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Institute
In this article, the video demonstrated is an example of a 76-year-old male patient who presented with recurrent intestinal bleeding of unknown origin at the university hospital. Previously performed upper and lower gastrointestinal tract endoscopy did not reveal a bleeding lesion. Capsule endoscopy revealed small-bowel angiectasia that were treated by argon plasma coagulation at subsequent balloon enteroscopy. This article is part of an expert video encyclopedia.
Small bowel endoscopy is indicated for patients with an unidentified bleeding site in esophagogastroduodenoscopy and ileocolonoscopy and symptoms of intestinal blood loss or unexplained anemia. In approximately two-thirds of these cases, capsule endoscopy (CE) detects a lesion within the small bowel that explains the patient's symptoms. In few cases, though, lesions outside of the small bowel might be revealed by CE. Therefore, attention to all intestines that are visualized by CE might be necessary not to overlook bleeding sites that had not been discovered by prior flexible endoscopy.
Here the case of a 71-year-old male patient with unexplained anemia is presented by the authors. Small-bowel CE revealed minor bleeding from a neoplastic mass in the cecum. The final diagnosis of an adenocarcinoma of the ascending colon was established after the patient underwent a right hemicolectomy. This article is part of an expert video encyclopedia.
Small bowel endoscopy is indicated for patients with an unidentified bleeding site in esophago-gastro-duodenoscopy and ileo-colonoscopy and symptoms of intestinal blood loss or unexplained anemia. In approximately two-thirds of these cases, capsule endoscopy (CE) detects a lesion within the small bowel that explains the patient's symptoms. In few cases, though, lesions outside of the small bowel might be revealed by CE. Therefore, attention to all intestines that are visualized by CE might be necessary not to overlook bleeding sites that had not been discovered by prior flexible endoscopy.
The authors present the case of a 71-year-old male patient who presented to their outpatient clinic for unexplained anemia. Small bowel CE revealed minor bleeding from an adenocarcinoma in the cecum. This article is part of an expert video encyclopedia.
Operatively altered anatomy might provide a challenge for endoscopic retrograde cholangiopancreatography. However, with the support of the balloon-assisted enteroscopy technique the access route to the biliary system even in long-limb Roux-Y anastomosis is feasible in most cases.
In this video case report, an 81-year-old woman was symptomatic for stone obstruction of the common bile duct (CBD). Complete gastrectomy had been performed in this patient for stomach cancer many years earlier. Balloon-assisted enteroscopy was used for retrograde access of the duodenum via a Roux-Y anastomosis. There was major difficulty in intubating the CBD via the native papilla in this case because access was prevented by the tangential approach of the enteroscope. After performing an incomplete papillectomy, the insertion of a guidewire into the CBD was feasible and the bile duct stone was removed. This article is part of an expert video encyclopedia.
Here the authors report the case of an elderly woman who had upper abdominal pain, upper gastrointestinal hemorrhage, and jaundice (a symptomatic triad termed the ‘Quincke’ triad) a few days after endoscopic sphincterotomy. Abdominal ultrasonography demonstrated an echo-rich filling of the choledochus consistent with hemobilia. Endoscopic retrograde cholangiography was immediately performed and blood clots were removed from the common bile duct. A nasobiliary catheter was placed to irrigate the bile duct for prevention of recurring obstruction of the bile ducts from blood clots. Further follow-up of the patient was uneventful. This article is part of an expert video encyclopedia.
Small-bowel tumors are rare and account for approximately 5% of all gastrointestinal tumors. Approximately 65% of small-bowel tumors are malignant, and approximately 40% of these tumors are adenocarcinomas. Similar to colorectal adenocarcinoma, premalignant adenomas of the small bowel may progress to carcinoma. This occurs both sporadically and in the context of hereditary tumor syndromes such as familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer (Lynch syndrome). Herein cases with small-bowel adenocarcinomas visualized with both capsule endoscopy and double-balloon enteroscopy are presented. This article is part of an expert video encyclopedia.
Herbal hepatotoxicity is a rare but highly disputed disease because numerous confounding variables may complicate accurate causality assessment. Case evaluation is even more difficult when the WHO global introspection method (WHO method) is applied as diagnostic algorithm. This method lacks liver specificity, hepatotoxicity validation, and quantitative items, basic qualifications required for a sound evaluation of hepatotoxicity cases. Consequently, there are no data available for reliability, sensitivity, specificity, positive and negative predictive value. Its scope is also limited by the fact that it cannot discriminate between a positive and a negative causality attribution, thereby stimulating case overdiagnosing and overreporting. The WHO method ignores uncertainties regarding daily dose, temporal association, start, duration, and end of herbal use, time to onset of the adverse reaction, and course of liver values after herb discontinuation. Insufficiently considered or ignored are comedications, preexisting liver diseases, alternative explanations upon clinical assessment, and exclusion of infections by hepatitis A-C, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), and varicella zoster virus (VZV). We clearly prefer as alternative the scale of CIOMS (Council for International Organizations of Medical Sciences) which is structured, quantitative, liver specific, and validated for hepatotoxicity. In conclusion, causality of herbal hepatotoxicity is best assessed by the liver specific CIOMS scale validated for hepatotoxicity rather than the obsolete WHO method that is liver unspecific and not validated for hepatotoxicity. CIOMS based assessments will ensure the correct diagnosis and exclude alternative diagnosis that may require other specific therapies.
For the pathologist, the diagnosis of drug induced liver injury (DILI) is challenging, because histopathological features mimic all primary hepatic and biliary diseases, lacking changes that are specific for DILI. Therefore, in any patient of suspected DILI who underwent liver biopsy, the pathologist will assure the clinician that the observed hepatic changes are compatible with DILI, but this information is less helpful due to lack of specificity. Rather, the pathologist should assess liver biopsies blindly, without knowledge of prior treatment by drugs. This will result in a detailed description of the histological findings, associated with suggestions for potential causes of these hepatic changes. Then, it is up to the physician to reassess carefully the differential diagnoses, if not done before. At present, liver histology is of little impact establishing the diagnosis of DILI with the required degree of certainty, and this shortcoming also applies to herb induced liver injury (HILI). To reach at the correct diagnoses of DILI and HILI, clinical and structured causality assessments are therefore better approaches than liver histology results obtained through liver biopsy, an invasive procedure with a low complication rate.
The relationship between achievement of a pathologic complete response (pCR) and favorable long-term outcome varies among breast cancer subtypes. We aimed to highlight which neoadjuvant treatment strategy could be most successful in each breast cancer subtype. A recent FDA meta-analysis on randomized neoadjuvant breast cancer trials suggests that the survival differences of patients with or without a pCR were less pronounced in luminal A-like tumors, despite the overall favorable prognosis of these patients. Moreover, even though the strong prognostic effect of pCR in HER2 positive and TNBC, the NOAH study was the only trial which showed a trend in surrogacy of pCR for long-term outcome in HER2-positive subtype. Results from GeparTrio study suggest that patients with hormone-positive tumors might need a response-guided approach, with either an intensification of treatment in case of an early response or a change to other chemotherapy in case of no early response. Furthermore, data from German neoadjuvant trials confirm that an increasing number of chemotherapy cycles is associated with a higher pCR rate, especially in patients with HER2-positive/hormone-positive tumors. In line with these suggestions, Tryphaena study showed a pCR rate that exceeding the 60% threshold, the highest pCR results presented in a large multicenter study. In TNBC, the highest pCR rate in the German neoadjuvant studies was obtained with the simultaneous application of docetaxel, doxorubicin and cyclophosphamide for 6 cycles. However, as shown in GaparQuinto and NSABP 40 trials, treatment effect in TNBC might be further maximized by adding bevacizumab, and two randomized neoadjuvant trials are expected this year to report data on the efficacy of carboplatin.
Hepatology highlights
(2013)
Cognition requires the dynamic modulation of effective connectivity, i.e. the modulation of the postsynaptic neuronal response to a given input. If postsynaptic neurons are rhythmically active, this might entail rhythmic gain modulation, such that inputs synchronized to phases of high gain benefit from enhanced effective connectivity. We show that visually induced gamma-band activity in awake macaque area V4 rhythmically modulates responses to unpredictable stimulus events. This modulation exceeded a simple additive superposition of a constant response onto ongoing gamma-rhythmic firing, demonstrating the modulation of multiplicative gain. Gamma phases leading to strongest neuronal responses also led to shortest behavioral reaction times, suggesting functional relevance of the effect. Furthermore, we find that constant optogenetic stimulation of anesthetized cat area 21a produces gamma-band activity entailing a similar gain modulation. As the gamma rhythm in area 21a did not spread backwards to area 17, this suggests that postsynaptic gamma is sufficient for gain modulation.
Sinnbild der Liebe, Motor des Lebens, faustgroßer Muskelsack – all das ist das Herz. Zahlreiche Sprichworte in allen Sprachen der Welt zeigen, welch zentrale Bedeutung wir Menschen diesem lebenswichtigen Organ immer schon beigemessen haben. Auch wenn wir heute wissen, dass das Herz nicht Sitz der Seele ist – seine zentrale Bedeutung ist unumstritten und ganz real. Auch und gerade dann, wenn es um alternde Herzen geht.
Ziel der vorliegenden prospektiven, experimentellen, randomisierten kontrollierten In-vitroStudie war es, zwei Dentinadhäsive, die der sechsten (One-Up-Bond F, Tokuyama) und siebten (G-Bond, GC Tokio) Generation angehören, unter ISO-Bedingungen zu untersuchen und einer Kontrollgruppe (Clearfil SE, Kuraray), die der sechsten Generation zugeordnet wird, gegenüberzustellen. Neunzig unversehrte humane Molaren der zweiten Dentition wurden eingebettet. Das Dentin wurde mit Siliziumcarbidscheiben der Körnung 600 bearbeitet, um eine Schmierschicht zu erhalten. Anschließend wurden die Dentinproben randomisiert in drei Gruppen eingeteilt und die jeweiligen Dentinadhäsive wurden nach Herstellerangaben appliziert. Mittels einer Versuchsapparatur, die in Anlehnung an die ISO/TS 11405:2003 hergestellt wurde, wurde das Kompositmaterial Tetric EvoCeram in der Farbe A2 aufgetragen und lichtgehärtet. Eine Alterung der Proben fand bei 500 Thermocycling-Zyklen bei Temperaturen von 5°C und 55°C statt. Mit einer Universalprüfmaschine Zwicki (Vorschubgeschwindigkeit 0,5 mm/min) wurde die Scherhaftfestigkeit der Proben bestimmt. Anschließend wurden die abgescherten Dentinproben unter dem Rasterelektronenmikroskop bei einer Vergrößerung von 20-fach und 2000-fach bezüglich der auftretenden Frakturmodi untersucht.
Die Haftkraft-Mittelwerte von Clearfil SE betrugen 4,22 MPa, von G-Bond 3,83 MPa und von One-Up-Bond F 7,11 MPa. Bei der statistischen Analyse mittels Kruskal-Wallis-Test wurde die Signifikanz ermittelt. Eine Signifikanz zwischen den Dentinadhäsiven One-UpBond F und G-Bond lag vor. Einzig Clearfil SE war statistisch nicht signifikant gegenüber den anderen Produkten. Die Bruchanalyse ergab, dass G-Bond eine hohe Anzahl (46,7 %) an kohäsiven Frakturen aufwies, Clearfil SE mehr als die Hälfte (66,7 %) gemischte Frakturen und dass One-Up-Bond F kaum adhäsive (3,3 %) Frakturen zeigte, sondern hauptsächlich (80 %) gemischte Brüche. Signifikante Unterschiede waren zwischen dem Bruchverhalten von Clearfil SE und G-Bond sowie zwischen G-Bond und One-Up-Bond F zu beobachten.
Unter der Limitation der vorliegenden In-vitro-Studie erscheint die Anwendung von G-Bond aufgrund der erhaltenen statistisch signifikant niedrigeren Haftwerten als nicht empfehlenswert.
MoSyD-Szenestudie ... : die offene Drogenszene in Frankfurt am Main / Centre for Drug Research
(2013)
Bei seiner Einschulung hatte Wolfgang Niedecken ein besonderes Erlebnis, als er im Alter von 6 Jahren bemerkte, dass es höchste Zeit war, ordentlich sprechen zu lernen. Im Elternhaus war ausschließlich Kölsch gesprochen worden. Hochdeutsch war seine erste Fremdsprache, die sie in letzter Konsequenz auch immer geblieben ist. Denken, empfinden und träumen tut Niedecken nach wie vor auf Kölsch, wie er selbst beteuert.
Im Sommer 1976 schreibt Wolfgang Niedecken seinen ersten Song auf Kölsch: "Helfe kann dir keiner". 1979 erscheint sein erstes Album mit dem Titel: "Wolfgang Niedecken’s BAP rockt andere kölsche Leeder".
Nie hat sich BAP auf seinen Tourneen vor den „Karren politischer Machthaber“ spannen lassen. Zu Zeiten zweier deutscher Staaten sorgten die offenen Worte von „Deshalv spill`mer he“ für einen Eklat. Das Lied sprach sich unmissverständlich nicht nur für die westdeutsche Friedensbewegung, sondern ebenfalls für die ostdeutschen Friedens- und Menschenrechtsinitiativen aus. Als die DDR-Kulturbehörden BAP verboten, den Song zu spielen, platzt am Vorabend des ersten Konzertes im Berliner Palast der Republik die über 14 Stationen geplante und längst ausverkaufte DDR-Tournee.
Am 9. November 1992 findet das „Arsch huh“-Konzert gegen Ausländerfeindlichkeit und Rassismus auf dem Kölner Chlodwigplatz vor über 100.000 Menschen statt. Danach ähnliche Konzerte in Frankfurt „Heute die, morgen Du“ und in Leipzig „Gewalt ätzt“ vor ähnlich großer Kulisse. Für sein gesellschaftspolitisches Engagement bekommt Niedecken 1998 das Bundesverdienstkreuz von Bundespräsident Roman Herzog überreicht. In der Laudatio heißt es: „Kölsch-Rock, BAP und Kölner Dialekt sind untrennbar mit ihm verbunden. Er ist einer der profiliertesten Rockmusiker Deutschlands. Als engagierter Künstler hat er sich nachhaltig für Frieden, Toleranz, Demokratie und gegen Fremdenfeindlichkeit eingesetzt.“
Zu Niedeckens 60. Geburtstag, den er am 30. März 2011 mit etwa 500 Gästen auf einem Rheinschiff feiert, sendet der WDR die „Niedecken-Nacht“. Zu seinem Geburtstag erscheint im Verlag Hoffmann und Campe auch das Buch „Für 'ne Moment. Autobiographie“. Auf über 500 Seiten erzählt der Musiker von seiner Familie, einer behüteten frühen Kindheit und der schwierigen Zeit als Heranwachsender im katholischen Internat, von seinem Kunststudium und Aufenthalten in der New Yorker Kunstszene, der ehe zufälligen Gründung von BAP, die zur erfolgreichsten Mundartgruppe Deutschlands wurde.
Und dann das: Am 2. November gegen 13 Uhr bemerkt Wolfgang Niedecken beim Lesen, „dass ich nichts mehr kapierte. Ich musste die Seiten immer wieder neu lesen. Dann wurde es nebelig vor den Augen, alles sah merkwürdig aus, mein ganzes Umfeld hatte amorphe Formen. Und dann begegnete ich Gott sei Dank meinem Schutzengel.“ Wolfgang Niedecken hatte einen Schlaganfall erlitten, obwohl er eigentlich kein typischer Schlaganfallpatient war. Es kann also jeden treffen! Dank des schnellen Reagierens seiner Frau Tina konnte das Schlimmste verhindert werden.
Sie kommen per Schiff, Flugzeug, Auto oder in den Profilen von Wanderschuhen reiselustiger Globetrotter – Pflanzen, Tiere und Mikroorganismen, die in unseren Breiten normalerweise nicht heimisch sind. Teilweise führen sie bei uns anfangs über Jahre und Jahrzehnte ein Schattendasein – um sich dann plötzlich explosionsartig zu vermehren und heimische Arten zu verdrängen. Förderlich für diese Invasion fremder Arten ist auch der Klimawandel.
Inflammation has been recognized as a common trait in the pathogenesis of multifactorial diseases including obesity, where a low-grade inflammation has been established and may be responsible for the cardiovascular risk related to the disease. Obesity has also been associated with the increased incidence and a worse outcome of rheumatoid arthritis (RA) and osteoarthritis (OA). RA is characterized by systemic inflammation, which is thought to play a key role in accelerated atherosclerosis and in the increased incidence of cardiovascular disease, an important comorbidity in patients with RA. The inflammatory process underlying the cardiovascular risk both in obesity and RA may be mediated by adipocytokines, a heterogeneous group of soluble proteins mainly secreted by the adipocytes. Many adipocytokines are mainly produced by white adipose tissue. Adipocytokines may also be involved in the pathogenesis of OA since a positive association with obesity has been found for weight-bearing and nonweight-bearing joints, suggesting that, in addition to local overload, systemic factors may contribute to joint damage. In this review we summarize the current knowledge on experimental models and clinical studies in which adipocytokines were examined in obesity, RA, and OA and discuss the potential of adipocytokines as comorbidity biomarkers for cardiovascular risk.
Introduction. The use of ultrasound during resuscitation is emphasized in the latest European resuscitation council guidelines of 2013 to identify treatable conditions such as pericardial tamponade. The recommended standard treatment of tamponade in various guidelines is pericardiocentesis. As ultrasound guidance lowers the complication rates and increases the patient’s safety, pericardiocentesis should be performed under ultrasound guidance. Acute care physicians actually need to train emergency pericardiocentesis. Methods. We describe in detail a pericardiocentesis ultrasound model, using materials at a cost of about 60 euros. During training courses of focused echocardiography n=67, participants tested the phantom and completed a 16-item questionnaire, assessing the model using a visual analogue scale (VAS). Results. Eleven of fourteen questions were answered with a mean VAS score higher than 60% and thus regarded as showing the strengths of the model. Unrealistically outer appearance and heart shape were rated as weakness of the model. A total mean VAS score of all questions of 63% showed that participants gained confidence for further interventions. Conclusions. Our low-cost pericardiocentesis model, which can be easily constructed, may serve as an effective training tool of ultrasound-guided pericardiocentesis for acute and critical care physicians.
