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Acinetobacter baumannii is outstanding for its ability to cope with low water activities which significantly contributes to its persistence in hospital environments. The vast majority of bacteria are able to prevent loss of cellular water by amassing osmoactive compatible solutes or their precursors into the cytoplasm. One such precursor of an osmoprotectant is choline that is taken up from the environment and oxidized to the compatible solute glycine betaine. Here, we report the identification of the osmotic stress operon betIBA in A. baumannii. This operon encodes the choline oxidation pathway important for the production of the solute glycine betaine. The salt-sensitive phenotype of a betA deletion strain could not be rescued by addition of choline, which is consistent with the role of BetA in choline oxidation. We found that BetA is a choline dehydrogenase but also mediates in vitro the oxidation of glycine betaine aldehyde to glycine betaine. BetA was found to be associated with the membrane and to contain a flavin, indicative for BetA donating electrons into the respiratory chain. The choline dehydrogenase activity was not salt dependent but was stimulated by the compatible solute glutamate.
As some cognitive functions decline in old age, the ability to decide about important life events such as medical treatment is endangered. Environmental support to improve the comprehension of health-related information is therefore necessary. With a small-scale explorative approach, the present survey study aimed at investigating person-environment fit (PE-fit) of support provided during medical consultations. This fit was calculated by assessing the match between aids provided by five medical practitioners during medical consultations and aids most appreciated by the geriatric patients (N = 88). The results showed that the largest discrepancies of used and appreciated aids could be found concerning the opportunity to discuss decisions with relatives, the possibility to take notes, the use of objects, pictures and a keyword list. Female patients indicated a lower PE-fit. These findings highlight discrepancies between the use of specific aids and the wishes of patients and call for thoughtful use of aids during consultations with geriatric patients.
Purpose: Amblyopia with eccentric fixation, especially when not diagnosed early, is a therapeutic challenge, as visual outcome is known to be poorer than in amblyopia with central fixation. Consequently, treatment after late diagnosis is often denied. Electronic monitoring of occlusion provides us the chance to gain first focussed insight into age-dependent dose response and treatment efficiency, as well as the shift of fixation in this rare group of paediatric patients. Methods: In our prospective pilot study, we examined amblyopes with eccentric fixation during 12 months of occlusion treatment. We evaluated their visual acuity, recorded patching duration using a TheraMon®-microsensor, and determined their fixation with a direct ophthalmoscope. Dose-response relationship and treatment efficiency were calculated. Results: The study included 12 participants with strabismic and combined amblyopia aged 2.9–12.4 years (mean 6.5). Median prescription of occlusion was 7.7 h/day (range 6.6–9.9) and median daily received occlusion was 5.2 h/day (range 0.7–9.7). At study end, median acuity gain was 0.6 log units (range 0–1.6) and residual interocular visual acuity difference (IOVAD) 0.3 log units (range 0–1.8). There was neither significant acuity gain nor reduction in IOVAD after the 6th month of treatment. Children younger than 4 years showed best response with lowest residual IOVAD at study end. Efficiency calculation showed an acuity gain of approximately one line from 100 h of patching in the first 2 months and half a line after 6 months. There was a significant decline of treatment efficiency with age (p = 0.01). Foveolar fixation was achieved after median 3 months (range 1–6). Three patients (> 6 years) did not gain central fixation. Conclusion: Eccentric fixation is a challenge to therapy success. Based on electronic monitoring, our study quantified for the first time the reduction of treatment efficiency with increasing age in amblyopes with eccentric fixation. Despite some improvement in patients up to 8 years, older patients showed significantly lower treatment efficiency. In younger patients with good adherence, despite poor initial acuity, central fixation and low residual IOVAD could be attained after median 3 months. Hence, the necessity of early diagnosis and intensive occlusion should be emphasized.
Background: Transcutaneous auricular vagus nerve stimulation (taVNS) has been investigated regarding its therapeutic properties in several several conditions such as epilepsy, migraine and major depressive disorder and was shown to access similar neural pathways as invasive vagus nerve stimulation. While the vagus nerve's role in gut motility is physiologically established, the effect of taVNS has scarcely been investigated in humans and yielded conflicting results. Real-time gastric magnetic resonance imaging (rtMRI) is an established reproducible method to investigate gastric motility non-invasively. Objective: To investigate the influence of taVNS on gastric motility of healthy participants using rtMRI. Methods: We conducted a randomized, double-blind study using high-frequency (HF) stimulation at 25Hz or low-frequency (LF) taVNS at 1Hz after ingestions of a standardized meal in 57 healthy participants. The gastric motility index (GMI) was determined by measuring the amplitude and velocity of the peristaltic waves using rtMRI. Results: After HF taVNS, GMI was significantly higher than after LF stimulation (p = 0.005), which was mainly attributable to a higher amplitude of the peristaltic waves (p = 0.003). Conclusion: We provide evidence that 4-h of taVNS influences gastric motility in healthy human participants for the first time using rtMRI. HF stimulation is associated with higher amplitudes of peristaltic waves in the gastric antrum compared to LF stimulation. Further studies are needed to investigate the effect of different frequencies of taVNS and its therapeutic properties in conditions with impaired gastric motility.
Transjugular intrahepatic portosystemic shunt (TIPS) is the most effective measure to treat complications of portal hypertension. However, liver function may deteriorate after TIPS. Predictors of liver function and outcome after TIPS are therefore important for management of TIPS patients. The study aimed to evaluate the impact of liver volume on transplant-free survival (TFS) after TIPS, as well as the evolution of liver volume and its relationship with liver function after TIPS. A retrospective analysis of all consecutive patients who underwent TIPS in a tertiary care university liver center between 2012 and 2017 (n = 216) was performed; n = 72 patients with complete prior and follow-up (FU) computed tomography (CT) imaging studies were included in the study. Volumetry of the liver was performed by a semi-automatic 9-lobe image segmentation algorithm at baseline and FU (FU 1: 90–180 d; FU 2: 180–365 d; FU 3: 365–545 d; FU 4: 545–730 d; FU 5: >730 d). Output variables were total liver volume (TLV, cm3), left liver volume (LLV, cm3), right liver volume (RLV, cm3) and TLV/body weight ratio. CT derived liver volumes were correlated with liver function tests, portosystemic pressure gradient (PPG) measurements and survival. To assess predictors of liver volume change over time we fitted linear mixed models. Kaplan–Meier analysis was performed and validated by matched pair analysis followed by Cox regression to determine independent prognostic factors for survival. The median TLV at baseline was 1507.5 cm3 (773.7–3686.0 cm3). Livers with higher baseline liver volumes and larger TLV/weight ratios retained their volume after an initial loss while smaller livers continuously lost volume after TIPS. At the first follow-up period (90–180 d post-TIPS) lower liver volumes and TLV/weight ratios were associated with higher bilirubin levels. Within the final multivariable model containing time (days since TIPS), baseline INR and baseline TLV, the average loss of liver volume was 0.74 mL per day after TIPS. Twelve-month overall transplant-free survival was 89% and median overall TFS was 33 months. The median TFS for a baseline TLV/body weight ratio > 20 was significantly higher compared with ≤20 (40.0 vs. 27.0 months, p = 0.010) while there were no differences regarding the indication for TIPS or etiology of liver disease in the matched pair analysis. Lower TLV/weight ratios before TIPS were associated with shorter TFS and should therefore be critically considered when selecting patients for TIPS. In addition, this study provides first evidence of an effect of TIPS on subsequent liver volume change and associated liver function.
