1
|
Köhler A, Yadav PK, Liedl R, Shil JB, Grischek T, Dietrich P. A data-driven approach for simplifying the estimation of time for contaminant plumes to reach their maximum extent. JOURNAL OF CONTAMINANT HYDROLOGY 2024; 263:104336. [PMID: 38552336 DOI: 10.1016/j.jconhyd.2024.104336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/19/2024] [Accepted: 03/17/2024] [Indexed: 04/30/2024]
Abstract
Globally there exist a very large number of contaminated or possibly contaminated sites where a basic preliminary assessment has not been completed. This is largely, among others, due to limited simple methods/models available for estimating key site quantities such as the maximum plume length, further denoted as Lmax and the corresponding time T=TLmax, at which the plume reaches its maximum extent L=Lmax. An approach to easily obtain an estimate of TLmax in particular is presented in this work. Limited availability of high-quality field data, particularly of TLmax, necessitates the use of synthetic data, which constrains the overall model development works. Taking BIOSCREEN-AT (transient 3D model) as a base model, this work proposes second-order polynomial models, with only two parameters, for estimating Lmax and TLmax. This reformulation of the well established solution significantly reduces data requirement and workload for initial site assessment purposes. A global sensitivity analysis (Morris, 1991), using a large number of random synthetic data, identifies the first-order decay rate constants in the plume λEFF and at the source γ as dominantly most influential for TLmax. For Lmax, the first-order decay rate constant λEFF and groundwater velocity v are the two important parameters. The sensitivity analysis also identifies that these parameters non-linearly impact TLmax or Lmax. With this information, the proposed polynomial models (each for Lmax and TLmax) were trained to obtain model coefficients, using a large amount of synthetic data. For verification, the developed models were tested using four datasets comprising over 100 sample sets against the results obtained from BIOSCREEN-AT and the developed BIOSCREEN-AT-based steady-state model. Additionally, the developed models were evaluated against two well documented field sites. The proposed models largely simplify estimation, particularly, of TLmax, for which only very limited field or literature information is available.
Collapse
|
2
|
El-Ahmar M, Koch F, Köhler A, Moikow L, Ristig M, Ritz JP. Correction to: Laparoscopic rectal resection without epidural catheters-does it work? Int J Colorectal Dis 2024; 39:40. [PMID: 38519703 PMCID: PMC10959812 DOI: 10.1007/s00384-024-04612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
|
3
|
Köhler A, Förster N, Zander M, Ulrichs C. Inter- and intraspecific diversity of Salix bark phenolic profiles - A resource for the pharmaceutical industry. Fitoterapia 2023; 170:105660. [PMID: 37648031 DOI: 10.1016/j.fitote.2023.105660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/01/2023]
Abstract
Due to their content of phenolic compounds, willow bark preparations are used as an herbal remedy. The large diversity of phenolic secondary metabolites in Salix still provides a resource for the identification of bioactive compounds in particular species, including species not yet in focus from a phytopharmaceutical perspective. The present study describes the bark phenolic profile of 13 Salix species analyzed by HPLC-MS: Salix alba, Salix babylonica, Salix daphnoides, Salix fragilis, Salix hastata, Salix myrsinifolia, Salix pentandra, Salix purpurea, Salix repens (including subspecies S. repens ssp. arenaria and S. repens ssp. repens), Salix rosmarinifolia, Salix sachalinensis, Salix triandra and Salix viminalis. The analyzed profiles comprised the chemical groups of salicylates, flavonoids, procyanidins, phenolic acid derivatives, and some unclassified phenolics. Particular compounds were detected in species where they have not been previously reported. Apart from interspecific diversity, qualitative variability within species was observed as certain components were detected only in some of the analyzed genotypes. The knowledge on specific phenolic profiles of species and genotypes is the basis for the selection of suitable willow bark material with certain desired bioactive properties. Furthermore, the high inter- and intraspecific variability points out the necessity for product standardization of willow bark raw material.
