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The inclusive production of the charm-strange baryon Ω0c is measured for the first time via its semileptonic decay into Ω−e+νe at midrapidity (|y| < 0.8) in proton–proton (pp) collisions at the centre-of-mass energy √s = 13 TeV with the ALICE detector at the LHC. The transverse momentum (pT) differential cross section multiplied by the branching ratio is presented in the interval 2 < pT < 12 GeV/c. The branching-fraction ratio BR(Ω0c → Ω−e+νe)/BR(Ω0c → Ω−π+) is measured to be 1.12 ± 0.22 (stat.) ± 0.27 (syst.). Comparisons with other experimental measurements, as well as with theoretical calculations, are presented.
The inclusive production of the charm-strange baryon Ω0c is measured for the first time via its semileptonic decay into Ω−e+νe at midrapidity (|y| < 0.8) in proton–proton (pp) collisions at the centre-of-mass energy √s = 13 TeV with the ALICE detector at the LHC. The transverse momentum (pT) differential cross section multiplied by the branching ratio is presented in the interval 2 < pT < 12 GeV/c. The branching-fraction ratio BR(Ω0c → Ω−e+νe)/BR(Ω0c → Ω−π+) is measured to be 1.12 ± 0.22 (stat.) ± 0.27 (syst.). Comparisons with other experimental measurements, as well as with theoretical calculations, are presented.
The total charm-quark production cross section per unit of rapidity dσ(cc)/dy, and the fragmentation fractions of charm quarks to different charm-hadron species f(c → hc), are measured for the first time in p–Pb collisions at √sNN = 5.02 TeV at midrapidity (−0.96 < y < 0.04 in the centre-ofmass frame) using data collected by ALICE at the CERN LHC. The results are obtained based on all the available measurements of prompt production of ground-state charm-hadron species: D0, D+,D+s, and J/ψ mesons, and Λ+cand Ξ0cbaryons. The resulting cross section is dσ(cc)/dy = 219.6±6.3 (stat.)+10.5−11.8(syst.)+7.6−2.9(extr.)±5.4 (BR)±4.6 (lumi.)±19.5 (rapidity shape) +15.0 (Ω0c) mb, which is consistent with a binary scaling of pQCD calculations from pp ollisions. The measured fragmentation fractions are compatible with those measured in pp collisions at √s = 5.02 and 13 TeV, showing an increase in the relative production rates of charm baryons with respect to charm mesons in pp and p–Pb collisions compared with e+e − and e−p collisions. The pT-integrated nuclear modification factor of charm quarks, RpPb(cc) = 0.91±0.04 (stat.) +0.08 −0.09 (syst.) +0.04 −0.03 (extr.)±0.03 (lumi.), is found to be consistent with unity and with theoretical predictions including nuclear modifications of the parton distribution functions.
This work aims to differentiate strangeness produced from hard processes (jet-like) and softer processes (underlying event) by measuring the angular correlation between a high-momentum trigger hadron (h) acting as a jet-proxy and a produced strange hadron (φ(1020) meson). Measuring h–φ correlations at midrapidity in p–Pb collisions at √sNN = 5.02 TeV as a function of event multiplicity provides insight into the microscopic origin of strangeness enhancement in small collision systems. The jet-like and the underlying-event-like strangeness production are investigated as a function of event multiplicity. They are also compared between a lower and higher momentum region. The evolution of the per-trigger yields within the near-side (aligned with the trigger hadron) and away-side (in the opposite direction of the trigger hadron) jet is studied separately, allowing for the characterization of two distinct jet-like production regimes. Furthermore, the h–φ correlations within the underlying event give access to a production regime dominated by soft production processes, which can be compared directly to the in-jet production. Comparisons between h–φ and dihadron correlations show that the observed strangeness enhancement is largely driven by the underlying event, where the φ/h ratio is significantly larger than within the jet regions. As multiplicity increases, the fraction of the total φ(1020) yield coming from jets decreases compared to the underlying event production, leading to high-multiplicity events being dominated by the increased strangeness production from the underlying event
Objectives: Stenosis of the biliary anastomosis predisposes liver graft recipients to bacterial cholangitis. Antibiotic therapy (AT) is performed according to individual clinical judgment, but duration of AT remains unclear.
Methods: All liver graft recipients with acute cholangitis according to the Tokyo criteria grade 1 and 2 after endoscopic retrograde cholangiography (ERC) were included. Outcome of patients treated with short AT (<7 days) was compared to long AT (>6 days). Recurrent cholangitis (RC) within 28 days was the primary end point.
Results: In total, 30 patients were included with a median of 313 (range 34–9849) days after liver transplantation until first proven cholangitis. Among 62 cases in total, 51/62 (82%) were graded as Tokyo-1 and 11/62 (18%) as Tokyo-2. Overall median duration of AT was 6 days (1–14) with 36 cases (58%) receiving short AT and 26 (42%) receiving long AT. RC was observed in 10 (16%) cases, without significant difference in occurrence of RC in short versus long AT cases. CRP and bilirubin were significantly higher in patients with long AT, while low serum albumin and low platelets were associated with risk of RC.
Conclusion: A shorter antibiotic course than 7 days shows good results in selected, ERC-treated patients for post-transplantation biliary strictures.
A new chiral SU(3) Lagrangian is proposed to describe the properties of kaons and anti-kaons in the nuclear medium. The saturation properties of nuclear matter are reproduced as well as the results of the Dirac-Brückner theory. After introducing the coupling between the omega meson and the kaon, our results for e ective kaon and anti-kaon energy are quite similar as calculated in the one-boson-exchange model.