Hormonal contraceptives are an effective and safe method for preventing pregnancy. Progestins used in contraception are either components of combined hormonal contraceptives (tablets, patches or vaginal rings) or are used as a single active ingredient in progestin mono-preparations (the progestin-only pill (POP), implants, intrauterine systems or depot preparations). Progestins are highly effective in long-term contraception when used properly, and have a very good safety profile with very few contraindications. A new oestrogen-free ovulation inhibitor (POP) has recently been authorised in the USA and the EU. This progestin mono-preparation contains 4 mg of drospirenone (DRSP), which has anti-gonadotropic, anti-mineralocorticoidic and anti-androgenic properties. The hormone administration regimen of 24 days followed by a 4-day hormone-free period was chosen to improve bleeding control and to maintain oestradiol concentrations at early follicular-phase levels, preventing oestrogen deficiency. Clinical trials have demonstrated a high contraceptive effectiveness, a very low risk of cardiovascular side effects and a favourable menstrual bleeding pattern. Due to the long half-life of DRSP (30 – 34 hours), the effectiveness of the preparation is maintained even if a woman forgets to take a pill on a single occasion. Studies involving deliberate 24-hour delays in taking a pill have demonstrated that ovulation inhibition is maintained if a single pill is missed. Following a summary of the current status of oestrogen-free contraception, this review article will describe the clinical development programme of the 4 mg DRSP mono-preparation and the resulting data on the effectiveness and safety of this new oestrogen-free oral hormonal contraceptive.
The policy studies literature is divided on how information processing takes place in policy processes. Punctuated equilibrium theory claims that policymakers tend to process information disproportionately, giving more weight to some incoming signals than to others. By contrast, thermostatic models of policymaking argue that policymakers respond in a more proportionate way. In this paper, we analyse information processing in the adoption of Total Allowable Catches (TACs) under the European Union’s (EU) Common Fisheries Policy. Based on a novel measure for the proportionality of information processing, it shows that over time TACs have become more closely aligned with incoming signals about fish stocks. This development can be explained through a combination of changing discourses around fisheries conservation and institutional adjustments in EU fisheries policy. This analysis has implications for the debate between punctuated equilibrium and thermostatic models of policymaking and our understanding of the effectiveness of EU fisheries policies.
As some cognitive functions decline in old age, the ability to decide about important life events such as medical treatment is endangered. Environmental support to improve the comprehension of health-related information is therefore necessary. With a small-scale explorative approach, the present survey study aimed at investigating person-environment fit (PE-fit) of support provided during medical consultations. This fit was calculated by assessing the match between aids provided by five medical practitioners during medical consultations and aids most appreciated by the geriatric patients (N = 88). The results showed that the largest discrepancies of used and appreciated aids could be found concerning the opportunity to discuss decisions with relatives, the possibility to take notes, the use of objects, pictures and a keyword list. Female patients indicated a lower PE-fit. These findings highlight discrepancies between the use of specific aids and the wishes of patients and call for thoughtful use of aids during consultations with geriatric patients.
The original version of this Article contained errors where Table S5 and Table S6 were incorrectly cited. As the result, in the Methods section, under the subheading ‘Germline transformation, crossing setups and insertion junction sequencing’, “Progeny were scored for transformation marker presence during either the larval, pupal and adult stage by using a fluorescence stereo microscope (SteREO Discovery.V8, Zeiss) with appropriate filter sets (Table S4).” now reads: “Progeny were scored for transformation marker presence during either the larval, pupal and adult stage by using a fluorescence stereo microscope (SteREO Discovery.V8, Zeiss) with appropriate filter sets (Table S5).” And, under the subheading ‘Light sheet-based fluorescence microscopy’, “Metadata for the three datasets are provided in Table S5.” now reads: “Metadata for the three datasets are provided in Table S6.” In Data availability section, “Microscopy data can be accessed as described in Table S5.” now reads: “Microscopy data can be accessed as described in Table S6.” Additionally, in the Supplementary Information 8 file, the “Data Access” row was omitted in Table S6. The “Data Access” row now reads: Dataset (DS) DS0001 DS0002 DS0003 Dataset Access DOI: 10.5281/zenodo.4892363 DOI: 10.5281/zenodo.4892373 DOI: 10.5281/zenodo.4892381 The original Supplementary Information 8 file is provided below. Finally, the Supplementary Information 1 and 5 files published with this Article contained tracked changes, these have now been removed. The original Article and accompanying Supplementary Information files have been corrected.
Objective: To assess the effect of cesarean section (CS) timing, elective versus unplanned, on the residual myometrial thickness (RMT) and CS scars. Methods: This is a prospective single-blinded observational cohort study with 186 observations. Patients indicated to undergo first singleton CS were preoperatively recruited. Exclusion criteria were history of repeated CS, vertical hysterotomy, diabetes, and additional uterine surgeries. Sonographic examination was performed for assessing the RMT ratio, the presence of a niche, fibrosis, and the distance from the scar to the internal os (SO) 1 year after CS. Power analysis was performed with 0.05 α, 0.1 β, and all statistical analyses were conducted with Stata®. Results: Wilcoxon rank-sum test for the association between CS timing, RMT ratio and SO showed Z values of −0.59 and −4.94 (P = 0.553 and P < 0.001), respectively. There was no association between CS timing and niches and fibrosis (P > 0.99 and P = 0.268, respectively). Linear regression between SO and the extent of cervical dilatation showed a −0.45 β (95% confidence interval −0.68 to −0.21) and a 10.22-mm intercept (P < 0.001). Conclusion: RMT is independent of the timing of CS, but the SO distance shows a negative linear relationship with the cervical dilatation.
Background and purpose: Superficial siderosis of the central nervous system is a sporadic finding in magnetic resonance imaging, resulting from recurrent bleedings into the subarachnoid space. This study aimed to determine the frequency of spinal dural cerebrospinal fluid (CSF) leaks amongst patients with a symmetric infratentorial siderosis pattern. Methods: In all, 97,733 magnetic resonance images performed between 2007 and 2018 in our neurocenter were screened by a keyword search for “hemosiderosis” and “superficial siderosis.” Siderosis patterns on brain imaging were classified according to a previously published algorithm. Potential causative intracranial bleeding events were also assessed. Patients with a symmetric infratentorial siderosis pattern but without causative intracranial bleeding events in history were prospectively evaluated for spinal pathologies. Results: Forty-two patients with isolated supratentorial siderosis, 30 with symmetric infratentorial siderosis and 21 with limited (non-symmetric) infratentorial siderosis were identified. Amyloid angiopathy and subarachnoid hemorrhage were causes for isolated supratentorial siderosis. In all four patients with a symmetric infratentorial siderosis pattern but without a causative intracranial bleeding event in history, spinal dural abnormalities were detected. Dural leaks were searched for in patients with symmetric infratentorial siderosis and a history of intracranial bleeding event without known bleeding etiology, considering that spinal dural CSF leaks themselves may also cause intracranial hemorrhage, for example by inducing venous thrombosis due to low CSF pressure. Thereby, one additional spinal dural leak was detected. Conclusions: Persisting spinal dural CSF leaks can frequently be identified in patients with a symmetric infratentorial siderosis pattern. Diagnostic workup in these cases should include magnetic resonance imaging of the whole spine.
Nucleotide pools need to be constantly replenished in cancer cells to support cell proliferation. The synthesis of nucleotides requires glutamine and 5-phosphoribosyl-1-pyrophosphate produced from ribose-5-phosphate via the oxidative branch of the pentose phosphate pathway (ox-PPP). Both PPP and glutamine also play a key role in maintaining the redox status of cancer cells. Enhanced glutamine metabolism and increased glucose 6-phosphate dehydrogenase (G6PD) expression have been related to a malignant phenotype in tumors. However, the association between G6PD overexpression and glutamine consumption in cancer cell proliferation is still incompletely understood. In this study, we demonstrated that both inhibition of G6PD and glutamine deprivation decrease the proliferation of colon cancer cells and induce cell cycle arrest and apoptosis. Moreover, we unveiled that glutamine deprivation induce an increase of G6PD expression that is mediated through the activation of the nuclear factor (erythroid-derived 2)-like 2 (NRF2). This crosstalk between G6PD and glutamine points out the potential of combined therapies targeting oxidative PPP enzymes and glutamine catabolism to combat colon cancer.