Collapse
|
4
|
Costa AL, Mendes MF, Furlan-Lopes C, Bertazzo-Silva FA, Köhler A, Putzke J. First report of Zygothrica candens Burla, 1956 (Diptera, Drosophilidae) in mycophagic association with the mushroom Oudemansiella cubensis (Berk. and M.A. Curtis) R.H. Petersen, 2010 (Agaricales, Physalacriaceae) in southern Brazil. BRAZ J BIOL 2023; 82:e267871. [PMID: 36629545 DOI: 10.1590/1519-6984.267871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/04/2022] [Indexed: 01/11/2023] Open
|
5
|
El-Ahmar M, Koch F, Köhler A, Moikow L, Ristig M, Ritz JP. Laparoscopic rectal resection without epidural catheters-does it work? Int J Colorectal Dis 2022; 37:2031-2040. [PMID: 36001167 DOI: 10.1007/s00384-022-04242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Placement of an epidural catheter (EC) in colorectal resections is still recommended as a valid measure to achieve a low level of pain. However, EC is associated with increased invasiveness and with an increased risk of bladder emptying disorders and a decrease in blood pressure, which all relate to delayed mobilization. Preliminary data shows that EC placement may not be necessary for laparoscopic colon resections. The aim of this prospective study was to investigate how the omission of EC placement influences short-term postoperative outcomes in laparoscopic rectal resections. METHODS All laparoscopic rectal resections occurring between 2013 and 2020 were prospectively examined. Resections from January 2013 to February 2018 (group A) were compared with resections from March 2018 to December 2020 (group B; after the internal change of the perioperative pain regime). In addition to EC placement, the other target parameters of our study were urinary catheter placement during the inpatient stay, postoperative pain > 3 days on a numerical rating scale (NRS), mobilization in the first 5 postoperative days, time until the first postoperative bowel movement, postoperative complications according to Clavien-Dindo, intermediate care unit stay (IMC stay) in days, and hospital length of stay in days. RESULTS In the entire study period, 221 laparoscopic rectal resections were performed: 122 in group A and 99 resections in group B. The frequency of EC placement and urinary catheter placement, postoperative IMC stay, and hospital length of stay was significantly lower in group B (p < 0.05). The postoperative mobilization of patients in group B was possible more quickly. There were no differences in the level of pain, time until the first postoperative bowel movement, and postoperative complications according to Clavien-Dindo. CONCLUSION Omission of EC placement in laparoscopic rectal resections led to faster mobilization, a shorter IMC stay, and a shorter hospital stay without increasing the pain level. Postoperative complications did not change when an EC was not placed. Therefore, routine EC placement in laparoscopic rectal resections is unnecessary.
Collapse
|
6
|
Niemeyer P, Hanus M, Belickas J, László T, Gudas R, Fiodorovas M, Cebatorius A, Pastucha M, Hoza P, Magos K, Izadpanah K, Paša L, Vásárhelyi G, Sisák K, Mohyla M, Farkas C, Kessler O, Kybal S, Spiro R, Köhler A, Kirner A, Trattnig S, Gaissmaier C. Treatment of Large Cartilage Defects in the Knee by Hydrogel-Based Autologous Chondrocyte Implantation: Two-Year Results of a Prospective, Multicenter, Single-Arm Phase III Trial. Cartilage 2022; 13:19476035221085146. [PMID: 35354310 PMCID: PMC9137299 DOI: 10.1177/19476035221085146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the clinical outcome of a hydrogel-based autologous chondrocyte implantation (ACI) for large articular cartilage defects in the knee joint. DESIGN Prospective, multicenter, single-arm, phase III clinical trial. ACI was performed in 100 patients with focal full-thickness cartilage defects ranging from 4 to 12 cm2 in size. The primary outcome measure was the responder rate at 2 years using the Knee Injury and Osteoarthritis Outcome Score (KOOS). RESULTS Two years after ACI treatment, 93% of patients were KOOS responders having improved by ≥10 points compared with their pre-operative level. The primary endpoint of the study was met and demonstrated that the KOOS response rate is markedly greater than 40% with a lower 95% CI (confidence interval) of 86.1, more than twice the pre-specified no-effect level. KOOS improvement (least squares mean) was 42.0 ± 1.8 points (95% CI between 38.4 and 45.7). Mean changes from baseline were significant in the overall KOOS and in all 5 KOOS subscores from Month 3 (first measurement) to Month 24 (inclusive) (P < 0.0001). The mean MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score after 24 months reached 80.0 points (95% CI: 70.0-90.0 points) and 92.1 points in lesions ≤ 5 cm2. CONCLUSIONS Overall, hydrogel-based ACI proved to be a valuable treatment option for patients with large cartilage defects in the knee as demonstrated by early, statistically significant, and clinically meaningful improvement up to 2 years follow-up. Parallel to the clinical improvements, MRI analyses suggested increasing maturation, re-organization, and integration of the repair tissue. TRIAL REGISTRATION NCT03319797; EudraCT No.: 2016-002817-22.
