationen herausgestellt. Auch wenn manche gefundenen Einstellungen die Kriterien von einem IBF von weniger als 1 % und einem σ(55Fe) von weniger als 12 % gleichzeitig erfüllen, liegen diese Messpunkte so knapp an den definierten Grenzen, dass sie nicht für den Betrieb in der Spurendriftkammer von ALICE geeignet sind. Eine Erkenntnis, die trotzdem gewonnen werden konnte, ist, dass sich das Verhalten von verschiedenen Konfigurationen verstehen lässt. So ist die beste untersuchte Konfiguration die MP-LP-LP-S-Konfiguration gewesen, danach folgte die MP-S-LP-S und als schlechteste hat die MP-S-LP-SP-Konfiguration abgeschnitten. Dies ist genau die gleiche Reihenfolge, wie sie auch bei den S-Konfigurationen auftritt: S-LP-LP-S, dann S-S-LP-S und danach S-S-LP-SP. Ein wichtiger Schritt in einem guten Kompromiss zwischen Ionenrückfluss und σ(55Fe), scheinen zwei LP-GEMs an zweiter und dritter Stelle zu sein und weniger der Lochabstand der letzten GEM.
Die Druckabhängigkeit der Gasverstärkung hat einen großen Einfluss auf die Verstärkung und damit auf die Reproduzierbarkeit von Messungen. Bei einem Höhenunterschied von ca. 400 m ergibt sich eine Änderung der Verstärkung von ca. 35 %. Zusätzlich wird dieser Effekt von lokalen Wetterbedingungen überlagert. Der Einfluss des Luftdruckes kann jedoch mit dem Fit in Abbildung 43 berücksichtigt und damit herausgerechnet werden
During RUN3 (2021-2023) of the Large Hadron Collider, the Time Projection Chamber (TPC) of ALICE will be operated with quadruple stacks of Gas Electron Multipliers (GEMs). This technology will allow to overcome the rate limitation due to the gated operation of the Multi-Wire Proportional Chambers (MWPCs) used in RUN1 (2009-2013) and RUN2 (2015-2018).
As part of the Upgrade project, long-term irradiation tests, so called "ageing tests", have been carried out. A test setup with a detector using a quadruple stack of 10x10cm2 GEMs was built and operated in Ar-CO2 and Ne-CO2-N2 gas mixtures. The detector performance such as gas gain and energy resolution were monitored continuously. In addition, outgassing tests of materials used for the assembly process of the upgraded TPC were performed. To reach the expected dose of the GEM-based TPC, the detector was operated at much higher gains than the TPC. It was found, that the GEMs could keep their performance within the projected lifetime of the TPC. Most of the tested materials showed no negative impact on the detector. For the tested epoxy adhesive no certain conclusion could be drawn.
At much higher doses than expected for the upgraded TPC, a new phenomenon was observed, which changed the hole geometry of the GEMs and led to a degradation of the energy resolution. Even though its occurrence is not expected during the lifetime of the GEM-based TPC, simulations were carried out to study this effect more systematically. The simulations confirmed, that a change of the hole geometries of the GEMs, lead to an increase of the local gain variation, which results in a decrease of the energy resolution.
Furthermore the effect of methane as quench gas on GEMs was studied, even though this gas is not foreseen to be used in the TPC. From ageing tests with single-wire proportional counters it is well known that hydrocarbons are produced in the plasma of the avalanches, which cover the electrodes and lead to a degradation of the detector performance. Even though GEMs have a quite different geometry, the ageing tests showed, that also this technology tends to methane-induced ageing. A loss of gas gain as well as a degradation of the energy resolution due to deposits on the electrodes was monitored. A qualitative and quantitative comparison between ageing in GEMs and proportional counters was performed.
Background and objectives: Preoperative anaemia is an independent risk factor for a higher morbidity and mortality, a longer hospitalization and increased perioperative transfusion rates. Managing preoperative anaemia is the first of three pillars of Patient Blood Management (PBM), a multidisciplinary concept to improve patient safety. While various studies provide medical information on (successful) anaemia treatment pathways, knowledge of organizational details of diagnosis and management of preoperative anaemia across Europe is scarce.
Materials and methods: To gain information on various aspects of preoperative anaemia management including organization, financing, diagnostics and treatment, we conducted a survey (74 questions) in ten hospitals from seven European nations within the PaBloE (Patient Blood Management in Europe) working group covering the year 2016.