Purpose: Amblyopia with eccentric fixation, especially when not diagnosed early, is a therapeutic challenge, as visual outcome is known to be poorer than in amblyopia with central fixation. Consequently, treatment after late diagnosis is often denied. Electronic monitoring of occlusion provides us the chance to gain first focussed insight into age-dependent dose response and treatment efficiency, as well as the shift of fixation in this rare group of paediatric patients. Methods: In our prospective pilot study, we examined amblyopes with eccentric fixation during 12 months of occlusion treatment. We evaluated their visual acuity, recorded patching duration using a TheraMon®-microsensor, and determined their fixation with a direct ophthalmoscope. Dose-response relationship and treatment efficiency were calculated. Results: The study included 12 participants with strabismic and combined amblyopia aged 2.9–12.4 years (mean 6.5). Median prescription of occlusion was 7.7 h/day (range 6.6–9.9) and median daily received occlusion was 5.2 h/day (range 0.7–9.7). At study end, median acuity gain was 0.6 log units (range 0–1.6) and residual interocular visual acuity difference (IOVAD) 0.3 log units (range 0–1.8). There was neither significant acuity gain nor reduction in IOVAD after the 6th month of treatment. Children younger than 4 years showed best response with lowest residual IOVAD at study end. Efficiency calculation showed an acuity gain of approximately one line from 100 h of patching in the first 2 months and half a line after 6 months. There was a significant decline of treatment efficiency with age (p = 0.01). Foveolar fixation was achieved after median 3 months (range 1–6). Three patients (> 6 years) did not gain central fixation. Conclusion: Eccentric fixation is a challenge to therapy success. Based on electronic monitoring, our study quantified for the first time the reduction of treatment efficiency with increasing age in amblyopes with eccentric fixation. Despite some improvement in patients up to 8 years, older patients showed significantly lower treatment efficiency. In younger patients with good adherence, despite poor initial acuity, central fixation and low residual IOVAD could be attained after median 3 months. Hence, the necessity of early diagnosis and intensive occlusion should be emphasized.
Why bank money creation?
(2022)
We provide a rationale for bank money creation in our current monetary system by investigating its merits over a system with banks as intermediaries of loanable funds. The latter system could result when CBDCs are introduced. In the loanable funds system, households limit banks’ leverage ratios when providing deposits to make sure they have enough “skin in the game” to opt for loan monitoring. When there is unobservable heterogeneity among banks with regard to their (opportunity) costs from monitoring, aggregate lending to bank-dependent firms is inefficiently low. A monetary system with bank money creation alleviates this problem, as banks can initiate lending by creating bank deposits without relying on household funding. With a suitable regulatory leverage constraint, the gains from higher lending by banks with a high repayment pledgeability outweigh losses from banks which are less diligent in monitoring. Bank-risk assessments, combined with appropriate risk-sensitive capital requirements, can reduce or even eliminate such losses.
The present paper proposes an overview of the existing literature covering several aspects related to environmental, social, and governance (ESG) factors. Specifically, we consider studies describing and evaluating ESG methodologies and those studying the impact of ESG on credit risk, debt and equity costs, or sovereign bonds. We further expand the topic of ESG research by including the strand of the literature focusing on the impact of climate change on financial stability, thus allowing us to also consider the most recent research on the impact of climate change on portfolio management.
We investigate the link between Big Five personality traits and the marginal propensity to consume (MPC) for users of a German financial account aggregator app. We use 1,700 survey responses and transaction data of 56,000 app users to assess whether Big Five personality traits help explain MPC heterogeneity. We find that extraversion corresponds to an increase in consumption whereas agreeableness and neuroticism correspond to a decrease in consumption. We test this with trust and risk preferences and find that risk indicates more explanatory power in consumption response than the Big Five. Our findings help policy makers target individuals more efficiently.
The Russian war of aggression against Ukraine since 24 February 2022 has intensified the discussion of Europe’s reliance on energy imports from Russia. A ban on Russian imports of oil, natural gas and coal has already been imposed by the United States, while the United Kingdom plans to cease imports of oil and coal from Russia by the end of 2022. The German Federal Government is currently opposing an energy embargo against Russia. However, the Federal Ministry for Economic Affairs and Climate Action is working on a strategy to reduce energy imports from Russia. In this paper, the authors give an overview of the German and European reliance on energy imports from Russia with a focus on gas imports and discuss price effects, alternative suppliers of natural gas, and the potential for saving and replacing natural gas. They also provide an overview of estimates of the consequences on the economic outlook if the conflict intensifies.
This briefing paper describes and evaluates the law and economics of institution(al) protection schemes. Throughout our analysis, we use Europe’s largest such scheme, that of German savings banks, as paradigm. We find strengths and weaknesses: Strong network-internal monitoring and early warning seems to be an important contributor to IPS network success. Similarly, the geographical quasi-cartel encourages banks to build a strong client base, including SME, in all regions. Third, the growth of the IPS member institutions may have benefitted from the strictly unlimited protection offered, in terms of euro amounts per account holder. The counterweighing weaknesses encompass the conditionality of the protection pledge and the underinvestment risk it entails, sometimes referred to as blackmailing the government, as well as the limited diversification potential of the deposit insurance within the network, and the near-incompatibility of the IPS model with the provisions of the BRRD, particularly relating to bail-in and resolution. Consequently, we suggest, as policy guidance, to treat large IPS networks similar to large banking groups, and put them as such under the direct supervision of the ECB within the SSM. Moreover, we suggest strengthening the seriousness of a deposit insurance that offers unlimited protection. Finally, to improve financial stability, we suggest embedding the IPS model into a multi-tier deposit re-insurance scheme, with a national and a European layer. This document was provided by the Economic Governance Support Unit at the request of the ECON Committee.
SAFE Update April 2022
(2022)
Attributive participle constructions in German behave like adjectives in terms of inflection and position, but keep their verbal arguments. They can be extended by adjuncts or arguments and these extended attributive present participles mainly occur in written language (Weber, 1994). As the same content can also be expressed in a relative clause (RC), I compare both constructions in order to find out under which conditions a participle construction could lead to processing difficulties and how this relates to RC processing.
Based on previous assumptions for production (e.g. Weber, 1971; Fabricius-Hansen, 2016), three potential factors on the comprehension of prenominal modifiers and RCs are investigated: modifier length, the internal structure and multiple levels of embedding. The hypotheses for an effect on modifier length are mainly based on two processing accounts that make opposite predictions under specific circumstances: memory-based accounts such as the dependency locality theory (DLT) (e.g. Gibson, 2000) and expectation-based accounts such as surprisal (e.g. Levy, 2008). An increase in modifier length results in more intervening material between determiner and noun for the participle construction, contrary to RCs where these elements are adjacent. This separation of the DP could increase memory load. Therefore, longer participles would slow down processing of the noun, while there should be no difference for RCs. Two acceptability judgment experiments showed a tendency for longer participle phrases to receive lower ratings. The modifier length was further investigated in online processing. Contrary to the predicted locality effect, self-paced reading data reveals an anti-locality effect for participle phrases, with lower RTs on the noun when additional material was present inside the modifier. This experiment was followed up by an eye-tracking experiment which replicated the anti-locality effect, but at the participle instead at the noun.
The second factor that was investigated is the argument structure of the participle (or RC verb). My hypothesis is that more “prototypical” adjectives in terms of syntactic structure and semantics are more acceptable and easier to process. Attributive participles are considered hybrids between verbs and adjectives (e.g. Fuhrhop & Teuber, 2000; L¨ubbe & Rapp, 2011) due to their modifier internal verbal function, but adjectival position and agreement with the noun. This double role could lead to difficulties, in particular with a more complex verbal structure. Therefore, the prediction was that the presence of an accusative object inside a participle phrase would lead to lower acceptability ratings and higher reading times in online processing. In the first two acceptability experiments, this prediction was borne out. In addition, an SPR experiment was conducted which manipulated the presence of either an accusative object or adjunct for participles (of verbs that could be used intransitively and transitively) and the corresponding RCs. The experiment showed an effect of the presence of an accusative object on the participle, with higher reading times if an object was present, compared to an adjunct. No such difference was found for the RC verb, which indicates that only participles are processed more slowly when there is an accusative object. An alternative explanation for this finding is the inherent imperfective aspect of the present participle: a direct object could change the event structure in such a way that the aspect no longer matches.
