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A non-fundamentalist return to origin: the new Islamic reformers’ methodology of (re)interpretation
(2020)
Focusing on some contemporary Islamic reformers’ solutions, in particular, Abolkarim Soroush, Mohsen Kadivar, and Fazlur Rahman, to concrete issues in Muslim societies, this article examines two different methodological strategies of alternative readings of the Sunna: an archeological one and a genealogical one. In the archeological perspective, the holy text has been considered as a repository of answers to all sorts of questions. Through a pathological analysis, this view suggests solutions to correct distortions and looks for new windows seeking an original interpretation of the Qur’an. The genealogical view, on the other hand, puts aside this pathology and instead insists on the idea of the contingency of any interpretation. Regardless of accuracy and validity, according to the genealogical view, all interpretations have addressed temporal and contextual questions. What is important in this perspective is not returning to an original source for finding the exact message of Allah, or correcting previous interpretations, but recurrently referring to an open-ended text in order to explore the futures of the Qur’an.
Baseline presence of NAFLD predicts weight loss after gastric bypass surgery for morbid obesity
(2020)
Background. Bariatric surgery is a widely used treatment for morbid obesity. Prediction of postoperative weight loss currently relies on prediction models, which mostly overestimate patients’ weight loss. Data about the influence of Non-alcoholic fatty liver disease (NAFLD) on early postoperative weight loss are scarce. Methods. This prospective, single-center cohort study included 143 patients receiving laparoscopic gastric bypass surgery (One Anastomosis-Mini Gastric Bypass (OAGB-MGB) or Roux-en-Y Gastric Bypass (RYGB)). Liver biopsies were acquired at surgery. NAFLD activity score (NAS) assigned patients to “No NAFLD”, “NAFL” or “NASH”. Follow up data were collected at 3, 6 and 12 months. Results. In total, 49.7% of patients had NASH, while 41.3% had NAFL. Compared with the No NAFLD group, NAFL and NASH showed higher body-mass-index (BMI) at follow-up (6 months: 31.0 kg/m2 vs. 36.8 kg/m2 and 36.1 kg/m2, 12 months: 27.0 kg/m2 vs. 34.4 and 32.8 kg/m2) and lower percentage of total body weight loss (%TBWL): (6 months: 27.1% vs. 23.3% and 24.4%; 12 months: 38.5% vs. 30.1 and 32.6%). Linear regression of NAS points significantly predicts percentage of excessive weight loss (%EWL) after 6 months (Cologne-weight-loss-prediction-score). Conclusions. Histopathological presence of NAFLD might lead to inferior postoperative weight reduction after gastric bypass surgery. The mechanisms underlying this observation should be further studied.
O artigo trata da “Filosofia da Nova Música” de Theodor Adorno e tem como problema de investigação saber quais são os valores estéticos apresentados pelo autor para identificar Schoenberg como o representante do progresso musical. Como objetivos específicos para esse trabalho foram definidos: a identificação das principais características estéticas nas obras musicais de Stravinsky e de Schoenberg e apontar alguns fundamentos filosóficos para diferenciar progresso e regressão na estética musical de Adorno. Ao caracterizar sua concepção estética como filosofia da arte, Adorno toma a produção e a recepção como expressões de uma relação dialética com o meio social e tece críticas especialmente a indústria cultural e a arte burguesa que tinham como propósito agradar o ouvido e permitir que os produtores e receptores estabelecessem uma relação de troca no mercado capitalista. Por isso, sua estética está assentada na crítica e na possibilidade de criação dissonante e autônoma, análises que foram realizadas no âmbito desta investigação que tem como foco a questão da música enquanto objeto estético de progresso ou regressão da audição.
Background: Previously, we used inhibitors blocking BET bromodomain binding proteins (BRDs) in Ewing sarcoma (EwS) and observed that long term treatment resulted in the development of resistance. Here, we analyze the possible interaction of BRD4 with cyclin-dependent kinase (CDK) 9. Methods: Co-immunoprecipitation experiments (CoIP) to characterize BRD4 interaction and functional consequences of inhibiting transcriptional elongation were assessed using drugs targeting of BRD4 or CDK9, either alone or in combination. Results: CoIP revealed an interaction of BRD4 with EWS-FLI1 and CDK9 in EwS. Treatment of EwS cells with CDKI-73, a specific CDK9 inhibitor (CDK9i), induced a rapid downregulation of EWS-FLI1 expression and block of contact-dependent growth. CDKI-73 induced apoptosis in EwS, as depicted by cleavage of Caspase 7 (CASP7), PARP and increased CASP3 activity, similar to JQ1. Microarray analysis following CDKI-73 treatment uncovered a transcriptional program that was only partially comparable to BRD inhibition. Strikingly, combined treatment of EwS with BRD- and CDK9-inhibitors re-sensitized cells, and was overall more effective than individual drugs not only in vitro but also in a preclinical mouse model in vivo. Conclusion: Treatment with BRD inhibitors in combination with CDK9i offers a new treatment option that significantly blocks the pathognomonic EWS-ETS transcriptional program and malignant phenotype of EwS.
The complexity of atmospherical processes has always yielded a multitude of ways of knowing about the weather. What has been lacking in the historiography of meteorology so far is a way to formulate differences between forms of knowledge in a way that does not privilege modern scientific structures, but focuses instead on the epistemological category of causality. Using causality as ground of comparison for different knowledge claims, I shall argue, may enable researchers to investigate meteorological knowledge across time periods, perhaps even geographical regions, in a more symmetrical manner. This review demonstrates this approach as a means to organize a large set of historical meteorological writings from German countries between 1750 and 1850. Three distinct forms of knowledge (Semiotics, Physics, and Organics of the weather) during that time and in that region are suggested and will be described. While a bibliography with a national perspective from the 1880s was the basis for the selection of historical sources, such a setup proved awkward even to contemporaries. In addition, the bibliography came with a number of biases and shortcomings that will be critically reviewed.
Spatial and temporal processes shaping microbial communities are inseparably linked but rarely studied together. By Illumina 16S rRNA sequencing, we monitored soil bacteria in 360 stations on a 100 square meter plot distributed across six intra-annual samplings in a rarely managed, temperate grassland. Using a multi-tiered approach, we tested the extent to which stochastic or deterministic processes influenced the composition of local communities. A combination of phylogenetic turnover analysis and null modeling demonstrated that either homogenization by unlimited stochastic dispersal or scenarios, in which neither stochastic processes nor deterministic forces dominated, explained local assembly processes. Thus, the majority of all sampled communities (82%) was rather homogeneous with no significant changes in abundance-weighted composition. However, we detected strong and uniform taxonomic shifts within just nine samples in early summer. Thus, community snapshots sampled from single points in time or space do not necessarily reflect a representative community state. The potential for change despite the overall homogeneity was further demonstrated when the focus shifted to the rare biosphere. Rare OTU turnover, rather than nestedness, characterized abundance-independent β-diversity. Accordingly, boosted generalized additive models encompassing spatial, temporal and environmental variables revealed strong and highly diverse effects of space on OTU abundance, even within the same genus. This pure spatial effect increased with decreasing OTU abundance and frequency, whereas soil moisture – the most important environmental variable – had an opposite effect by impacting abundant OTUs more than the rare ones. These results indicate that – despite considerable oscillation in space and time – the abundant and resident OTUs provide a community backbone that supports much higher β-diversity of a dynamic rare biosphere. Our findings reveal complex interactions among space, time, and environmental filters within bacterial communities in a long-established temperate grassland.
Maintaining biodiversity and ecosystem function is critical on national and global scales. However, while only a fraction of the global biodiversity is known, its current decline is unprecedented, making biodiversity hotspots a conservation priority. The Sierra Gorda Biodiversity Reserve (SGBR) in Central Mexico is known for its rich biodiversity. It is an example of the juxtaposition between species discovery and extinction: aquatic species richness is mostly unknown as no efforts have investigated aquatic communities so far, but are already anthropogenically stressed. We hypothesized that invasive species are already well established in various protected areas and investigated this by assessing the threat of invasive species that are already established within the SGBR on the native biodiversity. By combining field sampling with peer-reviewed literature and local reports, we identify the presence of various non-native species in SGBR. Among these non-native species identified were opportunistic predatory fish and potentially-pathogen transmitting molluscs, but also, a habitat engineer capable of modifying ecosystem functions. Moreover, we highlight that these species were introduced despite legislation and without any knowledge among authorities. As a result, we underline the necessity to describe native species, control invasive and prevent the introduction of further non-native species. If accelerated action is not taken, we risk losing a considerable amount of described and unknown freshwater biota. Keywords: Anthropocene, Biodiversity loss, Freshwater, Invasive species, Mexico, Nature reserve.
Neuronal nitric oxide synthase (NOS-I) impacts on fear/anxiety-like behavior in animals. In humans, the short (S) allele of a functional promotor polymorphism of NOS1 (NOS1 ex1f-VNTR) has been shown to be associated with higher anxiety and altered fear conditioning in healthy subjects in the amygdala and hippocampus (AMY/HIPP). Here, we explore the role of NOS1 ex1f-VNTR as a pathophysiological correlate of panic disorder and agoraphobia (PD/AG). In a sub-sample of a multicenter cognitive behavioral therapy (CBT) randomized controlled trial in patients with PD/AG (n = 48: S/S-genotype n=15, S/L-genotype n=21, L/L-genotype n=12) and healthy control subjects, HS (n = 34: S/S-genotype n=7, S/L-genotype n=17, L/L-genotype=10), a differential fear conditioning and extinction fMRI-paradigm was used to investigate how NOS1 ex1f-VNTR genotypes are associated with differential neural activation in AMY/HIPP. Prior to CBT, L/L-allele carriers showed higher activation than S/S-allele carriers in AMY/HIPP. A genotype × diagnosis interaction revealed that the S-allele in HS was associated with a pronounced deactivation in AMY/HIPP, while patients showed contrary effects. The interaction of genotype × stimulus type (CS+, conditioned stimulus associated with an aversive stimulus vs. CS-, unassociated) showed effects on differential learning in AMY/HIPP. All effects were predominately found during extinction. Genotype associated effects in patients were not altered after CBT. Low statistical power due to small sample size in each subgroup is a major limitation. However, our findings provide first preliminary evidence for dysfunctional neural fear conditioning/extinction associated with NOS1 ex1f-VNTR genotype in the context of PD/AG, shedding new light on the complex interaction between genetic risk, current psychopathology and treatment-related effects.
Das Gehirn weist in mehreren Bereichen anatomische Asymmetrien zwischen beiden Hemisphären auf, so auch in Bereichen der Hörrinde. Zudem ist bereits langjährig bekannt, dass menschliche Sprache vorrangig in der linken Gehirnhälfte, d.h. linksseitig lateralisiert, verarbeitet wird. Daraus folgend stellt sich die Frage, ob dies eine besondere Spezialisierung ist, oder ob es noch weitere lateralisierte Hirnfunktionen gibt. Viele akustische Signale haben dabei frequenzmodulierte (FM) Komponenten, die im Hörsystem für die Erkennung nach Parametern wie Richtung und Dauer der Modulation analysiert werden müssen. Ob die Analyse von FM-Komponenten oder einzelner Reizparameter im Gehirn lateralisiert stattfindet, wurde in der Literatur meist mit bildgebenden Verfahren untersucht.
Für das Erkennen und Unterscheiden der Modulationsrichtung weist eine Vielzahl von Studien auf eine erhöhte Aktivität in der rechten Hörrinde hin. Für die Analyse von Stimulusdauern ist es bisher allerdings noch unklar bzw. umstritten, ob diese lateralisiert erfolgt. Für die Untersuchung der Lateralisierung einfacher Sprachkomponenten werden häufig Konsonant-Vokal-Silben (CV-Silben) verwendet. In einer Vielzahl von Studien konnte eine linkslastige Lateralisierung, wie bei der Spracherkennung, gezeigt werden.
In der vorliegenden Arbeit wurde nun untersucht, ob ein eindeutigeres Muster von Lateralisierung zu finden ist, wenn diese in Wahrnehmungsexperimenten, untersucht wird. Dabei wurde ein zu untersuchender Teststimulus (FM-/CV-Stimulus) auf einem Ohr mit einem kontralateralen breitbandigen Rauschen auf dem anderen Ohr gleichzeitig präsentiert. Durch die Struktur der Hörbahn kann dabei davon ausgegangen werden, dass in einer Hemisphäre des Vorderhirns vorrangig Informationen aus dem kontralateralen Ohr verarbeitet und Informationen aus dem ipsilateralen Ohr unterdrückt werden und sich somit Rückschlüsse auf die Funktion/Beteiligung einer Hemishpäre ziehen lassen. Das Rauschen diente dabei zur unspezifischen Aktivierung der gegenüberliegenden Hemisphäre.
Die Lateralisierung wurde systematisch für unterschiedlich komplexe Reize untersucht. Dazu wurden in zwei Versuchsreihen Unterscheidungsexperimente durchgeführt, die sich in mehrere Messungen (mit mehreren Durchläufen) mit unterschiedlichen Parametereinstellungen gliederten. Pro Durchlauf musste sich die Versuchsperson immer zwischen zwei Antwortmöglichkeiten entscheiden (2-AFC-Verfahren). Der Schalldruckpegel des Rauschens war dabei für alle Messungen konstant. Der Schalldruckpegel der Teststimuli blieb zwar während einer Messung konstant, wurde jedoch innerhalb eines Experimentes von Messung zu Messung reduziert.
In einer gemeinsamen Analyse wurden jeweils die Fehlerraten und Reaktionszeiten beider Ohren, getrennt nach Seite und FM-/ CV-Stimulus, miteinander verglichen, um so auf eine mögliche Lateralisierung schließen zu können. Damit die Daten der Versuchspersonen bei vergleichbarer Schwierigkeit analysiert werden konnten, wurde als Vergleichswert zwischen allen Versuchspersonen der Schalldruckpegel der ersten Messung mit einer Fehlerrate von mindestens 15,0 % gewählt (15 %-Kriterium). Um auszuschließen, dass das Hörvermögen der Versuchspersonen Unterschiede zwischen beiden Ohren aufweist, wurde vor jeder Messung der „Punkt subjektiver Gleichheit“ für die Lautstärke-wahrnehmung zwischen linkem und rechten Ohr bestimmt.
In der ersten Versuchsreihe wurde dabei die Verarbeitung der Modulationsrichtung und der Stimulusdauer von FM-Stimuli untersucht. Es zeigte sich für beide Experimente, dass ein sinkender Schalldruckpegel des FM-Stimulus zu einer steigenden Fehlerrate führte. Unter Anwendung des 15 %-Kriteriums waren die Fehlerraten für die Unterscheidung der Modulationsrichtung signifikant geringer, wenn der FM-Stimulus auf dem linken Ohr präsentiert wurde. Dies ist ein deutlicher Hinweis für eine rechtslastige Lateralisierung.
Für die Unterscheidung der Stimulusdauer gab es dagegen keinen signifikanten Unterschied zwischen den Fehlerraten beider Ohren. Somit muss davon ausgegangen werden, dass beide Hemisphären für diese Aufgabe benötigt werden und eine bilaterale Verarbeitung stattfindet. In den Reaktionszeiten konnten in beiden Experimente keine signifikanten Unterschiede gezeigt werden. Die Unterscheidung der Modulationsrichtung wurde dabei von allen Versuchspersonen als einfacher eingestuft als die Unterscheidung der Stimulusdauer, was sich auch in niedrigeren Antwortschnelligkeit und Fehlerraten bei vergleichbaren Schalldruckpegeln zeigte.
