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Collective behavior has been observed in high-energy heavy-ion collisions for several decades. Collectivity is driven by the high particle multiplicities that are produced in these collisions. At the Large Hadron Collider (LHC), features of collectivity have also been seen in high-multiplicity proton-proton collisions that can attain particle multiplicities comparable to peripheral Pb-Pb collisions. One of the possible signatures of collective behavior is the decrease of femtoscopic radii extracted from pion and kaon pairs emitted from high-multiplicity collisions with increasing pair transverse momentum. This decrease can be described in terms of an approximate transverse mass scaling. In the present work, femtoscopic analyses are carried out by the ALICE collaboration on charged pion and kaon pairs produced in pp collisions at s√=13 TeV from the LHC to study possible collectivity in pp collisions. The event-shape analysis method based on transverse sphericity is used to select for spherical versus jet-like events, and the effects of this selection on the femtoscopic radii for both charged pion and kaon pairs are studied. This is the first time this selection method has been applied to charged kaon pairs. An approximate transverse-mass scaling of the radii is found in all multiplicity ranges studied when the difference in the Lorentz boost for pions and kaons is taken into account. This observation does not support the hypothesis of collective expansion of hot and dense matter that should only occur in high-multiplicity events. A possible alternate explanation of the present results is based on a scenario of common emission conditions for pions and kaons in pp collisions for the multiplicity ranges studied.
Studying strangeness and baryon production mechanisms through angular correlations between charged
(2023)
The angular correlations between charged Ξ baryons and associated identified hadrons (pions, kaons, protons, Λ baryons, and Ξ baryons) are measured in pp collisions at s√=13 TeV with the ALICE detector to give insight into the particle production mechanisms and balancing of quantum numbers on the microscopic level. In particular, the distribution of strangeness is investigated in the correlations between the doubly-strange Ξ baryon and mesons and baryons that contain a single strange quark, K and Λ. As a reference, the results are compared to Ξπ and Ξp correlations, where the associated mesons and baryons do not contain a strange valence quark. These measurements are expected to be sensitive to whether strangeness is produced through string breaking or in a thermal production scenario. Furthermore, the multiplicity dependence of the correlation functions is measured to look for the turn-on of additional particle production mechanisms with event activity. The results are compared to predictions from the string-breaking model PYTHIA 8, including tunes with baryon junctions and rope hadronisation enabled, the cluster hadronisation ly or qualitatively by the Monte Carlo models, no one model can match all features of the data. These results provide stringent constraints on the strangeness and baryon number production mechanisms in pp collisions.
The Chiral Magnetic Wave (CMW) phenomenon is essential to provide insights into the strong interaction in QCD, the properties of the quark-gluon plasma, and the topological characteristics of the early universe, offering a deeper understanding of fundamental physics in high-energy collisions. Measurements of the charge-dependent anisotropic flow coefficients are studied in Pb-Pb collisions at center-of-mass energy per nucleon-nucleon collision sNN−−−√= 5.02 TeV to probe the CMW. In particular, the slope of the normalized difference in elliptic (v2) and triangular (v3) flow coefficients of positively and negatively charged particles as a function of their event-wise normalized number difference, is reported for inclusive and identified particles. The slope rNorm3 is found to be larger than zero and to have a magnitude similar to rNorm2, thus pointing to a large background contribution for these measurements. Furthermore, rNorm2 can be described by a blast wave model calculation that incorporates local charge conservation. In addition, using the event shape engineering technique yields a fraction of CMW (fCMW) contribution to this measurement which is compatible with zero. This measurement provides the very first upper limit for fCMW, and in the 10-60% centrality interval it is found to be 26% (38%) at 95% (99.7%) confidence level.
The first measurement of the e+e− pair production at midrapidity and low invariant mass in central Pb−Pb collisions at sNN−−−√=5.02 TeV at the LHC is presented. The yield of e+e− pairs is compared with a cocktail of expected hadronic decay contributions in the invariant mass (mee) and pair transverse momentum (pT,ee) ranges mee<3.5 GeV/c2 and pT,ee<8 GeV/c. For 0.18<mee<0.5 GeV/c2 the ratio of data to the cocktail of hadronic contributions without ρ mesons amounts to 1.42±0.12 (stat.)±0.17 (syst.)±0.12 (cocktail) and 1.44±0.12 (stat.)±0.17 (syst.)+0.17−0.21 (cocktail), including or not including medium effects in the estimation of the heavy-flavor background, respectively. It is consistent with predictions from two different models for an additional contribution of thermal e+e− pairs from the hadronic and partonic phases. In the intermediate-mass range (1.2<mee<2.6 GeV/c2), the pair transverse impact parameter of the e+e− pairs (DCAee) is used for the first time in Pb−Pb collisions to separate displaced dielectrons from heavy-flavor hadron decays from a possible (thermal) contribution produced at the interaction point. The data are consistent with a suppression of e+e− pairs from cc¯¯ and an additional prompt component. Finally, the first direct-photon measurement in the 10% most central Pb−Pb collisions at sNN−−−√=5.02 TeV is reported via the study of virtual direct photons in the transverse momentum range 1<pT<5 GeV/c. A model including prompt photons, as well as photons from the pre-equilibrium and fluid-dynamic phases, can reproduce the result, while being at the upper edge of the data uncertainties.
The ALICE Collaboration reports the measurement of semi-inclusive distributions of charged-particle jets recoiling from a high transverse momentum (high pT) hadron trigger in proton−proton and central Pb−Pb collisions at sNN−−−√=5.02 TeV. A data-driven statistical method is used to mitigate the large uncorrelated background in central Pb−Pb collisions. Recoil jet distributions are reported for jet resolution parameter R=0.2, 0.4, and 0.5 in the range 7<pT,jet<140 GeV/c and trigger−recoil jet azimuthal separation π/2<Δφ<π. The measurements exhibit a marked medium-induced jet yield enhancement at low pT and at large azimuthal deviation from Δφ∼π. The enhancement is characterized by its dependence on Δφ, which has a slope that differs from zero by 4.7σ. Comparisons to model calculations incorporating different formulations of jet quenching are reported. These comparisons indicate that the observed yield enhancement arises from the response of the QGP medium to jet propagation.