The third factor I investigate is an effect of double embedding on the acceptability of participle phrases and RCs. While double embedded participles are rated lower than double embedded RCs, there is a smaller decrease from single to double embedding for participles than for RCs, contrary to the predictions calculated by the metric of the DLT.
Overall, the results provide evidence for experience-based processing, but they cannot be explained by either memory- or experience-based accounts alone. The effect concerning the presence of an accusative object suggest that properties of the participle distinguish the construction from RCs and affect its processing. The thesis suggests that the latter effect needs to be investigated further in future research. Furthermore, the findings have implications for the role of attributive present participles in German and for hypotheses about similar constructions in other languages.
Standard biorelevant media reflect the average gastrointestinal (GI) physiology in healthy volunteers. The use of biorelevant media in in vitro experiments has become an important strategy to predict drug behaviour in vivo and is often combined with in silico tools in order to simulate drug plasma profiles over time. In addition to the healthy population, the effects of disease state or co-administration of other drugs on plasma profiles must be considered to assure drug efficacy and safety. Thus, there is a need for a more accurate representation of the human GI physiology when it is altered by disease or co-administered drugs in in vitro dissolution experiments.
This thesis focused on the development of biorelevant media and dissolution tests reflecting GI physiology in circumstances where the gastric pH is elevated. Diseases linked to an elevated gastric pH are hypochlorhydria and achlorhydria, but these days treatment with acid-reducing agents (ARAs) is the single greatest cause of elevation in gastric pH. pH-dependent drug-drug interactions (DDIs) with ARAs are frequent, as the ARAs are used in a number of diseases using a variety of drugs. As the drugs currently on the market are often poorly soluble and ionisable, their dissolution is highly dependent on the pH of the GI tract, especially the gastric pH.
The thesis research consisted of several steps. In the first step, physiological changes in the human GI tract during the therapy with ARAs were identified. Parameters of the standard biorelevant gastric medium FaSSGF were adjusted to the identified changes to reflect the impact of ARA co-administration on the gastric physiology. The media aim to assess the potential extent of the ARA impact on gastric physiology by introducing biorelevant media pairs, ARA pH 4 and pH 6 media, of which one reflects a lesser, and the other a stronger impact of ARAs.
In the second step these ARA media were implemented in in vitro dissolution set-ups.
The dissolution of poorly soluble ionisable drugs was assessed using one-stage, two-stage and transfer model set-ups, as well as using a more evolved in vitro system TIM-1. Comparison of results from dissolution set-ups using the standard, low pH, gastric biorelevant medium FaSSGF (pH 1.6 or 2), and the same set-ups using ARA pH 4 and pH 6 media, shows a decrease in dissolution rate and extent for weakly basic compounds PSWB 001 and dipyridamole, and an increase in rate and extent of dissolution for the weakly acidic compound raltegravir potassium, when the gastric pH is elevated. Due to different physicochemical properties, the extent of the impact of physiological changes during ARA therapy (when either ARA pH 4 or pH 6 medium is selected) on dissolution varied among the model drugs. Thus, the bracketing approach, which considers a range of the possible ARA co-administration impact on drug dissolution, was confirmed to be best practice in assessing the impact of ARAs.
In the third step, dissolution data from in vitro experiments with ARA media was implemented into in silico models. The predictions using various in silico model approaches in Simcyp™ Simulator (minimal and full PBPK model, dissolution input using DRM and DLM) successfully bracketed in vivo data on drug administration during ARA therapy and correctly predicted an overall decrease in plasma concentration for the two model weakly basic compounds and an increase in plasma concertation for the model weakly acidic compound.
In all assessed scenarios, the ARA methods proved to be an essential part of evaluating and predicting the impact of ARAs on drug pharmacokinetics, and appropriately predicted the extent of a possible impact of ARAs on the drug plasma profiles. Thus, the ARA biorelevant media and dissolution tests were demonstrated to be valuable tools reflecting administration of drugs when the gastric pH is elevated and able to predict the impact of ARA therapy on drug administration.
The ability to evaluate the impact of human (patho) physioloy on drug behaviour in the gastrointestinal tract is of great importance, as the GI conditions play a significant role in drug release and absorption. Thus, there is great interest on the part of the pharmaceutical industry and regulatory agencies to develop best practices in this field, especially for pH-dependent DDIs. The media and dissolution tests developed in this thesis are biorelevant methods appropriate for evaluation of the impact of elevated gastric pH on drug efficacy and safety. Such methods, used as a risk assessment tool, in connection with evaluation of the efficacy window and potential toxicity, may help to increase confidence about decisions as to whether a pH-effect will occur and whether it is relevant or not, prior to conducting clinical studies. They may also enable changes in inclusion/exclusion criteria during recruiting for large-scale efficacy trials. In fact, the biopharmaceutic approach to drug development is becoming standard practice on a number of fronts, including metabolic DDIs, renal and hepatic insufficiency, powering decision-making process and possibly even waiving certain types of clinical studies.
...
Treatment response to neoadjuvant chemoradiotherapy (nCRT) varies considerably among individual patients in advanced rectal cancer indicating a clinical need for markers to predict treatment efficacy and to stratify patients for future personalized treatment. In recent years, there is a tremendous evidence on a pivotal impact of immune components on the development/pathogenesis of cancer and on mediating response to radiation and chemotherapy. Moreover, liquid biopsy biomarkers have become increasingly attractive to predict treatment response because they are easy to collect, reflect information on different aspects of tumor biology and can be accurately measured by standardized methods.
This study aimed to investigate the peripheral blood and tumor tissue immune cell contexture in patients with rectal adenocarcinoma treated with nCRT and chemotherapy (CT) within a prospective randomized phase II CAO-ARO-AIO-12 trial, conducted in the context of DKTK (Deutsches Konsortium für translationale Krebsforschung) and FCI (Frankfurt Cancer Institute), to address the questions whether peripheral blood and/or primary tumor immune contexture predict for treatment response, were modulated by nCRT/CT and correlated with each other. By this, immune cell components were assayed by flow cytometry from peripheral blood mononuclear cells (PBMCs) at baseline, day 43, and pre-surgery of 22 patients treated with nCRT/CT and subsequently correlated with pathologic treatment response. Immunophenotyping was performed applying different staining panels covering myeloid immune cells and human leukocyte antigen (HLA) molecules, T lymphocyte subpopulations and programmed cell death (PD)-1 protein expression and regulatory T cells (Tregs). In addition, tumor tissue samples from pre-therapeutic biopsies and surgical specimens were analyzed by immunohistochemistry and multiparametric immunofluorescence.
The present prospective study raised the following issues. First, peripheral lymphocytes seem to play a crucial role in the nCRT/CT mediated systemic anticancer immunological response. Second, among the various lymphocyte subsets, peripheral blood, but not tissue resident T lymphocytes seem to play a central role in predicting treatment response. By this, baseline blood phenotyping revealed a lymphocyte distribution with high numbers of (CD3+CD4+) T helper cells and low numbers of (CD3+CD8+) cytotoxic T cells expressing PD1, activation markers GranzymeB, perforin and HLA-DR to be associated with an improved response (ypT0ypN0) to nCRT/CT in the patient’s cohort investigated. Further, a decrease in B lymphocyte (CD3+CD19+) count correlated with intermediate and impaired response while an elevated monocyte (CD14+CD33+) levels predicted a complete and intermediate (ypT1-4ypN0) response to nCRT/CT. On a tissue level, patients with a complete response displayed a decrease in the amount of infiltrating neutrophils as the immunoscore of CD15+ cells was significantly higher in patients’ biopsies compared to post-nCRT/CT surgical specimen, while in both, patients with complete and intermediate response an increase of natural killer (CD56+) cell density and GranzymeB expression was observed. Finally, no significant correlation was observed between peripheral blood and tissue immune marker expression.