In der zweiten Versuchsreihe wurde als Referenzmessung nochmals die Unterscheidung der Modulationsrichtungen von FM-Stimuli durchgeführt. Anschließend wurde die Unterscheidung von „da“ und „ga“ untersucht. Diese CV-Silben differieren ausschließlich in der FM-Komponente. Die Untercheidung von CV-Silben ohne Unterschied in der FM-Komponente wurde mittels „ta“ und „ka“ getestet. Für alle drei Experimente zeigte sich, dass ein geringerer Schalldruckpegel des FM- oder CV-Stimulus zu einer steigenden Fehlerrate führte. Unter Anwendung des 15 %-Kriteriums zeigte sich für die Unterscheidung der Modulationsrichtung ein Trend zu niedrigeren Fehlerraten bei der Präsentation des FM-Stimulus auf dem linken im Vergleich mit dem rechten Ohr. In den Reaktionszeiten konnten keine signifikanten Unterschiede gezeigt werden.
Für die Unterscheidung von „da“ und „ga“ ließ sich unter Anwendung des 15 %-Kriteriums in den Fehlerraten und Reaktionszeiten kein Vorteil eines Ohres nachweisen. Dagegen zeigten sich klare Unterschiede bei einzelnen Versuchspersonen. So waren die Fehlerraten für Versuchspersonen, die vorwiegend „da“ erkannt bzw. gehört hatten signifikant höher, wenn der CV-Stimulus auf dem rechten Ohr präsentiert wurde, für „ga“-Hörer war das Gegenteil der Fall. In den Reaktionszeiten konnte kein signifikanter Zusammenhang nachgewiesen werden. Somit ließ sich zeigen, dass je nach Strategie der Versuchsperson bzw. deren individueller Wahrnehmung der CV-Silben, Unterschiede in der Lateralisierung erreicht werden können.
Für die Unterscheidung von „ta“ und „ka“ zeigten sich unter Anwendung des 15 %-Kriteriums signifikant niedrigere Fehlerraten und Reaktionszeiten, wenn der CV-Stimulus auf dem linken Ohr präsentiert wurde. Dies weist deutlich auf eine rechtslastige Lateralisierung hin. Vergleicht man alle drei Experimente ließ sich zudem zeigen, dass die Unterscheidung der Modulationsrichtung einfacher war als die Unterscheidung verschiedener CV-Stimuli. Dabei war die Unterscheidung von „da“ und „ga“ für die Versuchspersonen schwieriger als die Unterscheidung von „ta“ und „ka“. Allerdings konnte in den Lateralisierungsdaten kein direkter Zusammenhang zwischen den FM- und „da“-/„ga“-Stimuli gezeigt werden.
Zusammenfassend konnte in allen fünf Experimenten eine verschieden stark lateralisierte Verarbeitung von akustischen Stimuli bei gleichzeitigem kontralateralen Rauschen gezeigt werden. Der Vorteil eines Ohres (bzw. einer Hemisphäre) war sowohl von der Aufgabe als auch vom Stimulustyp abhängig. Dabei gab es zum Teil starke Unterschiede in der Effektstärke und dem Grad der Lateralisierung zwischen den einzelnen Versuchspersonen. Insgesamt konnte gezeigt werden, dass sich die hier angewendete psychophysische Methode gut eignet, um Ergebnisse zur Lateralisierung von akustischen Stimuli zu gewinnen und somit die Verhaltensrelevanz von Ergebnissen aus Studien mit bildgebenden Verfahren zu überprüfen.
Previous studies in developing Xenopus and zebrafish reported that the phosphate transporter slc20a1a is expressed in pronephric kidneys. The recent identification of SLC20A1 as a monoallelic candidate gene for cloacal exstrophy further suggests its involvement in the urinary tract and urorectal development. However, little is known of the functional role of SLC20A1 in urinary tract development. Here, we investigated this using morpholino oligonucleotide knockdown of the zebrafish ortholog slc20a1a. This caused kidney cysts and malformations of the cloaca. Moreover, in morphants we demonstrated dysfunctional voiding and hindgut opening defects mimicking imperforate anus in human cloacal exstrophy. Furthermore, we performed immunohistochemistry of an unaffected 6-week-old human embryo and detected SLC20A1 in the urinary tract and the abdominal midline, structures implicated in the pathogenesis of cloacal exstrophy. Additionally, we resequenced SLC20A1 in 690 individuals with bladder exstrophy-epispadias complex (BEEC) including 84 individuals with cloacal exstrophy. We identified two additional monoallelic de novo variants. One was identified in a case-parent trio with classic bladder exstrophy, and one additional novel de novo variant was detected in an affected mother who transmitted this variant to her affected son. To study the potential cellular impact of SLC20A1 variants, we expressed them in HEK293 cells. Here, phosphate transport was not compromised, suggesting that it is not a disease mechanism. However, there was a tendency for lower levels of cleaved caspase-3, perhaps implicating apoptosis pathways in the disease. Our results suggest SLC20A1 is involved in urinary tract and urorectal development and implicate SLC20A1 as a disease-gene for BEEC.
Hypertonie stellt in der westlichen Welt die Haupttodesursache dar, obwohl sie im Hinblick auf die pharmakologischen Therapieoptionen gut behandelbar ist. Hauptursächlich ist hierfür eine, vor allem durch eine Non-Adhärenz (u.a. bedingt durch den asymptomatischen Charakter) und in selteneren Fällen eine aufgrund einer therapieresistente Hypertonie (TRH) verursachte, unzureichende Blutdruckkontrolle. Eine Möglichkeit zur Überprüfung der Therapietreue in der antihypertensiven Therapie ist der qualitative Nachweis der Arzneistoffe im Blut oder Urin. Unklar ist, inwiefern die Substanzen in einer biologischen Probe innerhalb des Dosierungsintervalls oder darüber hinaus nachweisbar sind und es zu einer Falschbeurteilung kommen kann.
Daher wurde eine quantitative chromatographisch-tandem-massenspektrometrische Methode für das Therapeutische Drug Monitoring von blutdrucksenkenden Arzneistoffen entwickelt und analytisch vollständig validiert. Bei 38 Patienten mit überwachter Medikamenteneinnahme wurde die Aussagekraft der Methode hinsichtlich der Bestätigung einer Adhärenz zunächst mittels zweier Wirkstoffkonzentrationen im Serum (Tal- und Spitzenspiegel) überprüft. Zur Bewertung der Konzentrationen wurden zwei Konzepte evaluiert. Einerseits wurde die untere Grenze des therapeutischen Referenzbereiches (TRR, Literaturdaten) und andererseits die mittels Rechenmodell (Daten pharmakokinetischer Studien) individuell ermittelte, dosisbezogene Arzneimittelkonzentration (DRC) evaluiert. In einem zweiten Studienansatz wurde diese neue quantitative Methode an einem Kollektiv von 36 ambulanten Patienten (ohne überwachte Medikamenteneinnahme) angewendet und zur Überprüfung der Aussagekraft mit Ergebnissen des etablierten Urinscreenings verglichen.
Die gemessenen Wirkstoffkonzentrationen von Atenolol (64 bis 564 ng/ml), Bisoprolol (2,5 bis 53 ng/ml), Metoprolol (5,8 bis 110 ng/ml), Nebivolol (0,32 bis 3,4 ng/ml), Hydrochlorothiazid (15 bis 606 ng/ml), Furosemid (22 ng/ml), Torasemid (17 bis 1829 ng/ml), Canrenon (25 bis 221 ng/ml), Amlodipin (2,4 bis 35 ng/ml), Lercanidipin (0,24 bis 21 ng/ml), Candesartan (6,0 bis 268 ng/ml), Telmisartan (22 bis 375 ng/ml) und Valsartan (115 bis 7962 ng/ml) haben gezeigt, dass die quantitative Analyse von Antihypertensiva in Serumproben und deren Auswertung auf Basis der individuell berechneten unteren DRC in der Beurteilung einer Adhärenz vielversprechend ist.
Die Auswertung auf Basis der unteren Grenze des TRR signalisierte bei den stationären Patienten (überwachte Einnahme) innerhalb der Substanzklasse der Diuretika (ohne Torasemid) bei 16,7 %, der β-Blocker bei 29,4 %, der Calciumkanal-Blocker bei 14,8 % und der AT1-Antagonisten bei 25 % fälschlicherweise eine Non-Adhärenz.
Die rein qualitative Urinanalyse zeigte im Falle der β-Blocker Atenolol, Bisoprolol und des Diuretikums HCT aufgrund einer hohen Bioverfügbarkeit, einer langen Halbwertszeit oder einer überwiegend renalen Ausscheidung der Muttersubstanz ein Nachweisfenster über das Dosierungsintervall hinaus, was bedingt, dass einige Patienten fälschlicherweise als adhärent gewertet wurden. Ein anderes Problem zeigte sich bei einigen Patienten, die mit dem AT1-Antagonist Candesartan oder dem Calciumkanal-Blocker Lercanidipin behandelt wurden und die als non-adhärent eingestuft wurden. Eine geringe Bioverfügbarkeit, eine hohe Metabolisierungsrate oder geringe renale Ausscheidung der unveränderten Arzneistoffe lies auf eine mangelhafte Nachweisbarkeit innerhalb des Dosierungsintervalls und damit auf eine eingeschränkte Beurteilbarkeit schließen.
Aus den Untersuchungen ergibt sich, dass es bei Anwendung qualitativer Nachweismethoden aufgrund besonderer Pharmakokinetiken einzelner antihypertensiver Wirkstoffe zur Fehleinschätzung der Adhärenz kommen kann. Die neu entwickelte Methodik in Form einer quantitativen Serumanalyse ist unter Verwendung patientenindividueller Bewertungskriterien bei dieser Fragestellung überlegen.
With obesity having doubled in the last decade, hypertension is on the rise. In one-third of hypertensive patients the metabolic syndrome is present. This might be one factor for the increasing number of prescriptions for angiotensin receptor blockers and calcium-channel blockers besides a more favorable risk-to-benefit ratio. The aim of the present study was to evaluate a therapeutic drug monitoring (TDM) method for assessment of adherence based on cut-offs in inpatients and to compare it to an established urine drug screening in outpatients. A method for quantification of calcium-channel blockers and angiotensin receptor blockers using high-performance liquid chromatography-tandem mass spectrometric analysis (LC-MS/MS) was developed and validated. The method was applied to serum samples of 32 patients under supervised medication to establish cut-off values for adherence assessment based on dose-related concentrations (DRC, calculated from pharmacokinetic data). Furthermore, corresponding urine and blood samples of 42 outpatients without supervised medication were analysed and the results compared with regard to adherence assessment. All serum concentrations measured for amlodipine (n = 40), lercanidipine (n = 14), candesartan (n = 10), telmisartan (n = 4) and valsartan (n = 10) in inpatients were above the patient specific lower DRC confirming adherence. Of 42 outpatients the identification of analytes in urine as well as the quantification in serum exhibited differing results. According to urinalysis, adherence was demonstrated in only 87.0% of prescriptions, compared to 91.3% for serum analyses. Differences were observed for amlodipine, lercanidipine and candesartan which can be explained by a higher specificity of the serum analysis approach due to pharmacokinetics. The present study confirms that assessing adherence based on serum drug concentrations with individually calculated lower DRCs is more accurate than using qualitative urine analysis. In particular, drugs with low bioavailability, low renal excretion or high metabolism rate such as lercanidipine and candesartan may lead to underestimation of adherence via urine analysis.
The coronavirus disease 2019 COVID-19 pandemic is rapidly spreading worldwide and is becoming a major public health crisis. Increasing evidence demonstrates a strong correlation between obesity and the COVID-19 disease. We have summarized recent studies and addressed the impact of obesity on COVID-19 in terms of hospitalization, severity, mortality, and patient outcome. We discuss the potential molecular mechanisms whereby obesity contributes to the pathogenesis of COVID-19. In addition to obesity-related deregulated immune response, chronic inflammation, endothelium imbalance, metabolic dysfunction, and its associated comorbidities, dysfunctional mesenchymal stem cells/adipose-derived mesenchymal stem cells may also play crucial roles in fueling systemic inflammation contributing to the cytokine storm and promoting pulmonary fibrosis causing lung functional failure, characteristic of severe COVID-19. Moreover, obesity may also compromise motile cilia on airway epithelial cells and impair functioning of the mucociliary escalators, reducing the clearance of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Obese diseased adipose tissues overexpress the receptors and proteases for the SARS-CoV-2 entry, implicating its possible roles as virus reservoir and accelerator reinforcing violent systemic inflammation and immune response. Finally, anti-inflammatory cytokines like anti-interleukin 6 and administration of mesenchymal stromal/stem cells may serve as potential immune modulatory therapies for supportively combating COVID-19. Obesity is conversely related to the development of COVID-19 through numerous molecular mechanisms and individuals with obesity belong to the COVID-19-susceptible population requiring more protective measures.
Human placentation is a highly invasive process. Deficiency in the invasiveness of trophoblasts is associated with a spectrum of gestational diseases, such as preeclampsia (PE). The oncogene B-cell lymphoma 6 (BCL6) is involved in the migration and invasion of various malignant cells. Intriguingly, its expression is deregulated in preeclamptic placentas. We have reported that BCL6 is required for the proliferation, survival, fusion, and syncytialization of trophoblasts. In the present work, we show that the inhibition of BCL6, either by its gene silencing or by using specific small molecule inhibitors, impairs the migration and invasion of trophoblastic cells, by reducing cell adhesion and compromising the dynamics of the actin cytoskeleton. Moreover, the suppression of BCL6 weakens the signals of the phosphorylated focal adhesion kinase, Akt/protein kinase B, and extracellular regulated kinase 1/2, accompanied by more stationary, but less migratory, cells. Interestingly, transcriptomic analyses reveal that a small interfering RNA-induced reduction of BCL6 decreases the levels of numerous genes, such as p21 activated kinase 1, myosin light chain kinase, and gamma actin related to cell adhesion, actin dynamics, and cell migration. These data suggest BCL6 as a crucial player in the migration and invasion of trophoblasts in the early stages of placental development through the regulation of various genes associated with the migratory machinery.
Background: Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with one or more perceived flaws in one’s own appearance. Previous studies provided evidence for deficits in configural and holistic processing in BDD. Preliminary evidence suggests abnormalities at an early stage of visual processing. The present study is the first examining early neurocognitive perception of the own face in BDD by using electroencephalography (EEG). We investigated the face inversion effect, in which inverted (upside-down) faces are disproportionately poorly processed compared to upright faces. This effect reflects a disruption of configural and holistic processing, and in consequence a preponderance of featural face processing.
Methods: We recorded face-sensitive event-related potentials (ERPs) in 16 BDD patients and 16 healthy controls, all unmedicated. Participants viewed upright and inverted (upside-down) images of their own face and an unfamiliar other face, each in two facial emotional expressions (neutral vs. smiling). We calculated the early ERP components P100, N170, P200, N250, and the late positive component (LPC), and compared amplitudes among both groups.