A new chiral SU(3) Lagrangian is proposed to describe the properties of kaons and antikaons in the nuclear medium, the ground state of dense matter and the kaon-nuclear interactions consistently. The saturation properties of nuclear matter are reproduced as well as the results of the Dirac-Brückner theory. After taking into account the coupling between the omega meson and the kaon, we obtain similar results for the e ective kaon and antikaon energies as calculated in the one-boson-exchange model while in our model the parameters of the kaon-nuclear interactions are constrained by the SU(3) chiral symmetry. PACS number(s): 14.40.Aq, 12.39.Fe, 21.30.Fe
Nonequilibrium models (three-fluid hydrodynamics, UrQMD, and quark molecular dynamics) are used to discuss the uniqueness of often proposed experimental signatures for quark matter formation in relativistic heavy ion collisions from the SPS via RHIC to LHC. It is demonstrated that these models - although they do treat the most interesting early phase of the collisions quite differently (thermalizing QGP vs. coherent color fields with virtual particles) -- all yield a reasonable agreement with a large variety of the available heavy ion data. Hadron/hyperon yields, including J/Psi meson production/suppression, strange matter formation, dileptons, and directed flow (bounce-off and squeeze-out) are investigated. Observations of interesting phenomena in dense matter are reported. However, we emphasize the need for systematic future measurements to search for simultaneous irregularities in the excitation functions of several observables in order to come close to pinning the properties of hot, dense QCD matter from data. The role of future experiments with the STAR and ALICE detectors is pointed out.
Plants, fungi and algae are important components of global biodiversity and are fundamental to all ecosystems. They are the basis for human well-being, providing food, materials and medicines. Specimens of all three groups of organisms are accommodated in herbaria, where they are commonly referred to as botanical specimens.The large number of specimens in herbaria provides an ample, permanent and continuously improving knowledge base on these organisms and an indispensable source for the analysis of the distribution of species in space and time critical for current and future research relating to global biodiversity. In order to make full use of this resource, a research infrastructure has to be built that grants comprehensive and free access to the information in herbaria and botanical collections in general. This can be achieved through digitization of the botanical objects and associated data.The botanical research community can count on a long-standing tradition of collaboration among institutions and individuals. It agreed on data standards and standard services even before the advent of computerization and information networking, an example being the Index Herbariorum as a global registry of herbaria helping towards the unique identification of specimens cited in the literature.In the spirit of this collaborative history, 51 representatives from 30 institutions advocate to start the digitization of botanical collections with the overall wall-to-wall digitization of the flat objects stored in German herbaria. Germany has 70 herbaria holding almost 23 million specimens according to a national survey carried out in 2019. 87% of these specimens are not yet digitized. Experiences from other countries like France, the Netherlands, Finland, the US and Australia show that herbaria can be comprehensively and cost-efficiently digitized in a relatively short time due to established workflows and protocols for the high-throughput digitization of flat objects.Most of the herbaria are part of a university (34), fewer belong to municipal museums (10) or state museums (8), six herbaria belong to institutions also supported by federal funds such as Leibniz institutes, and four belong to non-governmental organizations. A common data infrastructure must therefore integrate different kinds of institutions.Making full use of the data gained by digitization requires the set-up of a digital infrastructure for storage, archiving, content indexing and networking as well as standardized access for the scientific use of digital objects. A standards-based portfolio of technical components has already been developed and successfully tested by the Biodiversity Informatics Community over the last two decades, comprising among others access protocols, collection databases, portals, tools for semantic enrichment and annotation, international networking, storage and archiving in accordance with international standards. This was achieved through the funding by national and international programs and initiatives, which also paved the road for the German contribution to the Global Biodiversity Information Facility (GBIF).Herbaria constitute a large part of the German botanical collections that also comprise living collections in botanical gardens and seed banks, DNA- and tissue samples, specimens preserved in fluids or on microscope slides and more. Once the herbaria are digitized, these resources can be integrated, adding to the value of the overall research infrastructure. The community has agreed on tasks that are shared between the herbaria, as the German GBIF model already successfully demonstrates.We have compiled nine scientific use cases of immediate societal relevance for an integrated infrastructure of botanical collections. They address accelerated biodiversity discovery and research, biomonitoring and conservation planning, biodiversity modelling, the generation of trait information, automated image recognition by artificial intelligence, automated pathogen detection, contextualization by interlinking objects, enabling provenance research, as well as education, outreach and citizen science.We propose to start this initiative now in order to valorize German botanical collections as a vital part of a worldwide biodiversity data pool.
Molecular surveillance of carbapenem-resistant gram-negative bacteria in liver transplant candidates
(2021)
Background: Carbapenem-resistant Gram-negative bacteria (CRGN) cause life-threatening infections due to limited antimicrobial treatment options. The occurrence of CRGN is often linked to hospitalization and antimicrobial treatment but remains incompletely understood. CRGN are common in patients with severe illness (e.g., liver transplantation patients). Using whole-genome sequencing (WGS), we aimed to elucidate the evolution of CRGN in this vulnerable cohort and to reconstruct potential transmission routes.
Methods: From 351 patients evaluated for liver transplantation, 18 CRGN isolates (from 17 patients) were analyzed. Using WGS and bioinformatic analysis, genotypes and phylogenetic relationships were explored. Potential epidemiological links were assessed by analysis of patient charts.
Results: Carbapenem-resistant (CR) Klebsiella pneumoniae (n=9) and CR Pseudomonas aeruginosa (n=7) were the predominating pathogens. In silico analysis revealed that 14/18 CRGN did not harbor carbapenemase-coding genes, whereas in 4/18 CRGN, carbapenemases (VIM-1, VIM-2, OXA-232, and OXA-72) were detected. Among all isolates, there was no evidence of plasmid transfer-mediated carbapenem resistance. A close phylogenetic relatedness was found for three K. pneumoniae isolates. Although no epidemiological context was comprehensible for the CRGN isolates, evidence was found that the isolates resulted of a transmission of a carbapenem-susceptible ancestor before individual radiation into CRGN.