To validate and expand these findings, a continuation of the analysis in an extended patient cohort is necessary. In addition, a detailed insight on the role of peripheral blood T cells and monocytes and their activation status is desirable. Further, in a follow-up trial, soluble activation markers/cytokines should be assayed, further distinguishing activated from resting or exhausted lymphocytes.
Bacteria are true artists of survival, which rapidly adapt to environmental changes like pH shifts, temperature changes and different salinities. Upon osmotic shock, bacteria are able to counteract the loss of water by the uptake of potassium ions. In many bacteria, this is accomplished by the major K+ uptake system KtrAB. The system consists of the K+-translocating channel subunit KtrB, which forms a dimer in the membrane, and the cytoplasmic regulatory RCK subunit KtrA, which binds non-covalently to KtrB as an octameric ring. This unique architecture differs strongly from other RCK-gated K+ channels like MthK or GsuK, in which covalently tethered cytoplasmic RCK domains regulate a single tetrameric pore. As a consequence, an adapted gating mechanism is required: The activation of KtrAB depends on the binding of ATP and Mg2+ to KtrA, while ADP binding at the same site results in inactivation, mediated by conformational rearrangements. However, it is still poorly understood how the nucleotides are exchanged and how the resulting conformational changes in KtrA control gating in KtrB is still poorly understood.
Here,I present a 2.5-Å cryo-EM structure of ADP-bound, inactive KtrAB, which for the first time resolves the N termini of both KtrBs. They are located at the interface of KtrA and KtrB, forming a strong interaction network with both subunits. In combination with functional and EPR data we show that the N termini, surrounded by a lipidic environment, play a crucial role in the activation of the KtrAB system. We are proposing an allosteric network, in which an interaction of the N termini with the membrane facilitates MgATP-triggered conformational changes, leading to the active, conductive state.
The phospholipid bilayers are the primary constituents of the membrane in living cells in which lipids are hold together in bilayer leaflets through a combination of different forces into the liquid crystalline (Lα) phase. Despite their thin fragile formations, the phospholipid bilayers are responsible for performing a variety of important tasks in the cells, some of which are carried out directly by the lipid bilayers and some by various integral proteins embedded within the bilayers. There have been continues efforts over the past decades to replicate the compound biophysical properties of living cell membranes in model lipid bilayers.
An important question remains unanswered: is it possible to replicate physical properties under “non-equilibrium” conditions as found in cell membranes in model lipid bilayers? In almost all previous studies, the model lipid bilayers were under static conditions – for instance, at zero lateral pressure. However, in living organisms, the cell membranes are involved in continuous (nonequilibrium) exchange and (or) transport of lipid species with the surrounding environment which consequently leads them to experience continuous lateral pressure variations. One suitable in vitro approach is to spatiotemporally control the model lipid bilayers over a time period during which they can be spatially stimulated at a level compatible to that found under in vivo conditions. This can be achieved with high spatiotemporal resolution by making lipids light-dependent through implementation of azobenzene photoswitch in their structures.
In this study, a specific azobenzene containing photolipid (AzoPC) is integrated into POPE:POPG bilayers (POPE: 1-palmitoyl-2-oleoyl-sn-glycero-3-phosphoethanolamine, POPG: 1-palmitoyl-2-oleoyl-sn-glycero-3-phospho-(1'-rac-glycerol)) at ~14 mol% to construct a photo responsive model bilayers entitled as photoliposomes. Magic angle spinning solid-state NMR spectroscopy (MAS-NMR) at high field (850 MHz) is the measurement technique of choice by which it is possible to pursue the dynamics (fluidity) of the bulk lipids within the photoliposomes at atomistic resolution. It is shown that the AzoPCs undergo an efficient trans-to-cis isomerization (~85%) within the photoliposomes as the result of UV light absorption, and thermally relax back to the trans state during a period of ~65 h under the MAS measurement conditions. The order parameter measurements based on the C−H dipolar couplings reveal that the non-equilibrium cis-to-trans thermal isomerization impact of AzoPC on the fluidity of the bulk lipid is highly localized – the fluidity perturbations originate from specific order parameter changes in the middle section of the bulk lipid acyl chains. Further 1H NOESY measurements confirm the hypothesis that the azoswitch topologies in either cis and trans conformer of the photolipid is the key parameter in localized alteration of the C−H order parameters along the bulk lipid acyl chains.
Diacylglycerol kinase (DgkA) from E. coli is an enzyme responsible for the phosphorylation of diacylglycerol to phosphatidic acid, at the expense of adenosine triphosphate. Structurally, DgkA is a homo oligomer composed of three symmetric 14 kDa protomers, each of which has three transmembrane helices and one surface helix. Upon embedding within the photoliposomes, it is shown that DgkA enhances the AzoPC localization impact on the fluidity of the bulk lipids. In this regard, the results of a series of statistical simulations of lipid lateral diffusions along the bilayer leaflets in presence and absence of embedded proteins are accompanied with those of experimentally measured based upon which it is justified that membrane proteins markedly limit lipid lateral diffusions in the bilayers. In case of the DgkA proteo-liposomes with lipid-to-protein ratio of 50, it is estimated that the diffusion coefficient of lipids is above 2-fold lower compared to that of the protein free liposomes.
The cis-to-trans AzoPC isomerization and its following consequence in localized alteration of the bulk lipid fluidity is further investigated on the structural dynamics and enzymatic functionality of the embedded DgkA within the proteo-photoliposomes. It is revealed that DgkA structural dynamics are perturbated in a multi-scale, complex manner. The dynamics of residues located in different regions of DgkA changes with the light-induced AzoPC isomerization, but their time courses differ from residue to residue. For example, 29Ala, a residue on the hinge between the surface helix and membrane helix-1, exhibits the steepest time-dependent cross peak intensity changes in time-resolved NCA spectra. The impact of the lasting membrane fluidity perturbation on the enzymatic functionality of the embedded DgkA is subsequently measured which demonstrates a significant variation under cis- and trans-AzoPC conformations within the proteo-photoliposomes.
This paper examines auditor liability rules under imperfect information, costly litigation and risk averse auditors. A negligence rule fails in such a setting, because in equilibrium auditors will deviate with positive probability from any given standard. It is shown that strict liability outperforms negligence with respect to risk allocation, and the probability that a desired level of care is met by the audi tor if competitive liability insurance markets exist. Furthermore, our model explains the existence of insurance contracts containing obligations - a type of contract often observed in liability insurance markets.
Real estate is an important asset, but as a direct investment subject to several difficulties. Shares of public open end funds or of real estate stock corporations represent a possible way for an investor to avoid these problems. The focus of this paper is the analysis of inflation risk of European real estate securities. An overview of the institutional frameworks regarding these companies is given. The returns of real estate securities in France, Germany, Switzerland and the United Kingdom are examined for the period 1980:1-1998:12. Besides the classical Fama/Schwert-approach, shortfall risk measurements have been used. In this context, transaction costs in particular have been taken into account.
Damien Ajavon is a contemporary and conceptual textile artist currently living and working in Montreal who describes himself as a creative mind, TV-nerd and Dollarstore-Queen. For a long time, he did not consider himself an artist because he could not draw – a skill, he believed, a good artist should have. Now, he knows better: Creativity and the ability to share visions and expressions are his paper and pen.