Results: In the early P100, no face inversion effects were found in both groups. In the N170, both groups exhibited the common face inversion effects, with significantly larger N170 amplitudes for inverted than upright faces. In the P200, both groups exhibited larger inversion effects to other (relative to own) faces, with larger P200 amplitudes for other upright than inverted faces. In the N250, no significant group differences were found in face processing. In the LPC, both groups exhibited larger inversion effects to other (relative to own) faces, with larger LPC amplitudes for other inverted than upright faces. These overall patterns appeared to be comparable for both groups. Smaller inversion effects to own (relative to other) faces were observed in none of these components in BDD, relative to controls.
Conclusions: The findings suggest no evidence for abnormalities at all levels of early face processing in our observed sample of BDD patients. Further research should investigate the neural substrates underlying BDD symptomatology.
Movies are brilliant choices to be subjects of discourse analysis since they bear resemblance to real-life phenomena. Lion of The Desert is one of the movies that actualizes the use of the English language as the dialogue and presents Islamic historical values as its content. Among a myriad of sub-disciplines of discourse analysis, this paper attempts to investigate speech act phenomena in the utterances of Omar Mukhtar, the main character of the movie. The discourse analysis is conducted on his utterances in order to extract the types of speech acts he employs. Primary data sources include the movie video file and its script. We execute several procedural steps of extracting the data, commencing with watching the movie while reading its script; re-watching it to identify the aspects like voice, intonation, and mimics; interpreting, and classifying the types of speech acts in accordance with the classification procedure of John R. Searle’s speech act theory. The findings revealed four types of speech acts, namely, representative, directive, commissive, and expressive, being identified and classified in Mukhtar’s utterances. The most frequently used type of speech act was representative, which is performed in 56 utterances, followed by a directive act which appears in 53 utterances. Commissive and expressive speech acts emerge in 9 and 7 utterances respectively.
"Die Träume gehören zweifellos zur Wirklichkeit" : Traum-Erzählungen über Kindheit und für Kinder
(2020)
Theodor Storms Kindermärchen Der kleine Häwelmann, von dem Autor 1849 für seinen Sohn Hans verfasst und 1850 veröffentlicht, ist in seiner moralisch-komischen Form ein exemplarisches Exponat der Kinderliteratur des 19. Jahrhunderts. Gemäß der biedermeierlich gestimmten, belehrenden Funktion des Textes steht kindliche Allmachtsfantasie im Mittelpunkt des Geschehens. Die Haltung des ›Mehr-mehr‹ überschreitet indes die Grenzen der Moralerzählung. Entgegen der abschreckenden Funktion scheint vielmehr der kleine Häwelmann in der Verschränkung von Norm-Übertritt und Eskapismus ein ›modernes‹ Kind seiner Entstehungszeit zu sein und durchaus mit den Figuren des Struwwelpeters vergleichbar, die der Arzt und Kinderpsychiater Heinrich Hoffmann 1845 entworfen hat...
The role of radiation therapy in the treatment of (colo)-rectal cancer has changed dramatically over the past decades. Introduced with the aim of reducing the high rates of local recurrences after conventional surgery, major developments in imaging, surgical technique, systemic therapy and radiation delivery have now created a much more complex environment leading to a more personalized approach. Functional aspects including reduction of acute or late treatment-related side effects, sphincter or even organ-preservation and the unsolved problem of still high distant failure rates have become more important while local recurrence rates can be kept low in the vast majority of patients. This review summarizes the actual role of radiation therapy in different subgroups of patients with rectal cancer, including the current standard approach in different subgroups as well as recent developments focusing on neoadjuvant treatment intensification and/or non-operative treatment approaches aiming at organ-preservation.
Background: About 2000 children and adolescents under the age of 18 are diagnosed with cancer each year in Germany. Because of current medical treatment methods, a high survival rate can be reached for many types of the disease. Nevertheless, patients face a number of long-term effects related to the treatment. As a result, physical and psychological consequences have increasingly become the focus of research in recent years. Social dimensions of health have received little attention in health services research in oncology so far. Yet, there are no robust results that allow an estimation of whether and to what extent the disease and treatment impair the participation of children and adolescents and which factors mediate this effect. Social participation is of great importance especially because interactions with peers and experiences in different areas of life are essential for the development of children and adolescents.
Methods: Data are collected in a longitudinal, prospective, observational multicenter study. For this purpose, all patients and their parents who are being treated for cancer in one of the participating clinics throughout Germany will be interviewed within the first month after diagnosis (t1), after completion of intensive treatment (t2) and half a year after the end of intensive treatment (t3) using standardized questionnaires. Analysis will be done by descriptive and multivariate methods.
Discussion: The results can be used to identify children and adolescents in high-risk situations at an early stage in order to be able to initiate interventions tailored to the needs. Such tailored interventions will finally reduce the risk of impairments in the participation of children and adolescents and increase quality of life.
Trial registration: ClinicalTrials.gov: NCT04101123.
Esta investigación, titulada “La colonialidad de las metáforas: Las representaciones del VIH/sida y de los sujetos vinculados con la ‘enfermedad’, en los discursos periodístico y médico costarricenses (1983-1990) y en la narrativa nacional (1989-1999)”, consta de cuatro capítulos. En el primero, se presenta el tema de estudio y sus interrogantes, las aproximaciones teóricas, los aspectos metodológicos y la estructura del texto. En relación con los enfoques teóricos, se consideran las contribuciones de Paul Ricœur, Hans Blumenberg y Michel Foucault. Así, primero hay una reflexión sobre la metáfora, la narración y el pensamiento (Ricœur y Blumenberg). Segundo, se estudian los símbolos primarios del mal: la mancilla, el pecado y culpabilidad (Ricœur). Tercero, se analiza el concepto de biopolítica y el papel social de la medicina (Foucault). En la metodología, se parte de algunos principios de la Sociocrítica (relacionados con las nociones de texto, contexto y representación) y se propone, nuevamente con Foucault, un análisis del discurso en términos históricos. Asimismo, se introducen unas explicaciones de Philipp Sarasin, con el fin de resaltar la importancia de estudiar las metáforas, los símbolos, las tramas, etc. Para el caso específico de los textos literarios, se toman en cuenta otras posibilidades de análisis semiótico (aunque los textos literarios también son asumidos como parte de un corpus discursivo amplio, con un común denominador: el VIH/sida).
Los siguientes capítulos (II, III y IV) corresponden con el desarrollo de la investigación. Así, en los capítulos II y III, se reflexiona sobre las representaciones que los discursos periodístico y médico movilizaron durante la primera (1983-1986) y la segunda (1987-1990) mitades de la década de los años ochenta. Los discursos periodístico y médico son trabajados en conjunto, ya que las interacciones que se dieron entre estos campos fueron constantes. En total, se recabaron 490 noticias, artículos de opinión, reportajes, etc., publicados en el periódico La Nación. Además, se consideraron los múltiples aportes hechos por los médicos y especialistas, tanto en dicho diario como en diferentes trabajos académicos y en publicaciones institucionales (son alrededor de 38 textos más, entre libros, ensayos, informes, etc.). En el capítulo IV, se analizan los textos literarios sobre el VIH/sida que surgieron, entre los años ochenta y los noventa, en Costa Rica: el libro Tiempos del SIDA: Relatos de la vida real (1989), de Myriam Francis; la novela Paisaje con tumbas pintadas en rosa (1998), de José Ricardo Chaves; y los cuentos de Alfonso Chase, “Antes y ahora” y “Carpe Diem”, publicados en el libro Cara de santo, uñas de gato (1999).
Keystone mutualisms, such as corals, lichens or mycorrhizae, sustain fundamental ecosystem functions. Range dynamics of these symbioses are, however, inherently difficult to predict because host species may switch between different symbiont partners in different environments, thereby altering the range of the mutualism as a functional unit. Biogeographic models of mutualisms thus have to consider both the ecological amplitudes of various symbiont partners and the abiotic conditions that trigger symbiont replacement. To address this challenge, we here investigate 'symbiont turnover zones'--defined as demarcated regions where symbiont replacement is most likely to occur, as indicated by overlapping abundances of symbiont ecotypes. Mapping the distribution of algal symbionts from two species of lichen-forming fungi along four independent altitudinal gradients, we detected an abrupt and consistent β-diversity turnover suggesting parallel niche partitioning. Modelling contrasting environmental response functions obtained from latitudinal distributions of algal ecotypes consistently predicted a confined altitudinal turnover zone. In all gradients this symbiont turnover zone is characterized by approximately 12°C average annual temperature and approximately 5°C mean temperature of the coldest quarter, marking the transition from Mediterranean to cool temperate bioregions. Integrating the conditions of symbiont turnover into biogeographic models of mutualisms is an important step towards a comprehensive understanding of biodiversity dynamics under ongoing environmental change.
Introduction
(2020)
Ferric carboxymaltose (FCM) has been shown to achieve rapid replenishment of iron stores and correction of anaemia in various populations with iron deficiency. A decrease in serum phosphate (PO43−) levels, which in most cases is asymptomatic, has been reported with IV iron preparations. Hypophosphataemia (HP) is a known adverse drug reaction with FCM. This post hoc pooled analysis investigates the frequency, duration, risk factors, and clinical signs of HP as reported in interventional clinical trials with FCM. Pooled data from subjects enrolled across 45 clinical trials in different therapy areas were included. A three-step adjudication process was utilised to identify adverse events of HP. Stratified analyses by therapy group and stepwise logistic regression analysis were used to identify predictors of HP. This pooled analysis confirms that FCM is associated with increased rates of serum PO43− lowering, but mean serum PO43− values were seen to recover at Week 4 and further recover at Week 8. Among all subjects receiving FCM therapy (n = 6879), 41.4% (n = 2847) reached a PO43− nadir value <2.5 mg/dL at any point on study and 0.7% (n = 49) reached a nadir <1 mg/dL. Although gastroenterology and women’s health subjects were identified to be at higher risk, occurrence of severe HP (<1 mg/dL [0.3 mmol/L]) following FCM administration was not observed to be common among subjects in these studies. Furthermore, there was no correlation between laboratory serum PO43− values and the occurrence of reported adverse events related to low PO43− levels.
We estimate the temperature dependence of the bulk viscosity in a relativistic hadron gas. Employing the Green–Kubo formalism in the SMASH (Simulating Many Accelerated Strongly-interacting Hadrons) transport approach, we study different hadronic systems in increasing order of complexity. We analyze the (in)validity of the single exponential relaxation ansatz for the bulk-channel correlation function and the strong influence of the resonances and their lifetimes. We discuss the difference between the inclusive bulk viscosity of an equilibrated, long-lived system, and the effective bulk viscosity of a short-lived mixture like the hadronic phase of relativistic heavy-ion collisions, where the processes whose inverse relaxation rate are larger than the fireball duration are excluded from the analysis. This clarifies the differences between previous approaches which computed the bulk viscosity including/excluding the very slow processes in the hadron gas. We compare our final results with previous hadron gas calculations and confirm a decreasing trend of the inclusive bulk viscosity over entropy density as temperature increases, whereas the effective bulk viscosity to entropy ratio, while being lower than the inclusive one, shows no strong dependence to temperature.
Objectives: To assess tolerability and efficacy of lacosamide in adults with cerebrovascular epilepsy etiology (CVEE).
Materials and methods: Exploratory post hoc analyses of a double‐blind, initial monotherapy trial of lacosamide vs carbamazepine‐controlled release (carbamazepine‐CR) (SP0993; NCT01243177); a double‐blind conversion to lacosamide monotherapy trial (SP0902; NCT00520741); and an observational study of adjunctive lacosamide added to one antiepileptic drug (SP0973 VITOBA; NCT01098162). Patients with CVEE were identified based on epilepsy etiology recorded at baseline.
Results: In the initial monotherapy trial, 61 patients had CVEE (lacosamide: 27; carbamazepine‐CR: 34). 20 (74.1%) patients on lacosamide (27 [79.4%] on carbamazepine‐CR) reported treatment‐emergent adverse events (TEAEs), most commonly (≥10%) headache, dizziness, and fatigue (carbamazepine‐CR: headache, dizziness). A numerically higher proportion of patients on lacosamide than carbamazepine‐CR completed 6 months (22 [81.5%]; 20 [58.8%]) and 12 months (18 [66.7%]; 17 [50.0%]) treatment without seizure at last evaluated dose. In the conversion to monotherapy trial, 26/30 (86.7%) patients with CVEE reported TEAEs, most commonly (≥4 patients) dizziness, convulsion, fatigue, headache, somnolence, and cognitive disorder. During lacosamide monotherapy, 17 (56.7%) patients were 50% responders and six (20.0%) were seizure‐free. In the observational study, 36/83 (43.4%) patients with CVEE reported TEAEs, most commonly (≥5%) fatigue and dizziness. Effectiveness was assessed for 75 patients. During the last 3 months, 60 (80%) were 50% responders and 42 (56.0%) were seizure‐free.
Conclusions: These exploratory post hoc analyses suggested lacosamide was generally well tolerated and effective in patients with CVEE, with data from the initial monotherapy trial suggesting numerically better efficacy than carbamazepine‐CR.
Introduction: Cancer patients tend to prefer oral instead of parenteral chemotherapy. To date, there is little evidence on the medication adherence in cancer patients. We investigated medication adherence to tyrosine kinase inhibitors in patients suffering from non-small cell lung cancer. Methods: Tyrosine kinase inhibitor adherence was measured electronically by MEMS® (medication event monitoring system) over at least six months. Adherence rates were calculated in terms of Dosing Compliance, Timing Compliance, Taking Compliance, and Drug Holidays. Patients were dichotomized as adherent when Dosing Compliance and Timing Compliance were ≥80%, Taking Compliance ranged between 90 and 110%, and <1 Drug Holiday was registered. Quality of life was assessed by two questionnaires (EORTC QLQ-C30 version 3.0, EORTC QLQ-LC13) at three time points. Adverse drug events were reported via patient diaries. Results: Out of 32 patients enrolled, data from 23 patients were evaluable. Median Dosing Compliance, Taking Compliance, and Timing Compliance adherence rates of tyrosine kinase inhibitor intake amounted to 100%, 98%, and 99%, respectively; Drug Holidays were observed in three patients. Four patients were dichotomized as non-adherent. Three of them had a twice-daily tyrosine kinase inhibitor regimen. Median quality of life scores amounted to 67 (max. 100) and remained unchanged over the study period. Fatigue and rash were the most frequently reported adverse drug events. Conclusion: Medication adherence of non-small cell lung cancer patients treated with tyrosine kinase inhibitors was extraordinarily high and is likely to support the effectiveness of tyrosine kinase inhibitor treatment and a good quality of life over a long period of time. Adherence facilitating information and education is especially relevant for patients taking tyrosine kinase inhibitors in a twice-daily regimen.
Background: Despite a large body of evidence demonstrating the effectiveness of psychotherapy for posttraumatic stress for children and adolescents, the adoption of empirically supported treatments (ESTs) in routine care is low.
Objective: This implementation study aims to evaluate the dissemination of Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for children and adolescents with posttraumatic stress symptoms (PTSS) after child abuse and neglect (CAN) with a focus on supervision.