Collapse
|
7
|
Hannasch A, Laso Garcia A, LaBerge M, Zgadzaj R, Köhler A, Couperus Cabadağ JP, Zarini O, Kurz T, Ferrari A, Molodtsova M, Naumann L, Cowan TE, Schramm U, Irman A, Downer MC. Compact spectroscopy of keV to MeV X-rays from a laser wakefield accelerator. Sci Rep 2021; 11:14368. [PMID: 34257331 PMCID: PMC8277848 DOI: 10.1038/s41598-021-93689-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/22/2021] [Indexed: 11/24/2022] Open
Abstract
We reconstruct spectra of secondary X-rays from a tunable 250-350 MeV laser wakefield electron accelerator from single-shot X-ray depth-energy measurements in a compact (7.5 × 7.5 × 15 cm), modular X-ray calorimeter made of alternating layers of absorbing materials and imaging plates. X-rays range from few-keV betatron to few-MeV inverse Compton to > 100 MeV bremsstrahlung emission, and are characterized both individually and in mixtures. Geant4 simulations of energy deposition of single-energy X-rays in the stack generate an energy-vs-depth response matrix for a given stack configuration. An iterative reconstruction algorithm based on analytic models of betatron, inverse Compton and bremsstrahlung photon energy distributions then unfolds X-ray spectra, typically within a minute. We discuss uncertainties, limitations and extensions of both measurement and reconstruction methods.
Collapse
|
8
|
Köhler A, Förster N, Zander M, Ulrichs C. Compound-specific responses of phenolic metabolites in the bark of drought-stressed Salix daphnoides and Salix purpurea. PLANT PHYSIOLOGY AND BIOCHEMISTRY : PPB 2020; 155:311-320. [PMID: 32798899 DOI: 10.1016/j.plaphy.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/14/2020] [Accepted: 07/02/2020] [Indexed: 05/23/2023]
Abstract
The bark of willows (Salix spp.) is rich in bioactive phenolic compounds from different compound classes and is therefore used as an herbal remedy. The accumulation of these secondary plant metabolites is influenced by environmental factors, including the availability of water. To analyze the influence of drought stress on the profile of phenolic metabolites in willow bark, a pot experiment with Salix daphnoides Vill. and Salix purpurea L. was conducted. Plants were subjected to three irrigation treatments for four and ten weeks: 65-75% field capacity (well-watered), 33-38% field capacity (moderate drought), and 17-22% field capacity (severe drought). Shoot biomass and proline content were assessed as drought-sensitive traits. Contents of phenolic compounds were analyzed by high-performance liquid chromatography. Drought stress reduced shoot biomass and led to an increase of the bark proline content. The particular effects on phenolics depended on the individual compound, Salix species and drought stress duration. Whereas salicylates were not affected, some flavonoids and phenolic acid derivatives, as well as salireposide indicated treatment effects. The effects comprised decreasing as well as increasing contents. However, beyond the impact of drought stress, the observed responses are assumed to be superimposed by seasonal changes in the content of phenolics. Regarding the yield of willow shoots, the impairment of growth under water shortage seems to be more decisive than drought-induced changes of the bark metabolite content.
Collapse
|
9
|
Link H, Illerhaus G, Martens UM, Salar A, Depenbusch R, Köhler A, Engelhardt M, Mahlmann S, Zaiss M, Lammerich A, Bias P, Buchner A. Efficacy and safety of lipegfilgrastim versus pegfilgrastim in elderly patients with aggressive B cell non-Hodgkin lymphoma (B-NHL): results of the randomized, open-label, non-inferiority AVOID neutropenia study. Support Care Cancer 2020; 29:2519-2527. [PMID: 32944800 PMCID: PMC7981320 DOI: 10.1007/s00520-020-05711-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
Background Lipegfilgrastim has been shown to be non-inferior to pegfilgrastim for reduction of the duration of severe neutropenia (DSN) in breast cancer patients. This open-label, non-inferiority study assessed the efficacy and safety of lipegfilgrastim versus pegfilgrastim in elderly patients with aggressive B cell non-Hodgkin lymphoma (NHL) at high risk for chemotherapy-induced neutropenia. Patient and methods One hundred and one patients (median age, 75 years) were randomized to lipegfilgrastim or pegfilgrastim (6 mg/cycle) during six cycles of R-CHOP21. Results Lipegfilgrastim was non-inferior to pegfilgrastim for the primary efficacy endpoint, reduction of DSN in cycle 1. In the per-protocol population, mean (standard deviation) DSN was 0.8 (0.92) and 0.9 (1.11) days in the two groups, respectively; the adjusted mean difference between groups was − 0.3 days (95% confidence interval, − 0.70 to 0.19). Non-inferiority was also demonstrated in the intent-to-treat population. The incidence of severe neutropenia in cycle 1 was 51% (21/41) in the lipegfilgrastim group and 52% (23/44) in the pegfilgrastim group. Very severe neutropenia (ANC < 0.1 × 109/L) in cycle 1 was reported by 5 (12%) patients in the lipegfilgrastim group and 8 (18%) patients in the pegfilgrastim group. However, over all cycles, febrile neutropenia (strict definition) was reported by only 1 (2%) patient in each treatment group (during cycle 1 in the lipegfilgrastim group and cycle 6 in the pegfilgrastim group). The mean time to absolute neutrophil count recovery (defined as ≥ 2.0 × 109/L) was 8.3 and 9.4 days in the two groups, respectively. Serious adverse events occurred in 46% of patients in each group; none were considered treatment-related. Eight patients died during the study (2 in the lipegfilgrastim group, 5 in the pegfilgrastim group, and 1 who died before starting study treatment). No deaths occurred during the treatment period, and all were considered to be related to the underlying disease. Conclusions This study shows lipegfilgrastim to be non-inferior to pegfilgrastim for the reduction of DSN in elderly patients with aggressive B cell NHL receiving myelosuppressive chemotherapy, with a comparable safety profile. Trial registration number ClinicalTrials.gov identifier NCT02044276; EudraCT number 2013-001284-23 Electronic supplementary material The online version of this article (10.1007/s00520-020-05711-7) contains supplementary material, which is available to authorized users.