The ALICE Collaboration reports the measurement of semi-inclusive distributions of charged-particle jets recoiling from a high transverse momentum (high pT) hadron trigger in proton−proton and central Pb−Pb collisions at sNN−−−√=5.02 TeV. A data-driven statistical method is used to mitigate the large uncorrelated background in central Pb−Pb collisions. Recoil jet distributions are reported for jet resolution parameter R=0.2, 0.4, and 0.5 in the range 7<pT,jet<140 GeV/c and trigger−recoil jet azimuthal separation π/2<Δφ<π. The measurements exhibit a marked medium-induced jet yield enhancement at low pT and at large azimuthal deviation from Δφ∼π. The enhancement is characterized by its dependence on Δφ, which has a slope that differs from zero by 4.7σ. Comparisons to model calculations incorporating different formulations of jet quenching are reported. These comparisons indicate that the observed yield enhancement arises from the response of the QGP medium to jet propagation.
The ALICE Collaboration reports measurements of the semi-inclusive distribution of charged-particle jets recoiling from a high transverse momentum (high pT) charged hadron, in pp and central Pb−Pb collisions at center of mass energy per nucleon−nucleon collision sNN−−−√=5.02 TeV. The large uncorrelated background in central Pb−Pb collisions is corrected using a data-driven statistical approach, which enables precise measurement of recoil jet distributions over a broad range in pT,chjet and jet resolution parameter R. Recoil jet yields are reported for R=0.2, 0.4, and 0.5 in the range 7<pT,chjet<140 GeV/c and π/2<Δφ<π, where Δφ is the azimuthal angular separation between hadron trigger and recoil jet. The low pT,chjet reach of the measurement explores unique phase space for studying jet quenching, the interaction of jets with the quark-gluonnplasma generated in high-energy nuclear collisions. Comparison of pT,chjet distributions from pp and central Pb−Pb collisions probes medium-induced jet energy loss and intra-jet broadening, while comparison of their acoplanarity distributions explores in-medium jet scattering and medium response. The measurements are compared to theoretical calculations incorporating jet quenching.
The ALICE Collaboration reports measurements of the semi-inclusive distribution of charged-particle jets recoiling from a high transverse momentum (high pT) charged hadron, in pp and central Pb−Pb collisions at center of mass energy per nucleon−nucleon collision sNN−−−√=5.02 TeV. The large uncorrelated background in central Pb−Pb collisions is corrected using a data-driven statistical approach, which enables precise measurement of recoil jet distributions over a broad range in pT,chjet and jet resolution parameter R. Recoil jet yields are reported for R=0.2, 0.4, and 0.5 in the range 7<pT,chjet<140 GeV/c and π/2<Δφ<π, where Δφ is the azimuthal angular separation between hadron trigger and recoil jet. The low pT,chjet reach of the measurement explores unique phase space for studying jet quenching, the interaction of jets with the quark-gluonnplasma generated in high-energy nuclear collisions. Comparison of pT,chjet distributions from pp and central Pb−Pb collisions probes medium-induced jet energy loss and intra-jet broadening, while comparison of their acoplanarity distributions explores in-medium jet scattering and medium response. The measurements are compared to theoretical calculations incorporating jet quenching.
The first measurements of skewness and kurtosis of mean transverse momentum (⟨pT⟩) fluctuations are reported in Pb−Pb collisions at sNN−−−√ = 5.02 TeV, Xe−Xe collisions at sNN−−−√ = 5.44 TeV and pp collisions at s√=5.02 TeV using the ALICE detector. The measurements are carried out as a function of system size ⟨dNch/dη⟩1/3|η|<0.5, using charged particles with transverse momentum (pT) and pseudorapidity (η), in the range 0.2<pT<3.0 GeV/c and |η|<0.8, respectively. In Pb−Pb and Xe−Xe collisions, positive skewness is observed in the fluctuations of ⟨pT⟩ for all centralities, which is significantly larger than what would be expected in the scenario of independent particle emission. This positive skewness is considered a crucial consequence of the hydrodynamic evolution of the hot and dense nuclear matter created in heavy-ion collisions. Furthermore, similar observations of positive skewness for minimum bias pp collisions are also reported here. Kurtosis of ⟨pT⟩ fluctuations is found to be in good agreement with the kurtosis of Gaussian distribution, for most central Pb−Pb collisions. Hydrodynamic model calculations with MUSIC using Monte Carlo Glauber initial conditions are able to explain the measurements of both skewness and kurtosis qualitatively from semicentral to central collisions in Pb--Pb system. Color reconnection mechanism in PYTHIA8 model seems to play a pivotal role in capturing the qualitative behavior of the same measurements in pp collisions.
The ALICE Collaboration reports a search for jet quenching effects in high-multiplicity (HM) proton−proton collisions at s√ = 13 TeV, using the semi-inclusive azimuthal-difference distribution Δφ of charged-particle jets recoiling from a high transverse momentum (high-pT,trig) trigger hadron. Jet quenching may broaden the Δφ distribution measured in HM events compared to that in minimum bias (MB) events. The measurement employs a pT,trig-differential observable for data-driven suppression of the contribution of multiple partonic interactions, which is the dominant background. While azimuthal broadening is indeed observed in HM compared to MB events, similar broadening for HM events is observed for simulations based on the PYTHIA 8 Monte Carlo generator, which does not incorporate jet quenching. We elucidate the origin of the broadening by comparing biases induced by HM selection in the data and simulations, and discuss its implications for the study of jet quenching in small collision systems.