Method: In a cluster-randomized controlled trial, the study will evaluate the implementation of TF-CBT focussing on the training of therapists including the provision of supervision. The effectiveness of specialized trauma-focused supervision will be compared to supervision as usual with respect to the successful implementation of TF-CBT for youths with PTSS administered by psychotherapists with different levels of professional experience. The primary outcome is whether the patient receives a treatment with sufficient adherence to the TF-CBT manual. The unit of randomization will be the therapists. The main outcome will be analysed using multilevel logistic regressions. Secondary outcomes will concern further patient-related (reduction of PTSS and depressive symptoms) and therapist-related (professional quality of life) variables. Additional exploratory analyses are planned.
Discussion: Since the trial is designed as an implementation study, it permits naturalistic referrals to the participating therapists by patients, caregivers, child and youth welfare agencies and paediatricians. The strict primary outcome will help evaluating the role of model-based supervision in the implementation process. The explorative outcomes will evaluate whether implementation success translates into better patient outcomes. We expect that the dissemination measures will lead to a successful implementation of TF-CBT and promote sustainable structures in routine care that will remain in place after study completion and offer access to ESTs for future children and youths with a history of CAN.
This essay argues for the philosophical standing of Walter Benjamin’s early work and posits a deeper continuity between this early work as a philosopher and the subsequent development of his work as a writer. When these fragments are read in proper relation to each other, they reveal for the first time many of the key innovations of Benjamin as a philosopher, as well as his points of influence on Horkheimer and Adorno. His early ‘Program’ critiques the Enlightenment conception of experience as a means for gaining empirical knowledge, and announces the need for a new concept of experience. Benjamin follows through on this program with a method of philosophical enquiry that is by turns fragmentary and constellational, developing a series of provisional notions of experience, which form a constellation with one another: perception, mimesis, language as a medium of experience, observation and memory.
The teaching of professional roles in medical education is an interdisciplinary concern. However, surgeons require specific standards of professionalism for certain context-based situations. In addition to communication, studies require collaboration, leadership, error-/conflict-management, patient-safety and decision-making as essential competencies for surgeons. Standards for corresponding competencies are defined in special chapters of the German National Competency-based Learning Objectives for Undergraduate Medical Education (NKLM; chapter 8, 10). The current study asks whether these chapters are adequately taught in surgical curricula. Eight German faculties contributed to analysing mapping data considering surgical courses of undergraduate programs. All faculties used the MERlin mapping platform and agreed on procedures for data collection and processing. Sub-competency and objective coverage, as well as the achievement of the competency level were mapped. Overall counts of explicit citations were used for analysis. Collaboration within the medical team is a strongly represented topic. In contrast, interprofessional cooperation, particularly in healthcare sector issues is less represented. Patient safety and dealing with errors and complications is most emphasized for the Manager/Leader, while time management, career planning and leadership are not addressed. Overall, the involvement of surgery in teaching the competencies of the Collaborator and Manager/Leader is currently low. However, there are indications of a curricular development towards explicit teaching of these roles in surgery. Moreover, implicitly taught roles are numerous, which indicates a beginning awareness of professional roles.
The nucleoside analogue nelarabine, the prodrug of arabinosylguanine (AraG), is effective against T-cell acute lymphoblastic leukaemia (T-ALL) but not against B-cell ALL (B-ALL). The underlying mechanisms have remained elusive. Here, data from pharmacogenomics studies and a panel of ALL cell lines reveal an inverse correlation between nelarabine sensitivity and the expression of SAMHD1, which can hydrolyse and inactivate triphosphorylated nucleoside analogues. Lower SAMHD1 abundance is detected in T-ALL than in B-ALL in cell lines and patient-derived leukaemic blasts. Mechanistically, T-ALL cells display increased SAMHD1 promoter methylation without increased global DNA methylation. SAMHD1 depletion sensitises B-ALL cells to AraG, while ectopic SAMHD1 expression in SAMHD1-null T-ALL cells induces AraG resistance. SAMHD1 has a larger impact on nelarabine/AraG than on cytarabine in ALL cells. Opposite effects are observed in acute myeloid leukaemia cells, indicating entity-specific differences. In conclusion, SAMHD1 promoter methylation and, in turn, SAMHD1 expression levels determine ALL cell response to nelarabine.
OTC discount
(2020)
We document a sizable OTC discount in the interdealer market for German sovereign bonds where exchange and over-the-counter trading coexist: the vastmajority of OTC prices are favorable with respect to exchange quotes. This is a challenge for theories of OTC markets centered around search frictions but consistent with models of hybrid markets based on information frictions. We show empiricallythat proxies for both frictions determine variation in the discount, which is largely passed on to customers. Dealers trade on the exchange for immediacy and via brokers for opacity and anonymity, highlighting the complementary roles played by the di↵erent protocols.
Mobilität ist eine wesentliche Voraussetzung für soziale Teilhabe. Jedoch ist Mobilität mit Kosten verbunden, sodass die soziale Teilhabe bei geringen finanziellen Mitteln gefährdet sein kann. Das Projekt Social2Mobility begegnet dieser Problematik, indem es das Ziel verfolgt, die soziale Teilhabe von Menschen, die von finanzieller Armut betroffen oder bedroht sind, durch Stärkung ihrer Mobilität zu steigern. Um dieses Ziel zu erreichen, soll im Rahmen des Projektes in der Region Hannover ein Reallabor eingerichtet werden. Das Arbeitspapier begleitet dessen Konzeption und geht der Frage nach, inwiefern in der Region Hannover ein Reallabor zum Thema mobilitätsbezogene soziale Exklusion eingerichtet werden kann. So werden in diesem Arbeitspapier die konzeptionellen Überlegungen zur räumlichen Verortung, zur Zielgruppenauswahl und zu möglichen Themen für das Reallabor dargestellt. Zudem werden die Spezifizierung auf die Zielgruppen Haushalte mit Kindern und ältere Menschen (ab 60 Jahren) sowie die Auswahl der Kommune Ronnenberg als Verortung für das Reallabor begründet.
Dieser Beitrag reflektiert und ergänzt die aktuelle Diskussion über die Empfehlungen des Wissenschaftsrats zur Weiterentwicklung der Friedens- und Konfliktforschung. Wir richten dabei den Blick auf die vom Wissenschaftsrat attestierten Schwachstellen im Bereich empirisch-analytischer Methoden und erläutern ihre Auswirkungen auf Interdisziplinarität, Internationalität und Politikberatung der deutschen Friedens- und Konfliktforschung. Wir argumentieren, unter Verweis auf den Bericht des Wissenschaftsrats, dass eine breitere Methodenausbildung und -kenntnis von großer Bedeutung für interdisziplinäre und internationale Zusammenarbeit, aber auch für die Politikberatung ist. Zukünftige Initiativen innerhalb der Friedens- und Konfliktforschung sollten die Methodenvielfalt des Forschungsbereichs angemessen berücksichtigen und einen besonderen Fokus auf die Ausbildung im Bereich empirisch-analytischer Methoden legen, um das Forschungsfeld in diesem Bereich zu stärken. Unser Beitrag entspringt einer Diskussion innerhalb des Arbeitskreises „Empirische Methoden der Friedens- und Konfliktforschung“ der Arbeitsgemeinschaft Friedens- und Konfliktforschung.
Differentialdiagnostik der frühen primären Myelofibrose (präPMF) gemäß der neuen WHO-Klassifikation
(2020)
Die vorliegende Arbeit stützt sich auf die retrospektive Begutachtung von 348 Knochenmarkbiopsien, welche anhand der WHO-Klassifikation von 2016 erneut reevaluiert wurden. Insbesondere widmeten wir uns der Differentialdiagnostik der „echten ET“ und der thrombozythämisch verlaufenden Form der PMF (präPMF). Die Einteilung erfolgte anhand morphologischer Kriterien, wie sie in der WHO-Klassifikation von 2016 aufgeführt sind.
Zusammengefasst ist eine richtungsweisende diagnostische Entscheidung der Patienten mit ET und präPMF nur möglich, wenn man sowohl die molekulargenetischen und klinischen Parameter in Kombination mit histologischen Kriterien und deren charakteristischen Mustern betrachtet. Eine repräsentative Knochenmarkbiopsie und deren standardisierte Befundung ist daher von absoluter diagnostischer Wichtigkeit für die Subtypisierung der MPN. Augenmerk sollte auf das typisch dargebotene morphologische Muster gelegt werden und nicht auf einzelne Merkmale. Die vorliegende Knochenmarkbiopsie muss nicht, wie früher praktiziert, anhand vieler einzelner Merkmale detailliert betrachtet und bewertet werden. Durch eine kombinierte Betrachtung von nur wenigen morphologischen Schlüsselparametern ist bereits eine Diagnose mit hoher Reproduzierbarkeit möglich. Mit dieser Arbeit wird der Stellenwert der WHO-Klassifikation unterstrichten, da die hier vorgegebenen Kriterien absolut essentiell und trotzdem in ihrem Umfang ausreichend sind, um die Differentialdiagnostik der MPN in Zukunft zu verbessern.
For private investors it is imperative to a) understand and define their own, individual risk preferences, b) assess their financial and demographic circumstances to determine the individual risk-taking potential, and c) form and maintain a well-diversified risky portfolio. The three chapters of my thesis each match one of these three tasks. \\ \noindent The first chapter of my thesis presents novel experimental evidence to test the existence of a potential projection bias in loss aversion, a significant determinant of investor preferences, thus matching task a). The second chapter is devoted to the determination of private investors' risk-taking potential based on their financial and socio-demographic circumstances, matching task b): In a large portfolio experiment, we examine the ability and heterogeneity of lay and professional advisors in matching investor demographics, such as age and income, with risky asset portfolio shares. The third and final chapter addresses the question on how to reach and maintain an efficient risky portfolio, therefore matching task c): It analyzes a decision support system for private investors that allows its users to simulate any arbitrary set of securities, and by reporting aggregated expected return and risk, to optimize their current portfolio.
Although the therapeutic armamentarium for bladder cancer has considerably widened in the last few years, severe side effects and the development of resistance hamper long-term treatment success. Thus, patients turn to natural plant products as alternative or complementary therapeutic options. One of these is curcumin, the principal component of Curcuma longa that has shown chemopreventive effects in experimental cancer models. Clinical and preclinical studies point to its role as a chemosensitizer, and it has been shown to protect organs from toxicity induced by chemotherapy. These properties indicate that curcumin could hold promise as a candidate for additive cancer treatment. This review evaluates the relevance of curcumin as an integral part of therapy for bladder cancer.
Recent documentation shows that a curcumin-induced growth arrest of renal cell carcinoma (RCC) cells can be amplified by visible light. This study was designed to investigate whether this strategy may also contribute to blocking metastatic progression of RCC. Low dosed curcumin (0.2 µg/mL; 0.54 µM) was applied to A498, Caki1, or KTCTL-26 cells for 1 h, followed by exposure to visible light for 5 min (400–550 nm, 5500 lx). Adhesion to human vascular endothelial cells or immobilized collagen was then evaluated. The influence of curcumin on chemotaxis and migration was also investigated, as well as curcumin induced alterations of α and β integrin expression. Curcumin without light exposure or light exposure without curcumin induced no alterations, whereas curcumin plus light significantly inhibited RCC adhesion, migration, and chemotaxis. This was associated with a distinct reduction of α3, α5, β1, and β3 integrins in all cell lines. Separate blocking of each of these integrin subtypes led to significant modification of tumor cell adhesion and chemotactic behavior. Combining low dosed curcumin with light considerably suppressed RCC binding activity and chemotactic movement and was associated with lowered integrin α and β subtypes. Therefore, curcumin combined with visible light holds promise for inhibiting metastatic processes in RCC.
Prostate cancer patients whose tumors develop resistance to conventional treatment often turn to natural, plant-derived products, one of which is sulforaphane (SFN). This study was designed to determine whether anti-tumor properties of SFN, identified in other tumor entities, are also evident in cultivated DU145 and PC3 prostate cancer cells. The cells were incubated with SFN (1–20 µM) and tumor cell growth and proliferative activity were evaluated. Having found a considerable anti-growth, anti-proliferative, and anti-clonogenic influence of SFN on both prostate cancer cell lines, further investigation into possible mechanisms of action were performed by evaluating the cell cycle phases and cell-cycle-regulating proteins. SFN induced a cell cycle arrest at the S- and G2/M-phase in both DU145 and PC3 cells. Elevation of histone H3 and H4 acetylation was also evident in both cell lines following SFN exposure. However, alterations occurring in the Cdk-cyclin axis, modification of the p19 and p27 proteins and changes in CD44v4, v5, and v7 expression because of SFN exposure differed in the two cell lines. SFN, therefore, does exert anti-tumor properties on these two prostate cancer cell lines by histone acetylation and altering the intracellular signaling cascade, but not through the same molecular mechanisms.
A novel, broad-acting peptide inhibitor of double-stranded DNA virus gene expression and replication
(2020)
Viral infections are a global disease burden with only a limited number of antiviral agents available. Due to newly emerging viral pathogens and increasing occurrence of drug resistance, there is a continuous need for additional therapeutic options, preferably with extended target range. In the present study, we describe a novel antiviral peptide with broad activity against several double-stranded DNA viruses. The 22-mer peptide TAT-I24 potently neutralized viruses such as herpes simplex viruses, adenovirus type 5, cytomegalovirus, vaccinia virus, and simian virus 40 in cell culture models, while being less active against RNA viruses. The peptide TAT-I24 therefore represents a novel and promising drug candidate for use against double-stranded DNA viruses.
In the current dismal situation of the COVID-19 pandemic, effective management of patients with pneumonia and acute respiratory distress syndrome is of vital importance. Due to the current lack of effective pharmacological concepts, this situation has caused interest in (re)considering historical reports on the treatment of patients with low-dose radiation therapy for pneumonia. Although these historical reports are of low-level evidence per se, hampering recommendations for decision-making in the clinical setting, they indicate effectiveness in the dose range between 0.3 and 1 Gy, similar to more recent dose concepts in the treatment of acute and chronic inflammatory/degenerative benign diseases with, e.g., a single dose per fraction of 0.5 Gy. This concise review aims to critically review the evidence for low-dose radiation treatment of COVID-19 pneumopathy and discuss whether it is worth investigating in the present clinical situation.
Since type and duration of an appropriate adjuvant chemotherapy in early-stage ovarian cancer (OC) are still being debated, novel markers for a better stratification of these patients are of utmost importance for the design of an improved chemotherapeutical strategy. In contrast to numerous cancer studies on cellular proliferation based on the immunohistochemistry-driven evaluation of protein expression, we compared mRNA and protein expression of two independent markers of cellular proliferation, Ki-67 and Plk1, in a large cohort of 243 early-stage OC and their relationship with clinicopathological features and survival. Based on marker expression we demonstrate that early-stage OC patients (stages I/II, low-grade, serous) with high expression (Ki-67, Plk1) had a significantly shorter progression-free survival (PFS) and overall survival (OS) compared to patients with low expression (Ki-67, Plk1). Remarkably, based on mRNA expression this significant difference got lost in advanced stages (III/IV): At least for PFS, high levels of Ki-67 and Plk1 correlate with moderately better survival compared to patients with low expressing tumors. Our data suggest that in addition to Ki-67, Plk1 is a novel marker for the stratification of early-stage OC patients to maximize therapeutic efforts. Both, Ki-67 and Plk1, seem to be better suited in early-stages (I/II) as therapeutical targets compared to advanced-stages (III/IV) OC.