Conclusion: The integrative epidemiological study reveals a high diversity of CRGN in liver cirrhosis patients. Mutation of carbapenem-susceptible ancestors appears to be the dominant way of CR acquisition rather than in-hospital transmission of CRGN or carbapenemase-encoding genetic elements. This study underlines the need to avoid transmission of carbapenem-susceptible ancestors in vulnerable patient cohorts.
Abstract: The e ect of vacuum fluctuations on the in-medium hadronic properties is investigated using a chiral SU(3) model in the nonlinear realization. The e ect of the baryon Dirac sea is seen to modify hadronic properties and in contrast to a calculation in mean field approximation it is seen to give rise to a significant drop of the vector meson masses in hot and dense matter. This e ect is taken into account through the summation of baryonic tadpole diagrams in the relativistic Hartree approximation (RHA), where the baryon self energy is modified due to interactions with both the non-strange ( ) and the strange ( ) scalar fields.
Compelling evidence for the creation of a new form of matter has been claimed to be found in Pb+Pb collisions at SPS. We discuss the uniqueness of often proposed experimental signatures for quark matter formation in relativistic heavy ion collisions. It is demonstrated that so far none of the proposed signals like J/psi meson production/suppression, strangeness enhancement, dileptons, and directed flow unambigiously show that a phase of deconfined matter has been formed in SPS Pb+Pb collisions. We emphasize the need for systematic future measurements to search for simultaneous irregularities in the excitation functions of several observables in order to come close to pinning the properties of hot, dense QCD matter from data.
The quark-molecular-dynamics model is used to study microscopically the dynamics of the coloured quark phase and the subsequent hadron formation in relativistic S+Au collisions at the CERN-SPS. Particle spectra and hadron ratios are compared to both data and the results of hadronic transport calculations. The non-equilibrium dynamics of hadronization and the loss of correlation among quarks are studied.
A model based on chiral SU(3)-symmetry in nonlinear realisation is used for the investigation of nuclei, superheavy nuclei, hypernuclei and multistrange nuclear objects (so called MEMOs). The model works very well in the case of nuclei and hypernuclei with one Lambda-particle and rules out MEMOs. Basic observables which are known for nuclei and hypernuclei are reproduced satisfactorily. The model predicts Z=120 and N=172, 184 and 198 as the next shell closures in the region of superheavy nuclei. The calculations have been performed in self-consistent relativistic mean field approximation assuming spherical symmetry. The parameters were adapted to known nuclei.
We investigate various properties of neutron star matter within an e ective chiral SU(3)L × SU(3)R model. The predictions of this model are compared with a Walecka-type model. It is demonstrated that the importance of hy- peron degrees are strongly depending on the interaction used, even if the equation of state near saturation density is nearly the same in both models. While the Walecka-type model predicts a strange star core with strangeness fraction fS 4/3, the chiral model allows only for fS 1/3 and predicts that 0, + and 0 will not exist in star, in contrast to the Walecka-type model. PACS: 26.60+c, 21.65+f, 24.10Jv
A microscopic model of deconfined matter based on color interactions between semi-classical quarks is studied. A hadronization mechanism is imposed to examine the properties and the disassembly of a thermalized quark plasma and to investigate the possible existence of a phase transition from quark matter to hadron matter.
Abstract. A generalized Lagrangian for the description of hadronic matter based on the linear SU(3)L × SU(3)R -model is proposed. Besides the baryon octet, the spin-0 and spin-1 nonets, a gluon condensate associated with broken scale invariance is incorporated. The observed values for the vacuum masses of the baryons and mesons are reproduced. In mean-field approximation, vector and scalar interactions yield a saturating nuclear equation of state. Finite nuclei can be reasonably described, too. The condensates and the e ective baryon masses at finite baryon density and temperature are discussed.
A generalized Lagrangian for the description of hadronic matter based on the linear SU(3)L × SU(3)R -model is proposed. Besides the baryon octet, the spin-0 and spin-1 nonets, a gluon condensate associated with broken scale invariance is incorporated. The observed values for the vacuum masses of the baryons and mesons are reproduced. In mean-field approximation, vector and scalar interactions yield a saturating nuclear equation of state. We discuss the di culties and possibilities to construct a chiral invariant baryon-meson interaction that leads to a realistic equation of state. It is found that a coupling of the strange condensate to nucleons is needed to describe the hyperon potentials correctly. The effective baryon masses and the appearance of an abnormal phase of nearly massless nucleons at high densities are examined. A nonlinear realization of chiral symmetry is considered, to retain a Yukawa-type baryon-meson interaction and to establish a connection to the Walecka-model.
We investigate the properties of di erent modifications to the linear -model (including a dilaton field associated with broken scale invariance) at finite baryon density and nonzero temperature T. The explicit breaking of chiral symmetry and the way the vector meson mass is generated are significant for the appearance of a phase of nearly vanishing nucleon mass besides the solution describing normal nuclear matter. The elimination of the abnormal solution prohibits the onset of a chiral phase transition but allows to lower the compressibility to a reasonable range. The repulsive contributions from the vector mesons are responsible for the wide range of stability of the normal phase in the (µ, T)-plane. The abnormal solution becomes not only energet- ically preferable to the normal state at high temperature or density, but also mechanically stable due to the inclusion of dilatons. PACS number:12.39.F
A significant drop of the vector meson masses in nuclear matter is observed in a chiral SU(3) model due to the e ects of the baryon Dirac sea. This is taken into account through the summation of baryonic tadpole diagrams in the relativistic Hartree approximation. The appreciable decrease of the in-medium vector meson masses is due to the vacuum polarisation e ects from the nucleon sector and is not observed in the mean field approximation.