This doctoral thesis is concerned with the development of a method that allows to measure in vivo and non-invasively the mid-infrared absorption spectra of human epidermis, using photoacoustic spectroscopy. The main focus is the monitoring of the glucose level in epidermal interstitial fluid and its correlation with the blood glucose level; which is the most important parameter for the diagnosis and treatment of diabetes mellitus. Most publications in this field have only reported measurements in vitro for the absorption spectra of epidermis in the mid-infrared range. Using the approach presented in this work, it was possible to record in vivo and in situ the absorption spectra of skin of volunteers; and with these spectra, the changing glucose concentration could be monitored. The novelty of the photoacoustic method introduced here is that it operates in acoustic resonance in the ultrasound range. This considerably reduces the signal noise due to the external acoustic background. Although the photoacoustic method reported in this work was used to measure glucose in human epidermis, it can also be applied to other solid samples with relevant absorption bands in the mid-infrared. Furthermore, it can be used in other spectral regions if the laser source covers relevant absorption bands of the sample.
Among the discussed risk factors for high-titre inhibitor (HRI) development in patients with hemophilia A (HA) are high dose FVIII replacement therapy and use of recombinant FVIII concentrates (rFVIII). The aim of this study was to evaluate the aforementioned risk factors for HRI development in children with hemophilia A ≤2%. About 288 ascertained PUPs (Israel and Germany) were followed after initial HA diagnosis over 200 exposure days. Inhibitor-free survival, hazard ratios (HR), and 95% confidence intervals (CIs) were calculated. Adjustment was performed for factor VIII concentrates, median single dose over the first three months of treatment, first FVIII administration before the age of three months, presence of risk HA gene mutations, “intensive treatment moments” and “year of birth” (proxy for different treatment periods). HRI occurred in 71/288 children (24.7%). In multivariate analysis adjusted for “year of birth”, underlying risk gene mutations (HR/CI: 2.37/1.40–3.99), FVIII dose, measured per one IU increase per kgbw (HR/CI: 1.05/1.04–1.07), and first FVIII administration before the age of three months showed a significant impact on HR development. The risk of HRI development was similar for recombinant or plasmatic FVIII products. Children at risk should be treated with carefully calculated lower dose regimens, adapted to individual bleeding situations.
Background. Incomplete revascularization negatively affects survival after coronary artery bypass surgery (CABG). Since gender and classification technique might impact outcome and reporting, we investigated their effect on revascularization patterns and mortality. Methods. A cohort of bypass patients (N = 1545, 23% women) was enrolled prospectively. The degree of revascularization was determined as mathematical difference between affected vessels upon diagnosis and number of grafts or the surgeon’s rating on the case file. Results. Although men displayed more triple-vessel disease, they obtained complete revascularization more frequently than women (85% versus 77%, P < 0.001). The two calculation methods identified analogous percentages of incompletely revascularized patients, yet there was only a 50% overlap between the two groups. Mathematically, more women, older patients, and patients with NYHA class III/IV appeared incompletely revascularized, while the surgeons identified more patients undergoing technically challenging procedures. Regardless of the definition, incompleteness was a significant risk factor for mortality in both genders (mathematical calculation: HR 2.62, 95% CI 1.76–3.89, P < 0.001; surgeon: HR 2.04, 95% CI 1.35–3.89, P = 0.001). Conclusions. Given the differences in identification patterns, we advise that the mathematical calculation be performed after-procedure in all patients regardless of the surgeons’ rating to uncover additional subjects at increased risk.
Objective. To test the influence of personalized ultrasound (PersUS) on patient management in critical care. Design of the Study. Prospective, observational, and critical care setting. Four substudies compared PersUS and mobile ultrasound, work distribution, and diagnostic and procedural quality. Patients and Interventions. 640 patient ultrasound exams including 548 focused diagnostic exams and 92 interventional procedures. Main Outcome Measures. Number of studies, physician’s judgement of feasibility, time of usage per patient, and referrals to echo lab. Results. Randomized availability of PersUS increased its application in ICU work shifts more than twofold from 33 to 68 exams mainly for detection and therapy of effusions. Diagnostic and procedural quality was rated as excellent/very good in PersUS-guided puncture in 95% of cases. Integrating PersUS within an initial physical examination of 48 randomized cases in an emergency department, PersUS extended the examination time by 100 seconds. Interestingly, PersUS integration into 53 randomized regular ward rounds of 1007 patients significantly reduced average contact time per patient by 103 seconds from 8.9 to 7.2 minutes. Moreover, it lowered the patient referral rate to an echo lab from 20% to 2% within the study population. Conclusions. We propose the development of novel ultrasound-based clinical pathways by integration of PersUS.
The mitogen-activated protein kinase (MAPK) pathway is the canonical signaling pathway for many receptor tyrosine kinases, such as the Epidermal Growth Factor Receptor. Downstream of the receptors, this pathway involves the activation of a kinase cascade that culminates in a transcriptional response and affects processes, such as cell migration and adhesion. In addition, the strength and duration of the upstream signal also influence the mode of the cellular response that is switched on. Thus, the same components can in principle coordinate opposite responses, such as proliferation and differentiation. In recent years, it has become evident that MAPK signaling is regulated and fine-tuned by proteins that can bind to several MAPK signaling proteins simultaneously and, thereby, affect their function. These so-called MAPK scaffolding proteins are, thus, important coordinators of the signaling response in cells. In this review, we summarize the recent advances in the research on MAPK/extracellular signal-regulated kinase (ERK) pathway scaffolders. We will not only review the well-known members of the family, such as kinase suppressor of Ras (KSR), but also put a special focus on the function of the recently identified or less studied scaffolders, such as fibroblast growth factor receptor substrate 2, flotillin-1 and mitogen-activated protein kinase organizer.
There is a wide range of important pharmaceuticals used in treatment of cancer. Besides their known effects on tumor cells, there is growing evidence for modulation of the immune system. Immunomodulatory drugs (IMiDs®) play an important role in the treatment of patients with multiple myeloma or myelodysplastic syndrome and have already demonstrated antitumor, anti-angiogenic, and immunostimulating effects, in particular on natural killer (NK) cells. Tyrosine kinase inhibitors are directly targeting different kinases and are known to regulate effector NK cells and expression of NKG2D ligands (NKG2DLs) on tumor cells. Demethylating agents, histone deacetylases, and proteasome inhibitors interfere with the epigenetic regulation and protein degradation of malignant cells. There are first hints that these drugs also sensitize tumor cells to chemotherapy, radiation, and NK cell-mediated cytotoxicity by enhanced expression of TRAIL and NKG2DLs. However, these pharmaceuticals may also impair NK cell function in a dose- and time-dependent manner. In summary, this review provides an update on the effects of different novel molecules on the immune system focusing NK cells.
Aberrant epigenetic regulators control expansion of human CD34+ hematopoietic stem/progenitor cells
(2013)
Transcription is a tightly regulated process ensuring the proper expression of numerous genes regulating all aspects of cellular behavior. Transcription factors regulate multiple genes including other transcription factors that together control a highly complex gene network. The transcriptional machinery can be “hijacked” by oncogenic transcription factors, thereby leading to malignant cell transformation. Oncogenic transcription factors manipulate a variety of epigenetic control mechanisms to fulfill gene regulatory and cell transforming functions. These factors assemble epigenetic regulators at target gene promoter sequences, thereby disturbing physiological gene expression patterns. Retroviral vector technology and the availability of “healthy” human hematopoietic CD34+ progenitor cells enable the generation of pre-leukemic cell models for the analysis of aberrant human hematopoietic progenitor cell expansion mediated by leukemogenic transcription factors. This review summarizes recent findings regarding the mechanism by which leukemogenic gene products control human hematopoietic CD34+ progenitor cell expansion by disrupting the normal epigenetic program.
The overall staining by GS clearly reveals astrocytes, including all cells of the astroglial family (1), i.e., Bergmann glia, Müller cells (2), tanycytes (3), and ependymal cells. The star shaped morphology from classical silver impregnations relates to cortical and hippocampal astrocytes, which display a comparable pattern in material stained for GFAP. However, the dense population of GS stained astrocytes found in all diencephalic and mesencephalic regions, known to display faint GFAP-labeling (unpublished observations) indicated that while apparently all astrocytes contain GS they have GFAP-ir filaments only in a region-dependent pattern. This is complicated by the emerging view that "astrocytes" constitute a heterogeneous population even within a given region. In the rat hippocampus, combined immunostainings have revealed that the "classical" GFAP-ir astrocyte constitutes a subpopulation of GS-ir astrocytes, which can also lack GFAP staining [direct double staining (4)]. In view of several astroglial subtypes and/or glial precursors present in the adult rodent brain, anti-GS appears to be the most general astrocyte marker, covering all subtypes. In addition, GS has been found early on to label exclusively astrocytic cells and no other glial or neuronal cell types in situ or in culture [reviewed by (5)]. GS has, thus, been applied as a reliable astrocyte marker in very many studies since.
"Complex cells" in rat hippocampus, initially assumed to be an astrocyte subtype (6) but now understood to belong to NG2 cells, a fourth glial type in the CNS (7), may display faint GS-ir in the soma but not its fine processes. Oligodendrocyte precursor cells, possibly also related to NG2 cells, were found to be devoid of GS-ir (8). The immunocytochemical profile and possible heterogeneity of NG2 cells is still under debate to date. Disputing the exclusion of non-astrocytic cells in GS staining, some authors have later reported GS+ oligodendrocytes, although this has not been investigated systematically. Reports on non-astrocytic GS will be discussed in detail here.
The effect of 10 Hz transcranial alternating current stimulation (tACS) on corticomuscular coherence
(2013)
Synchronous oscillatory activity at alpha (8–12 Hz), beta (13–30 Hz), and gamma (30–90 Hz) frequencies is assumed to play a key role for motor control. Corticomuscular coherence (CMC) represents an established measure of the pyramidal system's integrity. Transcranial alternating current stimulation (tACS) offers the possibility to modulate ongoing oscillatory activity. Behaviorally, 20 Hz tACS in healthy subjects has been shown to result in movement slowing. However, the neurophysiological changes underlying these effects are not entirely understood yet. The present study aimed at ascertaining the effects of tACS at 10 and 20 Hz in healthy subjects on CMC and local power of the primary sensorimotor cortex. Neuromagnetic activity was recorded during isometric contraction before and at two time points (2–10 min and 30–38 min) after tACS of the left primary motor cortex (M1), using a 306 channel whole head magnetoencephalography (MEG) system. Additionally, electromyography (EMG) of the right extensor digitorum communis (EDC) muscle was measured. TACS was applied at 10 and 20 Hz, respectively, for 10 min at 1 mA. Sham stimulation served as control condition. The data suggest that 10 Hz tACS significantly reduced low gamma band CMC during isometric contraction. This implies that tACS does not necessarily cause effects at stimulation frequency. Rather, the findings suggest cross-frequency interplay between alpha and low gamma band activity modulating functional interaction between motor cortex and muscle.
The present study investigates the hemispheric contributions of neuronal reorganization following early single-sided hearing (unilateral deafness). The experiments were performed on ten cats from our colony of deaf white cats. Two were identified in early hearing screening as unilaterally congenitally deaf. The remaining eight were bilaterally congenitally deaf, unilaterally implanted at different ages with a cochlear implant. Implanted animals were chronically stimulated using a single-channel portable signal processor for two to five months. Microelectrode recordings were performed at the primary auditory cortex under stimulation at the hearing and deaf ear with bilateral cochlear implants. Local field potentials (LFPs) were compared at the cortex ipsilateral and contralateral to the hearing ear. The focus of the study was on the morphology and the onset latency of the LFPs. With respect to morphology of LFPs, pronounced hemisphere-specific effects were observed. Morphology of amplitude-normalized LFPs for stimulation of the deaf and the hearing ear was similar for responses recorded at the same hemisphere. However, when comparisons were performed between the hemispheres, the morphology was more dissimilar even though the same ear was stimulated. This demonstrates hemispheric specificity of some cortical adaptations irrespective of the ear stimulated. The results suggest a specific adaptation process at the hemisphere ipsilateral to the hearing ear, involving specific (down-regulated inhibitory) mechanisms not found in the contralateral hemisphere. Finally, onset latencies revealed that the sensitive period for the cortex ipsilateral to the hearing ear is shorter than that for the contralateral cortex. Unilateral hearing experience leads to a functionally-asymmetric brain with different neuronal reorganizations and different sensitive periods involved.
Human deep sleep is characterized by reduced sensory activity, responsiveness to stimuli, and conscious awareness. Given its ubiquity and reversible nature, it represents an attractive paradigm to study the neural changes which accompany the loss of consciousness in humans. In particular, the deepest stages of sleep can serve as an empirical test for the predictions of theoretical models relating the phenomenology of consciousness with underlying neural activity. A relatively recent shift of attention from the analysis of evoked responses toward spontaneous (or “resting state”) activity has taken place in the neuroimaging community, together with the development of tools suitable to study distributed functional interactions. In this review we focus on recent functional Magnetic Resonance Imaging (fMRI) studies of spontaneous activity during sleep and their relationship with theoretical models for human consciousness generation, considering the global workspace theory, the information integration theory, and the dynamical core hypothesis. We discuss the venues of research opened by these results, emphasizing the need to extend the analytic methodology in order to obtain a dynamical picture of how functional interactions change over time and how their evolution is modulated during different conscious states. Finally, we discuss the need to experimentally establish absent or reduced conscious content, even when studying the deepest sleep stages.
In Chinese medicine acupuncture points are treated by physical stimuli to counteract various diseases. These stimuli include mechanical stress as applied during the needle manipulation or tuina, high temperatures as applied during moxibustion, and red laser light applied during laser acupuncture. This study aimed to investigate cellular responses to stimuli that might occur in the tissue of acupuncture points. Since they have a characteristically high density of mast cells that degranulate in response to acupuncture, we asked whether these processes lead to ATP release. We tested in in vitro experiments on mast cells of the human mast-cell line HMC-1 the effects of the physical stimuli; mechanical stress was applied by superfusion of the cells with hypotonic solution, heat was applied by incubation of the cells at 52°C, and red laser light of 657 nm was used for irradiation. We demonstrate that all the stimuli induce ATP release from model human mast HMC-1 cells, and this release is associated with an intracellular free Ca2+ rise. We hypothesize that ATP released from mast cells supplements the already known release of ATP from keratinocytes and, by acting on P2X receptors, it may serve as initial mediator of acupuncture-induced analgesia.
Human adipose tissue derived stem cells promote liver regeneration in a rat model of toxic injury
(2013)
In the light of the persisting lack of donor organs and the risks of allotransplantations, the possibility of liver regeneration with autologous stem cells from adipose tissue (ADSC) is an intriguing alternative. Using a model of a toxic liver damage in Sprague Dawley rats, generated by repetitive intraperitoneal application of retrorsine and allyl alcohol, the ability of human ADSC to support the restoration of liver function was investigated. A two-thirds hepatectomy was performed, and human ADSC were injected into one remaining liver lobe in group 1 (n = 20). Injection of cell culture medium performed in group 2 (n = 20) served as control. Cyclosporine was applied to achieve immunotolerance. Blood samples were drawn weekly after surgery to determine liver-correlated blood values. Six and twelve weeks after surgery, animals were sacrificed and histological sections were analyzed. ADSC significantly raised postoperative albumin (P < 0.017), total protein (P < 0.031), glutamic oxaloacetic transaminase (P < 0.001), and lactate dehydrogenase (P < 0.04) levels compared to injection of cell culture medium alone. Transplanted cells could be found up to twelve weeks after surgery in histological sections. This study points towards ADSC being a promising alternative to hepatocyte or liver organ transplantation in patients with severe liver failure.
Retroviral vectors are powerful tools in clinical gene therapy as they integrate permanently into the target cell genome and thus guarantee long-term expression of transgenes. Therefore, they belong to the most frequently used application platforms in clinical gene therapy involving a broad range of different target cells and tissues. However, stable genomic integration of retroviral vectors can be oncogenic, as reported in several animal models and in clinical trials. In particular, γ-retroviral vectors, which derive from naturally mutagenic γ-retroviruses, integrate semirandomly into the host genome with regard to the target sequence, but have a preference for regions of active transcription and regulatory elements of transcriptionally active genes. The integration can result in overexpression of adjacent genes or disruption of ‘target’ gene expression. Moreover, γ-retroviral integration can cause modified transcripts and proteins through alternative or aberrant splicing or through premature termination of transcription.
Initially, the event of insertional mutagenesis and subsequent induction of leukemia by the genotoxicity of a γ-retroviral vector was described in a mouse model after genetic modification of hematopoietic stem cells (HSCs). Vector-related activation and overexpression of the oncogene ecotropic viral integration site-1 (Evi1) fostered clonal outgrowth and leukemogenesis. Additional genotoxic events of γ-retroviral vectors were observed in clinical HSC gene therapy trials for X-linked severe combined immune deficiency (SCID-X1), chronic granulomatous disease (X-CGD), and Wiskott-Aldrich Syndrome (WAS). But, genotoxicity induced by γ-retroviral vectors has never been described in clinical gene therapy trials involving adoptive transfer of genetically modified mature T lymphocytes. This fact is surprising, since T cells are long-lived and have a high capacity of self-renewal.
In a previous study, the susceptibility towards oncogenic transformation of mature T cells and HSCs after genetic modification was compared. It could be demonstrated that T-cell receptor (TCR)-polyclonal mature T cells are far less prone to transformation after γ-retroviral transfer of (proto-)oncogenes in vivo than HSCs. Additional experiments revealed that TCR-oligoclonal (OT-I and P14) mature T cells are transformable in the same setting and give rise to mature T-cell lymphomas (MTCLs).