The innate immune system is the first line of host defense that senses invading pathogens by various surveillance mechanisms, involving pattern recognition receptors (PRRs) such as Toll-like receptors (TLRs). Furthermore, in response to stress, tissue injury or ischemia, cells release endogenous danger-associated molecular patterns (DAMPs) which activate PRRs in order to prompt an effective immune response. Activation of PRRs by DAMPs initiates signaling transduction pathways which drive sterile inflammation by the production of pro-inflammatory effector molecules. Biglycan, a class I small leucine-rich proteoglycan (SLRP), is proteolytically released from the extracellular matrix (ECM) in response to tissue stress and injury or de novo synthesized by activated macrophages. In its soluble form, biglycan operates as an ECM-derived DAMP and triggers a potent inflammatory response by engaging TLR2 and TLR4 on immune cells. By selective utilization of TLR2/4 and the TLR adaptor molecules adaptor molecule myeloid differentiation primary response gene 88 (MyD88) or TIR domain-containing adaptor-inducing interferon-β (TRIF) biglycan differentially regulates the production of TLR downstream mediators or inflammatory molecules. In this way, biglycan triggers the activation of mitogen-activated protein kinase (MAPK) p38, extracellular signal-regulated kinase (Erk) and nuclear factor kappa-light-chain enhancer of activated B cells (NF-κB) in a primarily MyD88-dependent manner. In contrast, biglycan induces the expression of (C–C motif) ligand (CCL)5 and chemokine (C-X-C motif) ligand (CXCL)10 over TLR4/TRIF, heat shock protein 70 (HSP70) production over TLR2 and the synthesis of tumor necrosis factor (TNF)-α, CCL2 and CCL20 by utilizing TLR2/4/MyD88. As a consequence, biglycan promotes the recruitment of immune cells such as neutrophils, T cells, B cells and macrophages into the inflamed tissue. Research over the past years showed that biglycan-induced inflammation is involved in the pathogenesis of various inflammatory diseases such as lupus nephritis (LN), sepsis and renal ischemia/reperfusion injury (IRI), whereby genetic deletion of biglycan or TLR2/4 alleviated disease outcome. Unfortunately, the selective interaction of biglycan to TLRs and TLR adaptors complicates the identification of an efficient pharmacological target in biglycan-mediated inflammation. Yet, the necessity of possible co-receptors in biglycan signaling such as cluster of differentiation 14 (CD14) which was found in a high molecular complex with biglycan was not addressed so far.
In the first part of the present study, by utilizing primary peritoneal murine macrophages we demonstrated that the biglycan-induced expression and synthesis of TNF-α and CCL2 via TLR2/4/MyD88, CCL5 through TLR4/TRIF and HSP70 over TLR2 is blunted in CD14 deficient mice, proving that CD14 is essential in TLR2- and TLR4-mediated biglycan signaling. Pre-incubation of macrophages with an anti-CD14 antibody significantly reduced the protein levels of TNF-α, CCL2, CCL5 and HSP70. In line with these data, pharmacological inhibition of CD14 alleviated the transcriptional activation of NF-κB by biglycan in HEK-Blue cells expressing hTLR2/CD14 as well as hTLR4/CD14/MD2 supporting CD14-dependency for biglycan/TLR2/4 signaling. Western blot analysis of phosphorylated p38, p44/42 and NF-κB in WT and CD14 deficient mice revealed that activation of biglycan-mediated TLR downstream signaling is CD14-dependent. Accordingly, biglycan-induced activation and nuclear translocation of p38, p44/42 and NF-κB was blocked in Cd14-/- mice as analyzed by confocal microscopy. Co-immunoprecipitation studies combined with microscale thermophoresis analysis showed that biglycan is in complex with CD14 in macrophages and in vitro binds directly with high affinity to CD14, thereby sustaining the concept that CD14 is a novel co-receptor in biglycan-mediated inflammation. Additionally, we provided proof-of-principle of our concept in an in vivo mouse model of renal IRI. Transient overexpression of biglycan in WT mice exacerbated the expression and production of TNF-α, CCL2, CCL5 and HSP70 in a CD14-dependent manner. Interestingly, pLIVE or pLIVE-hBGN-injected Cd14-/- mice displayed lower chemo- and cytokine levels in reperfused kidneys as compared to respective WT controls during renal IRI (30 h), indicating a renoprotective effect by CD14 deficiency. Flow cytometry analysis of kidney homogenates underlined the pivotal effect of CD14 in biglycan signaling as biglycan-mediated infiltration of CD11b- and F4/80-positive renal macrophages was abolished in Cd14-/- mice. Additionally, pLIVE or pLIVE-hBGN-injected CD14 deficient mice displayed lower numbers of renal CD11b- and F4/80-positive cells during renal IRI compared to WT mice. Analysis of F4/80- and CD38-positive cells isolated from mononuclear cell extracts from kidney homogenates of pLIVE or pLIVE-hBGN-injected WT and Cd14-/- mice revealed that biglycan triggers the polarization of pro-inflammatory M1 macrophages in a CD14-dependent manner. In line with this, Cd14-/- mice, either injected with pLIVE or pLIVE-hBGN, showed less F4/80- and CD38-positive cells during renal IRI than the respective WT control. As a corroboration of our data PAS-stained renal sections of pLIVE- or pLIVE-hBGN-injected WT or Cd14-/- mice uncovered that biglycan worsens tubular damage in IRI-subjected mice via CD14. At the same time, tubular damage was significantly reduced in IRI-subjected Cd14-/- mice as compared to WT mice. In correlation with these data, serum creatine levels were increased in pLIVE-hBGN-injected WT mice during renal IRI. In contrast, serum creatine levels were significantly less increased in pLIVE- or pLIVE-hBGN-injected Cd14-/- mice than in WT littermate controls. In conclusion we demonstrated that CD14 is a new high affinity ligand for biglycan-mediated pro-inflammatory signaling over TLR2 and TLR4 in macrophages. In vivo, soluble biglycan triggers the expression of various inflammatory mediators by utilizing the co-receptor CD14. Ablation of CD14 abolishes biglycan-induced renal macrophage infiltration and M1 macrophage polarization as well as overall kidney function by reduced tubular damage and serum creatinine levels. Therefore, this study identifies CD14 as a promising therapeutic target to ameliorate biglycan-induced inflammation.
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Ubiquitination is regarded as one of the key post-translational modifications in nearly all biological processes, endowed with numerous layers of complexity. Deubiquitinating enzymes (DUBs) dynamically counterbalance ubiquitination events by deconjugating ubiquitin signals from substrates. Dysregulation of the ubiquitin code and its negative regulators drive various pathologies, such as neurological disorders and cancer.
The DUB ubiquitin-specific peptidase 22 (USP22) is well-known for its essential role in the human Spt-Ada-Gcn5 acetyltransferase (SAGA) complex, mediating the removal of monoubiquitination events from Histone 2A and 2B (H2A and -B), thereby regulating gene transcription. In cancer, USP22 was initially described as a part of an 11-gene expression signature profile, predicting tumor metastasis, reoccurrence and death after therapy in a wide range of tumor cells. However, novel roles for USP22 have emerged recently, accrediting USP22 essential roles in regulating tumor development as well as apoptotic cell death signaling.
One of the hallmarks of cancer is the evasion of cell death, especially apoptosis, a form of programmed cell death (PCD). Necroptosis, a regulated form of necrosis, is regarded as an attractive therapeutic strategy to overcome apoptosis-resistance in tumor cells, although a profound understanding of the exact signaling cascade still remains elusive. Nevertheless, several ubiquitination and deubiquitination events are described in fine-tuning necroptotic signaling.
In this study, we describe a novel role for USP22 in regulating necroptotic cell death signaling in human tumor cell lines. USP22 depletion significantly delayed TNFa/Smac mimetic/zVAD.fmk (TBZ)-induced necroptosis, without affecting TNFa-induced nuclear factor-kappa B (NF-KB) signaling or TNFa-mediated extrinsic apoptosis. Intriguingly, re-expression of USP22 wildtype in the USP22 knockout background could re-sensitize HT-29 cells to TBZ-induced necroptosis, whereas re-constitution with the catalytic inactive mutant USP22 Cys185Ser did not rescue susceptibility to TBZ-induced necroptosis, confirming the USP22 DUB-function a pivotal role in regulating necroptotic cell death. USP22 depletion facilitated ubiquitination and unexpectedly also phosphorylation of Receptor-interacting protein kinase 3 (RIPK3) during necroptosis induction, as shown by Tandem Ubiquitin Binding Entities (TUBE) pulldowns and in vivo (de)ubiquitination immunoprecipitations. To substantiate our findings, we performed mass-spectrometric ubiquitin remnant profiling and identified the three novel USP22-regulated RIPK3 ubiquitination sites Lysine (K) 42, K351 and K518 upon TBZ-induced necroptosis. Further assessment of these ubiquitination sites unraveled, that mutation of K518 in RIPK3 reduced necroptosis-associated RIPK3 ubiquitination and additionally affected RIPK3 phosphorylation upon necroptosis induction. At the same time, genetic knock-in of RIPK3 K518R sensitizes tumor cells to TNFa-induced necroptotic cell death and amplified necrosome formation.
In summary we identified USP22 as a new regulator of TBZ-induced necroptosis in various human tumor cell lines and further unraveled the distinctive role of DUBs and (de)ubiquitination events in controlling programmed cell death signaling.
USP22 controls necroptosis by regulating receptor-interacting protein kinase 3 ubiquitination
(2020)
Dynamic control of ubiquitination by deubiquitinating enzymes is essential for almost all biological processes. Ubiquitin-specific peptidase 22 (USP22) is part of the SAGA complex and catalyzes the removal of mono-ubiquitination from histones H2A and H2B, thereby regulating gene transcription. However, novel roles for USP22 have emerged recently, such as tumor development and cell death. Apart from apoptosis, the relevance of USP22 in other programmed cell death pathways still remains unclear. Here, we describe a novel role for USP22 in controlling necroptotic cell death in human tumor cell lines. Loss of USP22 expression significantly delays TNFα/Smac mimetic/zVAD.fmk (TBZ)-induced necroptosis, without affecting TNFα-mediated NF-κB activation or extrinsic apoptosis. Ubiquitin remnant profiling identified receptor-interacting protein kinase 3 (RIPK3) lysines 42, 351, and 518 as novel, USP22-regulated ubiquitination sites during necroptosis. Importantly, mutation of RIPK3 K518 reduced necroptosis-associated RIPK3 ubiquitination and amplified necrosome formation and necroptotic cell death. In conclusion, we identify a novel role of USP22 in necroptosis and further elucidate the relevance of RIPK3 ubiquitination as crucial regulator of necroptotic cell death.
The p38α mitogen-activated protein kinase (MAPK) is activated through stress stimuli such as heat shock or hypoxia. In the nucleus, p38α modulates the activity of other kinases and transcription factors, a process that regulates the expression of specific target genes, most importantly pro-inflammatory cytokines. Dysregulation of p38α therefore plays a major role in the development of inflammatory diseases such as rheumatoid arthritis. Despite many years of intensive research, no p38 small-molecule inhibitors have been approved yet. Several inhibitor design strategies have been reported, leading to >100-fold selective compounds for α/β over the γ and δ isoforms. Achieving such a selectivity among the two structurally most related α and β isoforms, however, remains a challenging task. Targeting an inactive DFG-out conformation offers another strategy for the development of potent kinase inhibitors (type-II), exemplified by the BCR/ABL-inhibitor Imatinib. Achieving selectivity with type-II binders is challenging, because many kinases can adopt an inactive DFG-out conformation. This is exemplified by the p38 type-II inhibitor BIRB-796, which exhibits picomolar on-target affinity but only a poor kinome-wide selectivity. A potent and selective type-II chemical probe for p38α/β was still lacking at the start of this thesis.
The promising hit VPC-00628, was chosen for a combinatorial synthetic approach to develop a type-II chemical probe. The studies covered the optimization of the hinge-binding head group, the hydrophobic region I and the DFG-out deep pocket of the lead compound VPC-00628. Selectivity for the p38α and p38β isoforms was monitored during the optimization process, which identified several inhibitors with favorable isoform selectivity, providing valuable insights into the potential of isoform-selective inhibitor design for p38. A potent and highly selective p38 MAPK probe (SR-318) was discovered, which showed IC50 values in the low nanomolar range in HEK293T cells. An unusual P-loop conformation induced upon binding of SR-318 to p38α contributed most likely to the impressive selectivity profile within the kinome that surpassed both the parent compound and BIRB-796. A negative control compound, SR-321, was developed, to distinguish between on-target effects and non-specific effects due to cross-reactivity with other cellular proteins. Studies of the metabolic stability in human liver microsomes revealed a high stability of the compounds, with only a small amount of metabolites formed over several hours. Compound SR-318 also exhibited a good in vitro efficacy, quantitatively reducing the LPS-stimulated TNF-α release in whole blood. Taken together, SR-318 is a highly potent and selective type-II p38α/β chemical probe, which will help to gain a better understanding of the catalytic and non-catalytic functions of these key signaling kinases in physiology and pathology.
The next studies focused on the exploration of the highly dynamic allosteric back pocket of p38 MAPK, and allosteric BIRB-796 derived compounds for targeting the αC- and DFG-out pockets were synthesized. Kinase activities of allosteric pyrazole-urea fragments were analyzed against a comprehensive set of 47 diverse kinases by differential scanning fluorimetry (DSF), revealing that BIRB-796 off-targets remain a problem when targeting this back-pocket binding motif. Revisiting the recently published compound MCP-081, which combines the allosteric part of BIRB-796 with the active-site directed part of VPC-00628, showed that it displays a clean selectivity profile in our kinase panel. Because the potency of MCP-081 was slightly reduced compared with VPC-00628 and the allosteric tert-butyl pyrazole moiety seemed suboptimal, a set of VPC-00628 derivatives for targeting the αC-out pocket region was synthesized. Through structure-guided extension of the terminal amide of VPC-00628 toward this allosteric site, the potent and selective compound SR-43 was developed, which showed excellent cellular activity on p38 MAPK in NanoBRETTM assays (IC50 [p38α/β] = 14.0 ± 0.1/ 16.8 ± 0.1 nM). SR-43 showed a dose-dependent inhibition of activating phosphorylation of p38 in HCT-15 cells as well as inhibition of phosphorylation of p38 downstream substrates MK2 and Hsp27. In addition, SR-43 induced an anti-inflammatory response by blocking TNF-α release in whole blood and displayed a high metabolic stability. Selectivity profiling of SR-43 revealed a narrow selectivity for additional targets such as the discoidin domain receptor kinases (DDR1/2). DDR kinases play a central role in fibrotic disorders, such as renal and pulmonale fibrosis, atherosclerosis and different forms of cancer. Since selective and potent inhibitors for these important therapeutic targets are largely lacking and the existing inhibitors are of low scaffold diversity, the next study focused on the optimization of SR-43 toward DDR1/2 kinase inhibition. The synthetic work covered the optimization of the hinge-binding head group and the allosteric part of SR-43 toward DDR1/2 kinase inhibition. These studies provided novel insights into the P-loop folding process of p38 MAPK and how targeting of non-conserved amino acids affects inhibitor selectivity. Importantly, they led to the development of a selective dual DDR/p38 inhibitor probe, SR-302, with picomolar affinity for DDR2. SR-302 was efficient in vitro and showed a destabilizing effect on the surface adhesion protein E-cadherin in epithelial cells. In summary, SR-302 and its negative control SR-301 provide a valuable tool set for studying the phenotypic effects of DDR1/2 signaling, e.g., in cancer cell lines.