The measured particle ratios in central heavy-ion collisions at RHIC-BNL are investigated within a chemical and thermal equilibrium chiral SU(3) theta - omega approach. The commonly adopted noninteracting gas calculations yield temperatures close to or above the critical temperature for the chiral phase transition, but without taking into account any interactions. Contrary, the chiral SU(3) model predicts temperature and density dependent e ective hadron masses and e ective chemical potentials in the medium and a transition to a chirally restored phase at high temperatures or chemical potentials. Three di erent parametrizations of the model, which show di erent types of phase transition behaviour, are investigated. We show that if a chiral phase transition occured in those collisions, freezing of the relative hadron abundances in the symmetric phase is excluded by the data. Therefore, either very rapid chemical equilibration must occur in the broken phase, or the measured hadron ratios are the outcome of the dynamical symmetry breaking. Furthermore, the extracted chemical freeze-out parameters di er considerably from those obtained in simple noninteracting gas calculations. In particular, the three models yield up to 35 MeV lower temperatures than the free gas approximation. The in-medium masses turn out di er up to 150 MeV from their vacuum values.
The space-time dynamics and pion-HBT radii in central heavy ion-collisions at CERN-SPS and BNL-RHIC are investigated within a hydrodynamic simulation. The dependence of the dynamics and the HBT-parameters on the EoS is studied with different parametrizations of a chiral SU(3) sigma omega model. The selfconsistent collective expansion includes the e ects of e ective hadron masses, generated by the nonstrange and strange scalar condensates. Different chiral EoS show di erent types of phase transitions and even a crossover. The influence of the order of the phase transition and of the latent heat on the space-time dynamics and pion-HBT radii is studied. A small latent heat, i.e. a weak first-order chiral phase transition, or a smooth crossover lead to distinctly di erent HBT predictions than a strong first order phase transition. A quantitative description of the data, both at SPS energies as well as at RHIC energies, appears di cult to achieve within the ideal hydrodynamic approach using the SU(3) chiral EoS. A strong first-order quasi-adiabatic chiral phase transition seems to be disfavored by the pion-HBT data from CERN-SPS and BNL-RHIC.
Introduction: Until now it is not possible to determine the equation of state (EOS) of hadronic matter from QCD. One succesfully applied alternative way to describe the hadronic world at high densities and temperatures are effective models like the RMF-models [1], where the relevant degrees of freedom are baryons and mesons instead of quarks and gluons. Since approximate chiral symmetry is an essential feature of QCD, it should be a useful concept for building and restricting e ective models. It has been shown [2,3] that effective sigma-omega models including SU(2) chiral symmetry are able to obtain a reasonable description of nuclear matter and finite nuclei. Recently [4] we have shown that an extended SU(3) × SU(3) chiral sigma-omega model is able to describe nuclear matter ground state properties, vacuum properties and finite nuclei satisfactorily. This model includes the lowest SU(3) multiplets of the baryons (octet and decuplet[5]), the spin-0 and the spin-1 mesons as the relevant degrees of freedom. Here we will discuss the predictions of this model for dense, hot, and strange hadronic matter.
Nuclei can be described satisfactorily in a nonlinear chiral SU(3)-framework, even with standard potentials of the linearmodel. The condensate value of the strange scalar meson is found to be important for the properties of nuclei even without adding hyperons. By neglecting terms which couple the strange to the nonstrange condensate one can reduce the model to a Walecka model structure embedded in SU(3). We discuss inherent problems with chiral SU(3) models regarding hyperon optical potentials.
A nonlinear chiral SU(3) approach including the spin 3 2 decuplet is developed to describe dense matter. The coupling constants of the baryon resonances to the scalar mesons are determined from the decuplet vacuum masses and SU(3) symmetry relations. Di erent methods of mass generation show significant differences in the properties of the spin- 3 2 particles and in the nuclear equation of state
Compelling evidence for a new form of matter has been claimed to be formed in Pb+Pb collisions at SPS. We critically review two suggested signatures for this new state of matter: First the suppression of the J/psi , which should be strongly suppressed in the QGP by two different mechanisms, the color-screening [1] and the QCD-photoe ect [2]. Secondly the measured particle, in particular strange hadronic, ratios might signal the freeze-out from a quark-gluon phase.
We investigate the hadronic cooling of a quark droplet within a microscopic model. The color flux tube approach is used to describe the hadronization of the quark phase. The model reproduces experimental particle ratios equally well compared to a static thermal hadronic source. Furthermore, the dynamics of the decomposition of a quark-gluon plasma is investigated and time dependent particle ratios are found.
Chronic hepatitis C is a major reason for development of cirrhosis and hepatocellular carcinoma and a leading cause for liver transplantation. The development of direct-acting antiviral agents lead to (pegylated) interferon-alfa free antiviral therapy regimens with a remarkable increase in sustained virologic response (SVR) rates and opened therapeutic options for patients with advanced cirrhosis and liver graft recipients. This concise review gives an overview about most current prospective trials and cohort analyses for treatment of patients with liver cirrhosis and liver graft recipients. In patients with compensated cirrhosis Child-Pugh-Turcotte (CTP) class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. In patients with decompensated cirrhosis CTP class B or C, daclastasvir, ledipasvir, velpatasvir, and sofosbuvir are approved, and SVR rates higher than 90% can be achieved. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce. Reported SVR rates in patients with cirrhosis CTP class C are lower compared to patients with a less severe liver disease. In liver transplant recipients with a maximum of CTP class A, SVR rates are comparable to patients without LT. Patients with decompensated graft cirrhosis should be treated on an individual basis.