Collapse
|
10
|
Uhlig J, Potenberg J, Semsek D, Stübs P, Fichter C, Köhler A, Müller L, Reiser M, Siebenbach H, Göhler T, Jacobasch L, Kächele V, Timm B, Potthoff K, Marschner N. 457P 1st-line panitumumab plus FOLFIRI or FOLFOX for patients with RAS wildtype metastatic colorectal cancer in Germany: Interim results of the non-interventional study VALIDATE. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
11
|
Lumpkin AH, LaBerge M, Rule DW, Zgadzaj R, Hannasch A, Zarini O, Bowers B, Irman A, Couperus Cabadağ JP, Debus A, Köhler A, Schramm U, Downer MC. Coherent Optical Signatures of Electron Microbunching in Laser-Driven Plasma Accelerators. PHYSICAL REVIEW LETTERS 2020; 125:014801. [PMID: 32678646 DOI: 10.1103/physrevlett.125.014801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 05/27/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
We report observations of coherent optical transition radiation interferometry (COTRI) patterns generated by microbunched ∼200-MeV electrons as they emerge from a laser-driven plasma accelerator. The divergence of the microbunched portion of electrons, deduced by comparison to a COTRI model, is ∼9× smaller than the ∼3 mrad ensemble beam divergence, while the radius of the microbunched beam, obtained from COTR images on the same shot, is <3 μm. The combined results show that the microbunched distribution has estimated transverse normalized emittance ∼0.4 mm mrad.
Collapse
|
12
|
Pezzini C, Köhler A. First record of Conostigmus Dahlbom, 1858 (Hymenoptera: Megaspilidae) from Brazil and description of the female of Conostigmus binasutus Dessart & Cancemi, 1986. BRAZ J BIOL 2020; 80:373-376. [DOI: 10.1590/1519-6984.210780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/20/2019] [Indexed: 11/22/2022] Open
Abstract
Abstract Conostigmus Dahlbom, 1858 (Hymenoptera: Megaspilidae) is reported for the first time from Brazil. Here, we provide a diagnosis of Conostigmus binasutus Dessart & Cancemi, 1986 and the description and illustration of the female, previously unknown. The analyzed material was collected utilizing Malaise traps, in Manaus, Amazon, Brazil and deposited at the Invertebrate collection of INPA (Instituto Nacional de Pesquisas da Amazônia) of Manaus. A identification key and distribution map to the Neotropical species of Conostigmus is provided.
Collapse
|
13
|
Bruno P, Machado RAR, Glauser G, Köhler A, Campos-Herrera R, Bernal J, Toepfer S, Erb M, Robert CAM, Arce CCM, Turlings TCJ. Entomopathogenic nematodes from Mexico that can overcome the resistance mechanisms of the western corn rootworm. Sci Rep 2020; 10:8257. [PMID: 32427834 PMCID: PMC7237494 DOI: 10.1038/s41598-020-64945-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/28/2020] [Indexed: 12/30/2022] Open
Abstract
Natural enemies of herbivores are expected to adapt to the defence strategies of their preys or hosts. Such adaptations may also include their capacity to cope with plant metabolites that herbivores sequester as a defence. In this study, we evaluated the ability of Mexican entomopathogenic nematodes (EPN) to resist benzoxazinoids that are sequestered from maize roots by the western corn rootworm (WCR, Diabrotica virgifera virgifera; Coleoptera: Chrysomelidae), an important maize pest in America and Europe. From maize fields throughout Mexico, we retrieved 40 EPN isolates belonging to five different species, with a majority identified as Heterorhabditis bacteriophora. In the laboratory, all nematodes readily infected non-sequestering larvae of the banded cucumber beetle (D. balteata), while infectivity varied strongly for WCR larvae. While some H. bacteriophora isolates seemed negatively affected by benzoxazinoids, most showed to be resistant. Thus, EPN from Mexican maize fields can cope with these plant defence metabolites, but the results also indicate that WCR larvae possess other mechanisms that help to resist EPN. This work contributes to a better understanding of the capacity of herbivore natural enemies to resist plant defence metabolites. Furthermore, it identifies several benzoxazinoid-resistant EPN isolates that may be used to control this important maize pest.