Relapsing fever (RF) is claimed a neglected arthropod-borne disease caused by a number of diverse human pathogenic Borrelia (B.) species. These RF borreliae are separated into the groups of tick-transmitted species including B. duttonii, B. hermsii, B. parkeri, B. turicatae, B. hispanica, B. persica, B. caucasica, and B. myiamotoi, and the louse-borne Borrelia species B. recurrentis. As typical blood-borne pathogens achieving high cell concentrations in human blood, RF borreliae (RFB) must outwit innate immunity, in particular complement as the first line of defense. One prominent strategy developed by RFB to evade innate immunity involves inactivation of complement by recruiting distinct complement regulatory proteins, e.g., C1 esterase inhibitor (C1-INH), C4b-binding protein (C4BP), factor H (FH), FH-like protein-1 (FHL-1), and factor H-related proteins FHR-1 and FHR-2, or binding of individual complement components and plasminogen, respectively. A number of multi-functional, complement and plasminogen-binding molecules from distinct Borrelia species have previously been identified and characterized, exhibiting considerable heterogeneity in their sequences, structures, gene localization, and their capacity to bind host-derived proteins. In addition, RFB possess a unique system of antigenic variation, allowing them to change the composition of surface-exposed variable major proteins, thus evading the acquired immune response of the human host. This review focuses on the current knowledge of the immune evasion strategies by RFB and highlights the role of complement-interfering and infection-associated molecules for the pathogenesis of RFB.
Markeninszenierung in Japan - zur narrativen Konstruktion der Lifestyle-Marken "Muji" und "Uniqlo"
(2020)
Die Einzelhandelsketten "Muji" und "Uniqlo" gelten als Musterbeispiele für international erfolgreiche Lifestyle-Marken aus Japan. Aus einer interdisziplinären Perspektive heraus identifiziert Christiane Rühle die Strukturen und Akteure dieser spezifischen Markeninszenierungen und arbeitet die dazugehörigen Positionen, Mittel und zentralen Motive heraus. Sie fragt im Kontext von unternehmensbezogener und nationalstaatlicher Imagebildung nach den Bezügen zwischen Konsum, Kultur und Identität und fokussiert dabei auf die Rolle, die privatwirtschaftliche Unternehmen innerhalb dieses Prozesses einnehmen.
Radiative transition of an excited baryon to a nucleon with emission of a virtual massive photon converting to dielectron pair (Dalitz decays) provides important information about baryon-photon coupling at low q2 in timelike region. A prominent enhancement in the respective electromagnetic transition Form Factors (etFF) at q2 near vector mesons ρ/ω poles has been predicted by various calculations reflecting strong baryon-vector meson couplings. The understanding of these couplings is also of primary importance for the interpretation of the emissivity of QCD matter studied in heavy ion collisions via dilepton emission. Dedicated measurements of baryon Dalitz decays in proton-proton and pion-proton scattering with HADES detector at GSI/FAIR are presented and discussed. The relevance of these studies for the interpretation of results obtained from heavy ion reactions is elucidated on the example of the HADES results.
Für ausgewählten Patienten mit Aortenklappeninsuffizienz (AI) bietet die Aortenklappenrekonstruktion eine sehr attraktive Alternative zum Klappenersatz, wodurch mögliche prothesenbezogene Komplikationen vermieden werden können.
Die begrenzte Zahl der Langzeitstudien sowie das Fehlen von standardisierten Verfahren machen die klappenerhaltende Aortenklappenchirurgie technisch anspruchsvoll.
Ziel dieser Arbeit ist es, die Langzeitergebnisse nach Aortenklappenrekonstruktion zu erfassen und die Haltbarkeit sowie die klappenbezogenen Komplikationen nach klappenerhaltender Aortenklappenchirurgie zu untersuchen.
Hierzu analysierten wir die klinischen Daten von 560 Patienten, die eine operative Versorgung mittels Aortenklappenrekonstruktion erhielten. Dabei wurden sowohl Segelpathologien (bikuspid sowie trikuspid) als auch Aortenwurzelpathologien berücksichtigt. Bei 56% der Patienten (n=313) wurde eine Reimplantation nach David durchgeführt. Bei 247 Patienten wurde bei isolierter Segelpathologie ohne Aortenwurzelbeteiligung eine Segelrekonstruktion durchgeführt. Pathologien der Aortenwurzel konnten mit subkommissuralen Nähten (bei 62 Patienten) oder mit Rekonstruktion des sinotubulären Übergangs (bei 60 Patienten) behoben werden. Begleitende Aorteneingriffe bei Aneurysma oder Dissektion der thorakalen Aorta wurden ebenfalls durchgeführt. So wurden bei 78 Patienten ein partieller Aortenbogenersatz, bei 12 Patienten ein kompletter Aortenbogenersatz und bei 14 Patienten ein Bogenersatz mit „Elephant Trunk“ Technik durchgeführt.
Die Nachuntersuchungen erfolgten anhand eines standardisierten Fragebogens 5 sowie durch transthorakal echokardiographische Verlaufskontrollen. Die durchschnittliche Nachuntersuchungszeit betrug 6.3 ± 4.6 Jahre, 97% der Patienten konnten dabei erfasst werden.
Die 30-Tage-Mortalität betrug 1,4%. Im Langzeitverlauf wurden 132 Verstorbene beobachtet, wobei 13 Patienten aufgrund eines kardiovaskulären Ereignisses verstarben. Das 10-Jahres-Überleben betrug 70%. Eine Reoperation war bei 39 Patienten notwendig, in 25 Fällen aufgrund von signifikanter Restinsuffizienz der Aortenklappe, in 5 Fällen aufgrund eines kombinierten Aortenklappenvitium. Endokarditis führte in 9 Fällen zur Reoperation (0,2% pro Patientenjahr). Die Freiheit von Reoperation betrug 88% nach 10 Jahren. Die klappenbezogenen Komplikationen ergaben eine kumulative linearisierte Inzidenz von 2% pro Patientenjahr.
Schlussfolgernd kann man sagen, dass die Aortenklappenrekonstruktion für ausgewählte Patienten eine gute Alternative zum Aortenklappenersatz darstellt. Die Haltbarkeit der Klappenfunktion erwies sich in der Langzeitbeobachtung als gut. Die adäquate Wahl der Operationstechnik bezogen auf die Pathologie führen zu guten Ergebnissen der Aortenklappenrekonstruktion mit akzeptabler Mortalität und Morbidität im Langzeitverlauf.
Background and Objectives: Delirium is a common and major complication subsequent to cardiac surgery. Despite scientific efforts, there are no parameters which reliably predict postoperative delirium. In delirium pathology, natriuretic peptides (NPs) interfere with the blood–brain barrier and thus promote delirium. Therefore, we aimed to assess whether NPs may predict postoperative delirium and long-term outcomes. Materials and Methods: To evaluate the predictive value of NPs for delirium we retrospectively analyzed data from a prospective, randomized study for serum levels of atrial natriuretic peptide (ANP) and the precursor of C-type natriuretic peptide (NT-proCNP) in patients undergoing coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (off-pump coronary bypass grafting; OPCAB). Delirium was assessed by a validated chart-based method. Long-term outcomes were assessed 10 years after surgery by a telephone interview. Results: The overall incidence of delirium in the total cohort was 48% regardless of the surgical approach (CABG vs. OPCAB). Serum ANP levels >64.6 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 100% (75.3–100) and specificity of 42.9% (17.7–71.1). Serum NT-proCNP levels >1.7 pg/mL predicted delirium with a sensitivity (95% confidence interval) of 92.3% (64.0–99.8) and specificity of 42.9% (17.7–71.1). Both NPs could not predict postoperative survival or long-term cognitive decline. Conclusions: We found a positive correlation between delirium and preoperative plasma levels of ANP and NT-proCNP. A well-powered and prospective study might identify NPs as biomarkers indicating the risk of delirium and postoperative cognitive decline in patients at risk for postoperative delirium.
Purpose: The primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis.
Methods: Between 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48–79). The mean follow-up was 27.7 months (range 8–50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score.
Results: Pain averaged 0.3 (range 0–4) at rest and 1.4 (range 0–4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3–6.5) and 22 kg (range 13.3–40), respectively. The DASH score accounted for 18.5 (range 0.8–41.7).
Conclusion: The modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.
We studied oscillatory mechanisms of memory formation in 48 younger and 51 older adults in an intentional associative memory task with cued recall. While older adults showed lower memory performance than young adults, we found subsequent memory effects (SME) in alpha/beta and theta frequency bands in both age groups. Using logistic mixed effects models, we investigated whether interindividual differences in structural integrity of key memory regions could account for interindividual differences in the strength of the SME. Structural integrity of inferior frontal gyrus (IFG) and hippocampus was reduced in older adults. SME in the alpha/beta band were modulated by the cortical thickness of IFG, in line with its hypothesized role for deep semantic elaboration. Importantly, this structure–function relationship did not differ by age group. However, older adults were more frequently represented among the participants with low cortical thickness and consequently weaker SME in the alpha band. Thus, our results suggest that differences in the structural integrity of the IFG contribute not only to interindividual, but also to age differences in memory formation.
Theoretical accounts agree that German restrictive relative clauses (RCs) are integrated at the level of syntax as well as at the level of prosody (; , ; ; ; ) in both the default verb-final and the marked verb-second variant (referred to as iV2). Both variants are assumed to show the same prosodic pattern, i. e., prosodic integration into the main clause, and not unintegrated prosody, which would signal a sequence of two main clauses. To date strong empirical evidence for this close correspondence between prosody and syntax in RCs is missing. Findings regarding prosodic integration of verb-final RCs are not consistent, and research regarding the prosody of iV2 structures is very scarce. Using a delayed sentence-repetition task, our study investigated whether subordination is signaled by prosody in RCs in both the verb-final and the V2 variant in adults (n = 21). In addition, we asked whether young language learners (n = 23), who at the age of 3 have just started to produce embedded clauses, are already sensitive to this mapping. The adult responses showed significantly more patterns of prosodic integration than of prosodic non-integration in the V-final and the iV2 structures, with no difference between the two conditions. Notably, the child responses mirrored this adult behavior, showing significantly more patterns of prosodic integration than of prosodic non-integration in both V-final and iV2 structures. The findings regarding adults’ prosodic realizations provide novel empirical evidence for the claim that iV2 structures, just like verb-final RCs, show prosodic integration. Moreover, our study strongly suggests that subordination is signaled by prosody already by age 3 in both verb-final and V2 variants of RCs.
Right-wing populist parties often resort to a xenophobic rhetoric which both exploits and fuels existing illiberal anti-immigrant sentiments. Since populist anti-immigrant sentiments are at odds with fundamental liberal values and challenge the implementation of any liberal ethics of migration, this essay argues that states should adopt civic education policies to counter such sentiments and persuade citizens to develop liberal attitudes towards immigrants. Empirical evidence suggests that sentiments may be malleable, and there are already examples of local governments devising or supporting initiatives aimed at dispelling prejudices and promoting positive interactions. It might be objected that a government’s involvement in shaping sentiments and opinions conflicts with liberal democratic states’ commitment to individual autonomy and electoral fairness. However, I argue that civic education policies are not necessarily incompatible with such values and I provide five criteria to identify policies that liberal democratic governments may legitimately adopt to counteract anti-immigrant sentiments.
Macrophage and tumor cell cross-talk is fundamental for lung tumor progression: we need to talk
(2020)
Regardless of the promising results of certain immune checkpoint blockers, current immunotherapeutics have met a bottleneck concerning response rate, toxicity, and resistance in lung cancer patients. Accumulating evidence forecasts that the crosstalk between tumor and immune cells takes center stage in cancer development by modulating tumor malignancy, immune cell infiltration, and immune evasion in the tumor microenvironment (TME). Cytokines and chemokines secreted by this crosstalk play a major role in cancer development, progression, and therapeutic management. An increased infiltration of Tumor-associated macrophages (TAMs) was observed in most of the human cancers, including lung cancer. In this review, we emphasize the role of cytokines and chemokines in TAM-tumor cell crosstalk in the lung TME. Given the role of cytokines and chemokines in immunomodulation, we propose that TAM-derived cytokines and chemokines govern the cancer-promoting immune responses in the TME and offer a new immunotherapeutic option for lung cancer treatment.
Tumor-associated macrophages (TAMs) influence lung tumor development by inducing immunosuppression. Transcriptome analysis of TAMs isolated from human lung tumor tissues revealed an up-regulation of the Wnt/β-catenin pathway. These findings were reproduced in a newly developed in vitro “trained” TAM model. Pharmacological and macrophage-specific genetic ablation of β-catenin reprogrammed M2-like TAMs to M1-like TAMs both in vitro and in various in vivo models, which was linked with the suppression of primary and metastatic lung tumor growth. An in-depth analysis of the underlying signaling events revealed that β-catenin–mediated transcriptional activation of FOS-like antigen 2 (FOSL2) and repression of the AT-rich interaction domain 5A (ARID5A) drive gene regulatory switch from M1-like TAMs to M2-like TAMs. Moreover, we found that high expressions of β-catenin and FOSL2 correlated with poor prognosis in patients with lung cancer. In conclusion, β-catenin drives a transcriptional switch in the lung tumor microenvironment, thereby promoting tumor progression and metastasis.
The production of light neutral mesons in AA collisions probes the physics of the Quark-Gluon Plasma (QGP), which is formed in heavy-ion collisions at the LHC. More specifically, the centrality dependent neutral meson spectra in AA collisions compared to its spectra in minimum-bias pp collisions, scaled with the number of hard collisions, provides information on the energy loss of partons traversing the QGP. The measurement allows to test with high precision the predictions of theoretical model calculations. In addition, the decay of the π0 and η mesons are the dominant back- grounds for all direct photon measurements. Therefore, pushing the limits of the precision of neutral meson production is key to learning about the temperature and space-time evolution of the QGP.
In the ALICE experiment neutral mesons can be detected via their decay into two photons. The latter can be reconstructed using the two calorimeters EMCal and PHOS or via conversions in the detector material. The excellent momentum resolution of the conversion photons down to very low pT and the high reconstruction efficiency and triggering capability of calorimeters at high pT, allow us to measure the pT dependent invariant yield of light neutral mesons over a wide kinematic range.
Combining state-of-the-art reconstruction techniques with the high statistics delivered by the LHC in Run 2 gives us the opportunity to enhance the precision of our measurements. In these proceedings, new ALICE run 2 preliminary results for neutral meson production in pp and Pb–Pb collisions at LHC energies are presented.
Background: The current COVID-19 pandemic has led to a surge of research activity. While this research provides important insights, the multitude of studies results in an increasing fragmentation of information. To ensure comparability across projects and institutions, standard datasets are needed. Here, we introduce the “German Corona Consensus Dataset” (GECCO), a uniform dataset that uses international terminologies and health IT standards to improve interoperability of COVID-19 data, in particular for university medicine.