Cdc2-like kinases (CLKs) represent a family of serine-threonine kinases involved in the regulation of splicing by phosphorylation of SR-proteins and other splicing factors. Although compounds acting against CLKs have been described, only a few show selectivity against dual-specificity tyrosine phosphorylation regulated-kinases (DYRKs). We here report a novel CLK inhibitor family based on a 6,7-dihydropyrrolo[3,4-g]indol-8(1H)-one core scaffold. Within the series, 3-(3-chlorophenyl)-6,7-dihydropyrrolo[3,4-g]indol-8(1H)-one (KuWal151) was identified as inhibitor of CLK1, CLK2 and CLK4 with a high selectivity margin towards DYRK kinases. The compound displayed a potent antiproliferative activity in an array of cultured cancer cell lines. The X-ray structure analyses of three members of the new compound class co-crystallized with CLK proteins corroborated a molecular binding mode predicted by docking studies.
Two missense mutations of the DYRK1B gene have recently been found to co-segregate with a rare autosomal-dominant form of metabolic syndrome. This gene encodes a member of the DYRK family of protein kinases, which depend on tyrosine autophosphorylation to acquire the catalytically active conformation. The mutations (H90P and R102C) affect a structural element named DYRK homology (DH) box and did not directly interfere with the conformation of the catalytic domain in a structural model of DYRK1B. Cellular assays showed that the mutations did not alter the specific activity of mature kinase molecules. However, a significant part of the mutant DYRK1B protein accumulated in detergent-insoluble cytoplasmic aggregates and was underphosphorylated on tyrosine. The mutant DYRK1B variants were more vulnerable to the HSP90 inhibitor ganetespib and showed enhanced binding to the co-chaperone CDC37 as compared to wild type DYRK1B. These results support the hypothesis that the mutations in the DH box interfere with the maturation of DYRK1B by tyrosine autophosphorylation and compromise the conformational stability of the catalytic domain, which renders the kinase susceptible to misfolding.
Dryopteris lacunosa – eine neue Art des Dryopteris-affinis-Aggregats (Dryopteridaceae, Pteridophyta)
(2011)
Eine weitere Sippe des Dryopteris-affinis-Aggregats wird als Art, D. lacunosa S. JESS., ZENNER, CH. STARK & BUJNOCH beschrieben. Sie lässt sich morphologisch von den anderen bisher beschriebenen Taxa des Aggregats unterscheiden, ist triploid und zeigt spezifische Phloroglucid- und RAPD- Bandenmuster. Bisher sind Funde aus Norditalien, Österreich, der Schweiz, Frankreich, Deutschland, Großbritannien und Irland belegt.
Background: Does the dogma of nephron sparing surgery (NSS) still stand for large renal masses? Available studies dealing with that issue are considerably biased often mixing imperative with elective indications for NSS and also including less malignant variants or even benign renal tumors. Here, we analyzed the oncological long-term outcomes of patients undergoing elective NSS or radical tumor nephrectomy (RN) for non-endophytic, large (≥7cm) clear cell renal carcinoma (ccRCC).
Methods: Prospectively acquired, clinical databases from two academic high-volume centers were screened for patients from 1980 to 2010. The query was strictly limited to patients with elective indications. Surgical complications were retrospectively assessed and classified using the Clavien-Dindo-classification system (CDS). Overall survival (OS) and cancer specific survival (CSS) were analyzed using the Kaplan-Meier-method and the log-rank test.
Results: Out of in total 8664 patients in the databases, 123 patients were identified (elective NSS (n = 18) or elective RN (n = 105)) for ≥7cm ccRCC. The median follow-up over all was 102 months (range 3–367 months). Compared to the RN group, the NSS group had a significantly longer median OS (p = 0.014) and median CSS (p = 0.04).
Conclusions: In large renal masses, NSS can be performed safely with acceptable complication rates. In terms of long-term OS and CSS, NSS was at least not inferior to RN. Our findings suggest that NSS should also be performed in patients presenting with renal tumors ≥7cm whenever technically feasible. Limitations include its retrospective nature and the limited availability of data concerning long-term development of renal function in the two groups.
In dieser Arbeit wurde deutlich, dass die Multilevel Monte Carlo Methode eine signifikante Verbesserung gegenüber der Monte Carlo Methode darstellt. Sie schafft es den Rechenaufwand zu verringern und in fast allen Fällen die gewollte Genauigkeit zu erreichen. Die Erweiterung durch Richardson Extrapolation brachte immer eine Verringerung des Rechenaufwands oder zumindest keine Verschlechterung, auch wenn nicht in allen Fällen die schwache Konvergenzordnung verdoppelt wurde.
Im Falle der Optionssensitivitäten ist eine Anwendung des MLMC-Algorithmus problematisch. Das Funktional, das auf den Aktienkurs angewendet wird, darf keine Unstetigkeitsstelle besitzen, bzw. im Falle des Gammas muss es stetig differenzierbar sein. Die Anwendung der MLMC Methode macht dann vor allem Sinn, wenn sich die Sensitivität als Funktion des Aktienkurses umformen lässt, so dass nur der Pfad der Aktie simuliert werden muss. Nur wenn dies nicht möglich ist, wäre es sinnvoll, die in Kapitel 6.5 am Beispiel des Deltas vorgestellte Methode zu benutzen, in der man einen zweiten Pfad für das Delta simuliert.