The first measurements of K∗(892)0 resonance production as a function of charged-particle multiplicity in Xe−Xe collisions at sNN−−−√= 5.44 TeV and pp collisions at s√= 5.02 TeV using the ALICE detector are presented. The resonance is reconstructed at midrapidity (|y|<0.5) using the hadronic decay channel K∗0→K±π∓. Measurements of transverse-momentum integrated yield, mean transverse-momentum, nuclear modification factor of K∗0, and yield ratios of resonance to stable hadron (K∗0/K) are compared across different collision systems (pp, p−Pb, Xe−Xe, and Pb−Pb) at similar collision energies to investigate how the production of K∗0 resonances depends on the size of the system formed in these collisions. The hadronic rescattering effect is found to be independent of the size of colliding systems and mainly driven by the produced charged-particle multiplicity, which is a proxy of the volume of produced matter at the chemical freeze-out. In addition, the production yields of K∗0 in Xe−Xe collisions are utilized to constrain the dependence of the kinetic freeze-out temperature on the system size using HRG-PCE model.
Long- and short-range correlations for pairs of charged particles are studied via two-particle angular correlations in pp collisions at s√=13 TeV and p−Pb collisions at sNN−−−√=5.02 TeV. The correlation functions are measured as a function of relative azimuthal angle Δφ and pseudorapidity separation Δη for pairs of primary charged particles within the pseudorapidity interval |η|<0.9 and the transverse-momentum interval 1<pT<4 GeV/c. Flow coefficients are extracted for the long-range correlations (1.6<|Δη|<1.8) in various high-multiplicity event classes using the low-multiplicity template fit method. The method is used to subtract the enhanced yield of away-side jet fragments in high-multiplicity events. These results show decreasing flow signals toward lower multiplicity events. Furthermore, the flow coefficients for events with hard probes, such as jets or leading particles, do not exhibit any significant changes compared to those obtained from high-multiplicity events without any specific event selection criteria. The results are compared with hydrodynamic-model calculations, and it is found that a better understanding of the initial conditions is necessary to describe the results, particularly for low-multiplicity events.
Modification of charged-particle jets in event-shape engineered Pb–Pb collisions at √sNN = 5.02 TeV
(2023)
Charged-particle jet yields have been measured in semicentral Pb−Pb collisions at center-of-mass energy per nucleon-nucleon collision sNN−−−√=5 TeV with the ALICE detector at the LHC. These yields are reported as a function of the jet transverse momentum, and further classified by their angle with respect to the event plane and the event shape, characterized by ellipticity, in an effort to study the path-length dependence of jet quenching. Jets were reconstructed at midrapidity from charged-particle tracks using the anti-kT algorithm with resolution parameters R= 0.2 and 0.4, with event-plane angle and event-shape values determined using information from forward scintillating detectors. The results presented in this letter show that, in semicentral Pb−Pb collisions, there is no significant difference between jet yields in predominantly isotropic and elliptical events. However, out-of-plane jets are observed to be more suppressed than in-plane jets. Further, this relative suppression is greater for low transverse momentum (< 50 GeV/c) R= 0.2 jets produced in elliptical events, with out-of-plane to in-plane jet-yield ratios varying up to 5.2σ between different event-shape classes. These results agree with previous studies indicating that jets experience azimuthally anisotropic suppression when traversing the QGP medium, and can provide additional constraints on the path-length dependence of jet energy loss.
Results on the transverse spherocity dependence of light-flavor particle production (π, K, p, ϕ, K∗0, K0S, Λ, Ξ) at midrapidity in high-multiplicity pp collisions at s√=13 TeV were obtained with the ALICE apparatus. The transverse spherocity estimator (SpT=1O) categorizes events by their azimuthal topology. Utilizing narrow selections on SpT=1O, it is possible to contrast particle production in collisions dominated by many soft initial interactions with that observed in collisions dominated by one or more hard scatterings. Results are reported for two multiplicity estimators covering different pseudorapidity regions. The SpT=1O estimator is found to effectively constrain the hardness of the events when the midrapidity (|η|<0.8) estimator is used. The production rates of strange particles are found to be slightly higher for soft isotropic topologies, and severely suppressed in hard jet-like topologies. These effects are more pronounced for hadrons with larger mass and strangeness content, and observed when the topological selection is done within a narrow multiplicity interval. This demonstrates that an important aspect of the universal scaling of strangeness enhancement with final-state multiplicity is that high-multiplicity collisions are dominated by soft, isotropic processes. On the contrary, strangeness production in events with jet-like processes is significantly reduced. The results presented in this article are compared with several QCD-inspired Monte Carlo event generators. Models that incorporate a two-component phenomenology, either through mechanisms accounting for string density, or thermal production, are able to describe the observed strangeness enhancement as a function of SpT=1O.
Long- and short-range correlations for pairs of charged particles are studied via two-particle angular correlations in pp collisions at s√=13 TeV and p−Pb collisions at sNN−−−√=5.02 TeV. The correlation functions are measured as a function of relative azimuthal angle Δφ and pseudorapidity separation Δη for pairs of primary charged particles within the pseudorapidity interval |η|<0.9 and the transverse-momentum interval 1<pT<4 GeV/c. Flow coefficients are extracted for the long-range correlations (1.6<|Δη|<1.8) in various high-multiplicity event classes using the low-multiplicity template fit method. The method is used to subtract the enhanced yield of away-side jet fragments in high-multiplicity events. These results show decreasing flow signals toward lower multiplicity events. Furthermore, the flow coefficients for events with hard probes, such as jets or leading particles, do not exhibit any significant changes compared to those obtained from high-multiplicity events without any specific event selection criteria. The results are compared with hydrodynamic-model calculations, and it is found that a better understanding of the initial conditions is necessary to describe the results, particularly for low-multiplicity events.