In the present thesis, the susceptibility of mature T cells towards insertional mutagenesis was investigated. Within the first part of the thesis, retroviral integration sites (RISs) from 33 murine MTCLs were retrieved and subsequently analyzed in terms of integration pattern, detection of common integration sites (CIS) and gene ontology (GO). As these bioinformatic results demonstrated that insertional mutagenesis most likely contributed to mature T-cell lymphomagenesis, the susceptibility of mature T cells was directly assessed in a mouse model. Therefore, murine TCR-oligoclonal OT-I T cells were transduced with an enhanced green fluorescent protein (EGFP) encoding γ-retroviral vector and gene-modified T cells were transplanted into RAG1-/- mice. After 16 months, including one round of serial transplantation, a case of MTCL emerged. Tumor cells were characterized by CD3, CD8, TCR and ICOS expression. Integration site analysis via ligation-mediated polymerase chain reaction (LM-PCR) revealed a proviral insertion in the Janus kinase 1 (Jak1) gene. Subsequent overexpression of Jak1 could be demonstrated on transcriptional and protein level. Furthermore, T-cell lymphoma cells were characterized by an activated Jak/STAT-pathway as signal transducer and activator of transcription 3 (STAT3) was highly phosphorylated. The overexpression of Jak1 was causally implicated in tumor growth promotion as specific pharmacological inhibition of Jak1 using Ruxolitinib significantly prolonged survival of mice transplanted with these Jak1-activated tumor cells. A concluding systematic metaanalysis of available gene expression data on human mature T-cell lymphomas/leukemias confirmed the relevance of Jak/STAT overexpression in sporadic human T-cell tumorigenesis.
This was the first reported case of an insertional mutagenesis event in mature T cells in vivo. Thus, the results obtained in this thesis underline the importance of long-term monitoring of genetically modified T cells in vivo and the evaluation of vector toxicology and safety in T-cell based gene therapies. In particular, the transduction of T cells with a recombinant TCR or CAR (chimeric antigen receptor) bears a risk enhancement, as normal T-cell homeostasis is perturbed besides the general risk of insertional mutagenesis.
The objective of this systematic review was to assess tooth wear against ceramic crowns in posterior region in vitro and in vivo. An electronic PubMed search was conducted to identify studies on tooth wear against ceramic crowns in posterior region. The selected studies were analyzed in regard to type of crowns, natural antagonist, measuring protocol and outcome. From a yield of 1 000 titles, 43 articles were selected for full-text analysis; finally, no in vitro and only five in vivo studies met the inclusion criteria. As there is heterogeneity in design, used measuring method, ceramics and analysis-form, a meta-analysis was not possible. Results of these studies are very controversial which makes a scientifically valid comparison impossible. This review indicated that some all-ceramic crowns are as wear friendly as metal-ceramic crowns. Up to now, it has been impossible to associate tooth wear with any specific causal agent. The role of ceramic surface treatment that might be responsible for the changing in rate of tooth wear seems undetermined as yet through clinical trials. The literature reveals that studies on this topic are subject to a substantial amount of bias. Therefore, additional clinical studies, properly designed to diminish bias, are warranted.
Choriocarcinoma is the most malignant tumor of gestational trophoblastic disease arising from any gestation. It has a tendency toward relapse as well as metastasis. Here, a case of relapsed high-risk choriocarcinoma (FIGO stage IV, WHO score 12) in a 37-year-old female presenting with vaginal bleedings is described. Relapse developed at the site of the surgical scar from hysterectomy that had been performed 2 years earlier. Although the patient was treated with aggressive chemotherapy, she was in a bad general condition and died from infection and liver insufficiency.
Background: Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice.
Methods: We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice.
Results: Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture.
Conclusions: Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.
Objectives: This study explores whether and how self-management support (SMS), a key element of well-coordinated chronic care, is integrated into existing chronic care approaches in 13 European countries.
Methodology: An expert review was conducted using a data template informed by the Chronic Care Model. Key informants (researchers and policymakers) from the 13 countries presented a sample of exemplary chronic care approaches and related SMS strategies. This was complemented by interviews with 27 Dutch care professionals investigating SMS implementation in practice.
Results: SMS remains relatively underdeveloped in Europe. Country-specific strategies are similar in involved providers (nurses) and settings (primary care), yet differ considerably in mode, format and materials used. SMS focuses mainly on patients medical and behavioral management, and less on emotional management. According to Dutch providers, barriers in financing and medical culture (e.g. length of consultation, patient-doctor communication) hamper implementation of SMS as an integral part of chronic care.
Conclusion: While Europe might increasingly be talking the talk of patient participation in chronic care, it appears far from walking the walk. Care professionals experience difficulties in operationalizing SMS in their daily routines. Stronger integration with the health promotion field may help patients and professionals to engage in productive partnerships.
Objective: Loss of function mutations in PINK1 typically lead to early onset Parkinson disease (PD). Zebrafish (Danio rerio) are emerging as a powerful new vertebrate model to study neurodegenerative diseases. We used a pink1 mutant (pink−/−) zebrafish line with a premature stop mutation (Y431*) in the PINK1 kinase domain to identify molecular mechanisms leading to mitochondrial dysfunction and loss of dopaminergic neurons in PINK1 deficiency.
Methods: The effect of PINK1 deficiency on the number of dopaminergic neurons, mitochondrial function, and morphology was assessed in both zebrafish embryos and adults. Genome-wide gene expression studies were undertaken to identify novel pathogenic mechanisms. Functional experiments were carried out to further investigate the effect of PINK1 deficiency on early neurodevelopmental mechanisms and microglial activation.
Results: PINK1 deficiency results in loss of dopaminergic neurons as well as early impairment of mitochondrial function and morphology in Danio rerio. Expression of TigarB, the zebrafish orthologue of the human, TP53-induced glycolysis and apoptosis regulator TIGAR, was markedly increased in pink−/− larvae. Antisense-mediated inactivation of TigarB gave rise to complete normalization of mitochondrial function, with resulting rescue of dopaminergic neurons in pink−/− larvae. There was also marked microglial activation in pink−/− larvae, but depletion of microglia failed to rescue the dopaminergic neuron loss, arguing against microglial activation being a key factor in the pathogenesis.
Interpretation: Pink1−/− zebrafish are the first vertebrate model of PINK1 deficiency with loss of dopaminergic neurons. Our study also identifies TIGAR as a promising novel target for disease-modifying therapy in PINK1-related PD. Ann Neurol 2013;74:837–847
Celiac disease (CD) is an immune-mediated enteropathy that is characterized by intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. Prevalence is high and has been estimated to range between 0.5% and 1.5%. Capsule endoscopy (CE) has a sensitivity and specificity of approximately 90%. CD is an important differential diagnosis for diagnostic workup for anemia, malabsorption, or diarrhea, and must be recognized reliably by the investigator. Moreover, CE is the preferred method to screen for complications in CD, such as enteropathy-associated T-cell lymphoma, ulcerative jejunitis, and small bowel adenocarcinoma. This article is part of an expert video encyclopedia.
Die offensichtlichen Ähnlichkeiten zwischen Neurasthenie und Burnout dürfen den wissenschaftlichen Blick jedoch nicht dazu verleiten, vorschnell von einer substantiellen Identität auszugehen. Es ist keineswegs gleichgültig, unter welchem Namen ein Leiden amtiert. Vielmehr gehe ich davon aus, dass die Etablierung eines neuen Begriffs ein Ereignis ist, das genauer in den Blick genommen zu werden verdient, weil es auf eine veränderte Problemlage hinweist. Die Frage lautet also, wie genau sich das Verhältnis zwischen Neurasthenie und Burnout darstellt, was diese beiden Begriffe trennt und verbindet, welche semantischen Bedeutungsebenen sich in ihnen jeweils abgelagert haben und welche Rückschlüsse sich aus der Untersuchung dieser Bedeutungsschichten für das Verständnis unserer Gegenwart möglicherweise ziehen lassen. Der erste Schritt einer solchen Fragestellung muss immer darin bestehen, die Phänomene gegeneinander zu legen und sie auf ihre Gemeinsamkeiten und Unterschiede hin zu untersuchen, um auf dieser Grundlage eine schärfere Kontur ihrer Besonderheiten zu erlangen - was im Folgenden geschehen soll.
Zieht man die vergeblichen Versuche der Mediziner und Philosophen in Betracht, eine sowohl praktikable, theoretisch konsistente und ethisch vertretbare Definition von Krankheit zu erarbeiten, wird die Differenz von Krankheitsbegriff und -metapher insgesamt problematisch. Der aktuell gebräuchliche, systemtheoretische Krankheitsbegriff bezieht sich beispielsweise gar nicht mehr auf Lebewesen, sondern auf die Kopplung bio-psycho-sozialer Systeme. Die Bindestriche in diesem Begriff übernehmen gewissermaßen die Funktion der Metapher: den Sprung über Kategoriengrenzen. Wenn Metaphern in den Wissenschaften grundsätzlich keinen guten Ruf genießen, gilt dies insbesondere für Krankheitsmetaphern. Zuletzt ist ihre Bedeutung für die pseudo-medizinische Legitimation und Durchführung des Holocaust umfangreich erforscht worden. Mit dem Paradigmenwechsel von der Hygiene zur Bakteriologie wurden Krankheiten demnach nicht mehr auf äußere Umstände, sondern auf labortechnisch identifizierbare Kontagien zurückgeführt. Diese medizinische 'Visualisierung des Feindes', welche Robert Koch durch die Markierung von Gewebeschnitten mit Annelinfarbe entscheidend voranbrachte, bot zusammen mit der monokausalen und ontologisierenden Erklärung von Krankheiten große metaphorische Anschlussflächen für die (bio-)politischen Diskurse, die sich seit dem 19. Jahrhundert mehr und mehr mit der Sicherung und Steigerung des Lebens beschäftigten.
The prevalence of food allergies has increased in the westernized countries during the past decades. Clinical manifestations of food allergies involve the skin (e.g. atopic dermatitis), the respiratory tract (e.g. rhinitis, and asthma), the ocular area (e.g. conjunctivitis), the gastrointestinal tract (e.g. food-protein-induced enterocolitis syndrome, food-induced proctocolitis, and eosinophilic gastroenteropathies), and the cardiovascular system (e.g. anaphylaxis). A curative treatment of these diseases has not been established yet. Oral immunotherapy (OIT) has gained attention as a potential therapy for food allergies. Continuous feeding of allergenic diet applied in the model described here mirrors to a certain extent an OIT treatment. It might be therefore useful to investigate efficacy and safety of OIT pre-clinically.
Mouse models have been widely used to analyse novel treatment approaches. Unfortunately, most of them have focussed on IgE-mediated hyperreactivity. Only a limited number of mouse models presenting mixed IgE- and non-IgE-mediated gastrointestinal symptoms and inflammation upon allergen-challenge are available. To study the mechanisms underlying the induction of food-induced gastrointestinal inflammation and subsequent oral tolerance induction, a mouse model of food-induced gastrointestinal allergy was established. BALB/c mice were sensitised with Ovalbumin (OVA) plus ALUM and subsequently challenged by feeding a diet containing egg white (EW diet). During the first seven days on EW diet, OVA-sensitised mice (OVA/ALUM EW mice) developed gastrointestinal symptoms (e.g. weight loss, ruffed fur, soft stool and less mobility) and inflammation in the small intestines accompanied by a strong induction of OVA-specific IgE antibodies and mouse mast cell protease-1 (mMCP-1). Proliferation of CD4+ T cells from spleen of OVA/ALUM EW mice was reduced compared controls. The result indicated that feeding EW diet induced T cell tolerance systemically. In contrast, CD4+ T cells isolated from MLN of OVA/ALUM EW mice showed stronger proliferation upon OVA stimulation in vitro than mice OVA-sensitised but fed a conventional diet, indicating that tolerance was not induced by short-term EW diet. Histological analysis of the small intestinal tissue of OVA/ALUM EW mice revealed strong inflammation present in the duodenum, jejunum and ileum at this time point.
Interestingly, the observed symptoms in OVA/ALUM EW mice resolved spontaneously after 7 days on EW diet, if the feeding was continued. In the next steps the CD4+ T cell-mediated immune response after 28 days continuous EW diet was assessed and revealed that tolerance was induced systemically as well as locally. This was shown by reduced proliferation and cytokine secretion of CD4+ T cells from MLN of OVA/ALUM EW mice after long-term EW diet. However, the inflammation in the jejunum was aggravated instead of resolved at this time point of allergenic diet. Our results suggest that application of OIT in food-allergic patients with gastrointestinal inflammation may need to be reconsidered, since continuous administration of allergenic food may aggravate inflammation in the local tissue. Interestingly, only the jejunum was affected by a worsened condition, whereas duodenum and ileum resolved inflammation. In accordance to the observed jejunal inflammation mMCP-1 levels in the sera were not changed. Allergen-specific IgE levels did not reach baseline level after long-term EW diet, although they were reduced compared to levels in mice after 7 days on EW diet. This result suggests that residual OVA-specific IgE antibodies would promote the jejunal inflammation by sustained activation of mast cells. Furthermore, our results suggest that IL-4 produced by activated Th2 cells could be an effector molecule to induce intestinal inflammation.
The second part of this thesis was aimed at verifying the hypothesis that IgE-mediated mast cell activation is a major effector mechanism in induction of chronic inflammation induced by long-term EW diet. For that mice deficient for FcεRI, a high affinity IgE receptor, were used. These mice were sensitised with OVA and fed EW diet as described for WT mice. Although FcεRI-deficient mice showed an intact Th2 immunity with IgE production, weight loss in the receptor-deficient mice was moderately induced by EW diet compared to WT mice, suggesting that this clinical symptom during the acute phase of allergic response is associated with IgE-mediated mechanisms. Surprisingly, the deficient mice presented comparable intestinal inflammation on day seven of EW diet as WT mice did. However, if EW diet was continued, recovery of intestinal inflammation was observed in FcεRI-deficient mice in contrast to WT mice. These results suggest that the induction of intestinal inflammation is not IgE-dependent. Nevertheless, this does not rule out a potential role of mast cells in the inflammation, because of their IgE-independent activation pathways. It also suggests the involvement of T cell-mediated mechanisms during induction of jejunal inflammation. Interestingly, the aggravated inflammation seen after long-term EW diet in WT mice seems to be IgE-dependent, considering that it was not observed in FcεRI-deficient mice. The elevated number of mast cells in the intestine of WT mice further led to a hypothesis that their continuous activation might be responsible for the chronification of allergic inflammation observed after long-term EW diet. In the context of OIT it further implies that IgE might be a poor prognostic factor for recovery of intestinal inflammation during and after an OIT treatment. In the third part of this thesis regulatory mechanisms employed by the immune system were analysed. Initial results from CD4+ T cells isolated from MLN from OVA/ALUM EW mice showed elevated IL-10 levels in their supernatants after short-term EW diet. IL-10-deficient mice were used to analyse the effect of this immunosuppressive cytokine in the mouse model presented here. However, IL-10-deficient mice tend to develop a strong Th1-dominated immune response. Nevertheless, an accelerated weight loss and slight inflammation of the jejunum was observed after short-term EW diet. Analysis of OVA-specific proliferation and cytokine production CD4+ T cells from Spleen and MLN of IL-10-deficient mice on EW diet suggested that systemic as well as local tolerance was induced after short-term and long-term EW diet feeding, respectively. The result suggests that IL-10 is dispensable for induction of T cell tolerance in our mouse model.
However, the presence of functionally active Tregs was observed during this study in WT mice fed short-term EW diet, suggesting that Tregs might have an important role in regulating the systemic or local immune response. T cell deletion as an alternative immune regulatory mechanism was also observed. Additionally, the efficacy of continuous EW diet (mirroring to a certain extent an OIT treatment) in induction of permanent tolerance was assessed. In OVA-sensitised WT mice continuous allergenic diet was stopped after resolution of clinical symptoms and reintroduced after a defined period on conventional diet. Evaluating the weight development showed that reintroduction of EW diet induced weight loss again, but not as pronounced as seen after short-term EW diet. Also the CD4+ T cell-mediated response was elevated again upon allergen stimulation in vitro. The results suggested that permanent tolerance was not induced in the chosen feeding regime.
The mouse model established and analysed here was used to investigate inflammatory and regulatory mechanisms underlying food-induced gastrointestinal allergy. It presents clinical symptoms and intestinal inflammation (Burggraf et al., 2011). This model is easy to be reproduced in different laboratories, and is useful for testing novel therapy approaches (Schülke et al., 2011; Bohnen et al., 2013). It further provides an opportunity to investigate basic mechanisms underlying OIT. This therapy approach is currently extensively investigated and our mouse model would help to understand the therapeutic mechanism of OIT.
Background: Lung ultrasound has become an emerging tool in acute and critical care medicine. Combined theoretical and hands-on training has been required to teach ultrasound diagnostics. Current computer technology allows for display, explanation, and animation of information in a remote-learning environment.
Objective: Development and assessment of an e-learning program for lung ultrasound.
Methods: An interactive online tutorial was created. A prospective learning success study was conducted with medical students using a multiple-choice test (Trial A). This e-learning program was used as preparation for a certified course followed by an evaluation of trained doctors (Trial B) by linear analogue scales. Pretests were compared with postcourse tests and sustainability tests as well as a posttest of a one-day custom classroom training.
Results: In Trial A, during the learning success study (n = 29), the increase of correct answers was 11.7 to 17/20 in the post-test and to 16.6/20 in the sustainability test (relative change 45.1%, P < 0.0001). E-learning almost equalled scores of classroom-based training regarding gain and retention of factual knowledge. In Trial B, nineteen participating doctors found a 79.5% increase of knowledge (median, 95% CI: 69%; 88%).
Conclusion: The basics of lung ultrasound can be taught in a highly effective manner using e-learning.
Neural oscillations at low- and high-frequency ranges are a fundamental feature of large-scale networks. Recent evidence has indicated that schizophrenia is associated with abnormal amplitude and synchrony of oscillatory activity, in particular, at high (beta/gamma) frequencies. These abnormalities are observed during task-related and spontaneous neuronal activity which may be important for understanding the pathophysiology of the syndrome. In this paper, we shall review the current evidence for impaired beta/gamma-band oscillations and their involvement in cognitive functions and certain symptoms of the disorder. In the first part, we will provide an update on neural oscillations during normal brain functions and discuss underlying mechanisms. This will be followed by a review of studies that have examined high-frequency oscillatory activity in schizophrenia and discuss evidence that relates abnormalities of oscillatory activity to disturbed excitatory/inhibitory (E/I) balance. Finally, we shall identify critical issues for future research in this area.