Weitere Verbesserungsmöglichkeiten könnten in der Wahl von anderen varianzreduzierenden Methoden liegen oder durch Verwendung von Diskretisierungsverfahren mit höherer starker Ordnung als das Euler-Verfahren (vgl. [7], Verwendung des Milstein-Verfahrens). In diesem Fall ist theoretisch ein Rechenaufwand der Größenordnung O(ϵexp-2) möglich, da die Anzahl der zu erstellenden Samples nicht mehr mit steigendem L erhöht wird. Somit könnte das L so groß gewählt werden, dass der Bias verschwindet und der MSE ausschließlich von der Varianz des Schätzers abhängt. Um diese auf eine Größenordnung von O(ϵexp2) zu bringen, ist es nötig, O(ϵexp2) Pfade zu erstellen (siehe Gleichung (3.6)), was den Rechenaufwand begründet.
Objectives: Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail.
Methods: Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list.
Results: In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died.
Conclusions: Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.
Eine Hybride zwischen Asplenium septentrionale (L.) Hoffm. subsp. septentrionale und A. viride (L.) HUDS. wird beschrieben. Der Bastard wurde in einem Exemplar bei Bosco-Gurin im Schweizer Kanton Tessin gefunden. Die morphologische Mittelstellung sowie Sporen-, Cytologische und Molekulargenetische Untersuchungen bestätigten die vermutete Abstammung.
Was verstehen Lehramtsstudierende unter Inklusion? Eine Untersuchung subjektiver Definitionen
(2019)
Der Begriff der Inklusion ist ein mehrdimensionales Konstrukt, das sowohl in Theorie als auch in Praxis unterschiedlich definiert ist. Für angehende Lehrkräfte bedeutet dies, dass sie sich mit unterschiedlichen Konnotationen dieses Begriffs auseinandersetzen müssen und dadurch möglicherweise eigene Begriffsdefinitionen vornehmen. Im Mittelpunkt dieses Beitrages steht die Frage nach den subjektiven Begriffsdefinitionen zum Begriff Inklusion. Im Rahmen einer schriftlichen Befragung wurden 290 Lehramtsstudierende mit Hilfe einer offenen Fragestellung zu ihrem Inklusionsverständnis befragt. Das Material wurde mittels qualitativer Inhaltsanalyse ausgewertet. Die Ergebnisse verweisen auf ein differenziertes Begriffsverständnis angehender Lehrkräfte. Es können vier Verständnistypen unterschieden werden, ausgehend von einem sehr engen bis hin zu einem sehr weiten und offenen Begriffsverständnis.
Chronic hepatitis C virus (HCV) infection is a leading cause for orthotopic liver transplantation (OLT) in the U.S. We investigated characteristics of HCV-infected patients registered for OLT, and explored factors associated with mortality. Data were obtained from the United Network for Organ Sharing and Organ Procurement and Transplantation network (UNOS/OPTN) registry. Analyses included 41,157 HCV-mono-infected patients ≥18 years of age listed for cadaveric OLT between February 2002 and June 2014. Characteristics associated with pre- and post-transplant survival and time trends over the study period were determined by logistic and Cox proportional hazard regression analyses and Poisson regressions. Most patients were white (69.1%) and male (70.8%). At waitlist registration, mean age was 54.6 years and mean MELD was 16. HCC was recorded in 26.9% of the records. A total of 51.2% of the patients received an OLT, 21.0% died or were too sick; 15.6% were delisted and 10.4% were still waiting. Factors associated with increased waitlist mortality were older age, female gender, blood type 0, diabetes, no HCC and transplant region (p<0.001). OLT recipient characteristics associated with increased risk for post OLT mortality were female gender, age, diabetes, race (p<0,0001), and allocation MELD (p = 0.005). Donor characteristics associated with waitlist mortality included age, ethnicity (p<0.0001) and diabetes (p<0.03). Waitlist registrations and OLTs for HCC significantly increased from 14.4% to 37.3% and 27.8% to 38.5%, respectively (p<0.0001). Pre- and post-transplant survival depended on a variety of patient-, donor-, and allocation- characteristics of which most remain relevant in the DAA-era. Still, intensified HCV screening strategies and timely and effective treatment of HCV are highly relevant to reduce the burden of HCV-related OLTs in the U.S.
Aim: Cellular CD81 is a well characterized hepatitis C virus (HCV) entry factor, while the relevance of soluble exosomal CD81 in HCV pathogenesis is poorly defined. We performed a case-control study to investigate whether soluble CD81 in the exosomal serum fraction is associated with HCV replication and inflammatory activity.
Patients and Methods: Four cohorts were investigated, patients with chronic hepatitis C (n = 37), patients with chronic HCV infection and persistently normal ALT levels (n = 24), patients with long term sustained virologic response (SVR, n = 7), and healthy volunteers (n = 23). Concentration of soluble CD81 was assessed semi-quantitatively after differential centrifugation ranging from 200 g to 100,000 g in the fifth centrifugation fraction by immunoblotting and densitometry.
Results: Soluble CD81 was increased in patients with chronic hepatitis C compared to healthy subjects (p = 0.03) and cured patients (p = 0.017). Patients with chronic HCV infection and persistently normal ALT levels and patients with long term SVR had similar soluble CD81 levels as healthy controls (p>0.2). Overall, soluble CD81 levels were associated with ALT levels (r = 0.334, p = 0.016) and severe liver fibrosis (p = 0.027).
Conclusion: CD81 is increased in the exosomal serum fraction in patients with chronic hepatitis C and appears to be associated with inflammatory activity and severity of fibrosis.