Long- and short-range correlations for pairs of charged particles are studied via two-particle angular correlations in pp collisions at √sNN = 13 TeV and p–Pb collisions at √s = 5.02 TeV. The correlation functions are measured as a function of relative azimuthal angle ∆φ and pseudorapidity separation ∆η for pairs of primary charged particles within the pseudorapidity interval |η| < 0.9 and the transverse-momentum interval 1 < pT < 4 GeV/c. Flow coefficients are extracted for the long-range correlations (1.6 < |∆η| < 1.8) in various high-multiplicity event classes using the low-multiplicity template fit method. The method is used to subtract the enhanced yield of away-side jet fragments in high-multiplicity events. These results show decreasing flow signals toward lower multiplicity events. Furthermore, the flow coefficients for events with hard probes, such as jets or leading particles, do not exhibit any significant changes compared to those obtained from high-multiplicity events without any specific event selection criteria. The results are compared with hydrodynamic-model calculations, and it is found that a better understanding of the initial conditions is necessary to describe the results, particularly for low-multiplicity events.
HLA-DRB1 and HLA-DQB1 genetic diversity modulates response to lithium in bipolar affective disorders
(2021)
Bipolar affective disorder (BD) is a severe psychiatric illness, for which lithium (Li) is the gold standard for acute and maintenance therapies. The therapeutic response to Li in BD is heterogeneous and reliable biomarkers allowing patients stratification are still needed. A GWAS performed by the International Consortium on Lithium Genetics (ConLiGen) has recently identified genetic markers associated with treatment responses to Li in the human leukocyte antigens (HLA) region. To better understand the molecular mechanisms underlying this association, we have genetically imputed the classical alleles of the HLA region in the European patients of the ConLiGen cohort. We found our best signal for amino-acid variants belonging to the HLA-DRB1*11:01 classical allele, associated with a better response to Li (p < 1 × 10−3; FDR < 0.09 in the recessive model). Alanine or Leucine at position 74 of the HLA-DRB1 heavy chain was associated with a good response while Arginine or Glutamic acid with a poor response. As these variants have been implicated in common inflammatory/autoimmune processes, our findings strongly suggest that HLA-mediated low inflammatory background may contribute to the efficient response to Li in BD patients, while an inflammatory status overriding Li anti-inflammatory properties would favor a weak response.
Bipolar disorder (BD) is a genetically complex mental illness characterized by severe oscillations of mood and behavior. Genome-wide association studies (GWAS) have identified several risk loci that together account for a small portion of the heritability. To identify additional risk loci, we performed a two-stage meta-analysis of >9 million genetic variants in 9,784 bipolar disorder patients and 30,471 controls, the largest GWAS of BD to date. In this study, to increase power we used ~2,000 lithium-treated cases with a long-term diagnosis of BD from the Consortium on Lithium Genetics, excess controls, and analytic methods optimized for markers on the Xchromosome. In addition to four known loci, results revealed genome-wide significant associations at two novel loci: an intergenic region on 9p21.3 (rs12553324, p = 5.87×10-9; odds ratio = 1.12) and markers within ERBB2 (rs2517959, p = 4.53×10-9; odds ratio = 1.13). No significant X-chromosome associations were detected and X-linked markers explained very little BD heritability. The results add to a growing list of common autosomal variants involved in BD and illustrate the power of comparing well-characterized cases to an excess of controls in GWAS.
Purpose: Molecular diagnostics including next generation gene sequencing are increasingly used to determine options for individualized therapies in brain tumor patients. We aimed to evaluate the decision-making process of molecular targeted therapies and analyze data on tolerability as well as signals for efficacy.
Methods: Via retrospective analysis, we identified primary brain tumor patients who were treated off-label with a targeted therapy at the University Hospital Frankfurt, Goethe University. We analyzed which types of molecular alterations were utilized to guide molecular off-label therapies and the diagnostic procedures for their assessment during the period from 2008 to 2021. Data on tolerability and outcomes were collected.
Results: 413 off-label therapies were identified with an increasing annual number for the interval after 2016. 37 interventions (9%) were targeted therapies based on molecular markers. Glioma and meningioma were the most frequent entities treated with molecular matched targeted therapies. Rare entities comprised e.g. medulloblastoma and papillary craniopharyngeoma. Molecular targeted approaches included checkpoint inhibitors, inhibitors of mTOR, FGFR, ALK, MET, ROS1, PIK3CA, CDK4/6, BRAF/MEK and PARP. Responses in the first follow-up MRI were partial response (13.5%), stable disease (29.7%) and progressive disease (46.0%). There were no new safety signals. Adverse events with fatal outcome (CTCAE grade 5) were not observed. Only, two patients discontinued treatment due to side effects. Median progression-free and overall survival were 9.1/18 months in patients with at least stable disease, and 1.8/3.6 months in those with progressive disease at the first follow-up MRI.
Conclusion: A broad range of actionable alterations was targeted with available molecular therapeutics.
However, efficacy was largely observed in entities with paradigmatic oncogenic drivers, in particular with BRAF mutations. Further research on biomarker-informed molecular matched therapies is urgently necessary.