Collapse
|
14
|
Bender E, Jahnke SM, Köhler A. Chemotaxic Responses of Anisopteromalus calandrae (Howard) (Hymenoptera: Pteromalidae) to Odors of Larvae, Pupae, and the Diet of Lasioderma serricorne (Fabricius) (Coleoptera: Ptinidae). NEOTROPICAL ENTOMOLOGY 2020; 49:171-178. [PMID: 31820338 DOI: 10.1007/s13744-019-00742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
Many hymenopteran parasitoids are known as biocontrol agents, such as Anisopteromalus calandrae (Howard) (Hymenoptera: Pteromalidae), which is known to parasitize larvae and pupae of coleopteran pests including Lasioderma serricorne (Fabricius) (Coleoptera: Ptinidae). The success of these parasitoids is related to their searching ability, which is mediated through chemical stimuli of the habitat, food, and the progeny of the host itself. This study aimed to assess the chemotaxic responses of A. calandrae comparing the reproductive state of the insects and the experience of wasp females, to different development stages (larvae and pupae) and the presence or absence of the host diet. The chemotaxic responses of A. calandrae individuals at 2 to 4 days old were assessed in a "Y" type olfactometer. Virgin and paired females (without and with previous experience of parasitism) were exposed to larvae of last instar contrasted with pupae and to the diet of L. serricorne. Both virgin and mated males were tested only for diet. Virgin females showed a preference for the diet in contrast to the larvae and to the pupae in contrast to the diet. Paired females without experience choose larvae over diet and made no distinction between pupae and diet. Experienced mated females showed preference for the host to which it had access before, instead of any other alternative option, indicating that there may be changes in the preference through learning.
Collapse
|
15
|
Raakow J, Aydin M, Kilian M, Köhler A, Werner S, Pratschke J, Fikatas P. [Elective treatment of inguinal hernia in university surgery-an economic challenge]. Chirurg 2020; 90:1011-1018. [PMID: 31359111 DOI: 10.1007/s00104-019-1008-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Elective and emergency inguinal hernia surgery is a central task for general and abdominal surgeons. As a standard procedure it is regarded as having a relatively low income in the German diagnosis-related groups (DRG) system. This can lead to an economic imbalance, especially in a cost-intensive environment of a university hospital. The aim of this analysis was to investigate the influence of clinical factors on costs and the contribution margin as well as the overall economic evaluation of elective inguinal hernia surgery at a university hospital. MATERIAL AND METHODS All patients undergoing elective inguinal hernia surgery at two locations of the Charité University Medicine Berlin in 2014 and 2015 were included in the analysis. The influence of clinical, patient and surgical factors on the economic outcome of the cases was evaluated. RESULTS A total of 419 patients were included, mostly after a Lichtenstein operation (44.9%) and laparoscopic transabdominal preperitoneal (TAPP) surgery (53.9%). The greatest impact on the economic outcome was the occurrence of postoperative complications. Also, a patient clinical complexity level (PCCL) value of >1, more than 8 encoded secondary diagnoses and a duration of hospital stay of less than 2 days had a significantly negative impact on the contribution margin. Overall, elective inguinal hernia surgery led to a negative contribution margin of € 651 per case. CONCLUSION Elective inguinal hernia surgery in the environment of a university hospital has a high financial deficit; however, since a complete discontinuation of this treatment is not an alternative multifactorial approaches are required to improve the economic outcome.
Collapse
|
16
|
Wondraczek L, Pohnert G, Schacher FH, Köhler A, Gottschaldt M, Schubert US, Küsel K, Brakhage AA. Artificial Microbial Arenas: Materials for Observing and Manipulating Microbial Consortia. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1900284. [PMID: 30993782 DOI: 10.1002/adma.201900284] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/28/2019] [Indexed: 06/09/2023]
Abstract
From the smallest ecological niche to global scale, communities of microbial life present a major factor in system regulation and stability. As long as laboratory studies remain restricted to single or few species assemblies, however, very little is known about the interaction patterns and exogenous factors controlling the dynamics of natural microbial communities. In combination with microfluidic technologies, progress in the manufacture of functional and stimuli-responsive materials makes artificial microbial arenas accessible. As habitats for natural or multispecies synthetic consortia, they are expected to not only enable detailed investigations, but also the training and the directed evolution of microbial communities in states of balance and disturbance, or under the effects of modulated stimuli and spontaneous response triggers. Here, a perspective on how materials research will play an essential role in generating answers to the most pertinent questions of microbial engineering is presented, and the concept of adaptive microbial arenas and possibilities for their construction from particulate microniches to 3D habitats is introduced. Materials as active and tunable components at the interface of living and nonliving matter offer exciting opportunities in this field. Beyond forming the physical horizon for microbial cultivates, they will enable dedicated intervention, training, and observation of microbial consortia.