Eosinophilic cholangitis is a potentially underdiagnosed etiology in indeterminate biliary stricture
(2017)
AIM: To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS).
METHODS: All patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis.
RESULTS: one hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14).
CONCLUSION: EC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS.
Genetic heterogeneity of primary lesion and metastasis in small intestine neuroendocrine tumors
(2018)
Data on intratumoral heterogeneity of small intestine neuroendocrine tumors (SI-NETs) and related liver metastasis are limited. The aim of this study was to characterize genetic heterogeneity of 5 patients with SI-NETs. Therefore, formalin-fixed, paraffin-embedded tissue samples of primary and metastatic lesions as well as benign liver of five patients with synchronously metastasized, well differentiated SI-NETs were analyzed with whole exome sequencing. For one patient, chip based 850k whole DNA methylome analysis was performed of primary and metastatic tumor tissue as well as control tissue. Thereby, 156 single nucleotide variants (SNVs) in 150 genes were identified and amount of mutations per sample ranged from 9–34 (mean 22). The degree of common (0–94%) and private mutations per sample was strongly varying (6–100%). In all patients, copy number variations (CNV) were found and the degree of intratumoral heterogeneity of CNVs corresponded to SNV analysis. DNA methylation analysis of a patient without common SNVs revealed a large overlap of common methylated CpG sites. In conclusion, SI-NET primary and metastatic lesions show a highly varying degree of intratumoral heterogeneity. Driver events might not be detectable with exome analysis only, and further comprehensive studies including whole genome and epigenetic analyses are warranted.
Background: Definite diagnosis and therapeutic management of cholangiocarcinoma (CCA) remains a challenge. The aim of the current study was to investigate feasibility and potential impact on clinical management of targeted sequencing of intraductal biopsies.
Methods: Intraductal biopsies with suspicious findings from 16 patients with CCA in later clinical course were analyzed with targeted sequencing including tumor and control benign tissue (n = 55 samples). A CCA-specific sequencing panel containing 41 genes was designed and a dual strand targeted enrichment was applied.
Results: Sequencing was successfully performed for all samples. In total, 79 mutations were identified and a mean of 1.7 mutations per tumor sample (range 0–4) as well as 2.3 per biopsy (0–6) were detected and potentially therapeutically relevant genes were identified in 6/16 cases. In 14/18 (78%) biopsies with dysplasia or inconclusive findings at least one mutation was detected. The majority of mutations were found in both surgical specimen and biopsy (68%), while 28% were only present in biopsies in contrast to 4% being only present in the surgical tumor specimen.
Conclusion: Targeted sequencing from intraductal biopsies is feasible and potentially improves the diagnostic yield. A profound genetic heterogeneity in biliary dysplasia needs to be considered in clinical management and warrants further investigation.
Translational impact: The current study is the first to demonstrate the feasibility of sequencing of intraductal biopsies which holds the potential to impact diagnostic and therapeutical management of patients with biliary dysplasia and neoplasia.
Immune-modulating therapy is a promising therapy for patients with cholangiocarcinoma (CCA). Microsatellite instability (MSI) might be a favorable predictor for treatment response, but comprehensive data on the prevalence of MSI in CCA are missing. The aim of the current study was to determine the prevalence of MSI in a German tertiary care hospital. Formalin-fixed paraffin-embedded tissue samples, obtained in the study period from 2007 to 2015 from patients with CCA undergoing surgical resection with curative intention at Johann Wolfgang Goethe University hospital, were examined. All samples were investigated immunohistochemically for the presence of MSI (expression of MLH1, PMS2, MSH2, and MSH6) as well as by pentaplex polymerase chain reaction for five quasimonomorphic mononucleotide repeats (BAT-25, BAT-26, NR-21, NR-22, and NR-24). In total, 102 patients were included, presenting intrahepatic (n = 35, 34.3%), perihilar (n = 42, 41.2%), and distal CCA (n = 25, 24.5%). In the immunohistochemical analysis, no loss of expression of DNA repair enzymes was observed. In the PCR-based analysis, one out of 102 patients was found to be MSI-high and one out of 102 was found to be MSI-low. Thus, MSI seems to appear rarely in CCA in Germany. This should be considered when planning immune-modulating therapy trials for patients with CCA.
Patients after orthopic liver transplantation (OLT) are at risk of developing graft dysfunction. Sphingolipids (SL’s) have been identified to play a pivotal role in the regulation of hepatocellular apoptosis, inflammation and immunity. We aimed to investigate the serum SL profile in a prospective real-world cohort of post-OLT patients. From October 2015 until July 2016, 149 well-characterized post-OLT patients were analyzed. SL’s were assessed in serum probes via Liquid Chromatography/Tandem Mass Spectrometry. Twenty-nine (20%) patients had a biopsy proven graft rejection with decreased C20-ceramide (Cer) (p = 0.042), C18-dihydroceramide (DHC) (p = 0.022) and C24DHC (p = 0.060) levels. Furthermore, C18DHC (p = 0.044) and C24DHC (p = 0.011) were significantly down-regulated in patients with ischemic type biliary lesions (ITBL; n = 15; 10%). One-hundred and thirty-three patients (89%) have so far received tacrolimus as the main immunosuppressive agent with observed elevations of C14Cer (p = 0.052), C18Cer (p = 0.049) and C18:1Cer (p = 0.024). Hepatocellular carcinoma (HCC) pre-OLT was associated with increases in C24:1Cer (p = 0.024) and C24:1DHC (p = 0.024). In this large prospective cross-sectional study of patients, post-OLT serum levels of (very-)long chain (dihydro-)ceramides associate with graft rejection, ITBL, tacrolimus intake and HCC pre-OLT. Hence, serum SL’s may be indicative of graft complications. Further research is necessary to identify their diverse mechanistic role in regulating immunity and inflammation in patients post-OLT.