In unserem visuell geprägten Kulturkreis bestimmt das Gesicht die Identität eines Menschen - doch ab wann kann von einer Gesichtsauflösung gesprochen werden? Deutliche Abweichungen von der in der Gesellschaft bekannten und deshalb akzeptierten Norm lassen sich als Gesichtsdefekte, Gesichtsdeformitäten oder eben als Gesichtsauflösung betrachten. Ursächlich können beispielsweise Unfälle, Infektionen, Tumorerkrankungen oder angeborene Fehlbildungen sein. Der Alterungsprozess sollte hingegen nicht als Gesichtsauflösung interpretiert werden. Hier handelt es sich um eine Strukturanpassung des Gewebes. Aufgabe der Medizin bzw. in diesem Falle der gesichtschirurgischen Profession ist es, dem Vorgang der Gesichtsauflösung entgegen zu wirken. Sie bietet die Möglichkeit, durch rekonstruktive Verfahren das Gesicht in seiner Ursprünglichkeit zu erhalten bzw. wieder herzustellen. Besteht im Falle von Gesichtsdefekten keine Möglichkeit mehr, durch operative Techniken eine adäquate Wiederherstellung zu gewährleisten, so kann auf die Versorgung mit künstlichen Gesichtsteilen zurück gegriffen werden. Ziel ist es, ein dysmorphes (fehlgestaltetes) Gesicht in ein wieder erkennbares, also in dem soziokulturellen Umfeld des Betroffenen akzeptiertes Gesicht umzuwandeln. Angestrebt wird, das durch die unterschiedlichen Ursachen geschädigte Gesicht im Rahmen ästhetischer Aspekte wieder herzustellen. Dadurch soll dem Betroffenen die problemlose Integration in sein soziales Umfeld ermöglicht werden. Für den Betroffenen kann dadurch ein Teil der bekannten Normalität wieder hergestellt sowie ein akzeptables Dasein vermittelt werden.
Gesichtsauflösungen
(2013)
Zu Beginn des 18. Jahrhunderts wird aus einem wiedergeöffneten Stollen der Bergwerke von Falun in Schweden der nahezu unversehrte Leib eines verschütteten Mannes geborgen. Die verblüfften Bergleute blicken in ein frisches Gesicht, in "die noch unveränderten Gesichtszüge eines verunglückten Jünglings" – wie es in der Quelle, in Gotthilf Heinrich von Schuberts Ansichten von der Nachtseite der Naturwissenschaften (1808) heißt. Gleichsam eingelegt in Kupfervitriolwasser hat das Gesicht in 300 Ellen Tiefe überdauert, doch kann dessen Konservierung der Berührung mit Luft und Licht und mithin dem Auge der Umstehenden nicht standhalten. Gesicht und Körper lösen sich auf, zerfallen zu Staub, doch erst, nachdem ein altes Mütterchen "an Krücken und mit grauem Haar" den Konservierten erkennt und an ihre Brust drücken kann: Nicht die Mutter, nein sie ist die Braut des Jünglings von vor fünfzig Jahren, und ihr eingefallenes, "verwelktes" Gesicht kontrastiert der Wirkung des seinen. Die Geschichte vom konservierten Bergmanngesicht ist eine der bekanntesten Kombinationen von Literatur und anorganischer Chemie. Johann Peter Hebel und E.T.A. Hoffmann haben diese Geschichte der Flüssigkeiten als eine Art Antidoton gegen die Auflösungserscheinungen des Gesichts erzählt, die zumindest bei Hebel von einer Verwirrung der Chemikalien und ihrer Wirkungen geprägt ist. Denn die schnelle Auflösung, freilich nach vollzogener Identifikation durch die alte Braut, widerspricht dem chemischen Prozess, durch die jedoch deutlich werden soll, dass der unversehrte Kopf in Vitriol, seine Erkennbarkeit und Präsenz nur um den Preis der Sichtbarkeit zu haben ist: Allein als ein den Blicken und Interaktionen mit den Menschen entzogener Kopf bleibt er sich gleich, ist er intakt, unvergänglich. Damit wird gleichsam auf dem Haupt des aus der Zeitlichkeit herausgefallenen Bergmanns ein Spiel um natürliche und erworbene Konservierungsmodalitäten durch das Vitriol des Berges einerseits und das Gedächtnis der ergrauten Braut andererseits ausgetragen. Als Garanten gegen die Auflösung buhlen sie um die Haltbarkeit und physische Integrität des Menschen, genauer um das Bild von ihm. Durch eine "Verwirrung der Chemikalien", die im Übertrag von der Quelle zur Prosaerzählung erfolgte, wird der Konservierungsstoff Kupfervitriol oft als Eisenvitriol oder folgenreicher und entgegen der Nomenklatur gar als Schwefelsäure überliefert. In dieser starken Säure allerdings hätten sich nicht nur Gesicht und Körper des Bergmanns in maximal zwei Stunden, sondern auch das ganze Bergwerk zersetzt. Im konservierten Bergmann als der Geschichte einer aufgeschobenen Auflösung konvergieren einige Themenfelder der folgenden Beiträge: Neben dem Entzug und der Bergung eines unversehrten Antlitzes, dem eine Art facelifting zuteil wurde, sind es die Umstände seiner Erinnerung und die Bedingungen zu seiner Wiedererkennung, seine Fragilität und sein Zerfall. Themen, in die an dieser Stelle ein wenig eingeführt werden soll.
Bbackground: We aimed to investigate the prognostic value of tumour-infiltrating lymphocytes’ (TILs) expression in pretreatment specimens from patients with head and neck squamous cell carcinoma (HNSCC) treated with definitive chemoradiotherapy (CRT).
Methods: The prevalence of CD3+, CD8+, CD4+ and FOXP3+ TILs was assessed using immunohistochemistry in tumour tissue obtained from 101 patients before CRT and was correlated with clinicopathological characteristics as well as local failure-free- (LFFS), distant metastases free- (DMFS), progression-free (PFS) and overall survival (OS). Survival curves were measured using the Kaplan–Meier method, and differences in survival between the groups were estimated using the log-rank test. Prognostic effects of TIL subset density were determined using the Cox regression analysis.
Results: With a mean follow-up of 25 months (range, 2.3–63 months), OS at 2 years was 57.4% for the entire cohort. Patients with high immunohistochemical CD3 and CD8 expression had significantly increased OS (P=0.024 and P=0.028), PFS (P=0.044 and P=0.047) and DMFS (P=0.021 and P=0.026) but not LFFS (P=0.90 and P=0.104) in multivariate analysis that included predictive clinicopathologic factors, such as age, sex, T-stage, N-stage, tumour grading and localisation. Neither CD4 nor FOXP3 expression showed significance for the clinical outcome. The lower N-stage was associated with improved OS in the multivariate analysis (P=0.049).
Conclusion: The positive correlation between a high number of infiltrating CD3+ and CD8+ cells and clinical outcome indicates that TILs may have a beneficial role in HNSCC patients and may serve as a biomarker to identify patients likely to benefit from definitive CRT.
Trotz zunehmender Verbesserungen in der Diagnostik und Therapie von Krebserkrankungen leiden onkologische Patienten häufig unter gravierenden tumorund therapiebedingten Symptomen und Nebenwirkungen wie Fatigue, Reduktion der Leistungsfähigkeit und Lebensqualität (Courneya, 2003a; Crevenna et al., 2002; Ferriset al., 2009). Zahlreiche Untersuchungen und Übersichtsarbeiten zeigen, dass körperliche Aktivität in den verschiedenen Phasen der Krebstherapie möglich ist und zu einer Reduktion der Nebenwirkungen sowie zu einer Verbesserung der Lebensqualität und Leistungsfähigkeit führen kann (Cramp & Byron-Daniel, 2012; Jones & Peppercorn, 2010; Mishra et al., 2012b; Schmitz et al., 2010). In aktuellen Leitlinien wird körperliche Aktivität deshalb als wichtige supportive Therapiemaßnahme während der Akuttherapie und im Rahmen der Nachsorge sowie Rehabilitation empfohlen. Analog der zunehmenden Individualisierung medizinischer Diagnostik- und Therapiestrategien in der Onkologie (z. B. vergleichbare oder sequentielle Therapieregime, targeted therapies, Patientenwunsch), gibt es inzwischen auch im Bereich der Sportmedizin Forderungen nach individuell angepassten, effektiven körperlichen Trainingsprogrammen (Jensen et al., 2011). Bei der Erarbeitung dieser Bewegungsangebote sollten Informationen zur Einschätzung der körperlichen Leistungsfähigkeit sowie zu den individuellen persönlichen und medizinischen Voraussetzungen der Betroffenen berücksichtigt werden. Entsprechend muss bei der Planung der körperlichen Aktivität auch die aktuelle Behandlungsphase im Rahmen der onkologischen Therapien einbezogen werden. Neben der zeitlichen Einteilung der Therapiephasen in Akut- oder Rehabilitationsphase gibt es die Möglichkeit, den Therapieprozess in Abhängigkeit der Heilungsaussicht einzuordnen. Dabei wird die Prognose einer Tumorerkrankung in Abhängigkeit des Tumorstadiums, des Lymphknotenbefalls und der möglichen Metastasierung in einen heilbaren (kurativen) und nicht heilbaren (palliativen) Therapieansatz eingestuft. Während ein Großteil der Studien die Wirkung bewegungstherapeutischer Interventionen bei Patienten mit kurativem Therapieansatz untersucht, gibt es bisher nur sehr wenig Untersuchungen bei unheilbar kranken Tumorpatienten (Albrecht & Taylor, 2012). Infolgedessen sind Aussagen zu prognosebezogenen Informationen über die individuelle Leistungsfähigkeit und zu unterschiedlichen physischen und psychischen Reaktionenaufgrund körperlicher Aktivität bei dieser Patientengruppe bisher nur bedingt möglich und erlauben folglich keine zielgruppenspezifischen Empfehlungen.
Angesichts dieses Forschungsdefizits ist das Kernziel der vorliegenden Arbeit, mögliche Unterschiede von Lebensqualität, Fatigue und aerober Kapazität (VO2peak) in Abhängigkeit der Heilungsaussicht (kurativ/palliativ) initial zu identifizieren und gleichzeitig die jeweiligen Veränderungen im Rahmen der Intervention über den Gesamtuntersuchungszeitraum zu überprüfen.
Initial konnten 300 onkologische Patienten (histologisch gesichertes Malignom) mit unterschiedlichen Krebsentitäten, in verschiedenen Behandlungsphasen, mit bekannter klinischer Heilungsprognose (kurativ/palliativ) und unter Berücksichtigung definierter Ein- und Ausschlusskriterien in die Untersuchung eingeschlossen werden. Mit dem Ziel einer individuellen Sportberatung und Trainingsplangestaltung absolvierten die Studienteilnehmer eine sportmedizinische Gesundheits- und Leistungsdiagnostik zur Ermittlung der Ausdauerleistungsfähigkeit und Bestimmung des Trainingsbereichs. Die Messungen erfolgten auf dem Fahrradergometer (0W; 25W Inkrement; 3 Minuten) und umfassten Herzfrequenz, Blutdruck, maximale Sauerstoffaufnahmefähigkeit (VO2peak), Laktatkonzentration und subjektives Belastungsempfinden (Borg Skala). Baseline- und identische Wiederholungs-untersuchungen nach 4-6 und nach 16-20 Wochen dienten gleichzeitig der Erfassung der subjektiven Parameter Lebensqualität und Fatigue (EORTC QLQ-C30) (Aaronson et al., 1993). Der Trainingsplan wurde unter Einbeziehung persönlicher Präferenzen, individueller Leistungsfähigkeit und Empfehlungen zur Gesundheitsprävention der WHO (als Orientierung für den Trainingsumfang von 150 min/Wo.) erstellt und dem Patienten in einem ca. 20minütigen Beratungsgespräch erläutert. Art, Umfang und Häufigkeit des mindestens mit moderater Intensität absolvierten Ausdauertrainings wurde durch die Patienten in einem Trainingstagebuch dokumentiert. Die Gruppenzuteilung erfolgte in Abhängigkeit der Heilungsprognose (kurativ/palliativ) unter Verwendung des TNM-Systems. Patienten mit der Prognose „heilbar“ wurden der kurativen Stichprobe zugeteilt, während Patienten mit histologisch gesichertem Nachweis von Metastasen (M1) als palliativ eingestuft wurden.
Referenzwerte waren für die VO2peak: alters- und geschlechtsentsprechende Normdaten (Median) des American College of Sports Medicine und für die Daten des EORTCQLQ-C30: das Manual „EORTC QLQ-C30 Reference Values“ einer EORTCArbeitsgruppe (Scott, 2008). Die Dateneingabe und die Aufbereitung der Rohdaten erfolgte mit Hilfe von Microsoft Excel. Für die statistische Auswertung wurden alle statistischen Analysen anschließend mithilfe der Statistikprogramme SPSS 19.0 (SPSS Inc., Chicago, IL, USA) und „BIAS für Windows“, Version 10, 2012, Universität Frankfurt) durchgeführt. Das Signifikanzniveau wurde a priori auf p<0,05 festgelegt.
Insgesamt 158 Patienten (99 kurativ, 59 palliativ; 54,9±11,1 Jahre, 108 ♀, 50 ♂) nahmen an allen drei Untersuchungen teil. Der parameterfreie Mann-Whitney-Test zeigte sowohl für Lebensqualität als auch Fatigue-Symptomatik keine signifikanten Unterschiede bei der Eingangsuntersuchung zwischen kurativen und palliativen Teilnehmern. Für die VO2peak ergab der parametrische T-Test ebenfalls keine Unterschiede bei den Initialwerten. Nach Abschluss der Intervention zeigten sich in beiden Patientengruppen sowohl bei der Lebensqualität als auch der Fatigue-Symptomatik signifikante Verbesserungen über den gesamten Untersuchungszeitraum. Anschließende post-hoc-Tests ergaben keine signifikanten Gruppenunterschiede bezüglich der Entwicklung während der verschiedenen Untersuchungszeiträume und der Differenz von Initial- und Abschlusswert. Die Varianzanalyse mit Messwiederholung (Anova) zeigte sowohl für Kurativ- als auch Palliativpatienten signifikante Veränderungen der VO2peak über die Zeit. Einen Haupteffekt im Bezug auf die Gruppe oder eine Interaktion von Zeit und Gruppe gab es dabei nicht. Folglich entwickelten sich beide Gruppen über den Untersuchungszeitraum vergleichbar.
Die vorliegenden Ergebnisse zeigen, dass die Heilungsprognose, kurativ oder palliativ, keinen unterschiedlichen Einfluss auf die Trainierbarkeit der Betroffenen zu haben scheint. Körperliches Training führte bei beiden Patientengruppen dieser Studie zu signifikanten Verbesserungen der Zielparameter. Ein Vergleich der vorliegenden Daten mit bisherigen Untersuchungsergebnissen ist aufgrund der aktuell geringen Anzahl an Studien mit Palliativpatienten und einer bisher nicht einheitlichen Palliativ-Definition schwierig.
Die sporttherapeutische Beratung, welche neben der Vermittlung von Trainingsumfang und –intensität insbesondere Trainingsziele und deren Wirksamkeit aufzeigen soll, kann Patienten und ihrem Umfeld helfen, den Stellenwert von körperlichem Training zuverstehen und bestenfalls die Compliance erhalten. Darüber hinaus kann die allgemeine Leitlinien-Empfehlung von 150 Minuten moderates Ausdauertraining pro Woche als grober Richtwert bestätigt werden. Unterschiedlich hohe Trainingsumfänge in Abhängigkeit initialer Leistungsfähigkeit weisen indessen darauf hin, dass individuelle Trainingsempfehlungen zu bevorzugen sind. Als Konsequenz aus diesen Ergebnissen ist zu empfehlen, dass sich zukünftig körperliche Aktivität als unverzichtbarer Bestandteil des supportiven Therapieangebotes für Krebspatienten mit fortgeschrittener Erkrankung, speziell bei palliativ eingestuften Patienten, etabliert.
Weitere Untersuchungen zu diesem Thema sollten insbesondere darauf abzielen, Dosis-Wirkungs-Zusammenhänge zu ermitteln und diese in symptom- und entitätsspezifische Empfehlungen zu integrieren.
Medizinstudium, Examina und die Berufstätigkeit sind stressig; belastbare Daten zum allgemeinen und spezifischen Stress während des Medizinstudiums liegen nur in geringem Ausmaß vor. Wir haben die Stressbelastung und Resilienz der Frankfurter Medizinstudenten in den Kohorten 1. vorklinisches Semester, 1. klinisches Semester und PJ-Eintritt erhoben (Trierer Inventar zum chronischen Stress TICS, altersnormierter Mittelwert = 50; Resilienz-Skala RS11, kein Optimum, hohe Werte weisen auf Resilienz hin); an der Studie nahmen jeweils mehr als 90% der entsprechenden Kohorte teil. Während zu Studienbeginn der Summenwert (altersnormierter T-Wert) bei 56% lag, fiel dieser im 1. klin. Semester auf 54%, und stieg zum PJ nur gering wieder an. Unter den Subskalen fiel auf, dass Überlastung, Überforderung und chronische Besorgnis parallel zum Gesamtscore abfielen, die Subskala Unzufriedenheit jedoch zunahm (1. vorklin. Semester 53%, 1. klin. Semester 55%, PJ 58%). Die höchsten Werte in der PJ-Gruppe fanden sich ebenfalls für die Subskalen soziale Überlastung, Mangel an sozialer Anerkennung und Soziale Spannungen. Niedrigere Stressskala-Werte zeigten sich nach dem Staatsexamen M1 in den Subskalen Überlastung, Erfolgsdruck, Überforderung, soziale Isolierung, chronische Besorgnis und dem Summenscore. Überraschenderweise fiel der Summenwert der Resilienz vom 1. vorklinischen und 1. klinischen Semester (80,7%) auf 76,7% vor dem PJ-Eintritt, dieser Abfall zeigte sich für alle 11 Einzelitems dieses Fragebogens in gleicher Weise. Während eine Abnahme der Belastungsabhängigen Skalen Überlastung und Überforderung nach dem Staatsexamen M1 erwartet worden war, überraschte die im Gruppenvergleich abnehmende Resilienz bei den Studenten vor dem Praktischen Jahr. Ebenso überraschend war die fast kontinuierliche Zunahme auf der Subskala Unzufriedenheit während des Studiums. Inwieweit diese Differenzen auf das Studium zurückzuführen sind oder auf eine überzufällige Häufung bei den Studienabbrechern, wird in einer prospektiven Fortführung dieser Studie untersucht.