Collapse
|
17
|
Köhler A, Beyer J, Dargel S, Schleußner E. Fulminante Wundinfektion nach notfallmäßiger Sectio caesarea. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1692061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
18
|
Wuerstlein R, Kates R, Gluz O, Grischke EM, Schem C, Thill M, Hasmueller S, Köhler A, Otremba B, Griesinger F, Schindlbeck C, Trojan A, Otto F, Knauer M, Pusch R, Harbeck N. Strong impact of MammaPrint and BluePrint on treatment decisions in luminal early breast cancer: results of the WSG-PRIMe study. Breast Cancer Res Treat 2019; 175:389-399. [PMID: 30796651 PMCID: PMC6533223 DOI: 10.1007/s10549-018-05075-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE The WSG-PRIMe Study prospectively evaluated the impact of the 70-gene signature MammaPrint® (MP) and the 80-gene molecular subtyping assay BluePrint® on clinical therapy decisions in luminal early breast cancer. METHODS 452 hormone receptor (HR)-positive and HER2-negative patients were recruited (N0, N1). Physicians provided initial therapy recommendations based on clinicopathological factors. After prospective risk classification by MammaPrint/BluePrint was revealed, post-test treatment recommendations and actual treatment were recorded. Decisional Conflict and anxiety were measured by questionnaires. RESULTS Post-test switch (in chemotherapy (CT) recommendation) occurred in 29.1% of cases. Overall, physician adherence to MP risk assessment was 92.3% for low-risk and 94.3% for high-risk MP scores. Adherence was remarkably high in "discordant" groups: 74.7% of physicians initially recommending CT switched to CT omission following low-risk MP scores; conversely, 88.9% of physicians initially recommending CT omission switched to CT recommendations following high-risk MP scores. Most patients (99.2%) recommended to forgo CT post-test and 21.3% of patients with post-test CT recommendations did not undergo CT; among MP low-risk patients with pre-test and post-test CT recommendations, 40% did not actually undergo CT. Luminal subtype assessment by BluePrint was discordant with IHC assessment in 34% of patients. Patients' State Anxiety scores improved significantly overall, particularly in MP low-risk patients. Trait Anxiety scores increased slightly in MP high risk and decreased slightly in MP low-risk patients. CONCLUSIONS MammaPrint and BluePrint test results strongly impacted physicians' therapy decisions in luminal EBC with up to three involved lymph nodes. The high adherence to genetically determined risk assessment represents a key prerequisite for achieving a personalized cost-effective approach to disease management of early breast cancer.
Collapse
|
19
|
Machado RAR, Bruno P, Arce CCM, Liechti N, Köhler A, Bernal J, Bruggmann R, Turlings TCJ. Photorhabdus khanii subsp. guanajuatensis subsp. nov., isolated from Heterorhabditis atacamensis, and Photorhabdus luminescens subsp. mexicana subsp. nov., isolated from Heterorhabditis mexicana entomopathogenic nematodes. Int J Syst Evol Microbiol 2019; 69:652-661. [PMID: 30688647 DOI: 10.1099/ijsem.0.003154] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Two Gram-negative, rod-shaped, non-spore-forming bacteria, MEX20-17T and MEX47-22T, were isolated from the digestive system of Heterorhabditis atacamensis and Heterorhabditis mexicana entomopathogenic nematodes, respectively. Their 16S rRNA gene sequences suggest that strains MEX20-17T and MEX47-22T belong to the γ-Proteobacteria and to the genus Photorhabdus. Deeper analyses using housekeeping-gene-based and whole-genome-based phylogenetic reconstruction suggest that MEX20-17T is closely related to Photorhabdus khanii and that MEX47-22T is closely related to Photorhabdus luminescens. Sequence similarity scores confirm these observations: MEX20-17T and P. khanii DSM 3369T share 98.9 % nucleotide sequence identity (NSI) of concatenated housekeeping genes, 70.4 % in silico DNA-DNA hybridization (isDDH) and 97 % orthologous average nucleotide identity (orthoANI); and MEX47-22T and P. luminescens ATCC 29999T share 98.9 % NSI, 70.6 % isDDH and 97 % orthoANI. Physiological characterization indicates that both strains differ from all validly described Photorhabdus species and from their more closely related taxa. We therefore propose to classify MEX20-17T and MEXT47-22T as new subspecies within P. khanii and P. luminescens, respectively. Hence, the following names are proposed for these strains: Photorhabdus khanii subsp. guanajuatensis subsp. nov. with the type strain MEX20-17T (=LMG 30372T=CCOS 1191T) and Photorhabdus luminescenssubsp. mexicana subsp. nov. with the type strain MEX47-22T (=LMG 30528T=CCOS 1199T). These propositions automatically create Photorhabdus khanii subsp. khanii subsp. nov. with DSM 3369T as the type strain (currently classified as P. khanii), and Photorhabdus luminescenssubsp. luminescenssubsp. nov. with ATCC 29999T as the type strain (currently classified as P. luminescens).