U–Pb age spectra of detrital zircons related to the East European Platform could be traced in paragneiss through the whole Mid-German-Crystalline Zone (Variscides, Central Europe) from the Odenwald via the Spessart to the Ruhla crystalline forming an exotic unit between Armorica and Laurussia. The depositional ages of the paragneiss are defined by the youngest age of the detrital zircons and the oldest intrusion ages as Ordovician to Silurian. The Ediacaran dominated age spectrum of detrital zircons from the paragneiss of the East Odenwald suggests the latter to be derived from the shelf of the East European Platform (Baltica), which was influenced by the 1.5 Ga old detritus delivered from a giant intrusion (Mazury granitoid, Poland). The detrital zircon age spectrum of the lower Palaeozoic paragneiss of the East Odenwald and sandstone of the northern Holy Cross Mountains are identical. The pure Sveconorwegian spectrum of the lower Palaeozoic quartzite from the Spessart, (Kirchner and Albert Int J Earth Sci 2020) and the Ruhla (Zeh and Gerdes Gondwana Res 17:254–263, 2010) could be sourced from Bornholm and southern Sweden. A U–Pb age spectrum with 88% Palaeozoic detrital zircons from a volcano-sedimentary rock of the East Odenwald is interpreted to be derived from a Silurian magmatic arc (46%), which was probably generated during the drift of the Mid-German-Crystalline Zone micro-continent to the south. A tentative plate tectonic model of Mid-German-Crystalline Zone is presented taking into account (a) the East European Platform related age spectra of the detrital zircons (b) the Ordovician to Silurian depositional age of the metasediments (c) the Silurian and Early Devonian intrusion age of the plutonic and volcanic rocks and (d) the U–Pb ages of the Middle Devonian high-grade metamorphism. The East European Platform-related part of the Mid-German-Crystalline Zone is interpreted as a micro-continent, which drifted through the Rheic Ocean to the south and collided with the Saxothuringian (Armorican Terrane Assemblage) during the Early Devonian. Such large-scale tectonic transport from the northern continent to the southern continent is also known from the SW Iberia, where Laurussia-related metasediments of the Rheic suture zone are explained by a large scale tectonic escape (Braid et al. J Geol Soc Lond 168:383–392, 2011).
Objectives: To test the effect of race/ethnicity on cancer-specific mortality after radical prostatectomy or external beam radiotherapy in localized prostate cancer patients. Methods: In the Surveillance, Epidemiology and End Results database 2004–2016, we identified intermediate-risk and high-risk white (n = 151 632), Asian (n = 11 189), Hispanic/Latino (n = 20 077) and African American (n = 32 550) localized prostate cancer patients, treated with external beam radiotherapy or radical prostatectomy. Race/ethnicity-stratified cancer-specific mortality analyses relied on competing risks regression, after propensity score matching for patient and cancer characteristics. Results: Compared with white patients, Asian intermediate- and high-risk external beam radiotherapy patients showed lower cancer-specific mortality (hazard ratio 0.58 and 0.70, respectively, both P ≤ 0.02). Additionally, Asian high-risk radical prostatectomy patients also showed lower cancer-specific mortality than white patients (hazard ratio 0.72, P = 0.04), but not Asian intermediate-risk radical prostatectomy patients (P = 0.08). Conversely, compared with white patients, African American intermediate-risk radical prostatectomy patients showed higher cancer-specific mortality (hazard ratio 1.36, P = 0.01), but not African American high-risk radical prostatectomy or intermediate- and high-risk external beam radiotherapy patients (all P ≥ 0.2). Finally, compared with white people, no cancer-specific mortality differences were recorded for Hispanic/Latino patients after external beam radiotherapy or radical prostatectomy, in both risk levels (P ≥ 0.2). Conclusions: Relative to white patients, an important cancer-specific mortality advantage applies to intermediate-risk and high-risk Asian prostate cancer patients treated with external beam radiotherapy, and to high-risk Asian patients treated with radical prostatectomy. These observations should be considered in pretreatment risk stratification and decision-making.
The knob-associated histidine-rich protein (KAHRP) plays a pivotal role in the pathophysiology of Plasmodium falciparum malaria by forming membrane protrusions in infected erythrocytes, which anchor parasite-encoded adhesins to the membrane skeleton. The resulting sequestration of parasitized erythrocytes in the microvasculature leads to severe disease. Despite KAHRP being an important virulence factor, its physical location within the membrane skeleton is still debated, as is its function in knob formation. Here, we show by super-resolution microscopy that KAHRP initially associates with various skeletal components, including ankyrin bridges, but eventually colocalizes with remnant actin junctions. We further present a 35 Å map of the spiral scaffold underlying knobs and show that a KAHRP-targeting nanoprobe binds close to the spiral scaffold. Single-molecule localization microscopy detected ~60 KAHRP molecules/knob. We propose a dynamic model of KAHRP organization and a function of KAHRP in attaching other factors to the spiral scaffold.
Correction to: Clinical Rheumatology. DOI: https://doi.org/10.1007/s10067-021-05891-5
In the original published version of this article, the Figure 4 contained error. The line “ACR50 plus PASI100” has been presented incorrectly. The Figure 4 is now presented correctly. The original article has been corrected.
Four years after the Panama Papers scandal, tax avoidance remains an urgent moral-political problem. Moving beyond both the academic and policy mainstream, I advocate the “democratization of tax enforcement,” by which I mean systematic efforts to make tax avoiders accountable to the judgment of ordinary citizens. Both individual oligarchs and multinational corporations have access to sophisticated tax avoidance strategies that impose significant fiscal costs on democracies and exacerbate preexisting distributive and political inequalities. Yet much contemporary tax sheltering occurs within the letter of the law, rendering criminal sanctions ineffective. In response, I argue for the creation of Citizen Tax Juries, deliberative minipublics empowered to scrutinize tax avoiders, demand accountability, and facilitate concrete reforms. This proposal thus responds to the wider aspiration, within contemporary democratic theory, to secure more popular control over essential economic processes.
Objective: Evaluation of survival of teeth with class III furcation involvement (FI) ≥5 years after active periodontal treatment (APT) and identification of prognostic factors. Methods: All charts of patients who completed APT at the Department of Periodontology of Goethe-University Frankfurt, Germany, beginning October 2004 were screened for teeth with class III FI. APT had to be accomplished for ≥5 years. Charts were analysed for data of class III FI teeth at baseline (T0), at accomplishment of APT (T1), and at the last supportive periodontal care (T2). Baseline radiographic bone loss (RBL) and treatment were assessed. Results: One-hundred and sixty patients (age: 54.4 ± 9.8 years; 82 females; 39 active smokers; 9 diabetics, 85 stage III, 75 stage IV, 59 grade B, 101 grade C) presented 265 teeth with class III FI. Ninety-eight teeth (37%) were lost during 110, 78/137 (median, lower/upper quartile) months. Logistic mixed-model regression and mixed Cox proportional hazard model associated adjunctive systemic antibiotics with fewer tooth loss (26% vs. 42%; p = .019/.004) and RBL (p = .014/.024) and mean probing pocket depth (PPD) at T1 (p < .001) with more tooth loss. Conclusions: Subgingival instrumentation with adjunctive systemic antibiotics favours retention of class III furcation-involved teeth. Baseline RBL and PPD at T1 deteriorate long-term prognosis.
Digital wealth and its necessary regulation have gained prominence in recent years. The European Commission has published several documents and policy proposals relating, directly or indirectly, to the data economy. A data economy can be defined as an ecosystem of different types of market players collaborating to ensure that data is accessible and usable in order to extract value from data through, for example, creating a variety of applications with great potential to improve daily life. The value of data can increase from EUR 257 billion (1.85 of EU Gross Domestic Product (GDP)) to EUR 643 billion by 2020 (3.17% of EU GDP), according to the EU Commission. The legal implications of the increasing value of the data economy are clear; hence the need to address the challenges presented by its legal regulation.
NGO brokers between local needs and global norms: trajectories of development actors in Burkina Faso
(2021)
Local NGO brokers in Africa and beyond negotiate and mediate between (inter)national donors and potential beneficiaries within their communities. They translate local needs into development projects to make them suitable for international donors. This article looks at two main conditions that influence their work: First, windows of opportunity, which open and close according to structures and institutions beyond their sphere of influence; and second, their personality and skills. Based on two case studies from Burkina Faso, this article offers insights into biographies and life stories of such brokers where engagement leads to a distinguished lifestyle that contains aspects of cosmopolitanism and distinctiveness.