Der Beitritt zur Europäischen Union (EU) war seit Beginn der Transformation in Osteuropa eines der wichtigsten politischen Ziele der neu gewählten Regierungen. Im Mittelpunkt der öffentlichen Diskussion stand dabei weniger die Frage nach möglichen nationalen Opfern einer schnellen EU-Integration, sondern der Wunsch, die nach dem zweiten Weltkrieg erfolgte Teilung Europas endgültig zu überwinden. Nach über zehn Jahren Transformation und Privatisierung ist jedoch vielerorts Ernüchterung eingekehrt. Die politische Debatte um die EU-Integration der osteuropäischen Beitrittskandidaten wird zunehmend von den Kandidaten selbst kritisch geführt, und die Frage nach den nationalen Lasten eines EU-Beitritts gewinnt an Bedeutung. Je näher der Beitritt der osteuropäischen Staaten zur EU rückt, desto nachdrücklicher wird dort gefragt, ob die Mitgliedschaft in der Union ein Gewinn sein wird. Die Beitrittskandidaten befürchten u.a., dass die eigene Wirtschaft und ganze Berufsgruppen, wie z.B. die Bauern, dem EU-Wettbewerbsdruck nicht standhalten werden können. Auf der anderen Seite bremsen eigennützige Ansprüche der Altmitglieder die Osterweiterung der EU. Noch ist bei anstehenden Abstimmungen in den mittel- und osteuropäischen Ländern (MOEL) über den Beitritt überall eine Mehrheit dafür zu erwarten, doch die Euroskepsis wächst und die Europa-Kritiker gewinnen an politischem Einfluss. Die vorliegende Arbeit soll einen Beitrag zur Versachlichung der EU-Erweiterungsdiskussion leisten und die Zusammenhänge zwischen dem Transformationsprozess der MOEL und deren EU-Integration verdeutlichen. Eine sachliche Diskussion kann nur dann geführt werden, wenn dabei die Besonderheiten, die Gemeinsamkeiten und die Interdependenzen von Transformations- und Integrationsprozess berücksichtigt werden. Wir gehen dazu wie folgt vor. Zunächst beschreiben wir en Transformationsprozess aus ökonomischer Sicht (2.). Neben den wirtschaftlichen und sozialen Folgen der Transformation, soll die historische Pfadabhängigkeit verschiedener Transformationsergebnisse gezeigt und deren Bedeutung für die EU-Integrationsfähigkeit der MOEL diskutiert werden. Im Anschluss daran erläutern wir die Voraussetzungen einer EU-Osterweiterung aus Sicht der Beitrittskandidaten (Beitrittskriterien von Kopenhagen) und aus Sicht der Europäischen Union. Wir zeigen die aus einem Integrationsprozess resultierenden wirtschaftlichen, sozialen und politischen Folgen für Neu- und Altmitglieder auf und stellen den aktuellen Stand der EU-Beitrittsverhandlungen vor (3.). Die Arbeit endet mit der Darstellung alternativer Entwicklungen und einem Fazit (4.).
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.
Transfusion of red blood cells (RBC) in patients undergoing major elective cranial surgery is associated with increased morbidity, mortality and prolonged hospital length of stay (LOS). This retrospective single center study aims to identify the clinical outcome of RBC transfusions on skull base and non-skull base meningioma patients including the identification of risk factors for RBC transfusion. Between October 2009 and October 2016, 423 patients underwent primary meningioma resection. Of these, 68 (16.1%) received RBC transfusion and 355 (83.9%) did not receive RBC units. Preoperative anaemia rate was significantly higher in transfused patients (17.7%) compared to patients without RBC transfusion (6.2%; p = 0.0015). In transfused patients, postoperative complications as well as hospital LOS was significantly higher (p < 0.0001) compared to non-transfused patients. After multivariate analyses, risk factors for RBC transfusion were preoperative American Society of Anaesthesiologists (ASA) physical status score (p = 0.0247), tumor size (p = 0.0006), surgical time (p = 0.0018) and intraoperative blood loss (p < 0.0001). Kaplan-Meier curves revealed significant influence on overall survival by preoperative anaemia, RBC transfusion, smoking, cardiovascular disease, preoperative KPS ≤ 60% and age (elderly ≥ 75 years). We concluded that blood loss due to large tumors or localization near large vessels are the main triggers for RBC transfusion in meningioma patients paired with a potential preselection that masks the effect of preoperative anaemia in multivariate analysis. Further studies evaluating the impact of preoperative anaemia management for reduction of RBC transfusion are needed to improve the clinical outcome of meningioma patients.
Background: The elderly population deals with multimorbidity (three chronic conditions) and increasinged drug use with age. A comprehensive characterisation of the medication – including prescription and over-the-counter (OTC) drugs – of elderly patients in primary care is still insufficient.
Objectives: This study aims to characterise the medication (prescription and OTC) of multimorbid elderly patients in primary care and living at home by identifying drug patterns to evaluate the relationship between drugs and drug groups and reveal associations with recently published multimorbidity clusters of the same cohort.
Methods: MultiCare was a multicentre, prospective, observational cohort study of 3189 multimorbid patients aged 65 to 85 years in primary care in Germany. Patients and general practitioners were interviewed between 2008 and 2009. Drug patterns were identified using exploratory factor analysis. The relations between the drug patterns with the three multimorbidity clusters were analysed with Spearman-Rank-Correlation.
Results: Patients (59.3% female) used in mean 7.7 drugs; in total 24,535 drugs (23.7% OTC) were detected. Five drug patterns for men (drugs for obstructive pulmonary diseases (D-OPD), drugs for coronary heart diseases and hypertension (D-CHD), drugs for osteoporosis (D-Osteo), drugs for heart failure and drugs for pain) and four drug patterns for women (D-Osteo, D-CHD, D-OPD and drugs for diuretics and gout) were detected. Significant associations between multimorbidity clusters and drug patterns were detectable (D-CHD and CMD: male: ρ = 0.376, CI 0.322–0.430; female: ρ = 0.301, CI 0.624–0.340).