Collapse
|
20
|
Naumann G, Schröder S, Köhler A, Grosch A. Positive effects of vaginal bilateral hysteropexy with Splentis-tape on prolapse symptoms and quality of life in women with severe pelvic organ prolapse. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
21
|
Köhler A, Eyssel J, Nieder T. Von universellen Behandlungsdogmen und der Notwendigkeit einer individuellen Versorgung – Befürchtungen und Ansprüche an die medizinische Versorgung im Kontext von Trans*/Transsexualität. PPMP - PSYCHOTHERAPIE · PSYCHOSOMATIK · MEDIZINISCHE PSYCHOLOGIE 2018. [DOI: 10.1055/s-0038-1667942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
22
|
Köhler A, King R, Bahls M, Groß S, Steveling A, Gärtner S, Schipf S, Gläser S, Völzke H, Felix SB, Markus MRP, Dörr M. Cardiopulmonary fitness is strongly associated with body cell mass and fat-free mass: The Study of Health in Pomerania (SHIP). Scand J Med Sci Sports 2018; 28:1628-1635. [PMID: 29345858 DOI: 10.1111/sms.13057] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 01/02/2023]
Abstract
Peak oxygen uptake (VO2peak) is commonly indexed by total body weight (TBW) to determine cardiopulmonary fitness (CPF). This approach may lead to misinterpretation, particularly in obese subjects. We investigated the normalization of VO2peak by different body composition markers. We analyzed combined data of 3848 subjects (1914 women; 49.7%), aged 20-90, from two independent cohorts of the population-based Study of Health in Pomerania (SHIP-2 and SHIP-TREND). VO2peak was assessed by cardiopulmonary exercise testing. Body cell mass (BCM), fat-free mass (FFM), and fat mass (FM) were determined by bioelectrical impedance analysis. The suitability of the different markers as a normalization variable was evaluated by taking into account correlation coefficients (r) and intercept (α-coefficient) values from linear regression models. A combination of high r and low α values was considered as preferable for normalization purposes. BCM was the best normalization variable for VO2peak (r = .72; P ≤ .001; α-coefficient = 63.3 mL/min; 95% confidence interval [CI]: 3.48-123) followed by FFM (r = .63; P ≤ .001; α-coefficient = 19.6 mL/min; 95% CI: -57.9-97.0). On the other hand, a much weaker correlation and a markedly higher intercept were found for TBW (r = .42; P ≤ .001; α-coefficient = 579 mL/min; 95% CI: 483 to 675). Likewise, FM was also identified as a poor normalization variable (r = .10; P ≤ .001; α-coefficient = 2133; 95% CI: 2074-2191). Sex-stratified analyses confirmed the above order for the different normalization variables. Our results suggest that BCM, followed by FFM, might be the most appropriate marker for the normalization of VO2peak when comparing CPF between subjects with different body shape.
Collapse
|
23
|
Wilma K, Unger T, Tuncel Kostakoğlu S, Hollfelder M, Hunger C, Lang A, Gürek AG, Thelakkat M, Köhler J, Köhler A, Gekle S, Hildner R. Excited state dynamics and conformations of a Cu(ii)-phthalocyanine-perylenebisimide dyad. Phys Chem Chem Phys 2018; 19:22169-22176. [PMID: 28795737 DOI: 10.1039/c7cp04026a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We investigate the excited state dynamics and the conformations of a new molecular donor-bridge-acceptor system, a Cu(ii)-phthalocyanine (CuPc) covalently linked via a flexible aliphatic spacer to a perylenebisimide (PBI). We performed time-resolved polarization anisotropy and pump-probe measurements in combination with molecular dynamics simulations. Our data suggest the existence of three conformations of the dyad: two more extended, metastable conformations with centre-of-mass distances >1 nm between the PBI and CuPc units of the dyad, and a highly stable folded structure, in which the PBI and CuPc units are stacked on top of each other with a centre-of-mass distance of 0.4 nm. In the extended conformations the dyad shows emission predominantly from the PBI unit with a very weak contribution from the CuPc unit. In contrast, for the folded conformation the PBI emission of the dyad is strongly quenched due to fast energy transfer from the PBI to the CuPc unit (3 ps) and subsequent intersystem-crossing (300 fs) from the first excited singlet state of CuPc unit into its triplet state. Finally, the CuPc triplet state is deactivated non-radiatively with a time constant of 25 ns.