Die derzeitige Regelung der Zulassung zum Medizinstudium berücksichtigt die Abiturnote und Wartezeiten; universitäre Parameter können diese Kriterien modifizieren. Hierzu zählen z.B. die Leistungskurswahl, wie es an der Goethe-Universität Frankfurt gehandhabt wird. Im Rahmen der Untersuchung zu Stress und Resilienz bei Medizinstudenten haben wir bei den Studenten des 1. vorklinischen Semesters soziodemographische Daten erhoben, die einen Kohortenvergleich erlauben. Die chronische Stressbelastung wurde mit dem Trierer Inventar zum chronischen Stress TICS erhoben (T-Wert von 50 entspricht dem altersnormierten Durchschnitt), die Resilienz mit der Skala RS11 (keine Normwerte, hohe Werte weisen auf Resilienz hin); an der Studie nahmen 90% der Studienanfänger teil. Neben dem Summenscore für Stress wurden die 9 Subskalen Überlastung, Überforderung, Unzufriedenheit, Erfolgsdruck, Soziale Überlastung, soziale Spannungen, Soziale Isolierung, Mangelnde Soziale Anerkennung und Chronische Besorgnis erhoben. Signifikant höhere Werte bei Studentinnen (n=234) als bei Studenten (n=111) fanden sich für die Skalen Überlastung, Überforderung und chronische Besorgnis, mit dem größten Unterschied bei chronischer Besorgnis (♀ T-Wert von 56 der Altersnorm, ♂ 51). Bei älteren Studienanfängern (n=89, Alter >21 Jahre) fand sich eine leichte Korrelation mit den Skalen Soziale Überlastung und Mangel an sozialer Anerkennung; auch im Gruppenvergleich haben ältere Studenten mit einem T-Wert von 55 einen signifikant höheren Wert als junge Studenten (T-Wert 50). Auch die Notwendigkeit, das Studium ganz (n=86) oder teilweise (n=58) selbst zu finanzieren, erhöht die Werte auf den Skalen Soziale Überlastung, Soziale Spannung, Mangel an sozialer Anerkennung sowie den Summenscore. Keinen Einfluss hatten Parameter wie „nichtdeutsche Hochschulzugangsberechtigung“, dagegen finden sich bei Studenten mit einer nicht-deutschen Muttersprache (n=61) und Sprachschwierigkeiten (n=12) häufiger überfordert, überlastet, sozial nicht anerkannt, chronisch besorgt und gestresst. Ein erhöhter Stress bei Medizin-Anfängern wird bei Frauen, älteren Studienanfängern sowie eigener Finanzierung gesehen. Überraschend war der geringe Einfluss von Parametern wie Deutsch als Fremdsprache, oder kulturelle Faktoren, die über einen oder beide Elternteile außerhalb Deutschlands oder der EU erfasst wurden.
ß1-integrins are essential for angiogenesis but the mechanisms regulating integrin function in endothelial cells (EC) and their contribution to angiogenesis remain elusive. BRAG2 is a guanine nucleotide exchange factor for the small Arf-GTPases Arf5 and Arf6. The role of BRAG2 in EC and angiogenesis and the underlying molecular mechanisms remains unclear. siRNA-mediated BRAG2-silencing reduced EC angiogenic sprouting and migration. BRAG2-siRNA-transfection differentially affected a5ß1- and aVß3-integrin function: specifically, BRAG2-silencing increased focal/fibrillar adhesions and EC adhesion on ß1-integrin-ligands (fibronectin and collagen), while reducing the adhesion on the aVß3-integrin-ligand, vitronectin. Consistent with these results, BRAG2-silencing enhanced surface expression of a5ß1-integrin, while reducing surface expression of aVß3-integrin. Mechanistically, BRAG2 mediated recycling of aVß3-integrins and endocytosis of ß1-integrins and specifically of the active/matrix bound a5ß1-integrin present in fibrillar/focal adhesions (FA), suggesting that BRAG2 contributes to the disassembly of FA via ß1-integrin-endocytosis. Arf5 and Arf6 are promoting downstream of BRAG2 angiogenic sprouting, ß1-integrin-endocytosis and the regulation of FA. In vivo silencing of the BRAG2-orthologues in zebrafish embryos using morpholinos perturbed vascular development. Furthermore, in vivo intravitral injection of plasmids containing BRAG2-shRNA reduced pathological ischemia-induced retinal and choroidal neovascularization. These data reveals that BRAG2 is essential for developmental and pathological angiogenesis by promoting EC sprouting through regulation of adhesion by mediating ß1-integrin internalization and associates for the first time the process of ß1-integrin endocytosis with angiogenesis.
So far clinical human immunodeficiency virus (HIV) therapy is limited to non-curative treatments. However, as recently shown, alternative approaches such as HIV gene therapy have the potential to functionally cure the disease (e.g. the hematopoietic stem cell (HSC)-transplantation with a CCR5Δ32 homozygous transplant) (1). In contrast to the highly personalized medical treatment applied in the ‘Berlin case’, more broadly applicable approaches are currently under intensive investigation.
One example is the adeno-associated-virus (AAV)-mediated delivery of in vivo secreted antiviral entry inhibitors (iSAVE), the concept of which is based on the direct in vivo administration of a broadly applicable highly potent antiviral gene (here: a C46-derived entry inhibitory peptide interfering with HIV-1 membrane fusion). The AAV-based gene delivery is believed to overcome several limitations of gene therapeutic treatments based on ex vivo lentiviral trials in the past. It is (i) targeting differentiated HIV target cells (i.e. liver and differentiated lymphatic cells) reducing the risk of genotoxicity compared to stem cell-based trials, (ii) overcoming the limitation of a low number of genetically modifiable cells as in lentivirally based ex vivo transduction strategies (i.e. limited modifiable cell number due to culture conditions and lower vector titers) and (iii) using the safe AAV vector system, which has not been associated with major genotoxicity in men. (iv) Most importantly, the concept of secretable entry inhibitors does not require transduction of large amounts of cells due to the protective bystander effect. Thus, iSAVE might be a treatment principle for HIV infection that might be able to cure patients irrespective of their viral isolates or adherence.
Accordingly, the iSAVE concept could aim at two different sites in the patient for the production of antiviral transgenes, either the systemic production via suitable producer cells (e.g. hepatocytes) or the local production in the lymphatic system.
In a first approach, we are able to efficiently target hepatocytes using the natural AAV serotype 8 to express high plasma levels of secretable antiviral entry inhibitors in order to systemically suppress viral replication. In this setting we could show that iSAVE peptides are highly expressed in hepatocytes. However, plasma levels of iSAVE were insufficient when using a secretable peptide as sole antiviral transgene.
As a second treatment strategy, the iSAVE project aimed to deliver antiviral genes directly to the site of viral replication, the lymphatic system. Here, (i) a panel of naturally occurring AAV serotypes as well as (ii) AAV retargeting approaches were employed to design a highly efficient and selective AAV vector variant for gene delivery into the lymphatic system after intravenous vector administration.
In detail, (i) screening of the natural occurring serotypes revealed that the AAV serotype 1 (AAV-1) was best in targeting splenic tissue in two humanized mouse models, however at a very low level. After systemic AAV-1 vector administration neither transduction of human lymphocytes did occur nor was iSAVE expressed in the lymphatic system in a humanized mouse model.
(ii) In a second approach, we modified the well-characterized AAV-2 serotype in a tropism-defining region of its capsid gene by insertion of human peripheral blood lymphocytes (hPBL)-tropic peptide ligands. These in turn were selected by M13 in vivo phage display and by in vivo AAV peptide display. Selected variants were cloned and tested for hPBL transduction in vitro. Although the selected variants did not show increased expression efficacies compared to AAV-2 WT, it still might be possible that the selected variant are more specific for hPBLs as these conditions have not been tested.
As these selection processes required a humanized mouse model that comprises a functional lymphatic system, we established the previously described Trimera mouse model in our lab (2). We found that this mouse model could be further improved to allow engraftment of a lower number of gene-modified (gm) human T cells as in the classical Trimera model. These modified Trimera mice (mT3 mice) were conditioned by inclusion of cyclophosphamide (CTX) to the irradiation-conditioning scheme of the classical Trimera model.
Comparison of mT3 mice with established NSG and DKO mice in an adoptive gm T cell transplantation setting revealed that NSG mice were the most robust model providing high reproducibility in human T cell engraftment. MT3 mice allowed a substantial, yet more variable engraftment of gm T cells. Besides comparing engraftment kinetics, the graft quality (i.e. clonality and cytokine milieu) was analyzed. Again, NSG mice showed the most balanced homeostatic repopulation three weeks after transplantation, while mT3 mice were prone to Th1-type, oligloclonal repopulation, indicating an early onset of xenograft-versus-host disease. Finally, the lymphatic infiltration was analyzed. As expected, mT3 mice provided the most intact lymphatic structures, although the normal lymphatic morphology was not restored.
In conclusion, it was demonstrated in this work that AAV-mediated iSAVE gene therapy faces specific limitations depending on the respective targeting approach
In the systemic approach, iSAVE peptides have to be further optimized in terms of transgene design itself, as high-level accumulation in murine plasma was not feasible for the short iSAVE precursor. In the local, lymphatic targeting approach, AAV-mediated expression faces its limits in targeting specificity but foremost expression efficacy. Thus, the AAV vector itself needs further optimization for sufficient local iSAVE expression levels. Independently from the AAV-related approaches, a novel humanized mouse model was established in this work. Despite drawbacks regarding repopulation variability and set-up complexity, the novel mT3 mouse model comprised improved secondary lymphatic structures for adoptive T cell transfer, which might be an interesting platform for studies in lymphoma or leukemia therapy.
FIAS Scientific Report 2012
(2013)
Background: Characterisation of risk groups who may benefit from pneumococcal vaccination is essential for the generation of recommendations and policy.
Methods: We reviewed the literature to provide information on the incidence and risk of invasive pneumococcal disease (IPD) in at-risk children in Europe and North America. The PubMed database was searched using predefined search terms and inclusion/exclusion criteria for papers reporting European or North American data on the incidence or risk of IPD in children with underlying medical conditions.
Results: Eighteen references were identified, 11 from North America and 7 from Europe, with heterogeneous study methods, periods and populations. The highest incidence was seen in US children positive for human immunodeficiency virus infection, peaking at 4167 per 100,000 patient-years in 2000. Studies investigating changes in incidence over time reported decreases in the incidence of IPD between the late 1990s and early 2000s. The highest risk of IPD was observed in children with haematological cancers or immunosuppression. Overall, data on IPD in at-risk children were limited, lacking incidence data for a wide range of predisposing conditions. There was, however, a clear decrease in the incidence of IPD in at-risk children after the introduction of 7-valent pneumococcal conjugate vaccine into immunisation programmes, as previously demonstrated in the general population.
Conclusion: Despite the heterogeneity of the studies identified, the available data show a substantial incidence of IPD in at-risk children, particularly those who are immunocompromised. Further research is needed to determine the true risk of IPD in at-risk children, particularly in the post-PCV period, and to understand the benefits of vaccination and optimal vaccination schedules.
Epigenetic dysregulation contributes to the high cardiovascular disease burden in chronic kidney disease (CKD) patients. Although microRNAs (miRNAs) are central epigenetic regulators, which substantially affect the development and progression of cardiovascular disease (CVD), no data on miRNA dysregulation in CKD-associated CVD are available until now. We now performed high-throughput miRNA sequencing of peripheral blood mononuclear cells from ten clinically stable hemodialysis (HD) patients and ten healthy controls, which allowed us to identify 182 differentially expressed miRNAs (e.g., miR-21, miR-26b, miR-146b, miR-155). To test biological relevance, we aimed to connect miRNA dysregulation to differential gene expression. Genome-wide gene expression profiling by MACE (Massive Analysis of cDNA Ends) identified 80 genes to be differentially expressed between HD patients and controls, which could be linked to cardiovascular disease (e.g., KLF6, DUSP6, KLF4), to infection / immune disease (e.g., ZFP36, SOCS3, JUND), and to distinct proatherogenic pathways such as the Toll-like receptor signaling pathway (e.g., IL1B, MYD88, TICAM2), the MAPK signaling pathway (e.g., DUSP1, FOS, HSPA1A), and the chemokine signaling pathway (e.g., RHOA, PAK1, CXCL5). Formal interaction network analysis proved biological relevance of miRNA dysregulation, as 68 differentially expressed miRNAs could be connected to 47 reciprocally expressed target genes. Our study is the first comprehensive miRNA analysis in CKD that links dysregulated miRNA expression with differential expression of genes connected to inflammation and CVD. After recent animal data suggested that targeting miRNAs is beneficial in experimental CVD, our data may now spur further research in the field of CKD-associated human CVD.
Smac mimetic promotes apoptosis by neutralizing inhibitor of apoptosis (IAP) proteins and is considered as a promising cancer therapeutic. Although an autocrine/paracrine tumor necrosis factor-α (TNFα) loop has been implicated in Smac mimetic-induced cell death, little is yet known about additional factors that determine sensitivity to Smac mimetic. Using genome-wide gene expression analysis, we identify death receptor 5 (DR5) as a novel key mediator of Smac mimetic-induced apoptosis. Although several cell lines that are sensitive to the Smac mimetic BV6 die in a TNFα-dependent manner, A172 glioblastoma cells undergo BV6-induced apoptosis largely independently of TNFα/TNFR1, as the TNFα-blocking antibody Enbrel or TNFR1 knockdown provide little protection. Yet, BV6-stimulated nuclear factor-κB (NF-κB) activation is critically required for apoptosis, as inhibition of NF-κB by overexpression of dominant-negative IκBα superrepressor (IκBα-SR) blocks BV6-induced apoptosis. Unbiased genome-wide gene expression studies in IκBα-SR-overexpressing cells versus vector control cells reveal that BV6 increases DR5 expression in a NF-κB-dependent manner. Importantly, this BV6-stimulated upregulation of DR5 is critically required for apoptosis, as transient or stable knockdown of DR5 significantly inhibits BV6-triggered apoptosis. In addition, DR5 silencing attenuates formation of a RIP1/FADD/caspase-8 cytosolic cell death complex and activation of caspase-8, -3 and -9. By identifying DR5 as a critical mediator of Smac mimetic-induced apoptosis, our findings provide novel insights into the determinants that control susceptibility of cancer cells to Smac mimetic.
Chromosomal rearrangements of the human MLL (mixed lineage leukemia) gene are associated with high-risk infant, pediatric, adult and therapy-induced acute leukemias. We used long-distance inverse-polymerase chain reaction to characterize the chromosomal rearrangement of individual acute leukemia patients. We present data of the molecular characterization of 1590 MLL-rearranged biopsy samples obtained from acute leukemia patients. The precise localization of genomic breakpoints within the MLL gene and the involved translocation partner genes (TPGs) were determined and novel TPGs identified. All patients were classified according to their gender (852 females and 745 males), age at diagnosis (558 infant, 416 pediatric and 616 adult leukemia patients) and other clinical criteria. Combined data of our study and recently published data revealed a total of 121 different MLL rearrangements, of which 79 TPGs are now characterized at the molecular level. However, only seven rearrangements seem to be predominantly associated with illegitimate recombinations of the MLL gene (~ 90%): AFF1/AF4, MLLT3/AF9, MLLT1/ENL, MLLT10/AF10, ELL, partial tandem duplications (MLL PTDs) and MLLT4/AF6, respectively. The MLL breakpoint distributions for all clinical relevant subtypes (gender, disease type, age at diagnosis, reciprocal, complex and therapy-induced translocations) are presented. Finally, we present the extending network of reciprocal MLL fusions deriving from complex rearrangements.
Inhibition of the proteasome is considered as a promising strategy to sensitize cancer cells to apoptosis. Recently, we demonstrated that the proteasome inhibitor Bortezomib primes neuroblastoma cells to TRAIL-induced apoptosis. In the present study, we investigated whether Bortezomib increases chemosensitivity of neuroblastoma cells. Unexpectedly, we discover an antagonistic interaction of Bortezomib and microtubule-interfering drugs. Bortezomib significantly attenuates the loss of cell viability and induction of apoptosis on treatment with Taxol and different vinca alkaloids but not with other chemotherapeutics, that is, Doxorubicin and Cisplatinum. Importantly, Bortezomib inhibits G2/M transition by inhibiting proteasomal degradation of cell cycle regulatory proteins such as p21, thereby preventing cells to enter mitosis, the cell cycle phase in which they are most vulnerable to antitubulin chemotherapeutics. Consequently, Bortezomib counteracts Taxol-induced mitotic arrest and polyploidy, as shown by reduced expression of PLK1 and phosphorylated histone H3. In addition, Bortezomib antagonizes Taxol-mediated degradation of MCL-1 during mitotic arrest by preventing cells to enter mitosis and by inhibiting the proteasome. Downregulation of MCL-1 is critically required for Taxol-induced apoptosis, as overexpression of a phosphomutant MCL-1 variant, which is resistant to degradation, significantly diminishes Taxol-triggered apoptosis. Vice versa, attenuation of Bortezomib-mediated accumulation of MCL-1 by knockdown of MCL-1 significantly enhances Taxol/Bortezomib-induced apoptosis. Thus, Bortezomib rescues Taxol-induced apoptosis by inhibiting G2/M transition and mitigating MCL-1 degradation. The identification of this antagonistic interaction of Bortezomib and microtubule-targeted drugs has important implications for the design of Bortezomib-based combination therapies.