Conclusion: The drug patterns demonstrate non-random relations in drug use in multimorbid elderly patients and systematic associations between drug patterns and multimorbidity clusters were found in primary care.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) offers potential cure to acute myeloid leukemia (AML) patients. However, infections with commensal bacteria are an important cause for non-relapse mortality (NRM). We have previously described the impact of multidrug-resistant organism (MDRO) colonization on the survival of allo-HSCT patients. In the aforementioned publication, according to consensus, we there did not consider the opportunistic gram-negative bacterium Stenotrophomonas maltophilia (S. maltophilia) to be an MDRO. Since rate of S. maltophilia colonization is increasing, and it is not known whether this poses a risk for allo-HSCT patients, we here analyzed here its effect on the previously described and now extended patient cohort. We report on 291 AML patients undergoing allo-HSCT. Twenty of 291 patients (6.9%) were colonized with S. maltophilia. Colonized patients did not differ from non-colonized patients with respect to their age, remission status before allo-HSCT, donor type and HSCT-comorbidity index. S. maltophilia colonized patients had a worse overall survival (OS) from 6 months up to 60 months (85% vs. 88.1% and 24.7% vs. 59.7%; p = 0.007) due to a higher NRM after allo-HSCT (6 months: 15% vs. 4.8% and 60 months: 40.1% vs. 16.2% p = 0.003). The main cause of mortality in colonized patients was infection (46.2% of all deaths) and in non-colonized patients relapse (58.8% of all deaths). 5/20 colonized patients developed an invasive infection with S. maltophilia. The worse OS after allo-HSCT due to higher infection related mortality might implicate the screening of allo-HSCT patients for S. maltophilia and a closer observation of colonized patients as outpatients.
Age-related diseases, such as osteoarthritis, Alzheimer’s disease, diabetes, and cardiovascular disease, are often associated with chronic unresolved inflammation. Neutrophils play central roles in this process by releasing tissue-degenerative proteases, such as cathepsin G, as well as pro-inflammatory leukotrienes produced by the 5-lipoxygenase (5-LO) pathway. Boswellic acids (BAs) are pentacyclic triterpene acids contained in the gum resin of the anti-inflammatory remedy frankincense that target cathepsin G and 5-LO in neutrophils, and might thus represent suitable leads for intervention with age-associated diseases that have a chronic inflammatory component. Here, we investigated whether, in addition to BAs, other triterpene acids from frankincense interfere with 5-LO and cathepsin G. We provide a comprehensive analysis of 17 natural tetra- or pentacyclic triterpene acids for suppression of 5-LO product synthesis in human neutrophils. These triterpene acids were also investigated for their direct interference with 5-LO and cathepsin G in cell-free assays. Furthermore, our studies were expanded to 10 semi-synthetic BA derivatives. Our data reveal that besides BAs, several tetra- and pentacyclic triterpene acids are effective or even superior inhibitors of 5-LO product formation in human neutrophils, and in parallel, inhibit cathepsin G. Their beneficial target profile may qualify triterpene acids as anti-inflammatory natural products and pharmacological leads for intervention with diseases related to aging.
The mechanism by which the enzyme pyruvate decarboxylase from yeast is activated allosterically has been elucidated. A total of seven three-dimensional structures of the enzyme, of enzyme variants or of enzyme complexes from two yeast species (three of them reported here for the first time) provide detailed atomic resolution snapshots along the activation coordinate. The prime event is the covalent binding of the substrate pyruvate to the side chain of cysteine 221, thus forming a thiohemiketal. This reaction causes the shift of a neighbouring amino acid, which eventually leads to the rigidification of two otherwise flexible loops, where one of the loops provides two histidine residues necessary to complete the enzymatically competent active site architecture. The structural data are complemented and supported by kinetic investigations and binding studies and provide a consistent picture of the structural changes, which occur upon enzyme activation.
Purpose: Filler injections for aesthetic purposes are very popular, but can have far-reaching and irreversible consequences. This report describes the course of a patient with devastating complications after glabellar hyaluronic acid injection, their pathomechanism, management and outcome.
Observations: A healthy, 43-year-old woman underwent her first hyaluronic acid injection in the glabella and went blind on her left eye immediately thereafter. Massaging of the injection area and observation were performed, before she presented with swelling of the left forehead and upper lid, ptosis, complete ophthalmoplegia and blindness in our hospital. Immediate massaging of the globe and systemic therapy including acetylsalicylic acid, tinzaparin sodium and cortisone was initiated and hyaluronidase injections in the injection area were performed. In the further course, the patient developed necrotic and hemorrhagic skin and mucosal lesions, lagophthalmos, anterior and posterior segment ischemia and globe hypotonia with consecutive globe deformation. In the follow-up of 2.5 months, lid swelling, lagophthalmos and ptosis resolved and keratopathy improved but blindness, skin lesions and strabismus with reduced eye motility were still present and madarosis and early enophthalmos were detected.
Conclusions and Importance: The outcome of ophthalmic artery occlusion after hyaluronic acid filler injection is poor. Sufficient knowledge about facial anatomy, the implementation of filler injections and the management of complications is essential for the practitioner. The patient should be clarified about potential and even rare risks of these procedures.
Objective: The aim of the study was to analyse the psychometric properties of the EQ-5D in patients with social phobia.
Methods: We used a sample of 445 patients with social phobia with five measurement points over a 30 month period. The discriminative ability of the EQ-5D was analysed by comparing the patients' responses with the general population and between different disease severity levels. For test-retest reliability we assessed the level of agreement in patients' responses over time, when there was no change in the Liebowitz Social Anxiety Scale (LSAS). Construct validity was analysed by identifying correlations of the EQ-5D with more specific instruments. For responsiveness we compared the means of EQ VAS/EQ-5D index anchored on improved (deteriorated) health status and computed effect sizes as well as a receiver operating characteristic (ROC) curve.
Results: Compared to the general population, patients with social phobia reported more problems in the dimensions "usual activities", "pain/discomfort", and "anxiety/depression" and less problems in "mobility" and "self-care". The EQ-5D was able to distinguish between different disease severity levels. The test-retest reliability was moderate (intraclass correlation coefficient > 0.6). Correlations between the EQ-5D and other instruments were mostly small except for correlations with Beck Depression Inventory. The EQ-5D index seemed to be more responsive than the EQ VAS, but with only medium effect sizes (0.5 < effect size < 0.8) in the British EQ-5D index and only significant in patients with improved health status. The ROC analysis revealed no significant results.