Background: Computed tomography of the head (HCT) is a widely used diagnostic tool, especially for emergency and trauma patients. However, the diagnostic yield and outcomes of HCT for patients on medical intensive care units (MICUs) are largely unknown.
Methods: We retrospectively evaluated all head CTs from patients admitted to a single-center MICU during a 5-year period for CT indications, diagnostic yield, and therapeutic consequences. Uni- and multivariate analyses for the evaluation of risk factors for positive head CT were conducted.
Results: Six hundred ninety (18.8%) of all patients during a 5-year period underwent HCT; 78.7% had negative CT results, while 21.3% of all patients had at least 1 new pathological finding. The main indication for acquiring CT scan of the head was an altered mental state (AMS) in 23.5%, followed by a new focal neurology in 20.7% and an inadequate wake up after stopping sedation in 14.9% of all patients. The most common new finding was intracerebral bleeding in 6.4%. In 6.7%, the CT scan itself led to a change of therapy of any kind. Admission after resuscitation or a new focal neurology were independent predictors of a positive CT. Psychic alteration and AMS were both independent predictors of a higher chance of a negative head CT. Positive HCT during MICU is an independent predictor of lower survival.
Conclusions: New onset of focal neurologic deficit seems to be a good predictor for a positive CT, while AMS and psychic alterations seem to be very poor predictors. A positive head CT is an independent predictor of death for MICU patients.
Abstract Geant4 is a toolkit for simulating the passage of particles through matter. It includes a complete range of functionality including tracking, geometry, physics models and hits. The physics processes offered cover a comprehensive range, including electromagnetic, hadronic and optical processes, a large set of long-lived particles, materials and elements, over a wide energy range starting, in some cases, from 250 eV and extending in others to the TeV energy range. It has been designed and constructed to expose the physics models utilised, to handle complex geometries, and to enable its easy adaptation for optimal use in different sets of applications. The toolkit is the result of a worldwide collaboration of physicists and software engineers. It has been created exploiting software engineering and object-oriented technology and implemented in the C++ programming language. It has been used in applications in particle physics, nuclear physics, accelerator design, space engineering and medical physics. PACS: 07.05.Tp; 13; 23
The measured particle ratios in central heavy-ion collisions at RHIC-BNL are investigated within a chemical and thermal equilibrium chiral SU(3) σ–ω approach. The commonly adopted noninteracting gas calculations yield temperatures close to or above the critical temperature for the chiral phase transition, but without taking into account any interactions. Contrary, the chiral SU(3) model predicts temperature and density dependent effective hadron masses and effective chemical potentials in the medium and a transition to a chirally restored phase at high temperatures or chemical potentials. Three different parametrizations of the model, which show different types of phase transition behaviour, are investigated. We show that if a chiral phase transition occured in those collisions, “freezing” of the relative hadron abundances in the symmetric phase is excluded by the data. Therefore, either very rapid chemical equilibration must occur in the broken phase, or the measured hadron ratios are the outcome of the dynamical symmetry breaking. Furthermore, the extracted chemical freeze-out parameters differ considerably from those obtained in simple noninteracting gas calculations. In particular, the three models yield up to 35 MeV lower temperatures than the free gas approximation. The in-medium masses turn out to differ up to 150 MeV from their vacuum values.
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.
Alternative NADH dehydrogenases (NADH:ubiquinone oxidoreductases) are single subunit respiratory chain enzymes found in plant and fungal mitochondria and in many bacteria. It is unclear how these peripheral membrane proteins interact with their hydrophobic substrate ubiquinone. Known inhibitors of alternative NADH dehydrogenases bind with rather low affinities. We have identified 1-hydroxy-2-dodecyl-4(1H)quinolone as a high affinity inhibitor of alternative NADH dehydrogenase from Yarrowia lipolytica. Using this compound, we have analyzed the bisubstrate and inhibition kinetics for NADH and decylubiquinone. We found that the kinetics of alternative NADH dehydrogenase follow a ping-pong mechanism. This suggests that NADH and the ubiquinone headgroup interact with the same binding pocket in an alternating fashion.
Background: Since 2009, IPF patients across Europe are recruited into the eurIPFreg, providing epidemiological data and biomaterials for translational research.
Methods: The registry data are based on patient and physician baseline and follow-up questionnaires, comprising 1700 parameters. The mid- to long-term objectives of the registry are to provide clues for a better understanding of IPF phenotype sub-clusters, triggering factors and aggravating conditions, regional and environmental characteristics, and of disease behavior and management.
Results: This paper describes baseline data of 525 IPF subjects recruited from 11/2009 until 10/2016. IPF patients had a mean age of 68.1 years, and seeked medical advice due to insidious dyspnea (90.1%), fatigue (69.2%), and dry coughing (53.2%). A surgical lung biopsy was performed in 32% in 2009, but in only 8% of the cases in 2016, possibly due to increased numbers of cryobiopsy. At the time of inclusion in the eurIPFreg, FVC was 68.4% ± 22.6% of predicted value, DLco ranged at 42.1% ± 17.8% of predicted value (mean value ± SD). Signs of pulmonary hypertension were found in 16.8%. Steroids, immunosuppressants and N-Acetylcysteine declined since 2009, and were replaced by antifibrotics, under which patients showed improved survival (p = 0.001).
Conclusions: Our data provide important insights into baseline characteristics, diagnostic and management changes as well as outcome data in European IPF patients over time.
Trial registration: The eurIPFreg and eurIPFbank are listed in ClinicalTrials.gov(NCT02951416).