In der vorliegenden Arbeit wird untersucht, wie das Gehirn Bewusstsein erzeugt. Diese Frage wird als eines der größten Rätsel der heutigen Wissenschaft angesehen: Wie kann es sein, dass aus der Aktivität der Nervenzellen unsere subjektive Welt entsteht? Es ist offensichtlich nicht einfach, diese Frage wissenschaftlich zu untersuchen. Eine der vorgeschlagenen Strategien für die Untersuchung von Bewusstsein behauptet, dass man zunächst die neuronalen Korrelate des Bewusstseins finden sollte (Koch, 2004). Einer Definition zufolge sind die neuronalen Korrelate des Bewusstseins die kleinste Menge neuronaler Prozesse, die hinreichend für eine bestimmte bewusste Erfahrung sind (zum Beispiel für die bewusste Erfahrung des Blaubeergeschmacks). Manche behaupteten, die Entdeckung der neuronalen Korrelate des Bewusstseins würde es erlauben, dem Rätsel des Bewusstseins näher zu kommen (Crick & Koch, 1990). Nur wie soll man die neuronalen Korrelate des Bewusstseins finden? Eine relativ einfache Strategie dafür wurde schon vor mehr als 20 Jahren beschrieben. Es sollten einfach experimentelle Bedingungen erschaffen werden, in welchen ein Reiz manchmal bewusst wahrgenommen wird und manchmal nicht (Baars, 1989). Solche Analysen, die Bedingungen mit und ohne bewusste Wahrnehmung vergleichen, werden als „Kontrastierungsanalyse“ bezeichnet (da zwei Bedingungen miteinander kontrastiert werden). Es existieren viele verschiedene experimentelle Paradigmen, bei welchen man den Reiz unter denselben Bedingungen präsentieren kann, so dass er bei manchen Versuchsdurchgängen bewusst wahrgenommen wird, bei anderen nicht (Kim & Blake, 2005). Mit solchen experimentellen Paradigmen kann man angeblich die neuronalen Korrelate des Bewusstseins finden, wenn man a) bei jedem Durchgang die Versuchsperson fragt, ob oder was die Versuchsperson bei dem Durchgang wahrgenommen hat und b) gleichzeitig die neuronalen Prozesse misst (zum Beispiel mit EEG, MEG oder fMRT). Anschließend kann man die erhobenen neuronalen Daten unter den Bedingungen mit und ohne bewusste Wahrnehmung vergleichen.
Mittlerweile gibt es viele Studien, in denen solche experimentelle Paradigmen – und damit die Kontrastierungsanalyse – angewendet wurden. Insofern könnte man glauben, die neuronalen Korrelate des Bewusstseins seien schon gefunden worden. Allerdings ist dies nicht der Fall. Es existiert in der Literatur weiterhin Uneinigkeit darüber, ob die Korrelate des Bewusstseins früh oder spät in der Zeit liegen, und ob die Korrelate in sensorischen Arealen oder eher im hierarchisch höheren fronto-parietalen Kortex zu finden sind.
Nach unserer Meinung sind die experimentellen Paradigmen, die üblicherweise zum Auffinden der neuronalen Korrelate des Bewusstseins verwendet werden, nicht spezifisch genug, um diese eindeutig zu lokalisieren. Eher glauben wir, dass die klassische Kontrastierungsanalyse auch andere Prozesse als Ergebnisse hervorbringt und uns deshalb prinzipiell nicht zu den neuronalen Korrelaten des Bewusstseins führen kann.
Im Kapitel 2 wird erklärt, wieso die typischen experimentellen Paradigmen nicht die neuronalen Korrelate des Bewusstseins ausfindig machen können. Wir behaupten, dass der Vergleich neuronaler Daten aus experimentellen Bedingungen mit und ohne bewusste Wahrnehmung auch die neuronalen Prozesse widerspiegeln könnte, die bewussten Wahrnehmungen entweder vorausgehen oder folgen. Es ist beispielsweise bekannt, dass neuronale Prozesse vor Auftreten des Reizes darüber bestimmen können, ob der Reiz bewusst wahrgenommen wird oder nicht (Busch, Dubois, & VanRullen, 2009; Mathewson, Gratton, Fabiani, Beck, & Ro, 2009). Wenn man experimentelle Bedingungen mit und ohne bewusster Wahrnehmung miteinander vergleicht, werden auch solche Prozesse als Ergebnis auftauchen, obwohl diese zeitlich klar vor dem Reiz stattfinden und deshalb keine neuronalen Korrelate des Bewusstseins sein können. Es ist natürlich einfach zu entscheiden, dass diese Prozesse, die schon vor dem Reiz stattfinden, der bewussten Wahrnehmung vorausgehen müssen, aber es ist unmöglich zu sagen, ob ein neuronaler Prozess 100 oder 200 Millisekunden nach der Präsentation des Reizes immer noch ein Vorläuferprozess ist schon ein neuronales Korrelat des Bewusstseins darstellt. Deshalb ist die typische Kontrastierungsanalyse nicht spezifisch genug und wir wissen nicht, ob neuronale Prozesse, die durch die Kontrastierungsanalyse aufgedeckt werden, direkt die neuronalen Korrelate des Bewusstseins oder eher Prozesse vor der bewussten Wahrnehmung widerspiegeln.
Nicht nur die Vorläuferprozesse der bewussten Warnehmung stellen ein Problem dar. Auch Konsequenzen der bewussten Verarbeitung werden durch die Kontrastierungsanalyse gefunden. Beispielsweise wurden im medialen Temporallappen Neurone gefunden, die nur dann feuern, wenn ein Patient eine Person auf einem Bild bewusst erkennt, aber nicht feuern, wenn der Patient die Person auf dem Bild nicht bewusst wahrnimmt (Quiroga, Mukamel, Isham, Malach, & Fried, 2008). So könnte man vorerst meinen, dass das Feuern dieser Neurone das neuronale Korrelat des Bewusstseins sein könnte. Nach einer Läsion, sprich neuronalen Schädigung des medialen Temporallappens kann man die Welt jedoch weiterhin bewusst wahrnehmen (man hat jedoch Probleme mit dem Gedächtnis und Wiedererkennen). Insofern kann das Feuern dieser Neurone nicht das neuronale Korrelat des Bewusstseins sein und ist eher ein Beispiel für die Konsequenz der bewussten Verarbeitung. Wir behaupten, dass es noch viele andere solcher Vorläuferprozesse und Konsequenzen gibt, die notwendigerweise als Ergebnis bei der Kontrastierungsanalyse auftauchen, und also ist die typische Kontrastierungsanalyse extrem unspezifisch bezüglich der neuronalen Korrelate des Bewusstseins. In anderen Worten: Die typische Kontrastierungsanalyse, bei welcher man experimentelle Bedingungen mit und ohne bewusste Wahrnehmung miteinander vergleicht, wird uns nicht helfen die neuronalen Korrelate des Bewusstseins zu finden.
Wir glauben, dass neue experimentelle Paradigmen entwickelt werden sollten, um die neuronalen Korrelate des Bewusstseins ausfindig zu machen. Wahrscheinlich gibt es kein einfaches Experiment, mit dem man die Vorläuferprozesse und Konsequenzen vollständig vermeiden kann, um damit direkt die neuronalen Korrelate des Bewusstseins zu bestimmen. Eher braucht man viele verschiedene Experimente, die Schritt für Schritt unser Wissen über die neuronalen Korrelate des Bewusstseins erweitern.
In der vorliegenden Arbeit (in Kapiteln 3, 4 und 5) wird ein neues experimentelles Paradigma angewandt. Dieses Paradigma wird nicht alle oben erwähnten Probleme lösen, wird aber hoffentlich erlauben, einige Vorläuferprozesse der bewussten Wahrnehmung von den neuronalen Korrelaten des Bewusstseins auseinanderzuhalten. Der Vorteil unseres experimentellen Paradigmas besteht darin, dass die bewusste Wahrnehmung durch zwei verschiedene Vorläuferprozesse beeinflusst wird. Die Versuchspersonen müssen auf schnell präsentierten und mittels Rauschens undeutlich gemachten Bildern eine Person detektieren. Die experimentellen Bedingungen sind derart gestaltet, dass die Versuchspersonen nicht bei jedem Durchgang die Person auf dem Bild wahrnehmen können. Damit können wir den Wahrnehmungsprozess manipulieren. Bei einer Manipulation variieren wir den Anteil des Rauschens auf dem Bild und damit die sensorische Evidenz. Je weniger Rauschen, desto besser können die Versuchspersonen die Bilder wahrnehmen und desto öfter sehen sie auch bewusst die Person auf dem Bild. Bei der anderen experimentellen Manipulation der Wahrnehmung werden einige Bilder den Versuchspersonen vorher klar und ohne Rauschen gezeigt. Damit erschafft man Wissen über bestimmte Bilder, die später mit Rauschen präsentiert werden. Man kann zeigen, dass solch bestehendes Wissen tatsächlich die Wahrnehmung beeinflusst. Wenn die Versuchspersonen bestehendes Wissen über ein Bild haben, ist es wahrscheinlicher, dass sie die Person auf dem Bild bewusst wahrnehmen. Damit haben wir zwei verschiedene Vorläuferprozesse – sensorische Evidenz und bestehendes Wissen, die beide die bewusste Wahrnehmung beeinflussen. Beide Vorläuferprozesse erhöhen den Anteil der Durchgänge, in welchen die Versuchspersonen die Person auf dem Bild bewusst wahrnehmen.
Mit diesem experimentellen Paradigma möchten wir einige Aussagen über die neuronalen Korrelate des Bewusstseins testen. Wenn über einen neuronalen Prozess behauptet wird, dass er einem neuronalen Korrelat des Bewusstseins entspricht, müsste dieser Prozess von den beiden manipulierten Vorläuferprozessen in ähnlicher Weise beeinflusst werden, da bewusste Wahrnehmung durch beide manipulierten Vorläuferprozessen in ähnlicher Weise erleichtert wird. Wenn aber der Prozess, über den behauptet wird, er sei ein neuronales Korrelat des Bewusstseins, nicht durch beide Manipulationen geändert wird, kann dieser Prozess kein neuronales Korrelat des Bewusstseins sein, da er nicht beeinflusst wird, obwohl die bewusste Wahrnehmung geändert wurde.
Mit diesem experimentellen Paradigma und dieser Logik haben wir zwei unterschiedliche neuronale Prozesse getestet, von denen behauptet wird, dass sie den neuronalen Korrelaten des Bewusstseins entsprechen könnten. In Kapitel 3 wurde untersucht, ob lokale kategorienspezifische Gammabandaktivität die neuronalen Korrelate des Bewusstseins reflektieren könnte. In Kapitel 4 wurde mit diesem experimentellen Paradigma untersucht, ob die neuronale Synchronisierung dem neuronalen Korrelat des Bewusstseins entsprechen könnte.
Unsere Arbeit im Kapitel 3 baut auf der von Fisch und Kollegen (2009) auf. Fisch und Kollegen (2009) zogen aus ihrer experimentellen Arbeit den Schluss, dass lokale kategorienspezifische Gammabandaktivität die neuronalen Korrelate des Bewusstseins reflektieren könnte. Sie hatten Elektroden auf dem visuellen Kortex von Epilepsiepatienten implantiert und von diesen Elektroden die Gammabandaktivität abgeleitet. Im ersten Schritt suchten sie nach Elektroden, die kategorienspezifische Antworten zeigen. Bei den kategorienspezifischen Elektroden ist die Gammabandaktivität abhängig vom präsentierten Stimulusmaterial. Zum Beispiel kann man bei einer Elektrode auf dem Fusiform Face Area starke Gammabandaktivität nur dann messen, wenn ein Gesicht auf dem Bild zu sehen ist. Die Autoren benutzten solche kategorienspezifischen Elektroden, um nach den neuronalen Korrelaten des Bewusstseins zu suchen. Sie zeigten den Patienten Bilder von Gesichtern, Häusern und Objekten, die direkt nach der kurzen Präsentation maskiert wurden, so dass die Patienten nur bei manchen Durchgängen erkannten, was auf dem Bild war, bei anderen Durchgängen nicht. Dies entspricht der typischen Kontrastierungsanalyse. Die Ergebnisse haben klar gezeigt, dass bei diesen kategorienspezifischen Elektroden die Gammabandaktivität erhöht wurde, als die Patienten bewusst wahrnahmen, was auf dem Bild zu sehen war. Aus diesen Ergebnissen zogen die Autoren den Schluss, dass lokale kategorienspezifische Gammabandaktivität dem neuronalen Korrelat des Bewusstseins entspricht. Diese Aussage wollten wir mit unserem experimentellen Paradigma testen.
Um diese Behauptung zu untersuchen, erhoben wir sehr ähnliche Daten wie Fisch et al. (2009) und analysierten die Daten auf ähnliche Weise. Unsere experimentelle Frage war, ob die lokale kategorienspezifische Gammabandaktivität durch unsere beiden Manipulationen – sensorische Evidenz und bestehendes Wissen – in ähnlicher Weise erhöht wird. Dies sollte der Fall sein, wenn die lokale kategorienspezifische Gammabandaktivität dem neuronalen Korrelat des Bewusstseins entspricht, da sensorische Evidenz und bestehendes Wissen beide den Anteil der Durchgänge, in welchen die Versuchsperson die Person auf dem Bild bewusst wahrnimmt, erhöhen. Dieses Ergebnis wurde nicht gefunden. Stattdessen fanden wir, dass die lokale kategorien-spezifische Gammabandaktivität nur durch sensorische Evidenz erhöht wurde, bestehendes Wissen aber keinen Effekt auf diese Aktivierung hatte. Da bestehendes Wissen auch den Anteil der Durchgänge mit bewusster Wahrnehmung erhöht, die kategorienspezifische Gammabandaktivität aber nicht durch bestehendes Wissen erhöht wurde, kann man schlussfolgern, dass die kategorienspezifische Gammabandaktivität nicht die neuronalen Korrelate des Bewusstseins reflektieren kann.
Als nächstes (Kapitel 4) haben wir die Hypothese getestet, dass Synchronizität dem neuronalen Korrelat des Bewusstseins entspricht. Um diese Idee zu testen, maßen wir mittels Magnetoenzephalographie die magnetischen Felder des Gehirns, schätzten aus diesen Daten mittels Beamforming die neuronalen Aktivitätsquellen und quantifizierten die Synchronizität zwischen diesen Quellen. Wenn die interareale Synchronizität dem neuronalen Korrelat des Bewusstseins entspräche, sollte die Synchronizität für Bedingungen mit mehr sensorischer Evidenz und mit bestehendem Wissen erhöht sein. Dies wurde nicht beobachtet. Wir fanden, dass Synchronizität (gemittelt über die Quellen) nur bei den Bildern erhöht war, für die bestehendes Wissen vorlag. Ein ähnlicher Effekt für sensorische Evidenz wurde nicht gefunden. Insofern können wir sagen, dass unsere Befunde dagegen sprechen, dass neuronale Synchronizität den Mechanismus für Bewusstsein darstellt. Allerdings können wir das in diesem Fall auch nicht völlig ausschließen, denn Synchronizität könnte die Informationsverarbeitung auf einem kleineren Maßstab koordinieren als wir es mit dem MEG messen können (Singer, in press).
Im Kapitel 5 untersuchten wir, wie schnell bestehendes Wissen bewusste Verarbeitung beeinflussen kann. Um dies herauszufinden machten wir uns die intraindividuellen Unterschiede der perzeptuellen Leistung zu Nutze. Wir fanden, dass bestehendes Wissen bewusste Verarbeitung schon innerhalb der ersten 100 Millisekunden nach der Präsentation des Reizes beeinflusst. Wir beobachteten auch, dass ein größerer perzeptueller Effekt des bestehenden Wissens in geringerer neuronaler Aktivität in Durchgängen mit bestehendem Wissen hervorruft. Diese Ergebnisse sind im Einklang mit Theorien, die besagen, dass unsere Wahrnehmung bestehendes Wissen nutzt, um vorherzusagen, wie die visuelle Welt sich ändert und um die neuronalen Antworten zu verringern (Friston, 2010).
In der vorliegenden Arbeit wurde diskutiert, warum die typische Kontrastierungsanalyse uns nicht zu den neuronalen Korrelaten des Bewusstseins führen kann. Wir schlugen vor, dass neue experimentelle Paradigmen nötig sind, um näher an die neuronalen Korrelate des Bewusstseins heranzukommen. Es wurde ein neues Paradigma benutzt, um zwischen Vorläuferprozessen und neuronalen Korrelate des Bewusstseins zu unterscheiden. Mit diesem Paradigma wurden zwei sehr unterschiedliche Hypothesen getestet und gefunden, dass die kategorienspezifische Gammabandaktivität nicht die neuronalen Korrelate des Bewusstseins widerspiegeln kann. Wir hoffen, dass unsere Experimente eine Entwicklung von vielen weiteren und besseren experimentellen Paradigmen stimuliert, die zwischen den Vorläuferprozessen, den Konsequenzen und den eigentlichen Korrelaten des Bewusstseins unterscheiden können. Wenn man über die Kontrastierungsanalyse hinausgeht, kann man die gegenwärtigen Theorien des Bewusstseins testen und damit Schritt für Schritt näher an die neuronalen Grundlagen des Bewusstseins kommen.
Aim: The aim of this study was to measure cortico-cortical connectivity in multiple sclerosis (MS) patients by TMS-evoked potential (TEP) latencies in EEG evoked by transcranial magnetic stimulation (TMS) of the hand area of the primary motor cortex of one hemisphere. TEPs were recorded on the stimulated- and at the homologue site in the non-stimulated contralateral hemisphere. Both interhemispheric directions were tested. Interhemispheric latencies of the two main reproducible TEPs, the positive component at 60 ms and the negative component at 100 ms (P60 and N100, respectively), were expected to be significantly prolonged in MS-patients compared to healthy volunteers.
Material and methods: The study compared interhemispheric propagation of P60 and N100 in groups of 12 patients with early-stage relapsing-remitting MS (RRMS) and 16 age- and gender-matched healthy controls. The study was approved by the Ethics Committee of the Medical Faculty of the Goethe-University of Frankfurt/Main and conformed to the latest revision of the Declaration of Helsinki of 2008. TEPs were recorded by means of EEG and their latencies were statistically evaluated in 10 channels around the stimulation site and in 10 corresponding electrodes in the non-stimulated contralateral hemisphere. Interhemispheric conduction time was calculated by the difference of TEP latency in non-stimulated vs. stimulated hemisphere.