Conclusions: The EQ-5D was moderately reliable and responsive in patients with improved health status. Construct validity was limited.
Trial registration: Current controlled trials ISRCTN53517394.
Background: Transfusion of red blood cells (RBC) in patients undergoing major elective cranial surgery is associated with increased morbidity, mortality and prolonged hospital length of stay (LOS). This retrospective single center study aims to identify the impact of RBC transfusions on skull-base and non-skull-base meningioma patients including the identification of risk factors for RBC transfusion.
Methods: From October 2009 - October 2016 we retrospectively analyzed 423 primary meningioma patients undergoing surgery for primary meningioma resection our department.
Results: Of these 423 patients, 68 (16.1%) received RBC transfusion and 355 (83.9%) did not receive RBC units. Preoperative anaemia rate was significantly higher in transfused patients (17.7%) compared to patients without RBC transfusion (6.2%; p = 0.0015). In transfused patients, postoperative complications as well as hospital LOS was significantly higher (p < 00001) compared to non-transfused patients. After multivariate analyses, risk factors for RBC transfusion were preoperative American Society of Anesthesiologists (ASA) physical status score (p = 0.0247), tumor size (p = 0.0006), surgical time (p = 0.0018) and intraoperative blood loss (p < 0.001). Kaplan-Meier curves revealed significant influence on overall survival by preoperative anaemia, RBC transfusion, smoking, cardiovascular disease, preoperative KPS ≤ 60% and age (elderly ≥ 75 years).
Conclusion: We concluded that blood loss due to large tumors or localization near large vessels are the main triggers for RBC transfusion in meningioma patients paired with a potential preselection that masks the effect of preoperative anaemia in multivariate analysis. Further studies evaluating the impact of preoperative anaemia management for reduction of RBC transfusion are needed to improve clinical outcomes of meningioma patients.
Background: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.
Methods: This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).
Results: The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.
Conclusions: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient’s assessment is associated not only with practice-level factors, but also with individual, patient-level factors.
Rezensionen [2019]
(2019)
Verzeichnis
Einzelrezensionen
163 Babenhauserheide, Melanie: Harry Potter und die Widersprüche der Kulturindustrie. Eine ideologiekritische Analyse (DAVID N. SCHMIDT)
165 Ballis, Anja/Pecher, Claudia Maria/ Schuler, Rebecca (Hrsg.): Mehrsprachige Kinder- und Jugendliteratur. Überlegungen zur Systematik, Didaktik und Verbreitung (SVETLANA VISHEK)
167 Bannasch, Bettina/Matthes, Eva (Hrsg.): Kinder- und Jugendliteratur. Historische, erzähl- und medientheoretische, pädagogische und therapeutische Perspektiven (susanne blumesberger)
169 Batzke, Ina/ Erbacher, Eric C. /Heß, Linda M. / Lenhardt, Corinna (Hrsg.): Exploring the Fantastic. Genre, Ideology, and Popular Culture (THOMAS BITTERLICH)
170 Bertling, Maria: All-Age-Literatur. Die Entdeckung einer neuen Zielgruppe und ihrer Rezeptionsmodalitäten (NICOLA KÖNIG)
172 Blümer, Agnes: Mehrdeutigkeit übersetzen. Englische und französische Kinderliteraturklassiker der Nachkriegszeit in deutscher Übertrag (MARTINA SEIFERT)
174 Blumesberger, Susanne/Thunecke, Jörg (Hrsg.): Deutschsprachige Kinder- und Jugendliteratur während der Zwischenkriegszeit und im Exil. Schwerpunkt Österreich (KURT FRANZ)
176 Busch, Nathanael /Velten, Hans Rudolf (Hrsg.): Die Literatur des Mittelalters im Fantasyroman (SONJA LOIDL)
178 Cave, Roderick/Ayad, Sara (Hrsg.): Die Geschichte des Kinderbuches in 100 Büchern (ERNST SEIBERT)
180 Dettmar, Ute/Pecher, Claudia Maria/Schlesinger, Ron (Hrsg.): Märchen im Medienwechsel. Zur Geschichte und Gegenwart des Märchenfilms (MICHAEL STIERSTORFER)
182 Dommermuth, Clarissa: Wir sind dagegen – denn ihr seid dafür. Zur Tradition literarischer Jugendbewegungen im deutschsprachigen Raum (SUSANNE BLUMESBERGER)
184 Ellerbach, Benoît: L’Arabie contée aux Allemands. Fictions interculturelles chez Rafik Schami (ANNETTE KLIEWER)
185 Enklaar, Jattie/ Ester, Hans /Tax, Evelyne (Hrsg.): Studien über Kinder- und Jugendliteratur im europäischen Austausch von 1800 bis heute (IRIS SCHÄFER)
187 Ewers, Hans-Heino: Michael Ende neu entdecken. Was »Jim Knopf«,»Momo« und »Die unendliche Geschichte« Erwachsenen zu sagen haben (MARKUS JANKA)
189 Flegel, Monica/Parkes, Christopher (Hrsg.): Cruel Children in Popular Texts and Cultures (LENA HOFFMANN)
191 Garbe, Christine/Gürth, Christina et al. (Hrsg.): Attraktive Lesestoffe (nicht nur) für Jungen. Erzählmuster und Beispielanalysen zu populärer Kinder- und Jugendliteratur (THOMAS BITTERLICH)
193 Goga, Nina/Kümmerling-Meibauer, Bettina (Hrsg.): Maps and Mapping in Children’s Literature. Landscapes, Seascapes, and Cityscapes (Wolfgang Biesterfeld)
195 Hamer, Naomi /Nodelman, Perry / Reimer, Mavis (Hrsg.): More Words about Pictures. Current Research on Picturebooks and Visual/Verbal Texts for Young People (FARRIBA SCHULZ)
196 Hoffmann, Lena: Crossover. Mehrfachadressierung in Text, Markt und Diskurs (HEIDI LEXE)