The health and genetic data of deceased people are a particularly important asset in the field of biomedical research. However, in practice, using them is compli- cated, as the legal framework that should regulate their use has not been fully developed yet. The General Data Protection Regulation (GDPR) is not applicable to such data and the Member States have not been able to agree on an alternative regulation. Recently, normative models have been proposed in an attempt to face this issue. The most well- known of these is posthumous medical data donation (PMDD). This proposal supports an opt-in donation system of health data for research purposes. In this article, we argue that PMDD is not a useful model for addressing the issue at hand, as it does not consider that some of these data (the genetic data) may be the personal data of the living relatives of the deceased. Furthermore, we find the reasons supporting an opt-in model less convincing than those that vouch for alternative systems. Indeed, we propose a normative framework that is based on the opt-out system for non-personal data combined with the application of the GDPR to the relatives’ personal data.
The quality of life: protecting non-personal interests and non-personal data in the age of big data
(2021)
Under the current legal paradigm, the rights to privacy and data protection provide natural persons with subjective rights to protect their private interests, such as related to human dignity, individual autonomy and personal freedom. In principle, when data processing is based on non-personal or aggregated data or when such data pro- cesses have an impact on societal, rather than individual interests, citizens cannot rely on these rights. Although this legal paradigm has worked well for decades, it is increasingly put under pressure because Big Data processes are typically based indis- criminate rather than targeted data collection, because the high volumes of data are processed on an aggregated rather than a personal level and because the policies and decisions based on the statistical correlations found through algorithmic analytics are mostly addressed at large groups or society as a whole rather than specific individuals. This means that large parts of the data-driven environment are currently left unregu- lated and that individuals are often unable to rely on their fundamental rights when addressing the more systemic effects of Big Data processes. This article will discuss how this tension might be relieved by turning to the notion ‘quality of life’, which has the potential of becoming the new standard for the European Court of Human Rights (ECtHR) when dealing with privacy related cases.
Ownership of databases: personal data protection and intellectual property rights on databases
(2021)
When we think on initiatives on access to and reuse of data, we must consider both the European Intellectual Property Law and the General Data Protection Regulation (GDPR). The first one provides a special intellectual property (IP) right – the sui generis right – for those makers that made a substantial investment when creating the database, whether it contains personal or non-personal data. That substantial investment can be made by just one person, but, in many cases, it is the result of the activities of many people and/or some undertakings processing and aggregating data. In the modern digital economy, data are being dubbed the ‘new oil’ and the sui generis right might be con- sidered a right to control any access to the database, thus having an undeniable relevance. Besides, there are still important inconsistences between IP Law and the GDPR, which must be removed by the European legislator. The genuine and free consent of the data subject for the use of his/her data must remain the first step of the legal analysis.
Commercialization of consumers’ personal data in the digital economy poses serious, both conceptual and practical, challenges to the traditional approach of European Union (EU) Consumer Law. This article argues that mass-spread, automated, algorithmic decision-making casts doubt on the foundational paradigm of EU consumer law: consent and autonomy. Moreover, it poses threats of discrimination and under- mining of consumer privacy. It is argued that the recent legislative reaction by the EU Commission, in the form of the ‘New Deal for Consumers’, was a step in the right direction, but fell short due to its continued reliance on consent, autonomy and failure to adequately protect consumers from indirect discrimination. It is posited that a focus on creating a contracting landscape where the consumer may be properly informed in material respects is required, which in turn necessitates blending the approaches of competition, consumer protection and data protection laws.
Objective: This study was undertaken to evaluate the long-term efficacy, retention, and tolerability of add-on brivaracetam (BRV) in clinical practice. Methods: A multicenter, retrospective cohort study recruited all patients who initiated BRV between February and November 2016, with observation until February 2021. Results: Long-term data for 262 patients (mean age = 40 years, range = 5–81 years, 129 men) were analyzed, including 227 (87%) diagnosed with focal epilepsy, 19 (7%) with genetic generalized epilepsy, and 16 (6%) with other or unclassified epilepsy syndromes. Only 26 (10%) patients had never received levetiracetam (LEV), whereas 133 (50.8%) were switched from LEV. The length of BRV exposure ranged from 1 day to 5 years, with a median retention time of 1.6 years, resulting in a total BRV exposure time of 6829 months (569 years). The retention rate was 61.1% at 12 months, with a reported efficacy of 33.1% (79/239; 50% responder rate, 23 patients lost-to-follow-up), including 10.9% reported as seizure-free. The retention rate for the entire study period was 50.8%, and at last follow-up, 133 patients were receiving BRV at a mean dose of 222 ± 104 mg (median = 200, range = 25–400), including 52 (39.1%) who exceeded the recommended upper dose of 200 mg. Fewer concomitant antiseizure medications and switching from LEV to BRV correlated with better short-term responses, but no investigated parameters correlated with positive long-term outcomes. BRV was discontinued in 63 (24%) patients due to insufficient efficacy, in 29 (11%) for psychobehavioral adverse events, in 25 (10%) for other adverse events, and in 24 (9%) for other reasons. Significance: BRV showed a clinically useful 50% responder rate of 33% at 12 months and overall retention of >50%, despite 90% of included patients having previous LEV exposure. BRV was well tolerated; however, psychobehavioral adverse events occurred in one out of 10 patients. Although we identified short-term response and retention predictors, we could not identify significant predictors for long-term outcomes. Key Points Long-term postmarketing data for brivaracetam in 262 patients showed an overall retention rate of 50.8%; At 12 months, the 50% responder rate for brivaracetam was 33.1%, with 10.9% reporting seizure freedom; Previous treatment with levetiracetam (90%) did not impact brivaracetam retention or efficacy; Levetiracetam treatment failure should not preclude brivaracetam introduction; No long-term efficacy predictors could be identified.
Large companies are increasingly on trial. Over the last decade, many of the world’s biggest firms have been embroiled in legal disputes over corruption charges, financial fraud, environmental damage, taxation issues or sanction violations, ending in convictions or settlements of record-breaking fines, well above the billion-dollar mark. For critics of globalization, this turn towards corporate accountability is a welcome sea-change showing that multinational companies are no longer above the law. For legal experts, the trend is noteworthy because of the extraterritorial dimensions of law enforcement, as companies are increasingly held accountable for activities independent of their nationality or the place of the activities. Indeed, the global trend required understanding the evolution of corporate criminal law enforcement in the United States in particular, where authorities have skillfully expanded its effective jurisdiction beyond its territory. This paper traces the evolution of corporate prosecutions in the United States. Analyzing federal prosecution data, it then shows that foreign firms are more likely to pay a fine, which is on average 6,6 times larger.
Cancer microenvironment is now recognized as a critical regulator of all stages of cancer development. Beside the tumor vasculature and tumor-infiltrating immune cells, other stromal cells such as cancer-associated fibroblasts (CAFs) regulate tumor growth. Fibroblasts are ubiquitous cells in connective tissue, where they shape the extracellular matrix (ECM). Fibroblasts are usually quiescent but get activated when tissue homeostasis is disturbed. Then, activated fibroblasts rebuild the ECM and communicate with local cells to participate in wound repair. These repair properties can go awry when being unchecked, which can lead to fibrosis and subsequently cancer development. CAFs can promote cancer development by fostering tumor cell growth, polarizing immune cells to an immunosuppressive phenotype, and crosslinking collagen to enable tumor cell invasion. Molecular mechanisms of CAF activation, thus, need to be understood to target these cells in tumors. Prostanoid prostaglandin E2 (PGE2) is viewed as a pro-tumor lipid mediator as suggested by studies pharmacologically or genetically targeting the enzymes producing PGE2, such as microsomal PGE synthase-1 (mPGES-1) in tumor models. Similar to CAFs, PGE2 drives tumor cell growth and tumor-associated immune suppression. Therefore, I hypothesized that PGE2 may play a role in CAF activation.