Collapse
|
24
|
Couperus JP, Pausch R, Köhler A, Zarini O, Krämer JM, Garten M, Huebl A, Gebhardt R, Helbig U, Bock S, Zeil K, Debus A, Bussmann M, Schramm U, Irman A. Demonstration of a beam loaded nanocoulomb-class laser wakefield accelerator. Nat Commun 2017; 8:487. [PMID: 28887456 PMCID: PMC5591198 DOI: 10.1038/s41467-017-00592-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/12/2017] [Indexed: 11/09/2022] Open
Abstract
Laser-plasma wakefield accelerators have seen tremendous progress, now capable of producing quasi-monoenergetic electron beams in the GeV energy range with few-femtoseconds bunch duration. Scaling these accelerators to the nanocoulomb range would yield hundreds of kiloamperes peak current and stimulate the next generation of radiation sources covering high-field THz, high-brightness X-ray and γ-ray sources, compact free-electron lasers and laboratory-size beam-driven plasma accelerators. However, accelerators generating such currents operate in the beam loading regime where the accelerating field is strongly modified by the self-fields of the injected bunch, potentially deteriorating key beam parameters. Here we demonstrate that, if appropriately controlled, the beam loading effect can be employed to improve the accelerator's performance. Self-truncated ionization injection enables loading of unprecedented charges of ∼0.5 nC within a mono-energetic peak. As the energy balance is reached, we show that the accelerator operates at the theoretically predicted optimal loading condition and the final energy spread is minimized.Higher beam quality and stability are desired in laser-plasma accelerators for their applications in compact light sources. Here the authors demonstrate in laser plasma wakefield electron acceleration that the beam loading effect can be employed to improve beam quality by controlling the beam charge.
Collapse
|
25
|
Desurmont GA, Köhler A, Maag D, Laplanche D, Xu H, Baumann J, Demairé C, Devenoges D, Glavan M, Mann L, Turlings TCJ. The spitting image of plant defenses: Effects of plant secondary chemistry on the efficacy of caterpillar regurgitant as an anti-predator defense. Ecol Evol 2017; 7:6304-6313. [PMID: 28861234 PMCID: PMC5574803 DOI: 10.1002/ece3.3174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 04/16/2017] [Indexed: 11/30/2022] Open
Abstract
In the arms race between plants, herbivores, and their natural enemies, specialized herbivores may use plant defenses for their own benefit, and variation in plant traits may affect the benefits that herbivores derive from these defenses. Pieris brassicae is a specialist herbivore of plants containing glucosinolates, a specific class of defensive secondary metabolites. Caterpillars of P. brassicae are known to actively spit on attacking natural enemies, including their main parasitoid, the braconid wasp Cotesia glomerata. Here, we tested the hypothesis that variation in the secondary metabolites of host plants affects the efficacy of caterpillar regurgitant as an anti‐predator defense. Using a total of 10 host plants with different glucosinolate profiles, we first studied natural regurgitation events of caterpillars on parasitoids. We then studied manual applications of water or regurgitant on parasitoids during parasitization events. Results from natural regurgitation events revealed that parasitoids spent more time grooming after attack when foraging on radish and nasturtium than on Brassica spp., and when the regurgitant came in contact with the wings rather than any other body part. Results from manual applications of regurgitant showed that all parameters of parasitoid behavior (initial attack duration, attack interruption, grooming time, and likelihood of a second attack) were more affected when regurgitant was applied rather than water. The proportion of parasitoids re‐attacking a caterpillar within 15 min was the lowest when regurgitant originated from radish‐fed caterpillars. However, we found no correlation between glucosinolate content and regurgitant effects, and parasitoid behavior was equally affected when regurgitant originated from a glucosinolate‐deficient Arabidopsis thaliana mutant line. In conclusion, host plant affects to a certain extent the efficacy of spit from P. brassicae caterpillars as a defense against parasitoids, but this is not due to glucosinolate content. The nature of the defensive compounds present in the spit remains to be determined, and the ecological relevance of this anti‐predator defense needs to be further evaluated in the field.
Collapse
|