198 Josting, Petra/Reuter, Frank/Roeder, Caroline/Wolters, Ute (Hrsg.): »Denn sie rauben sehr geschwind jedes böse Gassenkind.« ›Zigeuner‹-Bilder in Kinder- und Jugendmedien (KURT FRANZ)
200 Langemeyer, Peter /Knutsen, Karen Patrick (Hrsg.): Narratology Plus. Studies in Recent International Narratives for Children and
Young Adults / Narratologie Plus. Studien zur Erzählweise in aktueller internationaler Kinder- und Jugendliteratur (NADINE BIEKER)
202 Museumsinsel Lüttenheid (Hrsg.): Rudolf Dirks. Zwei Lausbuben und die Erfindung des modernen Comics (LUKAS SARVARI)
204 Oeste, Bettina/Preußer, Ulrike (Hrsg.): Neuvermessung deutschsprachiger Erinnerungsstrategien in der Kinder- und Jugendliteratur nach 1990 (annette kliewer)
206 Planka, Sabine (Hrsg.): Berlin. Bilder einer Metropole in erzählenden Medien für Kinder und Jugendliche (KATHARINA EGERER)
208 Press, Alexander: Die Bilder des Comics. Funktionsweisen aus kunst- und bildwissenschaftlicher Perspektive (RALF VOLLBRECHT)
209 Schenk, Klaus /Zeisberg, Ingold (Hrsg.): Fremde Räume. Interkulturalität und Semiotik des Phantastischen (ANNETTE KLIEWER)
211 Schweizerisches Institut für Kinder- und Jugendmedien SIKJM (Hrsg.): Atlas der Schweizer Kinderliteratur. Expeditionen und
Panoramen (SUSANNE RIEGLER)
Sammelrezensionen
213 Heinemann, Caroline: Produktionsräume im zeitgenössischen Kinder- und Jugendtheater. – Hentschel, Ingrid: Theater zwischen Ich und Welt. Beiträge zur Ästhetik des Kinder- und Jugendtheaters. Theorien – Praxis – Geschichte (PHILIPP SCHMERHEIM)
215 Janka, Marcus /Stierstorfer, Michael (Hrsg.): Verjüngte Antike. Griechisch-römische Mythologie in zeitgenössischen Kinder- und Jugendmedien. – Stierstorfer, Michael: Antike Mythologie in der Kinder- und Jugendliteratur der Gegenwart. Unsterbliche Götter- und Heldengeschichten? (KARINA BECKER)
218 Josting, Petra/Kruse, Iris (Hrsg.): Paul Maar. Bielefelder Poet in Residence 2015 | Paderborner Kinderliteraturtage 2016. – Wicke, Andreas /Roßbach, Nikola (Hrsg.): Paul Maar. Studien zum kinder- und jugendliterarischen Werk (SONJA MÜLLER-CARSTENS)
In diesem Artikel und weiteren geplanten Folgen werden Ergänzungen, Nachträge, Erläuterungen und Korrekturen sowohl zum von der Taunusflora (Wittig & al. 2022) erfassten Gebiet (Vortaunus, Hoher Taunus, kammnaher Hintertaunus) als auch zum bisher nicht bearbeiteten kammfernen Bereich des Hintertaunus publiziert. Bei den bisherigen Ergänzungen und Nachträgen handelt es sich um die Ergebnisse der Nachbestimmung eines Belegs (Allium christophii), den Fund einer für das Gebiet bisher nicht genannten Art (Hylotelephium vulgare) sowie um Hinweise auf ältere Funde (Bolboschoenus maritimus, Polystichum lonchitis) und einen neueren Fund (Luronium natans). Weiterhin werden die wichtigsten Ergebnisse der Begehungen sechs kammferner Rasterfelder präsentiert (Rote-Liste- und sonstige seltene Arten). Als selten werden diejenigen Arten angesehen, die im bisherigen Kartierungsgebiet in maximal 5 % (= 26) der insgesamt 523 Rasterfelder gefunden wurden. Außerdem werden in der Taunusflora enthaltene Fehler korrigiert.
Background: It has been demonstrated that cognitive behavioural therapy (CBT) has a moderate effect on symptom reduction and on general well being of patients suffering from psychosis. However, questions regarding the specific efficacy of CBT, the treatment safety, the cost-effectiveness, and the moderators and mediators of treatment effects are still a major issue. The major objective of this trial is to investigate whether CBT is specifically efficacious in reducing positive symptoms when compared with non-specific supportive therapy (ST) which does not implement CBT-techniques but provides comparable therapeutic attention. Methods: The POSITIVE study is a multicenter, prospective, single-blind, parallel group, randomised clinical trial, comparing CBT and ST with respect to the efficacy in reducing positive symptoms in psychotic disorders. CBT as well as ST consist of 20 sessions altogether, 165 participants receiving CBT and 165 participants receiving ST. Major methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, analysis by intention to treat, data management using remote data entry, measures of quality assurance (e.g. on-site monitoring with source data verification, regular query process), advanced statistical analysis, manualized treatment, checks of adherence and competence of therapists. Research relating the psychotherapy process with outcome, neurobiological research addressing basic questions of delusion formation using fMRI and neuropsychological assessment and treatment research investigating adaptations of CBT for adolescents is combined in this network. Problems of transfer into routine clinical care will be identified and addressed by a project focusing on cost efficiency. Discussion: This clinical trial is part of efforts to intensify psychotherapy research in the field of psychosis in Germany, to contribute to the international discussion on psychotherapy in psychotic disorders, and to help implement psychotherapy in routine care. Furthermore, the study will allow drawing conclusions about the mediators of treatment effects of CBT of psychotic disorders. Trial Registration Current Controlled Trials ISRCTN29242879