This hypothesis was tested in two mouse models of breast cancer (orthotopic grafting model, and polyoma middle T oncogene transgenic model), besides using isolated mammary gland (MG) fibroblasts in vitro. As expected, given the pro-tumor function of PGE2, knocking out mPGES-1 reduced the growth of oncogene-driven and transplanted mammary tumors. Surprisingly, CAF density was markedly increased when mPGES-1 was depleted. Importantly, despite reduced primary tumor growth, I observed enhanced lung metastasis upon mPGES-1depletion. Using MG-derived fibroblasts in vitro furthermore revealed that treatment with PGE2 reduced a TGFβtriggered CAF-like activation state. Importantly, bioinformatics analysis of a human breast cancer patient dataset revealed a negative correlation of a PGE2 production signature with fibroblast marker genes. In a next step I investigated if the increased CAF infiltrate was connected to the reduced tumor growth upon depletion of PGE2. To unravel this, I first asked through which E prostanoid (EP) receptor PGE2 signals in fibroblasts. MG fibroblasts mainly expressed EP3, and EP3 KO fibroblasts showed a hyper-proliferative and activated phenotype, indicating EP3 as the main PGE2 receptor in MG fibroblasts. Co-injecting of EP3 KO MG fibroblasts and tumor cells in WT mice suppressed tumor growth, whereas co-injection of WT fibroblasts with tumor cell in mPGES-1 KO mice increased tumor growth. These data indicate that PGE2 restricts CAF levels through EP3, which supports tumor growth. Whole transcriptome mRNAsequencing of WT and mPGES-1 KO FACS-sorted CAFs combined with immunohistochemical data suggested a role of p38 mitogen-activated protein kinase (MAPK) in the modulation of fibroblast activation by PGE2.
In summary, I showed in two breast cancer models that mPGES-1 depletion delays breast cancer progression, which is probably driven by the EP3-PGE2 signaling axis in host stroma. PGE2 appears to be a potent anti-fibroblast activation agent in tumors via EP3 and downstream p38 MAPK signaling. This study therefore hits the dogmatic perception of the general pro-tumor nature of PGE2; showing that PGE2 might be a double-edged mediator that can promote tumor growth at the primary site by restricting CAF expansion, which may in turn hinder infiltration of tumor cells to a secondary site.
In the recent years, myxobacteria have emerged as a novel source of natural compounds with structural diversity and biological activity for drug discovery. In this work, the two myxobacterial compounds archazolid and vioprolide were characterized for their potential pharmacological effects in vascular endothelial cells. Archazolid is a wellestablished v-ATPase inhibitor found in Archangium gephyra and Cystobacter spec. As the v-ATPase represents a promising target in cancer treatment, the effects of archazolid have been intensively studied in cancer cells, but rarely in endothelial cells. Vioprolide is an antifungal and cytotoxic metabolite obtained from Cystobacter violaceus. There are only few studies on vioprolide, most of them focusing on its biosynthesis. Preliminary studies revealed that it inhibited TNF-induced expression of ICAM-1, indicating possible anti-inflammatory properties. As the endothelium plays an important role in cancer and inflammation, it represents an attractive drug target. Therefore, the archazolid and vioprolide were investigated regarding their effects on endothelial cells.
V-ATPase inhibition by archazolid resulted in anti-tumor and anti-metastatic effects in vitro and in vivo. Archazolid was used to study the consequences of v-ATPase inhibition in endothelial cells that might contribute to the anti-metastatic activities observed in vivo. To analyze the impact of archazolid on the interaction endothelial and cancer cells, in vitro cell adhesion and transmigration assays were performed using primary HUVEC or immortalized HMEC-1 and different cancer cell types (MDA-MB-231, PC-3 and Jurkat cells). For these experiments, only the endothelial cells were treated with archazolid. VATPase inhibition by archazolid led to an increased adhesion of the metastatic breast cancer cell line MDA-MB-231 and prostate cancer cell line PC-3 onto endothelial cells whereas the adhesion of Jurkat cells was unaffected. Interestingly, archazolid treatment of HUVECs decreased the transendothelial migration of MDA-MB-231 cells. Endothelial ICAM-1, VCAM-1, E-selectin and N-cadherin are potential ligands of interacting cancer cells. Therefore, the mRNA and surface protein levels of these cell adhesion molecules were measured via qRT-PCR and flow cytometry, respectively. These adhesion molecules were not responsible for the archazolid-induced cancer cell adhesion, as archazolid treatment of HUVECs did not upregulate their mRNA or surface expression. Instead, cell adhesion assays using a monoclonal antibody against integrin subunit β1 showed that β1-integrins expressed on MDA-MB-231 and PC-3 cells mediated the archazolid-induced cancer cell adhesion. Cell adhesion assays onto plastic coated with ECM components which are the major ligands of β1-integrins, revealed that MDA-MB231 and PC-3 cells preferably interact with collagen. So next, we investigated the influence of archazolid on surface collagen levels in HUVECs by immunostaining, which demonstrated an increase of nearly 50 % upon archazolid treatment. We confirmed the hypothesis that the expression and activity of cathepsin B, a lysosomal enzyme that degrades extracellular matrix components including collagen, was inhibited by archazolid in endothelial cells. Finally, overexpression of cathepsin B reduced the cancer cell adhesion on archazolid-treated HUVECs, but also in control cells, indicating a negative correlation between cathepsin B expression and cancer cell adhesion.
The influence of vioprolide on the interaction of endothelial cells with leukocytes was analyzed by in vitro cell adhesion assays using HUVECs and primary monocytes, THP-1 or Jurkat cells. Vioprolide inhibited the adhesion of these cells onto TNF-activated HUVECs. In addition, the endothelial-leukocyte interaction was observed in vivo by intravital microscopy in the mouse cremaster muscle. Vioprolide prevented the TNFinduced firm adhesion and transmigration of leukocytes, while leukocyte rolling was not affected. ICAM-1, VCAM-1 and E-selectin are cell adhesion molecules, which are upregulated by TNF and mediate leukocyte adhesion onto endothelial cells. Therefore, flow cytometric analysis was performed to measure their surface expression. Vioprolide significantly decreased TNF-induced expression of surface ICAM-1, VCAM-1 and E-selectin, which was in line with the in vitro results. In vivo, vioprolide may act in a different way on E-selectin expression, so that leukocyte rolling, which is governed by E-selectin, remained unaffected. qRT-PCR experiments revealed that the mRNA expression of ICAM-1 and VCAM-1 were also reduced by vioprolide, indicating a regulation on transcriptional level. In contrast, the mRNA expression of E-selectin was not decreased at the timepoint when surface protein expression was diminished. The induction of these cell adhesion molecules is mainly mediated by the transcription factor NFκB. A Dual-Luciferase® reporter assay was used to study the impact of vioprolide on the TNF-induced NFκB promotor activity. Vioprolide blocked the TNF-induced NFκB promotor activity while the TNF-induced IκBα degradation and nuclear translocation of the NFκB subunit p65 was not altered by vioprolide. Western blot analysis revealed that vioprolide had no effect on the activation of MAPK (p38, JNK) and AKT by TNF, which could interfere with the NFκB-dependent gene expression.
Taken together, archazolid and vioprolide are interesting myxobacterial compounds with different modes of actions. The study suggests that the v-ATPase inhibitor archazolid impairs the expression and activity of cathepsin B in endothelial cells, which leads to a higher amount of collagen on the endothelial surface. As a result, the adhesion of β1-integrin expressing metastatic cancer cells onto archazolid-treated endothelial cells increased while transendothelial migration was reduced. Further, archazolid represents a promising tool to elucidate the role of v-ATPase in endothelial cells. Vioprolide was able to prevent TNF-induced endothelial-leukocyte interaction in vitro and in vivo by interfering with NFκB-dependent gene expression. Further research is required to enlighten the underlying mechanism and the direct target of vioprolide.