Methods: Based on previous work (e.g., the ISARIC-WHO COVID-19 case report form) and in coordination with experts from university hospitals, professional associations and research initiatives, data elements relevant for COVID-19 research were collected, prioritized and consolidated into a compact core dataset. The dataset was mapped to international terminologies, and the Fast Healthcare Interoperability Resources (FHIR) standard was used to define interoperable, machine-readable data formats.
Results: A core dataset consisting of 81 data elements with 281 response options was defined, including information about, for example, demography, medical history, symptoms, therapy, medications or laboratory values of COVID-19 patients. Data elements and response options were mapped to SNOMED CT, LOINC, UCUM, ICD-10-GM and ATC, and FHIR profiles for interoperable data exchange were defined.
Conclusion: GECCO provides a compact, interoperable dataset that can help to make COVID-19 research data more comparable across studies and institutions. The dataset will be further refined in the future by adding domain-specific extension modules for more specialized use cases.
Background: The current COVID-19 pandemic has led to a surge of research activity. While this research provides important insights, the multitude of studies results in an increasing segmentation of information. To ensure comparability across projects and institutions, standard datasets are needed. Here, we introduce the “German Corona Consensus Dataset” (GECCO), a uniform dataset that uses international terminologies and health IT standards to improve interoperability of COVID-19 data.
Methods: Based on previous work (e.g., the ISARIC-WHO COVID-19 case report form) and in coordination with experts from university hospitals, professional associations and research initiatives, data elements relevant for COVID-19 research were collected, prioritized and consolidated into a compact core dataset. The dataset was mapped to international terminologies, and the Fast Healthcare Interoperability Resources (FHIR) standard was used to define interoperable, machine-readable data formats.
Results: A core dataset consisting of 81 data elements with 281 response options was defined, including information about, for example, demography, anamnesis, symptoms, therapy, medications or laboratory values of COVID-19 patients. Data elements and response options were mapped to SNOMED CT, LOINC, UCUM, ICD-10-GM and ATC, and FHIR profiles for interoperable data exchange were defined.
Conclusion: GECCO provides a compact, interoperable dataset that can help to make COVID-19 research data more comparable across studies and institutions. The dataset will be further refined in the future by adding domain-specific extension modules for more specialized use cases.
How is semantic information stored in the human mind and brain? Some philosophers and cognitive scientists argue for vectorial representations of concepts, where the meaning of a word is represented as its position in a high-dimensional neural state space. At the intersection of natural language processing and artificial intelligence, a class of very successful distributional word vector models has developed that can account for classic EEG findings of language, that is, the ease versus difficulty of integrating a word with its sentence context. However, models of semantics have to account not only for context-based word processing, but should also describe how word meaning is represented. Here, we investigate whether distributional vector representations of word meaning can model brain activity induced by words presented without context. Using EEG activity (event-related brain potentials) collected while participants in two experiments (English and German) read isolated words, we encoded and decoded word vectors taken from the family of prediction-based Word2vec algorithms. We found that, first, the position of a word in vector space allows the prediction of the pattern of corresponding neural activity over time, in particular during a time window of 300 to 500 ms after word onset. Second, distributional models perform better than a human-created taxonomic baseline model (WordNet), and this holds for several distinct vector-based models. Third, multiple latent semantic dimensions of word meaning can be decoded from brain activity. Combined, these results suggest that empiricist, prediction-based vectorial representations of meaning are a viable candidate for the representational architecture of human semantic knowledge.
Objective: To evaluate if 3 peptides derived from the cartilage oligomeric matrix protein (COMP), which wounded zones of cartilage secrete into synovial fluid, possess biological activity and might therefore be involved in the regulation of specific aspects of joint regeneration.
Methods: The 3 peptides were produced by chemical synthesis and then tested in vitro for known functions of the COMP C-terminal domain from which they derive, and which are involved in osteoarthritis: transforming growth factor-β (TGF-β) signaling, vascular homeostasis, and inflammation. Results. None of the peptides affected the gene expression of COMP in osteochondral progenitor cells (P > 0.05). We observed no effects on the vascularization potential of endothelial cells (P > 0.05). In cultured synovium explants, no differences on the expression of catabolic enzymes or proinflammatory cytokines were found when peptides were added (P > 0.05).
Discussion and conclusions: The 3 peptides tested do not regulate TGF-β signaling, angiogenesis and vascular tube formation, or synovial inflammation in vitro and therefore most likely do not play a major role in the disease process.
Background: Cognitive dysfunctions represent a core feature of schizophrenia and a predictor for clinical outcomes. One possible mechanism for cognitive impairments could involve an impairment in the experience-dependent modifications of cortical networks.
Methods: To address this issue, we employed magnetoencephalography (MEG) during a visual priming paradigm in a sample of chronic patients with schizophrenia (n = 14), and in a group of healthy controls (n = 14). We obtained MEG-recordings during the presentation of visual stimuli that were presented three times either consecutively or with intervening stimuli. MEG-data were analyzed for event-related fields as well as spectral power in the 1–200 Hz range to examine repetition suppression and repetition enhancement. We defined regions of interest in occipital and thalamic regions and obtained virtual-channel data.
Results: Behavioral priming did not differ between groups. However, patients with schizophrenia showed prominently reduced oscillatory response to novel stimuli in the gamma-frequency band as well as significantly reduced repetition suppression of gamma-band activity and reduced repetition enhancement of beta-band power in occipital cortex to both consecutive repetitions as well as repetitions with intervening stimuli. Moreover, schizophrenia patients were characterized by a significant deficit in suppression of the C1m component in occipital cortex and thalamus as well as of the late positive component (LPC) in occipital cortex.
Conclusions: These data provide novel evidence for impaired repetition suppression in cortical and subcortical circuits in schizophrenia. Although behavioral priming was preserved, patients with schizophrenia showed deficits in repetition suppression as well as repetition enhancement in thalamic and occipital regions, suggesting that experience-dependent modification of neural circuits is impaired in the disorder.
Das Leid der Frauen
(2020)
Die Erziehungswissenschaften sind eine Schlüsseldisziplin für die Zukunft unserer Gesellschaft; der Umgang der Menschen mit der Digitalisierung ist hier ein wichtiges Thema für Forschung und Lehre. An der Goethe-Universität kümmert sich eigens eine Arbeitsgruppe Medien darum, die unterschiedlichen Aktivitäten im Fachbereich und auch außerhalb zu begleiten und zu vernetzen.
Große Tasten, ein übersichtliches Display – die Hersteller von Mobiltelefonen haben sich geirrt, als sie spezielle Geräte für ältere Menschen entwickelten: Die Angebote sind gründlich gefloppt. Doch aus gerontologischer und erziehungswissenschaftlicher Sicht lohnt es sich durchaus, die besonderen Bedürfnisse von Seniorinnen und Senioren näher zu untersuchen. Nicht erst die Corona-Krise hat gezeigt, dass das Smartphone ein Schlüssel zu mehr Teilhabe und Lebensqualität sein kann. Dazu arbeitet Friedrich Wolf am Fachbereich Erziehungswissenschaften
Aus der Redaktion
(2020)
Since 2010, an intensified ambulatory cardiology care programme has been implemented in southern Germany. To improve patient management, the structure of cardiac disease management was improved, guideline-recommended care was supported, new ambulatory medical services and a morbidity-adapted reimbursement system were set up. Our aim was to determine the effects of this programme on the mortality and hospitalisation of enrolled patients with cardiac disorders. We conducted a comparative observational study in 2015 and 2016, based on insurance claims data. Overall, 13,404 enrolled patients with chronic heart failure (CHF) and 19,537 with coronary artery disease (CAD) were compared, respectively, to 8,776 and 16,696 patients that were receiving usual ambulatory cardiology care. Compared to the control group, patients enrolled in the programme had lower mortality (Hazard Ratio: 0.84; 95% CI: 0.77–0.91) and fewer all-cause hospitalisations (Rate Ratio: 0.94; 95% CI: 0.90–0.97). CHF-related hospitalisations in patients with CHF were also reduced (Rate Ratio: 0.76; 95% CI: 0.69–0.84). CAD patients showed a similar reduction in mortality rates (Hazard Ratio: 0.81; 95% CI: 0.76–0.88) and all-cause hospitalisation (Rate Ratio: 0.94; 95% CI: 0.91–0.97), but there was no effect on CAD-related hospitalisation. We conclude that intensified ambulatory care reduced mortality and hospitalisation in cardiology patients.
Das Staatsangehörigkeitsrecht verankert rechtlich Vorstellungen über Zugehörigkeit und bestimmt wer vollumfängliche Rechte in einer Gesellschaft hat und wer nicht. Jahrzehntelang wurde Migration in Deutschland als etwas temporäres betrachtet. Im Staatsangehörigkeitsrecht galt bis zur Reform 1999/2000 weitgehend das „ius sanguinis“, das Abstammungsrecht, das auf einem rassistischen und völkischen Staatsverständnis beruht. Diese Reform bedeutete somit mehr als eine reine Gesetzesänderung. Sie war eine Anerkennung Deutschlands als Einwanderungsland und die Veränderung der Vorstellung deutscher Identität. Als Reaktion entbrannte infolge der Reformpläne eine hitzige, rassistische Debatte in der Öffentlichkeit über ebendiese Fragen, die unter dem polarisierten Schlagwort „Doppelpass“ verhandelt wurde. Es war die lauteste migrationspolitische Debatte dieser Zeit.
Kurze Zeit vor Beginn dieser Debatte war die rechtsterroristische Gruppe „Nationalsozialistischer Untergrund“ (NSU) abgetaucht, um einem Haftbefehl zu entgehen. Der NSU war ein deutsches, neonazistisches Netzwerk, in dessen Mittelpunkt drei Terrorist*innen standen. Sie verübten über einen Zeitraum von zwölf Jahren eine rassistische Mordserie an neun Personen türkischer, kurdischer und griechischer Herkunft sowie drei Sprengstoffanschläge auf migrantische Orte und ermordeten eine Polizistin. Den ersten ihrer Sprengstoffanschläge begingen sie nur einen Monat nach der Unterzeichnung der Reform. Wenige Monate nach dem Inkrafttreten des Gesetzes begannen sie mit dem Anschlag auf Enver Şimşek ihre rassistische Mordserie.
Diese Arbeit untersucht anhand der Struktur der Historisch-Materialistischen Politikanalyse das Migrationsregime um die Staatsangehörigkeitsreform von 1999/2000 und wie der NSU darin verortet werden kann.
Die Kontextanalyse stellt auf der Grundlage einer Literaturrecherche die relevanten historischen und strukturellen Faktoren der Debatte sowie des NSU dar. Im nächsten Schritt werden mithilfe einer Analyse von Zeitungsartikel aus dieser Zeit die relevanten Akteur*innen identifiziert und in die vier Hegemonieprojekte neoliberal, sozial, linksliberal-alternativ und konservativ gruppiert. Darauffolgend wird der Ablauf der Debatte in vier Phasen darstellt und als Aushandlung der vier Hegemonieprojekte rekonstruiert. Dabei zeigt sich, dass kein Projekt sich vollumfänglich durchsetzen und Hegemonie erreichen konnte, sie jedoch unterschiedlich stark in den Medien repräsentiert wurden.
Im letzten Schritt betrachtet diese Arbeit Verbindungen dieser Migrationsregime-Analyse zum NSU. Sie kommt zu dem Ergebnis, dass der NSU kein Akteur im Migrationsregime um die Staatsangehörigkeitsdebatte von 1998/99 war. Aufgrund der geringen Erkenntnisse über spezifische Meinungen des NSU zum Staatsangehörigkeitsrecht, können keine kausalen Beziehungen hergestellt werden. Dennoch zeigt diese Arbeit Gemeinsamkeiten in den Weltbildern, Annahmen und migrationspolitischen Zielen des NSU, des konservativen Hegemonieprojektes sowie Teilen der Bevölkerung auf. Dadurch wird ein Beitrag dazu geleistet den NSU als Produkt und Teil der deutschen Gesellschaft zu begreifen.
Our knowledge of early evolution of snakes is improving, but all that we can infer about the evolution of modern clades of snakes such as boas (Booidea) is still based on isolated bones. Here, we resolve the phylogenetic relationships of Eoconstrictor fischeri comb. nov. and other booids from the early-middle Eocene of Messel (Germany), the best-known fossil snake assemblage yet discovered. Our combined analyses demonstrate an affinity of Eoconstrictor with Neotropical boas, thus entailing a South America-to-Europe dispersal event. Other booid species from Messel are related to different New World clades, reinforcing the cosmopolitan nature of the Messel booid fauna. Our analyses indicate that Eoconstrictor was a terrestrial, medium- to large-bodied snake that bore labial pit organs in the upper jaw, the earliest evidence that the visual system in snakes incorporated the infrared spectrum. Evaluation of the known palaeobiology of Eoconstrictor provides no evidence that pit organs played a role in the predator–prey relations of this stem boid. At the same time, the morphological diversity of Messel booids reflects the occupation of several terrestrial macrohabitats, and even in the earliest booid community the relation between pit organs and body size is similar to that seen in booids today.
Background: Patients with rare diseases (RDs) are often diagnosed too late or not at all. Clinical decision support systems (CDSSs) could support the diagnosis in RDs. The MIRACUM (Medical Informatics in Research and Medicine) consortium, which is one of four funded consortia in the German Medical Informatics Initiative, will develop a CDSS for RDs based on distributed clinical data from ten university hospitals. This qualitative study aims to investigate (1) the relevant organizational conditions for the operation of a CDSS for RDs when diagnose patients (e.g. the diagnosis workflow), (2) which data is necessary for decision support, and (3) the appropriate user group for such a CDSS.
Methods: Interviews were carried out with RDs experts. Participants were recruited from staff physicians at the Rare Disease Centers (RDCs) at the MIRACUM locations, which offer diagnosis and treatment of RDs.
An interview guide was developed with a category-guided deductive approach. The interviews were recorded on an audio device and then transcribed into written form. We continued data collection until all interviews were completed. Afterwards, data analysis was performed using Mayring’s qualitative content analysis approach.
Results: A total of seven experts were included in the study. The results show that medical center guides and physicians from RDC B-centers (with a focus on different RDs) are involved in the diagnostic process. Furthermore, interdisciplinary case discussions between physicians are conducted.
The experts explained that RDs exist which cannot be fully differentiated, but rather described only by their overall symptoms or findings: diagnosis is dependent on the disease or disease group. At the end of the diagnostic process, most centers prepare a summary of the patient case. Furthermore, the experts considered both physicians and experts from the B-centers to be potential users of a CDSS. The experts also have different experiences with CDSS for RDs.
Conclusions: This qualitative study is a first step towards establishing the requirements for the development of a CDSS for RDs. Further research is necessary to create solutions by also including the experts on RDs.
Background: Rare Diseases (RDs), which are defined as diseases affecting no more than 5 out of 10,000 people, are often severe, chronic and life-threatening. A main problem is the delay in diagnosing RDs. Clinical decision support systems (CDSSs) for RDs are software systems to support clinicians in the diagnosis of patients with RDs. Due to their clinical importance, we conducted a scoping review to determine which CDSSs are available to support the diagnosis of RDs patients, whether the CDSSs are available to be used by clinicians and which functionalities and data are used to provide decision support.
Methods: We searched PubMed for CDSSs in RDs published between December 16, 2008 and December 16, 2018. Only English articles, original peer reviewed journals and conference papers describing a clinical prototype or a routine use of CDSSs were included. For data charting, we used the data items “Objective and background of the publication/project”, “System or project name”, “Functionality”, “Type of clinical data”, “Rare Diseases covered”, “Development status”, “System availability”, “Data entry and integration”, “Last software update” and “Clinical usage”.