Results: An ANOVA on interhemispheric conduction time showed a significant prolongation for the N100 from left to right hemisphere in MS compared to controls, while no group differences were found for the P60 and the N100 from right to left hemisphere.
Conclusion: The results provide first evidence that the N100 may constitute an interesting marker to measure interhemispheric conduction delays in early-stage RRMS. The specificity of the present finding and its relation to fiber tract pathology should be examined in further correlative analyses with diffusion tensor imaging and other structural MRI data.
Opportunities to treat infection with hepatitis C virus (HCV) are evolving rapidly. From the introduction of interferon-α monotherapy in 1992 to the approval of telaprevir- and boceprevir-based triple therapies with pegylated interferon-α and ribavirin in 2011, the chances of curing patients infected with HCV genotype 1 have improved from <10% to approximately 70%. Significant further improvements are on the horizon, which may well cure virtually all hepatitis C patients with an all-oral, interferon-free regimen in the very near future. These exciting developments are reviewed in the present article.
Calcium-deficiency rickets (CDR) is a metabolic bone disease in children that is characterized by impaired mineralization and severe bone deformities. As CDR is often an endemic phenomenon that is almost exclusively restricted to tropical areas, environmental conditions are currently considered to be a possible predisposing factor for the CDR. Apart from a lack of macronutrients and micronutrients, an oversupply of potentially toxic elements (PTEs) in the soil-plant pathway of the CDR areas is thought to be involved in the aetiology of CDR. This study is the first to comprehensively analyze the impact of the environment on Ca deficiency and the resulting CDR.
To analyze the impact of the environment on CDR in developing countries, a rural region near Kaduna City, northern Nigeria, was chosen as a study area. From this area, cases of CDR have been reported since the early 2000s with a prevalence rate of 5%. Within this study area, 11 study sites, including areas with a high CDR prevalence (HR), a low CDR prevalence (LR) and no CDR prevalence (NR), were visited. In these HR, LR and NR study sites, the bedrock was investigated and the types of parent materials were identified. Local farmers were interviewed to determine the type and intensity of the land use. The soil types were determined along toposequences. The soil textures as well as the clay mineral fractions were determined. The pH values were measured, and the contents of organic carbon (OC) were determined. The potential cation-exchange capacity (CECpot) and the base saturation (BS) were analyzed. Furthermore, the total and plant-available macronutrient, micronutrient and PTE concentrations were measured in the soils. The drinking water was analyzed for pH values and the concentrations of Ca, Se and F were measured. The maize was analyzed for the Ca, Mg, K and P, Se and phytic acid (PA) contents.
The field and laboratory analyses on the bedrock showed that the HR, LR and NR study sites near Kaduna City, northern Nigeria, were underlain by Older Granites. A direct link between the distribution of the bedrock, the parent materials and the prevalence of CDR was not found. Interviews with the local farmers showed that the land use in the Kaduna study area is dominated by the cultivation of cash crops and food crops. Field analyzes on the soil types in the Kaduna study area showed that the distribution of the soil types is highly dependent on the topography and the distribution of the parent materials. In near vicinity to the inselbergs, Lixisols had developed on grus slope deposits. In the lower pediment and plain positions, Acrisols had developed on grus slope deposits and pisolite slope deposits. In the upper plains, Plinthosols had developed on pisolite slope deposits and in the river valleys, Fluvisols had developed on river deposits. Such soil types and soil type distributions are typical for granite-underlain areas in the northern guinea savanna of West Africa. Similarly, the physical soil conditions were representative for the soils of the northern guinea savanna: sandy topsoils, clayey subsoils and relatively high contents of kaolinite clay minerals in the clay fractions. With regard to the geochemical composition, no significant difference was found between the soils of the Kaduna study area and the soils of other granite-underlain areas in West Africa. Only the concentrations of P were considerably low in the soils of the Kaduna study area. However, P deficiency is a typical phenomenon in West African savanna soils and is not restricted to CDR areas. The micronutrient concentrations in the soils were low, but not critically low. Laboratory analyses on the amounts of PTEs showed that compared to worldwide background levels and international critical limits the PTE concentrations were very low in the soils of the Kaduna study area. In the drinking water, neither a significant lack of macronutrients and micronutrients, nor a noticeable oversupply of PTEs was found. The maize in the HR, LR and NR study sites contained normal contents of Mg, K and P, low contents of Ca and Se as well as slightly elevated concentrations of PA compared to West African food composition tables. Comparisons between the mineral contents of traditional and modern maize cultivars showed that the traditional maize cultivars contained significantly higher contents of Ca and noticeably lower concentrations of PA than the modern maize cultivars.
A direct link between the environmental conditions and the CDR in the Kaduna study area was considered unlikely, as neither a statistically significant lack of macronutrients and micronutrients, nor a statistically significant oversupply of PTEs was found in the environment of this area. Instead, the results indicated that the nutrition rather than the environmental conditions that impacts the prevalence of CDR.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD is caused by chronic exposure to cigarette smoke and/or other environmental pollutants that are believed to induce reactive oxygen species (ROS) that gradually disrupt signalling pathways responsible for maintaining lung integrity. Here we identify the antioxidant protein sestrin-2 (SESN2) as a repressor of PDGFRβ signalling, and PDGFRβ signalling as an upstream regulator of alveolar maintenance programmes. In mice, the mutational inactivation of Sesn2 prevents the development of cigarette-smoke-induced pulmonary emphysema by upregulating PDGFRβ expression via a selective accumulation of intracellular superoxide anions (O2−). We also show that SESN2 is overexpressed and PDGFRβ downregulated in the emphysematous lungs of individuals with COPD and to a lesser extent in human lungs of habitual smokers without COPD, implicating a negative SESN2-PDGFRβ interrelationship in the pathogenesis of COPD. Taken together, our results imply that SESN2 could serve as both a biomarker and as a drug target in the clinical management of COPD.
The need for test systems for nanoparticle biocompatibility, toxicity, and inflammatory or adaptive immunological responses is paramount. Nanoparticles should be free of microbiological and chemical contaminants, and devoid of toxicity. Nevertheless, in the absence of contamination, these particles may still induce undesired immunological effects in vivo, such as enhanced autoimmunity, hypersensitivity reactions, and fibrosis. Here we show that artificial particles of specific sizes affect immune cell recruitment as tested in a dermal air pouch model in mice. In addition, we demonstrate that the composition of nanoparticles may influence immune cell recruitment in vivo. Aside from biophysical characterizations in terms of hydrodynamic diameter, zeta potential, concentration, and atomic concentration of metals, we show that - after first-line in vitro assays - characterization of cellular and molecular effects by dermal air pouch analysis is straightforward and should be included in the quality control of nanoparticles. We demonstrate this for innate immunological effects such as neutrophil recruitment and the production of immune-modulating matrix metalloproteases such as MMP-9; we propose the use of air pouch leukocytosis analysis as a future standard assay.
Objectives: To describe changes in costs of managing hospitalised patients with acute myeloid leukaemia (AML) after chemotherapy in Germany over 3 yr, with a special focus on prophylaxis and treatment patterns as well as resource use related to invasive fungal infections (IFI).
Methods: The study was conducted as a retrospective, single-centre chart review in patients with AML hospitalised for chemotherapy, neutropenia and infections after myelosuppressive chemotherapy from January 2004 to December 2006 in Germany. The following resource utilisation data were collected: inpatient stay, mechanical ventilation, parenteral feeding, diagnostics, systemic antifungal medication and cost-intensive concomitant medication. Direct medical costs were calculated from hospital provider perspective.
Results: A total of 471 episodes in 212 patients were included in the analysis. Occurrence of IFI decreased from 5.9% in 2004 to 1.9% in 2006. Mean (± standard deviation) hospital stay decreased from 28.7 ± 17.9 d in 2004 to 22.4 ± 11.8 d in 2006. From 2004 to 2006, the use of a single antifungal drug increased from 30.4% to 46.9%, whereas the use of multiple antifungal drugs decreased from 24.4% to 13.1%. The use of liposomal amphotericin B declined between 2004 and 2006 (21.4% vs. 3.8%) and caspofungin between 2005 and 2006 (19.3% vs. 8.1%). Total costs per episode declined from €19051 ± 19024 in 2004 to €13531 ± 9260 in 2006; major reductions were observed in the use of antimycotics and blood products as well as length of hospital stay.
Conclusion: Analysis of real-life data from one single centre in Germany demonstrated a change in antifungal management of patients with AML between 2004/2005 and 2006, accompanied by a decline in total costs.
Gene therapy on the move
(2013)
The first gene therapy clinical trials were initiated more than two decades ago. In the early days, gene therapy shared the fate of many experimental medicine approaches and was impeded by the occurrence of severe side effects in a few treated patients. The understanding of the molecular and cellular mechanisms leading to treatment- and/or vector-associated setbacks has resulted in the development of highly sophisticated gene transfer tools with improved safety and therapeutic efficacy. Employing these advanced tools, a series of Phase I/II trials were started in the past few years with excellent clinical results and no side effects reported so far. Moreover, highly efficient gene targeting strategies and site-directed gene editing technologies have been developed and applied clinically. With more than 1900 clinical trials to date, gene therapy has moved from a vision to clinical reality. This review focuses on the application of gene therapy for the correction of inherited diseases, the limitations and drawbacks encountered in some of the early clinical trials and the revival of gene therapy as a powerful treatment option for the correction of monogenic disorders.
Neurons which lose part of their input respond with a compensatory increase in excitatory synaptic strength. This observation is of particular interest in the context of neurological diseases, which are accompanied by the loss of neurons and subsequent denervation of connected brain regions. However, while the cellular and molecular mechanisms of pharmacologically induced homeostatic synaptic plasticity have been identified to a certain degree, denervation-induced homeostatic synaptic plasticity remains not well understood. Here, we employed the entorhinal denervation in vitro model to study the role of tumor necrosis factor alpha (TNFα) on changes in excitatory synaptic strength of mouse dentate granule cells following partial deafferentation. Our experiments disclose that TNFα is required for the maintenance of a compensatory increase in excitatory synaptic strength at 3–4 days post lesion (dpl), but not for the induction of synaptic scaling at 1–2 dpl. Furthermore, laser capture microdissection combined with quantitative PCR demonstrates an increase in TNFα-mRNA levels in the denervated zone, which is consistent with our previous finding on a local, i.e., layer-specific increase in excitatory synaptic strength at 3–4 dpl. Immunostainings for the glial fibrillary acidic protein and TNFα suggest that astrocytes are a source of TNFα in our experimental setting. We conclude that TNFα-signaling is a major regulatory system that aims at maintaining the homeostatic synaptic response of denervated neurons.
Polo-like kinase 1, a pivotal regulator of mitosis and cytokinesis, is highly expressed in a broad spectrum of tumors and its expression correlates often with poor prognosis, suggesting its potential as a therapeutic target. p53, the guardian of the genome, is the most important tumor suppressor. In this review, we address the intertwined relationship of these two key molecules by fighting each other as eternal rivals in many signaling pathways. p53 represses the promoter of Polo-like kinase 1, whereas Polo-like kinase 1 inhibits p53 and its family members p63 and p73 in cancer cells lacking functional p53. Plk1 inhibitors target all rapidly dividing cells irrespective of tumor cells or non-transformed normal but proliferating cells. Upon treatment with Plk1 inhibitors, p53 in tumor cells is activated and induces strong apoptosis, whereas tumor cells with inactive p53 arrest in mitosis with DNA damage. Thus, inactive p53 is not associated with a susceptible cytotoxicity of Polo-like kinase 1 inhibition and could rather foster the induction of polyploidy/aneuploidy in surviving cells. In addition, compared to the mono-treatment, combination of Polo-like kinase 1 inhibition with anti-mitotic or DNA damaging agents boosts more severe mitotic defects, effectually triggers apoptosis and strongly inhibits proliferation of cancer cells with functional p53. In this regard, restoration of p53 in tumor cells with loss or mutation of p53 will reinforce the cytotoxicity of combined Polo-like kinase 1 therapy and provide a proficient strategy for combating relapse and metastasis of cancer.
Chronic granulomatous disease (CGD) is a primary immunodeficiency characterized by impaired antimicrobial activity in phagocytic cells. As a monogenic disease affecting the hematopoietic system, CGD is amenable to gene therapy. Indeed in a phase I/II clinical trial, we demonstrated a transient resolution of bacterial and fungal infections. However, the therapeutic benefit was compromised by the occurrence of clonal dominance and malignant transformation demanding alternative vectors with equal efficacy but safety-improved features. In this work we have developed and tested a self-inactivating (SIN) gammaretroviral vector (SINfes.gp91s) containing a codon-optimized transgene (gp91(phox)) under the transcriptional control of a myeloid promoter for the gene therapy of the X-linked form of CGD (X-CGD). Gene-corrected cells protected X-CGD mice from Aspergillus fumigatus challenge at low vector copy numbers. Moreover, the SINfes.gp91s vector generates substantial amounts of superoxide in human cells transplanted into immunodeficient mice. In vitro genotoxicity assays and longitudinal high-throughput integration site analysis in transplanted mice comprising primary and secondary animals for 11 months revealed a safe integration site profile with no signs of clonal dominance.
Protein quality control systems (PQC), i.e. UPS and aggresome-autophagy pathway, have been suggested to be a promising target in cancer therapy. Simultaneous pharmacological inhibition of both pathways have shown increase efficacy in various tumors, such as ovarian and colon carcinoma. Here, we investigate the effect of concomitant inhibition of 26S proteasome by FDA-approved inhibitor Bortezomib, and HDAC6, as key mediator of the aggresome-autophagy system, by the highly specific inhibitor ST80 in rhabdomyosarcoma (RMS) cell lines. We demonstrated that simultaneous inhibition of 26S proteasome and selective aggresome-autophagy pathway significantly increases apoptosis in all tested RMS cell lines. Interestingly, we observed that a subpopulation of RMS cells was able to survive the co-treatment and, upon drug removal, to recover similarly to untreated cells. In this study, we identified co-chaperone BAG3 as the key mediator of this recovery: BAG3 is transcriptionally up-regulated specifically in the ST80/Bortezomib surviving cells and mediates clearance of cytotoxic protein aggregates by selective autophagy. Impairment of the autophagic pathway during the recovery phase, both by conditional knock-down of ATG7 or by inhibition of lysosomal degradation by BafylomicinA1, triggers accumulation of insoluble protein aggregates, loss of cell recovery and cell death similarly to stable short harpin RNA (shRNA) BAG3 knock-down. Our results are the first demonstration that BAG3 mediated selective autophagy is engaged to cope with proteotoxicity induced by simultaneous inhibition of constitutive PQC systems in cancer cell lines during cell recovery. Moreover, our data give new insights in the regulation of constitutive and on demand PQC mechanisms pointing to BAG3 as a promising target in RMS therapy.
Smoking tobacco throughout pregnancy is one of the single most important avoidable causes of adverse pregnancy outcomes. If compared with other risk factors in the perinatal period, exposure to tobacco smoke is considered to be amongst the most harmful. It is associated with high rates of long and short term morbidity and mortality for mother and child. Despite this importance until now a scientometric analysis about the development and the state of scientific knowledge about smoking and pregnancy has not been published. In order to close this gap this work was conceived. In this dissertation quantitative and qualitative data on this topic was analyzed using a variety of objective scientometric methods like the number of scientific contributions, the number of citations and the modified Hirsch-index (H-index). A collective volume of 10,043 entries covering a time period from 1900 to December 5, 2012 was obtained from the Web of Science (WoS) data base. Publishing activities of authors, institutions and countries, their cooperation, reception within the international scientific community and its reactions were interpreted and illustrated.
Glioblastoma is the most common and most aggressive type of brain tumor in adults. In contrast to epithelial cancers, glioblastomas do not metastasize. While the major treatment challenge in epithelial cancers is not the primary tumor but metastasis, glioblastoma patients die of the primary tumor.
However, there is a common theme which underlies the malignant properties of progressed epithelial cancers and glioblastoma: invasion from the primary tumor into the surrounding tissue. In the case of epithelial cancers this is the first and necessary step to metastasis, whereas invasion leads inevitably to tumor recurrence after resection in the case of glioblastoma, causing it to be incurable.
A cellular program which has been described in detail to promote the invasive phenotype in epithelial tumors, is the epithelial-mesenchymal-transition (EMT). Differentiated neural cells are not epithelial, thus, strictly speaking, EMT does not occur in glioblastoma. However, the traits acquired in the process of EMT, especially invasiveness and stemness, are highly relevant to glioblastoma. One of the key transcription factors known to induce EMT in epithelial cancers is ZEB1, which has been described only marginally in the central nervous system so far. Here, I investigate the expression and function of ZEB1 in glioblastoma and during human fetal neural development.
ZEB1 mRNA was significantly upregulated in all histological types of glioma, including glioblastoma, when compared to normal brain. There was no correlation between ZEB1 mRNA levels and tumor grade. Immunohistochemical staining of glioma samples demonstrated that ZEB1 was highly expressed in the great majority of tumor cells. In the developing human brain, intense staining for ZEB1 could be observed in the ventricular and subventricular zone, where stem- and progenitor cells reside. ZEB1 positive cells included cells stained with stem- and progenitor markers like PAX6, GFAP and Nestin. In contrast, ZEB1 was never found in early neuronal cells as identified by TUBB3 staining.
To gain insight into ZEB1 function I generated a human fetal neural stem cell line and a glioblastoma cell line with ZEB1 knockdown, which were compared with their respective control cell lines. First, I found that ZEB1 does not regulate the micro RNA 200 family in either cell line, which has been described as an essential ZEB1 target in epithelial cancers. Second, regulated target genes were identified with a genome wide microarray. The third approach was to directly identify genomic binding sites of ZEB1 by chromatin immunoprecipitation sequencing (ChIP-seq). All three approaches showed that the ZEB1 transcriptional program is surprisingly similar in the neural stem cell line and the glioblastoma cell line. In contrast, it bears only little resemblance to the program described in epithelial cancers.
The most interesting, previously unrecognized ZEB1 target gene identified in this study is integrin b1. It was regulated after ZEB1 knockdown detected by microarray analysis, and has a ZEB1 binding site in its promoter region detected by ChIP-seq. Finally, I addressed the question whether ZEB1 influences tumor growth and invasiveness in a glioblastoma model. After intracranial xenotransplantation in mice, ZEB1 knockdown glioblastoma cells formed significantly smaller and less invasive tumors than control glioblastoma cells.