Results: Organization and activity in the field of preoperative anaemia management were heterogeneous in the participating hospitals. Almost all hospitals had pathways for managing preoperative anaemia in place, however, only two nations had national guidelines. In six of the ten participating hospitals, preoperative anaemia management was organized by anaesthetists. Diagnostics and treatment focused on iron deficiency anaemia which, in most hospitals, was corrected with intravenous iron.
Conclusion: Implementation and approaches of preoperative anaemia management vary across Europe with a primary focus on treating iron deficiency anaemia. Findings of this survey motivated the hospitals involved to critically evaluate their practice and may also help other hospitals interested in PBM to develop action plans for diagnosis and management of preoperative anaemia.
Background Enhanced activity of histone deacetylases (HDAC) is associated with more aggressive tumour behaviour and tumour progression in various solid tumours. The over-expression of these proteins and their known functions in malignant neoplasms has led to the development of HDAC inhibitors (HDI) as new anti-neoplastic drugs. However, little is known about HDAC expression in renal cell cancer. Methods We investigated the expression of HDAC 1, 2 and 3 in 106 renal cell carcinomas and corresponding normal renal tissue by immunohistochemistry on tissue micro arrays and correlated expression data with clinico-pathological parameters including patient survival. Results Almost 60% of renal cell carcinomas expressed the HDAC isoforms 1 and 2. In contrast, HDAC 3 was only detected in 13% of all renal tumours, with particular low expression rates in the clear cell subtype. HDAC 3 was significantly higher expressed in pT1/2 tumours in comparison to pT3/4 tumours. Expression of class I HDAC isoforms correlated with each other and with the proliferative activity of the tumours. We found no prognostic value of the expression of any of the HDAC isoforms in this tumour entity. Conclusion Class I HDAC isoforms 1 and 2 are highly expressed in renal cell cancer, while HDAC 3 shows low, histology dependent expression rates. These unexpected differences in the expression patterns suggests alternative regulatory mechanisms of class I HDACs in renal cell cancer and should be taken into account when trials with isoform selective HDI are being planned. Whether HDAC expression in renal cancers is predictive of responsiveness for HDI will have to be tested in further studies.
CSF and serum biomarkers focusing on cerebral vasospasm and ischemia after subarachnoid hemorrhage
(2013)
Delayed cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) remain severe complications after subarachnoid hemorrhage (SAH). Although focal changes in cerebral metabolism indicating ischemia are detectable by microdialysis, routinely used biomarkers are missing. We therefore sought to evaluate a panel of possible global markers in serum and cerebrospinal fluid (CSF) of patients after SAH.
CSF and serum of SAH patients were analyzed retrospectively. In CSF, levels of inhibitory, excitatory, and structural amino acids were detected by high-performance liquid chromatography (HPLC). In serum, neuron-specific enolase (NSE) and S100B level were measured and examined in conjunction with CVS and DCI. CVS was detected by arteriography, and ischemic lesions were assessed by computed tomography (CT) scans.
All CSF amino acids were altered after SAH. CSF glutamate, glutamine, glycine, and histidine were significantly correlated with arteriographic CVS. CSF glutamate and serum S100B were significantly correlated with ischemic events after SAH; however, NSE did not correlate neither with ischemia nor with vasospasm. Glutamate, glutamine, glycine, and histidine might be used in CSF as markers for CVS. Glutamate also indicates ischemia. Serum S100B, but not NSE, is a suitable marker for ischemia. These results need to be validated in larger prospective cohorts.
Haematopoietic stem cells (HSCs) require the right composition of microRNAs (miR) for proper life-long balanced blood regeneration. Here we show a regulatory circuit that prevents excessive HSC self-renewal by upregulation of miR-193b upon self-renewal promoting thrombopoietin (TPO)-MPL-STAT5 signalling. In turn, miR-193b restricts cytokine signalling, by targeting the receptor tyrosine kinase c-KIT. We generated a miR-193b knockout mouse model to unravel the physiological function of miR-193b in haematopoiesis. MiR-193b−/− mice show a selective gradual enrichment of functional HSCs, which are fully competent in multilineage blood reconstitution upon transplantation. The absence of miR-193b causes an accelerated expansion of HSCs, without altering cell cycle or survival, but by decelerating differentiation. Conversely, ectopic miR-193b expression restricts long-term repopulating HSC expansion and blood reconstitution. MiR-193b-deficient haematopoietic stem and progenitor cells exhibit increased basal and cytokine-induced STAT5 and AKT signalling. This STAT5-induced microRNA provides a negative feedback for excessive signalling to restrict uncontrolled HSC expansion.