Results: The search identified 636 articles. After title and abstracting screening, as well as assessing the eligibility criteria for full-text screening, 22 articles describing 19 different CDSSs were identified. Three types of CDSSs were classified: “Analysis or comparison of genetic and phenotypic data,” “machine learning” and “information retrieval”. Twelve of nineteen CDSSs use phenotypic and genetic data, followed by clinical data, literature databases and patient questionnaires. Fourteen of nineteen CDSSs are fully developed systems and therefore publicly available. Data can be entered or uploaded manually in six CDSSs, whereas for four CDSSs no information for data integration was available. Only seven CDSSs allow further ways of data integration. thirteen CDSS do not provide information about clinical usage.
Conclusions: Different CDSS for various purposes are available, yet clinicians have to determine which is best for their patient. To allow a more precise usage, future research has to focus on CDSSs RDs data integration, clinical usage and updating clinical knowledge. It remains interesting which of the CDSSs will be used and maintained in the future.
According to the free radical theory of aging, reactive oxygen species (ROS) have been proposed to be a major cause of aging for a long time. Meanwhile, it became clear that ROS have diverse functions in a healthy organism. They act as second messengers, and as transient inhibitors of phosphatases and others. In fact, their detrimental role is highly dependent on the context of their production. NADPH oxidases (Nox) have been discovered as a controllable source of ROS. NoxO1 enables constitutive ROS formation by Nox1 by acting as a constitutively active cytosolic subunit of the complex. We previously found that both Nox1 and NoxO1 were highly expressed in the colon, and that NoxO1-/- deficiency reduces colon health. We hypothesized that a healthy colon potentially contributes to longevity and NoxO1 deficiency would reduce lifetime, at least in mouse. In contrast, here we provide evidence that the knockout of NoxO1 results in an elongated life expectancy of mice. No better endothelial function, nor an improved expression of genes related to longevity, such as Sirt1, were found, and therefore may not serve as an explanation for a longer life in NoxO1 deficiency. Rather minor systemic differences, such as lower body weight occur. As a potential reason for longer life, we suggest better DNA repair capacity in NoxO1 deficient mice. Although final fatal DNA damage appears similar between wildtype and NoxO1 knockout animals, we identified less intermediate DNA damage in colon cells of NoxO1-/- mice, while the number of cells with intact DNA is elevated in NoxO1-/- colons. We conclude that NoxO1 deficiency prolongs lifetime of mice, which correlates with less intermediate and potentially fixable DNA damage at least in colon cells.
Diese Dissertation soll die Frage beantworten, ob die Forderung der Krankenkassen, die Nabelhernie und die epigastrische Hernie als ambulante Operation zu realisieren, gerechtfertigt bzw. sinnvoll ist. Sie soll ferner Steuergrößen und Maßnahmen identifizieren, die die Überführung des Eingriffs in den ambulanten Rahmen begünstigen können.
Seit den achtziger Jahren des letzten Jahrhunderts wird versucht, durch die kurzstationäre und ambulante Operation verschiedener Krankheitsbilder der Forderung nach Kostenersparnis im Gesundheitswesen nachzukommen. Von den Krankenkassen wird gefordert, den Verschluss einer Hernia umbilicalis: Ohne Plastik: Mit Exstirpation einer Nabelzyste, den Verschluss einer Hernie epigastrica: Ohne Plastik sowie den Verschluss einer Hernia umbilicalis: Mit Plastik im Rahmen einer ambulanten Operation zu korrigieren. Entsprechend wurden diese Eingriffe 2005 in die Liste der ambulant zu erbringenden und stationsersetzenden Maßnahmen aufgenommen. Dennoch liegt die durchschnittliche stationäre Verweildauer nach diesem Eingriff weiterhin bei 3,5 Tagen.
Phylogenetisch ist die Entstehung von Nabelhernien durch anatomisch präformierte Schwachstellen der Bauchwand bedingt, an denen Muskulatur fehlt und nur Aponeurosen und Faszien vorhanden sind. Die Entstehung wird aber auch durch Begleiterkrankungen und Risikofaktoren begünstigt.
In die vorliegende Untersuchung wurden nach Anwendung verschiedener Ausschlusskriterien 95 Patienten aufgenommen, die im Zeitraum zwischen dem 24. August 2009 und dem 24. Juni 2012 mit der Hauptdiagnose einer Nabelhernie bzw. epigastrischen Hernie - Diagnose nach ICD10 - K42.0, K42.1, K42.9, K43.0, K43.1 und K43.9 in der Klinik für Allgemein- und Viszeralchirurgie der Hochtaunuskliniken Bad Homburg operiert wurden. Die selektierten Patienten, welche betrachtet wurden, teilten sich in 61 primäre Nabelhernien, fünf Rezidivnabelhernien, elf epigastrische Hernien, drei Rezidive epigastrischer Hernien und 15 Kombinationseingriffe mit simultaner Operation einer Nabelhernie und einer Leistenhernie auf.
Als Operationsverfahren kam entweder eine Naht Stoß-auf-Stoß (NSAS), die Technik nach Mayo mit einer Fasziendoppelung oder die Implantation von alloplastischem Fremdmaterial entweder mittels eines Ventralex™ Patch oder Proceed™ Patch in Sublay-Technik oder bei ausgedehnten Befunden eine retromuskuläre Mesh Plastik (RMMP) zum Einsatz. Als laparoskopisches Verfahren wurde das Intraperitoneale Onlay Mesh (IPOM) verwendet.
Die Auswertung für die deskriptive Statistik erfolgte mit Microsoft® Excel® 2013. Anschließend wurde die Auswertung der explorativen wie auch der mathematisch/induktiven Statistik mit Hilfe von BiAS. für Windows™ Version 11/2015 durchgeführt.
Nach Analyse des Patientengutes konnte anhand von Korrelationsanalysen herausgearbeitet werden, dass das Alter, die Anzahl der Begleiterkrankungen, die Anzahl der Risikofaktoren und die ASA-Klassifikation (American Society of Anesthesiologists), die Größe der Bruchlücke in Zentimetern und die Schmerzen am zweiten postoperativen Tag einen schwachen Zusammenhang rho (ρ) zwischen 0,23 und 0,39 mit der Liegedauer bei jedoch signifikanten p-Wert p ≤ 0,05 aufwiesen. Einen stärkeren Zusammenhang mit einem Korrelationskoeffizienten ρ von 0,42 und 0,40 im Hinblick auf die Liegedauer zeigten hierbei die Operationsdauer und die Schmerzen am ersten postoperativen Tag. Den stärksten signifikanten Zusammenhang mit einem ρ von 0,64 zeigten die Schmerzen am dritten postoperativen Tag.
Die Verweildauer wurde auch durch die Wahl des Operationsverfahrens beeinflusst. Hier ergab sich eine signifikante Verlängerung der Verweildauer durch unterschiedliche Operationsverfahren sowohl in der Begutachtung des Gesamtkollektivs als auch in der Subgruppe NSAS, Mayo und Patch.
Im Anschluss konnte anhand multivariater Analysen festgestellt werden, dass die Operationsdauer, das Operationsverfahren und die ASA-Klassifikation mit p-Werten ≤ 0,05 mit der Liegedauer signifikant korrelierten. Auch konnte mit Hilfe der multivariaten Analyse aufgezeigt werden, dass die Größe der Bruchlücke in Zentimetern und die Schmerzen am ersten und zweiten postoperativen Tag mit Signifikanzwerten ≤ 0,05 mit der Liegedauer korrelierten.
Nach der durchgeführten Analyse, wie auch nach Betrachtung der Literatur, ist die Grundlage zur Durchführbarkeit einer ambulanten Operation die Erfüllung der medizinischen Voraussetzungen, die Erfüllung der Kriterien für ambulante Operationen und die Erfüllung der Entlassungskriterien. Zudem sollten Patienten mit kardiovaskulären Erkrankungen, insbesondere bei Vorliegen einer Herzinsuffizienz, aber auch bei COPD, Asthma und Schlafapnoesyndrom und einem BMI größer 30 nicht für eine ambulante Operation in Betracht gezogen werden. Auch gelten ein ASA Status größer als 2, Nebenwirkungen der (Allgemein-)Narkose wie PONV, Schwindel, Schläfrigkeit und ein erhöhtes postoperatives Schmerzniveau sowie eine große Defektgröße als hinderlich für die ambulante Durchführung der Operationen.
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Die vorliegende Studie versucht einen Beitrag zur Erforschung von Implementationsmöglichkeiten des bilingualen Sprachvermögens von Schüler*innen mit Migrationshintergrund für den Regelschulkontext zu leisten, indem ein bilinguales Interaktionsangebot beim Peer-Learning für türkisch-deutschsprachig aufwachsende Schüler*innen der dritten und vierten Klasse in einem quasi-experimentellen Setting unter Verwendung von Mixed Methods untersucht wird.
Methoden
(2020)
Rezension zu: Akremi, Leila, Nina Baur, Hubert Knoblauch und Boris Traue (Hrsg.): Handbuch Interpretativ forschen. Weinheim, Basel: Beltz Juventa 2018. 961 Seiten. ISBN: 978-3-7799-3126-3. Preis: C 49,95.
This paper defends The Transformation of Values into Prices on the Basis of Random Systems, published in EIER, by answering to the Comments made in the same journal by Professors Mori, Morioka and Yamazaki. The clarifications mainly concern the justification of the randomness assumptions, the conditions needed to obtain the equality of total profit with total surplus value in the simplified one-industry system and the invariance of the results to changes in the units of measurement.
Background: Alterations in the SCN5A gene encoding the cardiac sodium channel Nav1.5 have been linked to a number of arrhythmia syndromes and diseases including long-QT syndrome (LQTS), Brugada syndrome (BrS) and dilative cardiomyopathy (DCM), which may predispose to fatal arrhythmias and sudden death. We identified the heterozygous variant c.316A > G, p.(Ser106Gly) in a 35-year-old patient with survived cardiac arrest. In the present study, we aimed to investigate the functional impact of the variant to clarify the medical relevance.
Methods: Mutant as well as wild type GFP tagged Nav1.5 channels were expressed in HEK293 cells. We performed functional characterization experiments using patch-clamp technique.
Results: Electrophysiological measurements indicated, that the detected missense variant alters Nav1.5 channel functionality leading to a gain-of-function effect. Cells expressing S106G channels show an increase in Nav1.5 current over the entire voltage window.
Conclusion: The results support the assumption that the detected sequence aberration alters Nav1.5 channel function and may predispose to cardiac arrhythmias and sudden cardiac death.
Monoterpenes and their monoterpenoid derivatives form a subclass of terpene(oid)s. They are widely used in medicines/pharmaceuticals, as flavor and fragrance compounds, or in agriculture and are also considered as future biofuels. However, for many of these substances, the extraction from natural sources poses challenges such as occurring at low concentrations in their raw material or because the natural sources are diminishing. Furthermore, many of the structurally more complex terpenoids cannot be chemically synthesized in an economic way. Therefore, microbial production provides an attractive alternative, taking advantage of the often distinct regio- and stereoselectivity of enzymatic reactions. However, monoterpenes and monoterpenoids are challenging products for industrial biotechnology processes due to their pronounced cytotoxicity, which complicates the production in microorganisms compared to longer-chain terpenes (sesquiterpenes, diterpenes, etc.).
The aim of this thesis was to generate a biotechnological complement to fossil-resources-based chemical processes for industrial monoterpenoid production. Therefore, a starting point for the further development of a microbial cell factory based on the microbe Pseudomonas putida KT2440 was aimed to be created. This production organism should be able to conduct a whole- cell biocatalysis to selectively oxyfunctionalize monoterpene hydrocarbons using renewable industrial by-products and waste streams as raw material for monoterpenoid production (Figure 1). As a model substance, the production of (-)-menthol should be addressed due to its industrial significance. (-)-Menthol is one of the world’s most widely-used flavor and fragrance compounds by volume as well as a medical component, having an annual production volume of over 30,000 tons. An approach for (-)-menthol production from renewable resources could be a biotechnological(-chemical) two-step conversion (Figure 1), starting from (+)-limonene, a by-product of the citrus fruit processing industry.
The thesis project was divided into three parts. In the first part, enzymes (limonene-3- hydroxylases) were to be identified that can convert (+)-limonene into the precursor of (-)-menthol, (+)-trans-isopiperitenol. To counteract product toxicity, in the second part, the tolerance of the intended production organism P. putida KT2440 towards monoterpenes and their monoterpenoid derivatives should be increased. Finally, in the third part, the identified hydroxylase enzymes would be expressed in the improved P. putida KT2440 strain to create a whole-cell biocatalyst for the first reaction step of a two-step (-)-menthol production, starting from (+)-limonene.
To achieve these objectives, different genetic/molecular biology and analytical methods were applied. In this way, two cytochrome P450 monooxygenase enzymes from the fungi Aureobasidium pullulans and Hormonema carpetanum could be identified and functionally expressed in Pichia pastoris, which can catalyze the intended hydroxylation reaction on (+) limonene with high stereo- and regioselectivity. A further characterization of the enzyme from A. pullulans showed that apart from (+) limonene the protein can also hydroxylate ( ) limonene, - and -pinene, as well as 3-carene.
Furthermore, within this thesis, mechanisms of microbial monoterpenoid resistance of P. putida could be identified. It was shown that the different monoterpenes and monoterpenoids tested have very different toxicity levels and that mainly the Ttg efflux pumps of P. putida GS1 are responsible for the tolerance to many of these compounds. Based on these results, a P. putida KT2440 strain with increased resistance to various monoterpenoids, including isopiperitenol, could then be generated, which can be used as a host organism for the further development of monoterpenoid-producing cell factories.
While within the scope of this work the heterologous expression of the fungal gene in prokaryotic cells in a functional form could not be realized despite different approaches, the identified enzymes, the monoterpenoid-tolerant P. putida strain and a plasmid developed for heterologous gene expression in P. putida provide a starting point for the further design of a microbial cell factory for biotechnological monoterpenoid production.
Degeneration of neurons, such as the inner ear spiral ganglion neurons (SGN), may be decelerated or even stopped by neurotrophic factor treatment, such as brain-derived neurotrophic factor (BDNF), as well as electrical stimulation (ES). In a clinical setting, drug treatment of the SGN could start directly during implantation of a cochlear implant, whereas electrical stimulation begins days to weeks later. The present study was conducted to determine the effects of consecutive BDNF and ES treatments on SGN density and electrical responsiveness. An electrode drug delivery device was implanted in guinea pigs 3 weeks after deafening and five experimental groups were established: two groups received intracochlear infusion of artificial perilymph (AP) or BDNF; two groups were treated with AP respectively BDNF in addition to ES (AP + ES, BDNF + ES); and one group received BDNF from the day of implantation until day 34 followed by ES (BDNF ⇨ ES). Electrically evoked auditory brainstem responses were recorded. After one month of treatment, the tissue was harvested and the SGN density was assessed. The results show that consecutive treatment with BDNF and ES was as successful as the simultaneous combined treatment in terms of enhanced SGN density compared to the untreated contralateral side but not in regard to the numbers of protected cells.