This study demonstrates that ZEB1 is widely expressed in glioma and relevant for glioblastoma growth and invasion. In contrast to what is known about ZEB1 function in epithelial cancers, ZEB1 is not associated with glioma progression, but instead seems to be an early and necessary event in tumorigenesis. Also with regard to ZEB1 target genes, ZEB1 functions differently in glioblastoma than in epithelial cancers. The two most important ZEB1 targets in epithelial cancers are E-cadherin and the miR-200 family members. Both are not relevant to ZEB1 function in glioblastoma. Interestingly, while the ZEB1 transcriptional program is different from the one described in epithelial cancers, it is highly similar in glioblastoma cells and fetal neural stem cells. This suggests that an embryonic pathway restricted to stem- and progenitor cells during development is reactivated in glioblastoma.
Previously known ZEB1 target genes were tissue specific and therefore seemed unlikely to mediate ZEB1 function in the central nervous system. However, the newly identified ZEB1 target gene integrin b1 is well known to play pivotal roles in both glioblastoma tumorigenesis and invasion as well as in neural stem cells. Additionally, integrin b1 is widely expressed and seems a likely ZEB1 target in other organs than the brain.
Taken together, I demonstrate that ZEB1 is a new regulator of glioblastoma growth and invasion. The transcriptional program of ZEB1 differs from the one in epithelial cancers but is strikingly similar to the one in neural stem cells. The newly identified ZEB1 target gene integrin b1 is likely to mediate crucial ZEB1 functios. Thus, this study identifies ZEB1 as a yet unrecognized player in glioblastoma and neural development. Furthermore, it sets the stage for more research which will help to deepen our understanding of ZEB1 function in the central nervous system and beyond.
C-Typ Lektin-ähnliche Rezeptoren (CTLRs) auf Lymphozyten des Immunsystems modulieren deren Effektorfunktionen wie Zytotoxizität oder Zytokinsekretion. Die Gene dieser Immunrezeptoren befinden sich in einer definierten genomischen Region, dem Natürlichen Killer Genkomplex (NKC), welcher im Menschen auf Chromosom 12 und in der Maus auf Chromosom 6 lokalisiert ist. Namensgebend für diesen Gencluster ist die erste Beschreibung von CTLRs auf Natürlichen Killerzellen (NK-Zellen), den Effektorlymphozyten des angeborenen Immunsystems. Einige NKC-kodierte CTLR, insbesondere Vertreter der C-Typ Lektin Familie 2 (CLEC2)-Rezeptorfamilie, werden jedoch auch in nicht-lymphozytären Zellen (z.B. humanes KACL in Keratinozyten, Maus Clr-f in Darmepithelzellen) vorgefunden und in Zusammenhang mit einer gewebsspezifischen Immunüberwachung gebracht. Bemerkenswerterweise sind die Lymphozytenassoziierten Rezeptoren dieser CLEC2-Proteine ebenso CTLRs, welche zudem eng benachbart zu den CLEC2-Proteinen im NKC kodiert sind, sodass es sich um genetisch gekoppelte Rezeptor-Liganden-Paare mit immunologischer Funktion handelt.
Zu Beginn der vorliegenden Arbeit richtete sich das Interesse auf ein bislang uncharakterisiertes Mitglied der CLEC2-Proteinfamilie (CLEC2L), das jedoch außerhalb des NKC und in unmittelbarer Nachbarschaft zu einem weiteren und ebenso uncharakterisierten CTLR (KLRG2) kodiert ist. Im Unterschied zu anderen Mitgliedern der CLEC2-Familie ist CLEC2L (wie auch KLRG2) in Säugetieren hochkonserviert. Im Rahmen dieser Arbeit wurde der Frage nachgegangen, ob CLEC2L wie andere Mitglieder der CLEC2-Proteinfamilie eine gewebsspezifische Expression aufweist, mit einem genetisch gekoppelten CTLR, d. h. mit KLRG2, interagiert und funktionell in Verbindung mit dem Immunsystem gebracht werden kann. Ziel dieser Arbeit war es somit, eine detaillierte Expressions- und Funktionsstudie zu CLEC2L durchzuführen.
Mittels quantitativer Echtzeit-PCR und in situ Hybridisierung konnte CLEC2L-RNA im humanen und Maus-Gehirn nachgewiesen werden. Da die Mengen dort das Expressionsniveau in anderen Organen bei Weitem überstiegen, wurde das CLEC2L-kodierte Protein als BACL (engl. Brain-Associated C-type Lectin) neu benannt. Ektop exprimiertes BACL bildet ähnlich wie viele andere CLEC2-Mitglieder ein disulfid-verknüpftes Homodimer auf der Zellmembran von Säugetierzellen. Um die endogene Proteinexpression dieses gehirnassoziierten „Waisen"-Rezeptors zu charakterisieren, wurde die BACL-Ektodomäne rekombinant produziert und als Immunogen zur Herstellung BACLspezifischer Antikörper eingesetzt. Mit diesen Antikörpern und einer Kombination immunologischer Techniken wie Immunhistochemie, Immunfluoreszenz und Immunpräzipitation konnte die Präsenz von BACL auf humanen und Maus-Neuronen des Gehirns mit einer besonders ausgeprägten Expression in Purkinje-Zellen zum ersten Mal gezeigt werden. Neben dem Gehirn wurden andere Bereiche des Nervensystems, darunter Spinalganglien und Retina, auf die Expression des BACL-Proteins untersucht. Hierbei konnte mittels Immunfluoreszenz und hochauflösender konfokaler Mikroskopie gezeigt werden, dass BACL mit Neuronenmembranen assoziiert ist. Die durchflusszytometrische Analyse von in vitro kultivierten Neurosphären untermauerte die Expression von endogenem BACL als membranständiges Oberflächenprotein.
Diverse Ansätze zur Identifizierung von Interaktionspartnern von BACL erbrachten letztlich keine eindeutigen Ergebnisse. KLRG2 wurde ursprünglich aufgrund seiner benachbarten genomischen Lokalisation als möglicher Rezeptor von BACL favorisiert, jedoch konnten weder Reporterassays noch durchflusszytometriebasierte Bindungsanalysen eine Interaktion dieser beiden Proteine aufzeigen. Auch die aus den massenspektrometrischen Analysen von humanen und Maus BACL-Immunpräzipitaten erhaltenen Kandidatenproteine konnten letztendlich nicht als Interaktionspartner von BACL eindeutig verifiziert werden.
Eine mögliche immunologische Bedeutung von BACL in vivo wurde im Rahmen von Tumorimplantationsexperimenten mit BACL-exprimierenden Tumorzellen untersucht. Hierbei wurde das Tumorwachstum von BACL- mit Kontroll-Transfektanten in C57BL/6 Mäusen verglichen. Der beobachtete Effekt des verlangsamten Tumorwachstums nach BACL-Überexpression war jedoch nicht auf BACL-Erkennung durch Lymphozyten zurückzuführen, wie anhand von immundefizienten Rag1-k.o. und NOD-SCID-gammak.o. Mäusen gezeigt werden konnte.
Insgesamt liefert diese Arbeit die Erstbeschreibung des bislang uncharakterisierten CTLRs BACL. Das Protein teilt strukturelle Merkmale mit Mitgliedern der CLEC2-Familie, unterscheidet sich jedoch deutlich durch (i) seine hohe Konservierung in Säugetieren, (ii) seine Kodierung außerhalb des NKC und (iii) seine pan-neuronale Expression. Die Erkenntnis, dass BACL in Maus- und in humanen Neuronen exprimiert wird, wirft die Frage nach seiner funktionellen Relevanz auf. Als Membranprotein könnte es eine wichtige Rolle in der neuronalen Kommunikation und bei zellulären Kontakten spielen. Die Frage nach der Funktion von BACL wird in zukünftigen Forschungsarbeiten zu klären sein.
Despite advances in allogeneic stem cell transplantation, BCR-ABL-positive acute lymphoblastic leukaemia (ALL) remains a high-risk disease, necessitating the development of novel treatment strategies. As the known oncomir, miR-17~92, is regulated by BCR-ABL fusion in chronic myeloid leukaemia, we investigated its role in BCR-ABL translocated ALL. miR-17~92-encoded miRNAs were significantly less abundant in BCR-ABL-positive as compared to -negative ALL-cells and overexpression of miR-17~19b triggered apoptosis in a BCR-ABL-dependent manner. Stable isotope labelling of amino acids in culture (SILAC) followed by liquid chromatography and mass spectroscopy (LC-MS) identified several apoptosis-related proteins including Bcl2 as potential targets of miR-17~19b. We validated Bcl2 as a direct target of this miRNA cluster in mice and humans, and, similar to miR-17~19b overexpression, Bcl2-specific RNAi strongly induced apoptosis in BCR-ABL-positive cells. Furthermore, BCR-ABL-positive human ALL cell lines were more sensitive to pharmacological BCL2 inhibition than negative ones. Finally, in a xenograft model using patient-derived leukaemic blasts, real-time, in vivo imaging confirmed pharmacological inhibition of BCL2 as a new therapeutic strategy in BCR-ABL-positive ALL. These data demonstrate the role of miR-17~92 in regulation of apoptosis, and identify BCL2 as a therapeutic target of particular relevance in BCR-ABL-positive ALL.
Object: Minimally invasive spine (MIS) procedures are increasingly being recognized as equivalent to open procedures with regard to clinical and radiographic outcomes. These techniques are also believed to result in less pain and disability in the immediate postoperative period. There are, however, little data to assess whether these procedures in combination with minimally invasive transforaminal interbody fusion (MI-TLIF) and percutaneous pedicle screw insertion are effective in complex cases of stenotic degenerative spondylolisthesis with severe facet joint osteoarthritis (FJO).
Methods: This study retrospectively reviewed all patients who underwent lumbar instrumentation, fusion and decompression for degenerative spondylolisthesis with severe stenosis and facet joint osteoarthritis (FJO) between June 2010 and June 2011. Blood loss, operative time and intraoperative complications were assessed in all surgically treated patients who were treated with MIS decompression, MI-TLIF and percutaneous transpedicular instrumentation. Clinical outcome was measured using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back pain, leg pain, and activity level. Satisfaction was assessed with VAS for satisfaction. Radiological follow-up includes x-ray films, computed tomography and in some cases magnetic tomography scan.
Results: Twenty four cases with severe stenotic changes accompanied by severe FJO were treated with minimally invasive procedure. The minimum follow-up was 6 months with a mean of 8 months. The mean preoperative ODI score was 46.8, decreasing to a mean of 23 postoperatively. The mean VAS leg and back pain scores were 67.5 improving to means of 25.8. Twenty one out of 24 cases experienced a clinical benefit according to VAS for satisfaction and ODI. Complications included wound healing disturbance (4%), CSF fistula (4%) and contralateral radiculopathy due to articular bone spurs (8%). The accuracy of pedicle screws was high and only one revision surgery was performed.
Conclusion: MIS for severe stenotic spondylolisthesis leads to adequate and safe decompression of lumbar stenosis and results in a highly significant reduction of symptoms and disability. MIS-TLIF and percutaneous pedicle screw insertion constitute a promising treatment alternative for patients with severe stenosis and facet joint osteoarthritis
In this manuscript a comprehensive coverage of recent developments in the drug therapy of vasospasm while providing the background information that neuroscientists need to understand its rationale. The range of new agents available for treatment of cerebral vasospasm is expanding rapidly along with rapid advances in pharmacology and physiology that are uncovering the mechanisms of this disease. Although there are many publications for treatment of cerebral vasospasm, most are focusing on different aspects of vasospasm treatment and many have limited value due to insufficient quality. Moreover, the complexity of this, in many cases deleterious condition, is enormous and the information needed to understand drug effects is accordingly often not readily available in a single source. A number of pharmacological and medical therapies are currently in use or being investigated in an attempt to reverse cerebral vasospasm, but only a few have proven to be useful. Current research efforts promise the eventual production of new medical therapies. At last, recommendations for the use of different treatment stages based on currently available clinical data are provided.
Background: Classical dance comprises gender specific movement tasks. There is a lack of studies which investigate work related traumatic injuries in terms of gender specific differences in detail.
Objective: To define gender related differences of occupational accidents.
Methods: Basis for the evaluation were occupational injuries of professional dancers from three (n = 785; f: n = 358, m: n = 427) state theatres.
Results: The incidence rate (0.36 per year) was higher in males (m: 0.45, f: 0.29). There were gender specific differences as to the localizations of injuries, particularly the spine region (m: 17.3%, f: 9.8%, p = 0.05) and ankle joint (m: 23.7%, f: 35.5%, p = 0.003). Compared to male dancers, females sustained more injuries resulting from extrinsic factors. Significant differences could specifically be observed with dance floors (m: 8.8%, f: 15.1%, p = 0.02). There were also significant gender differences observed with movement vocabulary.
Conclusion: The clearly defined gender specific movement activities in classical dance are reflected in occupational accidents sustained. Organisational structures as well as work environment represent a burden likewise to male and female dancers. The presented differences support the development of gender specific injury prevention measures.
Background: Only few studies deal with the workload of physical therapists and the health consequences, although this occupational group is quite important for the health care system in many industrialized countries (e.g. ca. 136 000 people are currently employed as physical therapists in Germany). Therefore, the current state of knowledge of work-related diseases and disorders of physical therapists is insufficient. The aim of the "Physical Therapist Cohort" (PTC) study is to analyze the association between work-related exposures and diseases among physical therapists in Germany. This article describes the protocol of the baseline assessment of the PTC study.
Methods/Design: A cross-sectional study will be conducted as baseline assessment and will include a representative random sample of approximately 300 physical therapists employed in Germany (exposure group), and a population-based comparison group (n = 300). The comparison group will comprise a sample of working aged (18–65 years) inhabitants of a German city. Variables of interest will be assessed using a questionnaire manual including questions regarding musculoskeletal, dermal, and infectious diseases and disorders as well as psychosocial exposures, diseases and disorders. In addition to subjective measures, a clinical examination will be used to objectify the questionnaire-based results (n = 50).
Discussion: The study, which includes extensive data collection, provides a unique opportunity to study the prospective association of work-related exposures and associated complaints of physical therapists. Baseline results will give first clues with regard to whether and how prevalent main exposures of physiotherapeutic work and typical work areas of physical therapists are associated with the development of work-related diseases. Thereby, this baseline assessment provides the basis for further investigations to examine causal relationships in accordance with a longitudinal design.
Nanoparticles (particles sized between 1 and 100 nanometers) are more and more used in all fields of science and medicine for their physicochemical properties. As gold has traditionally been considered as chemically inert and biocompatible, in particular, gold nanoparticles have been established as valuable tools in several areas of biomedical research. But in contrast to the multitude of studies that addressed the clinical use of gold nanoparticles, only little is known about potential toxicological effects such as induction of inflammatory immune responses, possible apoptotic cell death or developmental growth inhibition in embryos. Therefore the present study performed a systematic review of toxicological data, especially experimentally acquired data concerning in-vivo-toxicity, published in the PubMed. It can be stated that the data in this area of research is still largely limited. Especially, knowledge about size-, charge- and surface-chemistry dependent in-vivo-toxicity is needed to predict the hazard potential of auric nanoparticles (AuNPs) for humans.
T-cell receptor (TCR) polyclonal mature T cells are surprisingly resistant to oncogenic transformation after retroviral insertion of T-cell oncogenes. In a mouse model, it has been shown that mature T-cell lymphoma/leukemia (MTCLL) is not induced upon transplantation of mature, TCR polyclonal wild-type (WT) T cells, transduced with gammaretroviral vectors encoding potent T-cell oncogenes, into RAG1-deficient recipients. However, further studies demonstrated that quasi-monoclonal T cells treated with the same protocol readily induced MTCLL in the recipient mice. It has been hypothesized that in the TCR polyclonal situation, outgrowth of preleukemic cells and subsequent conversion to overt malignancy is suppressed through regulation of clonal abundances on a per-clone basis due to interactions between TCRs and self-peptide-MHC-complexes (spMHCs), while these mechanisms fail in the quasi-monoclonal situation. To quantitatively study this hypothesis, we applied a mathematical modeling approach. In particular, we developed a novel ordinary differential equation model of T-cell homeostasis, in which T-cell fate depends on spMHC-TCR-interaction-triggered stimulatory signals from antigen-presenting cells (APCs). Based on our mathematical modeling approach, we identified parameter configurations of our model, which consistently explain the observed phenomena. Our results suggest that the preleukemic cells are less competent than healthy competitor cells in acquiring survival stimuli from APCs, but that proliferation of these preleukemic cells is less dependent on survival stimuli from APCs. These predictions now call for experimental validation.
The neurophysiological changes associated with Alzheimer's Disease (AD) and Mild Cognitive Impairment (MCI) include an increase in low frequency activity, as measured with electroencephalography or magnetoencephalography (MEG). A relevant property of spectral measures is the alpha peak, which corresponds to the dominant alpha rhythm. Here we studied the spatial distribution of MEG resting state alpha peak frequency and amplitude values in a sample of 27 MCI patients and 24 age-matched healthy controls. Power spectra were reconstructed in source space with linearly constrained minimum variance beamformer. Then, 88 Regions of Interest (ROIs) were defined and an alpha peak per ROI and subject was identified. Statistical analyses were performed at every ROI, accounting for age, sex and educational level. Peak frequency was significantly decreased (p < 0.05) in MCIs in many posterior ROIs. The average peak frequency over all ROIs was 9.68 ± 0.71 Hz for controls and 9.05 ± 0.90 Hz for MCIs and the average normalized amplitude was (2.57 ± 0.59)·10(-2) for controls and (2.70 ± 0.49)·10(-2) for MCIs. Age and gender were also found to play a role in the alpha peak, since its frequency was higher in females than in males in posterior ROIs and correlated negatively with age in frontal ROIs. Furthermore, we examined the dependence of peak parameters with hippocampal volume, which is a commonly used marker of early structural AD-related damage. Peak frequency was positively correlated with hippocampal volume in many posterior ROIs. Overall, these findings indicate a pathological alpha slowing in MCI.