Purpose: The quality testing and approval procedure for most pharmaceutical products is a streamlined process with standardized procedures for the determination of critical quality attributes. However, the evaluation of semisolid dosage forms for topical drug delivery remains a challenging task. The work presented here highlights confocal Raman microscopy (CRM) as a valuable tool for the characterization of such products.
Methods: CRM, a laser-based method, combining chemically-selective analysis and high resolution imaging, is used for the evaluation of different commercially available topical acyclovir creams.
Results: We show that CRM enables the spatially resolved analysis of microstructural features of semisolid products and provides insights into drug distribution and polymorphic state as well as the composition and arrangement of excipients. Further, we explore how CRM can be used to monitor phase separation and to study skin penetration and the interaction with fresh and cryopreserved excised human skin tissue.
Conclusion: This study presents a comprehensive overview and illustration of how CRM can facilitate several types of key analyses of semisolid topical formulations and of their interaction with their biological target site, illustrating that CRM is a useful tool for research, development as well as for quality testing in the pharmaceutical industry.
Background and Aim: The main disadvantage of plastic stents is the high rate of stent occlusion. The usual replacement interval of biliary plastic stents is 3 months. This study aimed to investigate if a shorter interval of 6–8 weeks impacts the median premature exchange rate (mPER) in benign and malignant biliary strictures.
Methods: All cases with endoscopic retrograde cholangiopancreatography (ERCP) and plastic stent placement were retrospectively analyzed since establishing an elective replacement interval of every 6–8 weeks at our institution and mPER was determined.
Results: A total of 3979 ERCPs (1199 patients) were analyzed, including 1262 (31.7%) malignant and 2717 (68.3%) benign cases, respectively. The median stent patency (mSP) was 41 days (range 14–120) for scheduled stent exchanges, whereas it was 17 days (1–75) for prematurely exchanged stents. The mPER was significantly higher for malignant (28.1%, 35–50%) compared with benign strictures (15.2%, 10–28%), P < 0.0001, respectively. mSP was significantly shorter in cases with only one stent (34 days [1–87] vs 41 days [1–120]) and in cases with only a 7-Fr stent (28 days [2–79]) compared with a larger stent (34 days [1–87], P = 0.001). Correspondingly, mPER was significantly higher in cases with only one stent (23% vs 16.2%, P < 0.0001) and only a 7-Fr stent (31.3% vs 22.4%, P = 0.03).
Conclusion: A shorter replacement interval does not seem to lead to a clinically meaningful reduction of mPER in benign and malignant strictures. Large stents and multiple stenting should be favored as possible.
Background: In intensive care units (ICU) octogenarians become a routine patients group with aggravated therapeutic and diagnostic decision-making. Due to increased mortality and a reduced quality of life in this high-risk population, medical decision-making a fortiori requires an optimum of risk stratification. Recently, the VIP-1 trial prospectively observed that the clinical frailty scale (CFS) performed well in ICU patients in overall-survival and short-term outcome prediction. However, it is known that healthcare systems differ in the 21 countries contributing to the VIP-1 trial. Hence, our main focus was to investigate whether the CFS is usable for risk stratification in octogenarians admitted to diversified and high tech German ICUs.
Methods: This multicentre prospective cohort study analyses very old patients admitted to 20 German ICUs as a sub-analysis of the VIP-1 trial. Three hundred and eight patients of 80 years of age or older admitted consecutively to participating ICUs. CFS, cause of admission, APACHE II, SAPS II and SOFA scores, use of ICU resources and ICU- and 30-day mortality were recorded. Multivariate logistic regression analysis was used to identify factors associated with 30-day mortality.
Results: Patients had a median age of 84 [IQR 82–87] years and a mean CFS of 4.75 (± 1.6 standard-deviation) points. More than half of the patients (53.6%) were classified as frail (CFS ≥ 5). ICU-mortality was 17.3% and 30-day mortality was 31.2%. The cause of admission (planned vs. unplanned), (OR 5.74) and the CFS (OR 1.44 per point increase) were independent predictors of 30-day survival.
Conclusions: The CFS is an easy determinable valuable tool for prediction of 30-day ICU survival in octogenarians, thus, it may facilitate decision-making for intensive care givers in Germany.
Trial registration: The VIP-1 study was retrospectively registered on ClinicalTrials.gov (ID: NCT03134807) on May 1, 2017.